Retrospective evaluation of 4 methods for outcome prediction in overt disseminated intravascular coagulation in dogs (2009-2014): 804 cases
Retrospective evaluation of 4 methods for outcome prediction in overt disseminated intravascular coagulation in dogs (2009-2014): 804 cases
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DOI：
10.1111/vec.12777
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发表时间：
2018-11-01
影响因子：
1.3
通讯作者：
Brooks, Marjory B.
中科院分区：
文献类型：
--
作者：
Goggs, Robert;Mastrocco, Alicia;Brooks, Marjory B.
目的犬弥散性血管内凝血（DIC）的临床诊断具有挑战性。假设具有与明显DIC一致的实验室异常的犬的死亡率增加，因此存活率可用于评价DIC评分系统的性能。在临床患病犬中比较了四种DIC评分系统：国际血栓形成和止血学会（ISTH）评分;先前发表的兽医DIC评分;使用内部参考区间（RI）进行凝血试验的系统;以及使用内部RI值修改的已发表的兽医DIC评分。设计背景回顾性队列研究。大学教学医院。动物干预804只患有DIC相关潜在疾病的客户拥有的犬。没有。测量结果和主要结果结论：审查病历以确定已分析凝血时间、D-二聚体浓度、抗凝血酶活性、纤维蛋白原浓度和血小板计数组成的凝血组的犬。然后应用四种方法进行显性DIC评分，并评估这些评分预测死亡率的能力。使用机构RI诊断显性DIC提供了最准确的预后评估。根据6个参数中3个参数的异常进行评分，以识别明显的DIC，对死亡率的敏感性为72.7%，特异性为80.9%，准确率为78.4%。通过该方法诊断为明显DIC的犬的死亡率为62.5%，而非明显DIC的犬的死亡率为12.9%，非存活的相对风险为4.84（95%置信区间3.80-6.16）。在有DIC风险的犬中，内部RI评分系统可准确预测死亡率。通过进一步的前瞻性验证，该系统有望成为临床研究和临床实践中显性DIC一致表征的诊断工具。
Objective The clinical diagnosis of disseminated intravascular coagulation (DIC) in dogs is challenging. It was hypothesized that dogs with laboratory abnormalities consistent with overt DIC have increased mortality and hence survival could be used to evaluate the performance of DIC scoring systems. Four DIC scoring systems were compared in clinically ill dogs: The International Society of Thrombosis and Haemostasis (ISTH) score; a previously published veterinary DIC score; a system using in-house reference intervals (RIs) for coagulation assays; and the published veterinary DIC score modified by use of in-house RI values. Design Setting Retrospective cohort study. University teaching hospital. Animals Interventions Eight hundred four client-owned dogs with underlying disorders associated with DIC. None. Measurements and Main Results Conclusions Medical records were reviewed to identify dogs for which a coagulation panel consisting of coagulation times, D-dimer concentration, antithrombin activity, fibrinogen concentration, and platelet count had been analyzed. Four methods for overt DIC scoring were then applied, and the ability of these scores to predict mortality was evaluated. Use of institution RIs for diagnosis of overt DIC provided the most accurate prognostic assessment. A score based on abnormalities in 3 of 6 parameters to identify overt DIC was 72.7% sensitive and 80.9% specific for mortality and was accurate in 78.4% of cases. The mortality rate of dogs diagnosed with overt DIC via this method was 62.5%, compared to 12.9% in the dogs not in overt DIC, a relative risk of nonsurvival of 4.84 (95% confidence interval 3.80-6.16). In dogs at-risk for DIC, an in-house RI scoring system accurately predicted mortality. With further prospective validation, this system holds promise as a diagnostic tool for consistent characterization of overt DIC in clinical studies and clinical practice.