Prognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry
Prognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry
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DOI：
10.1016/j.jcrc.2017.12.003
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发表时间：
2018-04-01
影响因子：
3.7
通讯作者：
Shimizu, Keiki
中科院分区：
文献类型：
--
作者：
Hifumi, Toru;Kondo, Yutaka;Shimizu, Keiki
目的：中暑（HS）诱发弥散性血管内凝血（DIC）；然而，尚未在大量人群中充分评估 DIC 对 HS 患者的预后意义。本研究的目的是通过全国范围的登记来检验 DIC 对 HS 患者的预后意义。 材料和方法：从 2010 年、2012 年和 2014 年三个前瞻性、观察性、多中心 HS 登记处 (HSR) 获取并分析了有关 HS 的数据。进行单变量和多变量分析以确定医院死亡的独立预测因素。根据日本急性医学会（JAAM）诊断标准诊断 DIC，总分≥4 提示 DIC 诊断。 结果：本研究共纳入 705 例（中位年龄 68 岁；501 名男性）。医院死亡率为 7.1%（50 名患者）。多元回归分析显示，医院死亡率与 DIC 的存在显着相关（比值比 [OR]，2.16；95% 置信区间 [CI]，1.09-4.27；p = 0.028）。死亡率随着DIC评分的增加而恶化，当DIC评分为2时，死亡率显着增加至约10%。结论：DIC的存在是HS患者医院死亡率的独立预后因素。血液功能障碍是 HS 特定治疗的潜在目标。 (C) 2017 Elsevier Inc. 保留所有权利。
Purpose: Heat stroke (HS) induces disseminated intravascular coagulation (DIC); however, the prognostic significance of DIC in patients with HS has not yet been fully assessed in large populations. The aim of this study was to examine the prognostic significance of DIC in patients with HS using a nationwide registry.Materials and methods: Data regarding HS were obtained and analyzed from three prospective, observational, multicenter HS registries (HSRs): 2010, 2012, and 2014. Univariate and multivariate analyses were performed to identify independent predictors of hospital death. DIC was diagnosed according to the Japanese Association for Acute Medicine (JAAM) diagnostic criteria, with a total score >= 4 implying a DIC diagnosis.Results: In total, 705 (median age, 68 years; 501 men) were included in this study. Hospital mortality was 7.1% (50 patients). Multiple regression analysis revealed that hospital mortality was significantly associated with presence of DIC (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.09-4.27; p = 0.028). Mortality worsened as the DIC score increased, and increased remarkably to approximately 10% when the DIC score was 2.Conclusions: Presence of DIC was an independent prognostic factor of hospital mortality in patients with HS. Hematological dysfunction represents potential target for specific therapies in HS. (C) 2017 Elsevier Inc. All rights reserved.