Comparison between sepsis-induced coagulopathy and sepsis-associated coagulopathy criteria in identifying sepsis-associated disseminated intravascular coagulation

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.

Disseminated intravascular coagulation scores as predictors for progressive hemorrhage and neurological prognosis following traumatic brain injury

Coagulation abnormalities, such as disseminated intravascular coagulation （DIC）, are associated with progressive hemcrrhagic injury （PHI） following head trauma. However, the exact relationship between coagulopathy and PHI remains unclear. The present study utilized a scoring system defined by the International Society of Thrombosis and Haemostasis to investigate whether a high DIC score is predictive for PHI. This study was a multicenter prospective design involving four hospitals, a 6-month observation, and follow-up. Of 352 traumatic brain injury （TBI） patients, serial CT scan indicated approximately one third of patients developed progressive hemorrhage, which was most frequently observed in the frontal, temporal, and orbitofrontal lobes of patients with brain contusion. PHI-positive patients exhibited poor prognosis, as indicated by prolonged length of hospital/intensive care unit stay and high mortality. More importantly, a DIC score after TBI, as well as patient age and sex, could serve as predictors for PHI. In addition, DIC scores were closely associated with injury severity. Therefore, the DIC scoring system facilitated early PHI diagnosis in TBI patients, and DIC scores might serve as a valuable predictor for TBI patients with PHI.

弥漫性血管内凝血(Disseminated intravascular coagulation.DIC)的治疗

弥漫性血管内凝血是许多疾病发展过程中一组较复杂的出血征象。根据临床表现分为急性、亚急性和慢性三型。急性型病情危险且预后差。按病程又分为早期、中期和晚期、晚期治疗困难,预后不良。治疗原则1.总则(1)治疗原发病这是终止DIC的最关键措施。如控制感染。治疗恶性肿瘤,中止病理性妊振,减少内源性或外源性促凝血物质的吸收等。

1例凶险性前置胎盘行双侧骼内动脉球囊封堵联合剖宫产术后并发DIC的护理

总结1例凶险性前置胎盘行双侧骼内动脉球囊封堵联合剖宫产术后并发弥散性血管内凝血(DIC)的护理。通过多学科团队的联合诊治及护理,病人病情平稳出院。随访半年,病人状况良好。

Atractylenolide Ⅰ protects against lipopolysaccharide-induced disseminated intravascular coagulation by anti-inflammatory and anticoagulation effect

Objective:To investigate whether atractylenolide Ⅰ(ATL-Ⅰ) has protective effect on lipopolysaccharide(LPS)-induced disseminated intravascular coagulation(DIC) in vivo and in vitro,and explore whether NF-κB signaling pathway is involved in ATL-Ⅰ treatment.Methods:New Zealand white rabbits were injected with LPS through marginal ear vein over a period of 6h at a rate of 600 μg/kg(10 mL/h).Similarly,in the treatment groups,1.0,2.0,or 5.0 mg/kg ATL-Ⅰ were given.Both survival rate and organ function were tested,including the level of alanine aminotransferase(ALT),blood urine nitrogen(BUN),and TNF-α were examined by ELISA.Also haemostatic and fibrinolytic parameters in serum were measured.RAW 264.7 macrophage cells were administered with control,LPS,LPS + ATL-Ⅰ and ATL-Ⅰ alone,and TNF-α,phosphorylation(P)-IκBα,phosphorylation(P)-NF-κB(P65) and NF-κB(P65) were determined by Western blot.Results:The administration of LPS resulted in 73.3%mortality rate,and the increase of serum TNF-α,BUN and ALT levels.When ATL-Ⅰ treatment significantly increased the survival rate of LPS-induced DIC model,also improved the function of blood coagulation.And protein analysis indicated that ATL-Ⅰ remarkably protected liver and renal as decreasing TNF-α expression.In vitro,ATL-Ⅰ obviously decreased LPS-induced TNF-αproduction and the expression of P-NF-κB(P65),with the decrease of P-IκBα.Conclusions:ATL-Ⅰ has protective effect on LPS-induced DIC,which can elevate the survival rate,reduce organ damage,improve the function of blood coagulation and suppress TNF-α expression by inhibiting the activation of NF-κB signaling pathway.

Thrombomodulin in the management of acute cholangitisinduced disseminated intravascular coagulation

AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P < 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P < 0.01, OR = 12, 95%CI: 2.3-60). Although the difference did not reach statistical significance, primary diseases(malignancies)(P = 0.055, OR = 3.9, 95%CI: 0.97-16) and the non-use of r TM had a tendency to be associated with persistent DIC(P = 0.08, OR = 4.3, 95%CI: 0.84-22).CONCLUSION: The add-on effects of r TM are anticipated in the treatment of AC-induced DIC, although biliary drainage for AC remains crucial.

