Prognostic value of a simple evolving disseminated intravascular coagulation score in patients with severe sepsis
Prognostic value of a simple evolving disseminated intravascular coagulation score in patients with severe sepsis
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DOI：
10.1097/01.ccm.0000181296.53204.de
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发表时间：
2005-10-01
影响因子：
8.8
通讯作者：
Taylor, FB
中科院分区：
文献类型：
--
作者：
Kinasewitz, GT;Zein, JG;Taylor, FB
目的：我们推测，严重脓毒症的炎症反应所引起的凝血障碍将通过反映预后信息的血小板计数和凝血酶原时间的变化来反映。为了验证这一假设，我们观察了简单的弥散性血管内凝血(DIC)评分在预测严重脓毒症患者预后中的作用，该评分分别为：a)绝对血小板计数<；100x10(9)/L；b)凝血酶原时间15.0秒；c)血小板减少20%；以及d)凝血酶原时间增加0.3秒预测严重脓毒症患者的预后。地点：大学医学中心重症监护室。患者：163例危重重症脓毒症患者。干预：无。测量和主要结果：临床分为毛细血管渗漏综合征24例，多器官功能衰竭伴败血症死亡37例，多器官功能衰竭伴康复57例，以及改良多器官功能障碍综合征(MODS)评分迅速改善(未计分血小板减少)的45例。毛细血管渗漏综合征患者的急性生理学和慢性健康评估II评分、改良MODS和凝血酶原时间最高，而血小板计数最低，而良好患者的正常值最高。单纯进行性DIC评分随着临床分级的恶化而增加，并与器官衰竭的恶化(改良MODS增加)相关。病死率从简单演变评分为0的10%上升到评分为4的73%(p2出现多器官衰竭，其中一半死于败血症。结论：根据两个现成的全球凝血标志物计算出的前48小时简单演变DIC评分似乎反映了潜在疾病的严重程度。它可以很容易地在床边计算，并为严重脓毒症患者提供有用的预后信息。
Objective: We postulated that the coagulopathy initiated by the inflammatory response to severe sepsis would be reflected by changes in the platelet count and prothrombin time that convey prognostic information. To examine this hypothesis, we looked at the utility of a simple evolving disseminated intravascular coagulation (DIC) score that awarded 1 point for each of the following: a) an absolute platelet count < 100 x 10(9)/L; b) a prothrombin time > 15.0 secs; c) a 20% decrease in platelets; and d) a > 0.3-sec increase in prothrombin time in predicting outcome in patients with severe sepsis.Design: Prospective observational study. Setting: Intensive care units of university medical center.Patients: Patients were 163 critically ill severe sepsis patients.Interventions: None.Measurements and Main Results: Patients were clinically classified as having capillary leak syndrome (n = 24), multiple organ failure with death from sepsis (n = 37), or multiple organ failure with recovery (n = 57) or as well (n = 45) if they showed rapid improvement in their modified Multiple Organ Dysfunction Syndrome (MODS) score (which did not score for thrombocytopenia). Patients with capillary leak syndrome had the highest Acute Physiology and Chronic Health Evaluation II score, modified MODS, and prothrombin time and the lowest platelet counts, whereas well patients had the most normal values. The simple evolving DIC score increased with worsening clinical class and was associated with worsening organ failure (increased modified MODS). Mortality rate increased from 10% for a simple evolving score of 0 to 73% for a score of 4 (p 2 developed multiple organ failure and half of them died from sepsis.Conclusions: The simple evolving DIC score calculated in the first 48 hrs from two readily available global coagulation markers appears to reflect the severity of the underlying disorder. It can be easily calculated at the bedside and provides useful prognostic information for the patient with severe sepsis.