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脓毒症中的弥散性血管内凝血及相关因素

Disseminated Intravascular Coagulation in Sepsis and Associated Factors.

作者信息

Rinaldi Ikhwan, Sudaryo Mondastri Korib, Prihartono Nurhayati Adnan

机构信息

Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia.

Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.

出版信息

J Clin Med. 2022 Oct 31;11(21):6480. doi: 10.3390/jcm11216480.

Abstract

Background: sepsis is a life-threatening organ dysfunction caused by an excessive host immunological response to infection. The incidence of sepsis is increasing every year, and sepsis is the primary cause of mortality in intensive care units (ICUs). DIC is a coagulopathy syndrome that causes microvascular and macrovascular thrombosis and increases the risk of bleeding due to consumptive coagulopathy. The pathophysiology of DIC in sepsis is complex, and further research is required to investigate the involved mechanisms and risk factors. Method: this study is a prognostic analysis of a retrospective cohort. Samples were patients diagnosed with sepsis and admitted to Cipto Mangunkusumo National General Hospital from January 2016 to October 2022. Research subjects were followed until occurrence of DIC during sepsis or recovery from sepsis. The research subjects were selected from medical records using a consecutive total sampling approach. The inclusion criteria were patients aged ≥18 years old and diagnosed with sepsis according to qSOFA criteria with a score of 2. The exclusion criterion was an incomplete medical record. Bivariate and multivariate logistic regression analyses were performed to determine which independent variables contributed to the incidence of DIC and obtain the odds ratios (ORs). p < 0.05 was considered to indicate a statistically significant difference. Results: a total of 248 patients were included after considering the inclusion and exclusion criteria. Of these, 50 (20.2%) septic patients developed DIC. In the multivariate analysis, albumin ≤2.5 g/dL (OR: 2.363; 95% CI: 1.201−4.649), respiratory infection (OR: 2.414; 95% CI: 1.046−5.571), and antibiotic treatment ≥1 h (OR: 2.181; 95% CI: 1.014−4.689) were associated with DIC development. On the basis of the ROC curve, the area under the curve (AUC) was determined to be 0.705 with 95% CI = (0.631−0.778). Conclusion: in our study, the prevalence of DIC in septic patients was 20.2%. Low albumin, respiratory infection, and antibiotic treatment ≥1 h were found to be risk factors for development of DIC in septic patients.

摘要

背景

脓毒症是由宿主对感染的过度免疫反应引起的危及生命的器官功能障碍。脓毒症的发病率逐年上升,是重症监护病房(ICU)死亡的主要原因。弥散性血管内凝血(DIC)是一种凝血病综合征,可导致微血管和大血管血栓形成,并因消耗性凝血病增加出血风险。脓毒症中DIC的病理生理学很复杂,需要进一步研究以探讨其涉及的机制和危险因素。方法:本研究是一项回顾性队列的预后分析。样本为2016年1月至2022年10月期间诊断为脓毒症并入住西托·曼古库苏莫国家综合医院的患者。研究对象随访至脓毒症期间发生DIC或脓毒症康复。研究对象采用连续全样本方法从病历中选取。纳入标准为年龄≥18岁且根据qSOFA标准诊断为脓毒症且评分为2分的患者。排除标准为病历不完整。进行二元和多因素逻辑回归分析以确定哪些自变量导致DIC的发生并获得比值比(OR)。p<0.05被认为具有统计学显著差异。结果:考虑纳入和排除标准后,共纳入248例患者。其中,50例(20.2%)脓毒症患者发生了DIC。在多因素分析中,白蛋白≤2.5g/dL(OR:2.363;95%CI:1.201−4.649)、呼吸道感染(OR:2.414;95%CI:1.046−5.571)和抗生素治疗≥1小时(OR:2.181;95%CI:1.014−4.689)与DIC的发生相关。根据ROC曲线,曲线下面积(AUC)确定为0.705,95%CI =(0.631−0.778)。结论:在我们的研究中,脓毒症患者中DIC的患病率为20.2%。低白蛋白、呼吸道感染和抗生素治疗≥1小时被发现是脓毒症患者发生DIC的危险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5072/9658286/a67192522ca6/jcm-11-06480-g001.jpg

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