BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis patients.In this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-assoc...BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis patients.In this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-associated coagulopathy(SAC)criteria in identifying overt-DIC and preDIC status in sepsis patients.METHODS:Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022.The performances of the SIC and SAC were assessed to identify overt-DIC on days 1,3,7,or 14.The SIC status or SIC score on day 1,the SAC status or SAC score on day 1,and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC.The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation.RESULTS:On day 1,the incidences of coagulopathy according to overt-DIC,SIC and SAC criteria were 11.7%,22.0%and 31.5%,respectively.The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14(P<0.05).On day 1,the SIC score with a cut-off value>3 had a significantly higher sensitivity(72.00%)and area under the curve(AUC)(0.69)in identifying pre-DIC than did the SIC or SAC status(sensitivity:SIC status 44.00%,SAC status 52.00%;AUC:SIC status 0.62,SAC status 0.61).The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC(0.79 vs.0.69,P<0.001).Favorable effects of anticoagulant therapy were observed in SIC(adjusted hazard ratio[HR]=0.216,95%confidence interval[95%CI]:0.060–0.783,P=0.018)and SAC(adjusted HR=0.146,95%CI:0.041–0.513,P=0.003).CONCLUSION:The SIC and SAC seem to be valuable for predicting overt-DIC.The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.展开更多
Background:This study aimed to evaluate the diagnostic accuracy of magnetocardiograph,a relatively new noninvasive device,in patients with myocardial infarction(MI).Methods:To identify studies assessing the diagnostic...Background:This study aimed to evaluate the diagnostic accuracy of magnetocardiograph,a relatively new noninvasive device,in patients with myocardial infarction(MI).Methods:To identify studies assessing the diagnostic accuracy of magnetocardiography for MI,we searched four databases on November 7,2022,the Cochrane Central Register of Controlled Trials,MEDLINE,EMBASE,and Web of Science,plus ClinicalTrials.gov.Three reviewers screened the studies independently and emailed the authors for more precise data when necessary.The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to evaluate the quality of the included studies.STATA(version 17;Stata Corporation,College Station,TX,USA)was used for meta-analysis of 22 contingency table data.Results:A total of 6 articles were included in this study.The diagnostic parameters of all included studies were summarized as follows:the pooled sensitivity was 0.91(95%confidence intervals[95%CIs]:0.81–0.96;I 2=88.54);specificity was 0.83(95%CI:0.75–0.89;I 2=83);positive likelihood ratio was 5.3(95%CI:3.5–8.2);negative likelihood ratio was 0.1(95%CI:0.04–0.24);and diagnostic odds ratio was 51(95%CI:16–161).The area under the curve for the receiver operating characteristic curve was 0.92(95%CI:0.89–0.94).After metaregression analysis,we found that the number of channels and the way of environmental magnetic noise elimination were heterogeneous sources.Conclusion:In summary,our meta-analysis shows that magnetocardiography holds a high accuracy in diagnosing MI and takes the advantages of noninvasive,radiation-free,and noncontact.However,further high-quality studies to confirm its usefulness in diagnosing MI are warranted.展开更多
目的评估联合炎症和凝血标志物能否早期识别脓毒症DIC。方法本研究是一项单中心、回顾性、观察性研究,共纳入356例脓毒症患者。以脓毒症3.0版诊断标准定义脓毒症,以国际血栓与止血学会(International Society on Thrombosis and Hemosta...目的评估联合炎症和凝血标志物能否早期识别脓毒症DIC。方法本研究是一项单中心、回顾性、观察性研究,共纳入356例脓毒症患者。以脓毒症3.0版诊断标准定义脓毒症,以国际血栓与止血学会(International Society on Thrombosis and Hemostasis,ISTH)显性DIC诊断标准定义DIC。本研究纳入的炎症标志物包括肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、IL-2R、IL-6、IL-8、IL-10等,纳入的凝血标志物包括血小板(PLT)、国际标准化比值(INR)、D-二聚体、纤维蛋白原(Fib)等。结果在356例脓毒症患者中,301例住院期间未发生DIC(非DIC,non-DIC),32例在入院当天就存在DIC(overt DIC),23例在入院后1周内发生DIC(pre-DIC)。与非DIC患者相比,pre-DIC患者PLT和Fib降低(P<0.05),INR和D-二聚体升高(P<0.05),细胞因子(TNF-α、IL-1β、IL-2R、IL-8、IL-10)和PCT升高(P<0.05),APACHEⅡ和SOFA评分升高(P<0.05)。通过预测pre-DIC的ROC曲线分析,发现一些凝血和炎症标志物可以预测pre-DIC状态:INR的曲线下面积(AUC)最高,为0.773(95%CI:0.696~0.851);IL~2R的AUC在炎症标志物中最高,为0.700(95%CI:0.599~0.798);联合PLT、INR、Fib、D~二聚体和IL~2R可以得到最高AUC=0.843(95%CI:0.758~0.928)。入院当天IL-2R升高(>1064.5 U/mL)可以很好的预测脓毒症患者28 d病死率。结论炎症标志物IL-2R与脓毒症发生DIC有关,对于早期DIC有预测价值。联合凝血(血小板、INR、Fib、D-二聚体)和炎症标志物(IL-2R)有助于早期识别脓毒症DIC。展开更多
基金supported by the National Key Research and Development Program of China(2021YFC2501800)Shanghai Committee of Science and Technology(20Y11900100,21MC1930400,and 20DZ2261200)Clinical Research Plan of Shanghai Hospital Development Center(SHDC2020CR4059)。
文摘BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis patients.In this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-associated coagulopathy(SAC)criteria in identifying overt-DIC and preDIC status in sepsis patients.METHODS:Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022.The performances of the SIC and SAC were assessed to identify overt-DIC on days 1,3,7,or 14.The SIC status or SIC score on day 1,the SAC status or SAC score on day 1,and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC.The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation.RESULTS:On day 1,the incidences of coagulopathy according to overt-DIC,SIC and SAC criteria were 11.7%,22.0%and 31.5%,respectively.The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14(P<0.05).On day 1,the SIC score with a cut-off value>3 had a significantly higher sensitivity(72.00%)and area under the curve(AUC)(0.69)in identifying pre-DIC than did the SIC or SAC status(sensitivity:SIC status 44.00%,SAC status 52.00%;AUC:SIC status 0.62,SAC status 0.61).The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC(0.79 vs.0.69,P<0.001).Favorable effects of anticoagulant therapy were observed in SIC(adjusted hazard ratio[HR]=0.216,95%confidence interval[95%CI]:0.060–0.783,P=0.018)and SAC(adjusted HR=0.146,95%CI:0.041–0.513,P=0.003).CONCLUSION:The SIC and SAC seem to be valuable for predicting overt-DIC.The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.