Diagnostic and Prognostic Value of Plasma Factor V Activity and Parameters in Thrombin Generation for Disseminated Intravascular Coagulation in Patients with Hematological Malignancies

In this study,we used plasma factor V activity and parameters of the thrombin generation test to discuss their diagnostic and prognostic value for disseminated intravascular coagulation (DIC) in patients with hematological malignancies.A total of 164 patients who were diagnosed with hematological malignancies in the Department of Hematology,Union Hospital,between Apr 2014 and Dec.2014 were enrolled in this study.There were 131 patients in the study group and 33 patients in the control group in terms of the laboratory results for DIC.The patients in the study group were divided into a DIC subgroup (n=59) and a non-DIC subgroup (n=72) based on the International Society of Thrombosis and Hemostasis (ISTH) Integral System,and they were divided into four subgroups [score ≤3 (n=35),score=4 (n=37),score=5 (n=47),and score >6 (n=12)] according to ISTH scores.Using 28-day mortality as the endpoint,the patients in the study group were divided into a survival subgroup (n=111) and a non-survival subgroup (n=20).The results showed that the plasma factor V activity was significantly weaker,and lag time and time to peak were significantly shorter in the study group than in the control group (P<0.01).The factor V activity,peak and endogenous thrombin potential (ETP) were significantly decreased in the DIC subgroup as compared with those in the non-DIC subgroup (P<0.01).Among factor V activity,lag time,peak,ETP,and ttPeak,only the factor V activity was significantly decreased in the nonsurvival subgroup compared with the survival subgroup (P<0.01).With the increase in ISTH score,the ETP and peak decreased gradually.The binary logistic regression analysis revealed that PLT,D-dimer,factor V activity and ETP had linear relationship with DIC diagnosed by ISTH Integral System.Using DIC diagnosed by ISTH Integral System as the endpoint,the area under curve (AUC) of factor V activity was found to be similar to that of blood platelet count (PLT) and prothrombin time (PT).In conclusion,factor V activity,ETP and peak had diagnostic value for DIC in patients with hematological malignancies,and only factor V activity had limited prognostic value.

Myricetin protects against lipopolysaccharide-induced disseminated intravascular coagulation by anti-inflammatory and anticoagulation effect

Objective: To explore the therapeutic effect and mechanism of myricctin on disseminated intravascular coagulation(DIC). Methods: The DIC model was established by injection of60 mg/kg LPS in KM mice, and the treatment groups were injected myricetin with different concentrations(25 or 50 mg/kg) 30 min before the model was established. Both coagulation indicators and organ function were tested, including PT, APTT, fibrinogen. AST, ALT. BUN and tissue section. In vitro, the inflammatory model of RAW 264.7 macrophage cells were established by 10 μg/mL LPS. The treatment group was treated with 50 μmol/mL myricetin for 30 min before LPS, and the expression of TNF-a and p-NF-KB was detected, further to explore the therapeutic mechanism. Results: LPS-induced DIC led to a reduction of fibrinogen and a rise of PT, APTT,AST, ALT, BUN levels, but the treatment of myricctin significantly inhibited these abnormalities. Histopathology analysis also revealed that myricetin remarkably protected the liver and renal damage. In vitro, the expression of TNF-α and p-NF-κB induced by LPS was repressed by myricetin. Conclusions: This study provides new insights into the protective effects of myricetin in LPS-induced DIC by anticoagulant and anti-inflammatory via suppressing the activation of p-NF-κB which decreased TNF-α level.

