Modified score for disseminated intravascular coagulation in the critically ill
Modified score for disseminated intravascular coagulation in the critically ill
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DOI：
10.1007/s00134-005-2685-2
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发表时间：
2005-09-01
影响因子：
38.9
通讯作者：
Pettilä, V
中科院分区：
文献类型：
--
作者：
Sivula, M;Tallgren, M;Pettilä, V
目的：评估根据国际血栓形成与止血学会（ISTH）标准诊断显性弥散性血管内凝血（DIC）的价值，以及ISTH显性DIC评分中包含的参数在预测重症监护患者第28天死亡率方面的价值。此外，评估该评分的组成部分在诊断显性DIC中的价值。设计和背景：在大学医院重症监护室进行的回顾性临床研究。患者和参与者：2002年1月至2003年10月期间在ICU住院的494例连续患者。测量和结果：从计算机化数据库和患者文件中收集临床和实验室数据，包括止血参数。共有19%（95/494）的患者符合明显DIC的标准。他们的第28天死亡率高于没有明显DIC的患者（40%对16%）。最低血小板计数（曲线下面积，AUC，0.910），最高血浆D-二聚体（AUC 0.846），最低抗凝血酶（AUC 0.823），和Owren型凝血酶原时间活动（AUC 0.797）区分有和没有明显的DIC的患者，而血浆纤维蛋白原（AUC 0.690）的区分能力差。诊断为显性DIC的患者均未出现血浆纤维蛋白原降低。第1天SOFA和APACHE II评分、第一次CRP测量和最低抗凝血酶是第28天死亡率的独立预测因子。结论：显性DIC的诊断不是28天死亡率的独立预测因子。在ICU患者中，血浆抗凝血酶似乎是一个有希望的候选指标，而血浆纤维蛋白原的价值是值得怀疑的。
Objective: To assess the value of the diagnosis of overt disseminated intravascular coagulation (DIC) according to the International Society on Thrombosis and Haemostasis (ISTH) criteria and that of the parameters included in the ISTH score for overt DIC in predicting day 28 mortality in intensive care patients. Also, to assess the value of the components of the score in the diagnosis of overt DIC. Design and setting: Retrospective clinical study in a university hospital intensive care unit. Patients and participants: 494 consecutive patients admitted in the ICU between January 2002 and October 2003. Measurements and results: Clinical and laboratory data, including hemostatic parameters, were collected from computerized databases and patient files. Altogether 19% (95/494) of the patients fulfilled the criteria for overt DIC. Their day 28 mortality rate was higher than that of patients without overt DIC (40% vs. 16%). The lowest platelet count (area under curve, AUC, 0.910), highest plasma D-dimer (AUC 0.846), lowest antithrombin (AUC 0.823), and Owren-type prothrombin time activity (AUC 0.797) discriminated well the patients with and without overt DIC, whereas plasma fibrinogen (AUC 0.690) had poor discriminative power. No patient with the diagnosis of overt DIC had decreased plasma fibrinogen. Day-1 SOFA and APACHE II score, the first CRP measurement, and the lowest antithrombin were independent predictors of day 28 mortality. Conclusions: The diagnosis of overt DIC was not an independent predictor of day 28 mortality. In ICU patients plasma antithrombin seems a promising candidate in the panel of indicators for overt DIC whereas the value of plasma fibrinogen is in doubt.