基金supported by the National Key R&D Program of China(2020YFC1512700,2020YFC1512705,and 2020YFC1512703)National Science and Technology Fundamental Resources Investigation Project(2018FY100600 and 2018FY100602)+4 种基金Key R&D Program of Shandong Province(2021ZLGX02,2021SFGC0503,and 2022ZLGX03)Taishan Pandeng Scholar Program of Shandong Province(tspd20181220)Taishan Young Scholar Program of Shandong Province(tsqn202211312)the Interdisciplinary Young Researcher Groups Program of Shandong University(2020QNQT004)Youth Top-Talent Project of National Ten Thousand Talents Plan,and Qilu Young Scholar Program.
文摘Background:This study aimed to evaluate the diagnostic accuracy of magnetocardiograph,a relatively new noninvasive device,in patients with myocardial infarction(MI).Methods:To identify studies assessing the diagnostic accuracy of magnetocardiography for MI,we searched four databases on November 7,2022,the Cochrane Central Register of Controlled Trials,MEDLINE,EMBASE,and Web of Science,plus ClinicalTrials.gov.Three reviewers screened the studies independently and emailed the authors for more precise data when necessary.The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to evaluate the quality of the included studies.STATA(version 17;Stata Corporation,College Station,TX,USA)was used for meta-analysis of 22 contingency table data.Results:A total of 6 articles were included in this study.The diagnostic parameters of all included studies were summarized as follows:the pooled sensitivity was 0.91(95%confidence intervals[95%CIs]:0.81–0.96;I 2=88.54);specificity was 0.83(95%CI:0.75–0.89;I 2=83);positive likelihood ratio was 5.3(95%CI:3.5–8.2);negative likelihood ratio was 0.1(95%CI:0.04–0.24);and diagnostic odds ratio was 51(95%CI:16–161).The area under the curve for the receiver operating characteristic curve was 0.92(95%CI:0.89–0.94).After metaregression analysis,we found that the number of channels and the way of environmental magnetic noise elimination were heterogeneous sources.Conclusion:In summary,our meta-analysis shows that magnetocardiography holds a high accuracy in diagnosing MI and takes the advantages of noninvasive,radiation-free,and noncontact.However,further high-quality studies to confirm its usefulness in diagnosing MI are warranted.
文摘目的评估联合炎症和凝血标志物能否早期识别脓毒症DIC。方法本研究是一项单中心、回顾性、观察性研究,共纳入356例脓毒症患者。以脓毒症3.0版诊断标准定义脓毒症,以国际血栓与止血学会(International Society on Thrombosis and Hemostasis,ISTH)显性DIC诊断标准定义DIC。本研究纳入的炎症标志物包括肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、IL-2R、IL-6、IL-8、IL-10等,纳入的凝血标志物包括血小板(PLT)、国际标准化比值(INR)、D-二聚体、纤维蛋白原(Fib)等。结果在356例脓毒症患者中,301例住院期间未发生DIC(非DIC,non-DIC),32例在入院当天就存在DIC(overt DIC),23例在入院后1周内发生DIC(pre-DIC)。与非DIC患者相比,pre-DIC患者PLT和Fib降低(P<0.05),INR和D-二聚体升高(P<0.05),细胞因子(TNF-α、IL-1β、IL-2R、IL-8、IL-10)和PCT升高(P<0.05),APACHEⅡ和SOFA评分升高(P<0.05)。通过预测pre-DIC的ROC曲线分析,发现一些凝血和炎症标志物可以预测pre-DIC状态:INR的曲线下面积(AUC)最高,为0.773(95%CI:0.696~0.851);IL~2R的AUC在炎症标志物中最高,为0.700(95%CI:0.599~0.798);联合PLT、INR、Fib、D~二聚体和IL~2R可以得到最高AUC=0.843(95%CI:0.758~0.928)。入院当天IL-2R升高(>1064.5 U/mL)可以很好的预测脓毒症患者28 d病死率。结论炎症标志物IL-2R与脓毒症发生DIC有关,对于早期DIC有预测价值。联合凝血(血小板、INR、Fib、D-二聚体)和炎症标志物(IL-2R)有助于早期识别脓毒症DIC。