不同分子量肝素治疗急性早幼粒细胞白血病合并DIC的临床研究

目的:探讨普通肝素和低分子肝素对急性早幼粒细胞白血病(APL)合并弥散性血管内凝血(DIC)的疗效。方法:选择我院2019年3月—2023年3月收治的52例初诊APL伴DIC患者,随机分为普通肝素(UFH)组和低分子肝素(LMWH)组,两组患者均给予双诱导缓解方案治疗,观察两组患者DIC指标改善情况、血制品输注、出血程度和1个月内完全缓解和死亡情况。结果:与治疗前相比,两组治疗后第7天血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及D-二聚体含量均明显下降,纤维蛋白原(FIB)逐渐上升(P<0.05),但低分子肝素组治疗后第3天FIB升高较普通肝素组更显著(P<0.05),两组间其余指标比较差异无统计学意义(P>0.05)。治疗第7天普通肝素组有效率为65.38%,低分子肝素组有效率为76.92%,两组间比较差异无统计学意义(P>0.05)。治疗7d内两组患者血浆、冷沉淀、血小板输注量无明显差异(P>0.05),但低分子肝素组人纤维蛋白原输注量较普通肝素组明显减少(P<0.05)。两组初始治疗7d内出血情况无明显差异。治疗第30天,普通肝素组有21例骨髓完全缓解,2例未缓解,3例因脑出血导致死亡;低分子肝素组25例骨髓完全缓解,1例因脑出血死亡;两组间比较差异无显著性(P>0.05)。结论:普通肝素和低分子肝素治疗APL合并DIC同样有效。低分子肝素可更快地提升初诊APL合并DIC患者的FIB水平,减少早期人纤维蛋白原输注,可能减少早期致命出血事件。

Oxaliplatin induced disseminated intravascular coagulation: A case report and review of literature

Oxaliplatin in combination with a fluoropyrimide is a treatment option for colorectal cancer patients in the adjuvant and metastatic settings. Very few hematological emergencies have been reported associated with Oxaliplatin. These include autoimmune hemolytic anemia, thrombocytopenia and pancytopenia. We present a case report of a patient who developed hematuria and disseminated intravascular coagulation while receiving the second cycle of FOLFOX and bevacizumab for metastatic colon cancer.

Blue rubber bleb nevus syndrome complicated with disseminated intravascular coagulation and intestinal obstruction: A case report

BACKGROUND Blue rubber bleb nevus syndrome is a rare vascular malformation syndrome with unclear etiopathogenesis and noncurative treatments.It is characterized by multiple vascular malformations of the skin,gastrointestinal tract,and other visceral organs.The most common symptoms are intermittent gastrointestinal bleeding and secondary iron deficiency anemia,thus requiring repeated blood transfusions and hospitalizations.It is easily missed and misdiagnosed,and there is no specific treatment.CASE SUMMARY We report a case of blue rubber bleb nevus syndrome combined with disseminated intravascular coagulation and efficacy of treatment with argon plasma coagulation under enteroscopy and sirolimus.A 56-year-old female patient was admitted to the hospital with 3-year history of fatigue and dizziness that had aggravated over the past 10 d with melena.The patient had a history of repeated melena and multiple venous hemangiomas from childhood.After treatment with argon plasma coagulation combined with sirolimus for nearly 8 wk,the patient’s serum hemoglobin increased to 100 g/L.At the 12-mo follow-up,the patient was well with stable hemoglobin(102 g/L)and no recurrent intestinal bleeding.CONCLUSION Argon plasma coagulation and sirolimus may be an efficacious and safe treatment for blue rubber bleb nevus syndrome,which currently has no recommended treatments.

Fatal rhabdomyolysis and disseminated intravascular coagulation after total knee arthroplasty under spinal anesthesia:A case report

BACKGROUND Rhabdomyolysis develops as a result of skeletal muscle cell collapse from leakage of the intracellular contents into circulation.In severe cases,it can be associated with acute kidney injury and disseminated intravascular coagulation,leading to life threatening outcomes.Rhabdomyolysis can occur in the perioperative period from various etiologies but is rarely induced by tourniquet use during orthopedic surgery.CASE SUMMARY A 77-year-old male underwent right total knee arthroplasty using a tourniquet under spinal anesthesia.About 24 h after surgery,he was found in a drowsy mental state and manifested features of severe rhabdomyolysis,including fever,hypotension,oliguria,high creatine kinase,myoglobinuria,and disseminated intravascular coagulation.Despite supportive care,cardiac arrest developed abruptly,and the patient was not able to be resuscitated.CONCLUSION Severe rhabdomyolysis and disseminated intravascular coagulation can develop from surgical tourniquet,requiring prompt,aggressive treatments to save the patient.

The Present Situation on Disseminated Intravascular. Coagulation Studies

DIC is not a clinical entity in itself. Instead, it always occurs secondary to a broad spectrum of various diseases. DIC may be defined as an acquired syndrome characterized by the activation of intravascular coagulation up to intravascular fibrin formation. Although the trigger for the activation of the coagulation system may vary depending on the underlying condition, it is usually mediated by several cytokines. Thrombin generation proceeds via the (extrinsic) tissue factor/factor Ⅶ a route and simultaneous depression of inhibitory mechanisms, such as the protein C and protein S system. In addition, impaired fibrin degradation, dur to high circulating levels of PAI-1, contributes to enhanced introvascular fibrin deposition.

