Non-overt disseminated intravascular coagulation scoring for critically ill patients: The impact of antithrombin levels
Non-overt disseminated intravascular coagulation scoring for critically ill patients: The impact of antithrombin levels
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DOI：
10.1160/th08-07-0448
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发表时间：
2009-04-01
影响因子：
6.7
通讯作者：
Morita, Kiyoshi
中科院分区：
文献类型：
--
作者：
Egi, Moritoki;Morimatsu, Hiroshi;Morita, Kiyoshi
国际血栓与止血学会（ISTH）提出的非显性弥散性血管内凝血（DIC）评分算法的验证仍不完整。本研究的目的是评估将AT纳入非显性DIC评分对重症监护室（ICU）死亡的可预测性以及日本厚生劳动省（JMHW）或ISTH定义的显性DIC的后期发展的影响。我们对364例重症监护患者进行了回顾性观察研究。每日获得的DIC筛查凝血参数用于评分。分别有194例和196例患者被评分为阳性非显性DIC伴和不伴AT;两者之间的诊断一致性为78%。与非显性DIC患者相比，这些非显性DIC患者的死亡率显著升高。在37例ICU非幸存者中，AT的阳性非显性DIC评分先于ICU死亡的中位数为6.8天，与无AT的非显性DIC的中位数5.4天相比，这明显更早（p=0.022）。在入院后发生显性DIC的患者中，当使用AT时，从阳性非显性DIC到阳性显性DIC的时间段显著更长（显性DIC ISTH; 1.3天vs. 0.1天，p=0.004，显性DIC JMHW; 2.5天vs. 2.0天，p=0.04，AT vs.无AT）。非显性DIC评分可预测危重患者的高死亡风险。当纳入AT水平信息时，发现非显性DIC评分比无AT的非显性DIC评分更早预测显性DIC的发生。
Validation of a scoring algorithm for non-overt disseminated intravascular coagulation (DIC) proposed by the International Society on Thrombosis and Haemostasis (ISTH) is still incomplete. It was the objective of this study to assess the impact of including AT to non-overt DIC scoring on the predictability for intensive care unit (ICU) death and the later development of overt-DIC defined by the Japanese Ministry of Health and Welfare (JMHW) or the ISTH. We performed a retrospective observational study conducted in 364 patients in critical care. Coagulation parameters obtained daily for DIC screening were utilised for scoring. There were 194 and 196 patients scored as positive non-overt DIC with and without AT, respectively; diagnostic agreement between the two was 78%. As compared with patients without non-overt DIC, these non-overt DIC patients had significantly higher mortality. In 37 ICU non-survivors, positive non-overt DIC scoring with AT preceded ICU death by a median of 6.8 days, which was significantly earlier as compared with a median of 5.4 days for non-overt DIC without AT (p=0.022). In patients who developed overt-DIC after admission, the time period from positive non-overt DIC to positive overt-DIC was significantly longer when AT was utilised (overt-DIC ISTH; 1.3 days vs. 0.1 days, p=0.004, overt-DIC JMHW; 2.5 days vs. 2.0 days, p=0.04, with AT vs. without AT, respectively). Non-overt DIC scoring predicted a high risk of death in critically ill patients. When information on AT levels was included, non-overt DIC scoring was found to predict development of overt-DIC significantly earlier than non-overt DIC scoring without AT.