不同DIC诊断评分标准对严重脓毒症患者病情评价的比较

目的:探讨不同DIC评分标准判断严重脓毒症和脓毒症休克的患者DIC和MODS发生和预后的价值。方法:收集246例严重脓毒症和脓毒症休克患者入院第1、3、7天的各项生理参数和实验室指标,分别使用ISTH显性DIC评分标准、非显性DIC评分标准和JAAMDIC评分标准进行诊断评分,同时进行SOFA评分,观察不同DIC评分标准之间确诊率、诊断时间点的差异;比较DIC确诊组间的病死率、SOFA分值的差异,绘制三种DIC评分标准的ROC曲线,计算曲线下面积,衡量各个评分系统对危重患者的病情严重程度和预后的判断准确性。结果:三种评分标准均能在一定程度上准确反映危重病患者多脏器功能衰竭的发生和预后,使用ISTH显性标准确诊的患者病死率和SOFA分值最高,诊断时间点同时或晚于ISTH非显性标准和JAAM标准;在DIC确诊组间的病死率和SOFA分值的比较上,JAAM标准与ISTH显性标准之间差异无统计学意义(P>0.05),ISTH非显性标准与ISTH显性标准之间差异有统计学意义,JAAM标准和ISTH非显性标准之间,病死率差异无统计学意义、SOFA分值差异有统计学意义;3个评分标准的ROC曲线下面积分别为0.739、0.724和0.778,相互之间比较差异均有统计学意义。结论:ISTH显性标准诊断DIC特异性最高,敏感性差;ISTH非显性标准诊断DIC敏感性最高,特异性差;JAAM标准诊断DIC敏感性和特异性均较高,对危重病患者的MODS发生和预后判断更为准确,可作为早期干预治疗的首选诊断标准。

Comparison of illness evaluation of different diagnostic criteria for disseminated intravascular coagulation in patients with severe sepsis

Objective：To assess the value of the incidence and prognosis of disseminated intravascular coagula-tion（DIC） and multiple organ dysfunction syndrome（MODS） judged by different diagnostic criteria for DIC in pa-tients with severe sepsis and septic shock. Method：To collect the various physiological parameters and experimental indexes of 246 patients with severe sepsis and septic shock in first, third and seventh days of hospitalization, pro-pose respectively International Society of Thrombosis and Hemostasis（ISTH） overt DIC and non-overt DIC Crite-ria,and Japanese Association for Acute Medicine（JAAM） Criteria to produce diagnostic score and sequential organ failure assessment （SOFA） score,observe the differences of the diagnose rate and diagnosis time in various diag- nostic criteria for DIC,compare the differences of mortality rates and SOFA score in DIC diagnosed groups,draw the receiver operating characteristic（ROC） curve of three diagnostic criteria for DIC,calculate area under the curve and measure the accuracy of judgment of each scoring system in the disease severity and prognosis of critical pa- tients. Result：All three diagnostic criteria could reflect the occurrence and prognosis of multiple organ~ failure in critical patients to some extent. The mortality rates and SOFA score of patients diagnosed by ISTH overt Criteria were the highest and the diagnosis time of them was the same as or later than that diagnosed by ISTH non-overt Criteria and JAAM Criteria. In comparison of mortality rates and SOFA score in DIC diagnosed groups,there were no significant difference bet~veen JAAM Criteria and ISTH overt Criteria（P〉0.05）, whereas there were signifi-cant difference between ISTH non-overt Criteria and ISTH overt Criteria However, there existed not marked difference in mortality rates and marked difference in SOFA score between JAAM Criteria and ISTH non-overt Criteria. The area under the receiver operating characteristic （ROC） curve of three diagnostic criteria for DIC were respectively 0. 739,0. 724 and 0. 778, which showed significant difference in three groups. Conclusion：For the diag-nosis of DIC,ISTH overt Criteria had the highest specificity and less sensitivity,and ISTH non-overt Criteria pro-vided the highest sensitivity and less specificity, but JAAM Criteria showed higher sensitivity and specificity, which was more accurate in the incidence and prognosis of MODS in critical patients and could be used as the first choice diagnostic criteria in early intervention therapy.