血必净注射液对重症中暑合并DIC患者的临床疗效及其对PT、ALT、Cr水平的影响

目的分析血必净注射液对重症中暑合并弥散性血管内凝血(DIC)患者的临床疗效及其对凝血酶原时间(PT)、丙氨酸氨基转移酶(ALT)、肌酐(Cr)水平的影响。方法选取2018年7月至2019年10月在该院急诊病区治疗的68例重症中暑合并DIC患者作为研究对象,采用随机数字表法将其分为基础组和血必净组,每组34例。基础组采用基础退热、解痉挛等治疗,血必净组在基础组治疗的基础上采用国产药物血必净注射液治疗,观察两组患者的临床疗效,以及凝血、血小板、肾功能、血清酶及血管内皮损伤指标等水平。结果血必净组患者临床总有效率为97.06%,高于基础组的85.29%(P<0.05)。两组患者治疗前PT、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平、血小板计数(PLT)比较,差异均无统计学意义(P>0.05);血必净组患者治疗后FIB水平、PLT均高于治疗前,且血必净组均高于基础组,PT、APTT均短于治疗前,且血必净组均短于基础组(P<0.05)。两组患者治疗前肌酸激酶(CK)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、ALT水平比较,差异均无统计学意义(P>0.05);两组患者治疗后CK、AST、LDH、ALT水平均低于治疗前,且血必净组均低于基础组(P<0.05)。两组患者治疗前Cr、尿素氮(BUN)水平比较,差异均无统计学意义(P>0.05);两组患者治疗后Cr、BUN水平均低于治疗前,且血必净组均低于基础组(P<0.05)。两组患者治疗前血管假性血友病因子(vWF)、凝血酶调节蛋白(TM)水平比较,差异均无统计学意义(P>0.05);两组患者治疗后vWF、TM水平均低于治疗前,且血必净组均低于基础组(P<0.05)。结论血必净注射液治疗重症中暑合并DIC患者,能够通过改善其凝血功能,增强其肾功能,减少内皮损伤而提高临床疗效。

Bilateral Massive Pulmonary Embolism on Disseminated Intravascular Coagulation (DIVC) after Severe Postpartum Haemorrhage

The authors report a case of bilateral pulmonary embolism (PE) with intermediate risk at the University Hospital center of Treichville (CHUT). This is a postpartum PE in a 37-year-old obese, multiparous woman with postpartum hemorrhage from uterine rupture after vaginal delivery initiated by injectable oxytocin. This postpartum haemorrhage was managed by massive transfusion and hysterectomy. The initiation of thromboprophylaxis was delayed in view of its coagulation record, the first 3 days. Later, the patient presented respiratory distress for which the completion of a pulmonary angioscanner made it possible to make the diagnosis of PE whose clinical evolution under heparinotherapy was favorable.

Disseminated Intravascular Coagulation at Diagnosis in Acute Myeloblastic Leukaemia

Background: Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukaemia (AML), Acute Promyelocytic Leukaemia (APL) is well established to cause DIC. But there have been reports noted that abnormal DIC parameters also commonly observed in the patients with non-APL AML. This study evaluated the DIC parameters & DIC score according to International Society of Thrombosis and Haemostasis (ISTH) in newly diagnosed non-APL AML patients. Materials and Methods: This cross-sectional observational study was conducted in the Department of Haematology, BSMMU, Dhaka, Bangladesh. 48 newly diagnosed non-APL AML patients were enrolled. Platelets count was measured by auto analyzer (Sysmax XT 2000i/Pentra ABX-120DX) as well as checked manually. Prothrombin time, fibrinogen, D-Dimer were measured using STAGO Coagulation analyzer. The ISTH-DIC scoring system was used to calculate DIC score. The statistical analysis was carried out using the Statistical Package for Social Sciences version 24.0 for Windows. Chi-Square test & Fisher exact test was used for categorical variables. Unpaired t-test was used to compare mean between groups. For all statistical tests, p-value less than 0.05 was considered as statistically significant. Results: By analyzing 48 newly diagnosed patients with non-APL AML, found that DIC developed in 14.6% patients at presentation. Among the DIC parameters, PT and D-dimer were significantly higher in patients presented with DIC. Patients with DIC exhibit lower expression of CD117, CD34, HLA-DR and statistically significant association with negative expression of HLA-DR (p-value 0.034). No significant association was found between presence of DIC and age, gender, bleeding at presentation, morphological type, WBC count or peripheral blast percentage. Conclusion: Abnormalities of DIC parameters in common in patients with AML. A significant portion of patients with DIC have no apparent symptom or bleeding. So, routine screening of DIC parameter at presentation is recommended for early diagnosis & effective management of DIC.

