A multicenter, prospective validation study of the Japanese Association for Acute Medicine disseminated intravascular coagulation scoring system in patients with severe sepsis.
A multicenter, prospective validation study of the Japanese Association for Acute Medicine disseminated intravascular coagulation scoring system in patients with severe sepsis.
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DOI：
10.1186/cc12783
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发表时间：
2013-06-20
期刊：
影响因子：
--
通讯作者：
Japanese Association for Acute Medicine Sepsis Registry Study Group
中科院分区：
文献类型：
--
作者：
Gando S;Saitoh D;Ogura H;Fujishima S;Mayumi T;Araki T;Ikeda H;Kotani J;Kushimoto S;Miki Y;Shiraishi S;Suzuki K;Suzuki Y;Takeyama N;Takuma K;Tsuruta R;Yamaguchi Y;Yamashita N;Aikawa N;Japanese Association for Acute Medicine Sepsis Registry Study Group
为了验证日本急性医学协会（JAAM）弥散性血管内凝血（DIC）评分系统在严重脓毒症患者中的作用，我们在三级医院的15个重症监护中心进行了一项多中心前瞻性研究。本研究纳入了624例严重脓毒症患者。在诊断严重脓毒症当天（第1天）和第4天对JAAM DIC进行评分。还评估了疾病严重程度和器官功能障碍的评分。JAAM DIC的患病率为46.8%（292/624），21%的DIC患者按血小板减少率进行评分。与非DIC患者相比，JAAM DIC患者病情更重，全身炎症更严重，多器官功能障碍综合征（MODS）的发生率更高，预后更差。疾病严重程度、全身炎症、MODS和死亡率根据第1天JAAM DIC评分的增加而恶化。Kaplan-Meier曲线显示JAAM DIC患者的1年生存率低于无DIC患者（log-rank检验P <0.001）。第1天JAAM DIC评分（比值比= 1.282，P <0.001）和Delta JAAM DIC评分（比值比= 0.770，P <0.001）是28天死亡的独立预测因子。JAAM DIC评分从第1天到第4天的动态变化也影响了卒中。JAAM DIC评分系统包括第1天符合国际血栓与止血学会显性DIC标准的所有患者。国际血栓和止血学会评分系统遗漏了大量JAAM评分系统识别的死亡者。JAAM DIC评分系统在预测严重脓毒症患者的MODS和不良预后方面具有良好的预后价值，并且可以检测到更多需要治疗的患者。进行重复的每日JAAM评分增加了预测患者预后的能力。
To validate the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) scoring system in patients with severe sepsis, we conducted a multicenter, prospective study at 15 critical care centers in tertiary care hospitals. This study included 624 severe sepsis patients. JAAM DIC was scored on the day of diagnosis of severe sepsis (day 1) and day 4. Scores for disease severity and organ dysfunction were also evaluated. The prevalence of JAAM DIC was 46.8% (292/624), and 21% of the DIC patients were scored according to the reduction rate of platelets. The JAAM DIC patients were more seriously ill and exhibited more severe systemic inflammation, a higher prevalence of multiple organ dysfunction syndrome (MODS) and worse outcomes than the non-DIC patients. Disease severity, systemic inflammation, MODS and the mortality rate worsened in accordance with an increased JAAM DIC score on day 1. The Kaplan-Meier curves demonstrated lower 1-year survival in the JAAM DIC patients than in those without DIC (log-rank test P <0.001). The JAAM DIC score on day 1 (odds ratio = 1.282, P <0.001) and the Delta JAAM DIC score (odds ratio = 0.770, P <0.001) were independent predictors of 28-day death. Dynamic changes in the JAAM DIC score from days 1 to 4 also affected prognoses. The JAAM DIC scoring system included all patients who met the International Society on Thrombosis and Haemostasis overt DIC criteria on day 1. The International Society on Thrombosis and Haemostasis scoring system missed a large number of nonsurvivors recognized by the JAAM scoring system. The JAAM DIC scoring system exhibits good prognostic value in predicting MODS and poor prognosis in patients with severe sepsis and can detect more patients requiring treatment. Conducting repeated daily JAAM scoring increases the ability to predict the patient's prognosis.
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影响因子：
7.5
作者：
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通讯作者：
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