Disseminated Intravascular Coagulation in a Patient with Metastatic Pancreatic Neuroendocrine Tumour: A Case Report and Review of the Literature

A 67-year-old female patient presented with weight loss, diarrhoea and thrombocytopaenia of unknown aetiology. A computerised tomography (CT) scan demonstrated a mass in the head of the pancreas with liver metastases. A liver biopsy demonstrated a well-differentiated neuroendocrine carcinoma. She was commenced on a somatostatin analogue. Three months later she presented with spontaneous bleeding. Blood test demonstrated results consistent with disseminated intravascular coagulation (DIC). A restaging CT scan showed evidence of disease progression. The DIC was felt to be due to the underlying progressive malignancy. Having considered the potential risks associated with cytotoxic therapy in the context of a consumptive coagulopathy, the patient was commenced on weekly Carboplatin. The patient’s blood counts improved rapidly, and her bruising and bleeding resolved. Following a few weeks of stable blood results and clinical stability, her cytotoxic treatment was changed to a combination of Carboplatin and Etoposide, and to date she remains well on treatment.

The Diagnosis and Man Disseminated Intravascular Coagulation

This review describes disseminated intravascular coagulation(DIC) as a syndrome in which hemostatic factors are activated and products are generated. This syndrome ranges in severity from an obvious decompensated coagulopathy (overt-DIC) to the subclinical compensated activation of hemostatic factors(non-overt DIC). Ths first part of this review emphasizes two points: First, activation of the hemostatic system is controlled by a vast network of capillaries and venules through anticoagulant and antiinflammatory regulatory factors that operate from the endothelium( e. G. , protein C and thrombomodulin, tissue factor pathway inhibitor).

Current approach to disseminated intravascular coagulation related to sepsis-organ failure type

Disseminated intravascular coagulation(DIC) is a syndrome characterized by the systemic activation of blood clotting, which generates large amount of intravascular thrombin and fibrin. Various diseases may cause acceleration of the clotting cascade, inactivate the endogenous anticoagulants and modify fibrinolysis, having thus the formation of micro thrombi in the systemic circulation. The abnormalities in the hemostatic system in patients with DIC result from the sum of pathways that generate both hypercoagulability and augmented fibrinolysis. When the hypercoagulability state prevails, the main manifestation is organic failure. This subtype of DIC is often referred as "organ impairment" type, frequently seen in patients suffering from severe sepsis. To identify the underlying infection, early initiation of culture-based antimicrobial treatment, and to resolve any infection source promptly are keystone actions of DIC related to sepsis prevention and treatment. These should be combined with specific treatment related to each DIC subtype. In the context of septic shock, DIC is associated to increased severity, greater number and seriousness of organ failures, more frequent side-effects from treatment itself, and worse outcomes. Therefore, we ought to review the information available in the literature about approach and management of DIC in severe sepsis.

基于DIC评分早期分层抗凝对改善脓毒症预后的有效性和安全性研究

目的 探讨基于弥散性血管内凝血(DIC)评分早期分层抗凝对改善脓毒症预后的有效性和安全性。方法 选取脓毒症患者265例,根据DIC和SIC评分分组,将患者分为DIC组84例、脓毒症凝血病(SIC)组92例和对照组84例(正常凝血状态)。其中DIC组给予常规剂量低分子肝素抗凝治疗,SIC组给予半量低分子肝素治疗,对照组不给予抗凝等治疗。结果 DIC组ICU住院时间、呼吸机使用时间和总住院时间较对照组延长(P<0.05);28天病死率比较,DIC组、SIC组和对照组差异无统计学意义(P>0.05)。DIC组、SIC组治疗后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和D二聚体(D-Dimer,D-D)低于治疗前,且DIC组高于SIC和对照组(P<0.05),而血小板和纤维蛋白原(FIB)低于SIC组和对照组(P<0.05)。DIC组、SIC组和对照组治疗后乳酸、BUN和Scr均较治疗前降低,DIC组仍高于SIC组和对照组(P<0.05)。治疗后急性生理及慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)评分均较治疗前降低,SIC组评分低于对照组,DIC组APACHEⅡ评分高于SIC组和对照组(P<0.05)。DIC组、SIC组和对照组出血事件总发生率差异无显著性(P>0.05)。结论 基于脓毒症DIC评分早期分层抗凝在脓毒症治疗中有较好的效果,可减轻患者凝血功能和脏器损功能损害。