三种不同DIC评分对脓毒性休克器官功能损伤和预后评估的应用价值  

Evaluation of ISTH, JAAM and CDICS for predicting organ dysfunction and mortality in septic shock

作　　者：陈晓迎[1] 张燕[1] 张丹[1] Chen Xiao-ying;Zhang Yan;Zhang Dan(SICU of Critical Care Medicine Department, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China)

机构地区：[1]重庆医科大学附属第一医院重症医学科普外ICU,重庆400016

出　　处：《中国急救医学》2019年第2期170-174,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨国际血栓与止血协会(The International Society of Thrombisis and Hemostasis,ISTH)评分标准、日本急诊医学学会(Japanese Association for Acute Medicin,JAAM)、评分标准和中国弥散性血管内凝血诊断积分系统(Cheinese disseminated intravascular coagulation scoring,CDICS)三种弥漫性血管内凝血(disseminated intravascular coagulation,DIC)评分在评估脓毒性休克患者器官功能损伤和预后评估中的应用价值。方法回顾性分析96例脓毒性休克患者,记录临床资料及28d病死率,进行ISTH评分、JAAM评分及CDICS评分,并分为DIC组和非DIC(NODIC)组,分析两组器官功能损伤、危重程度及预后的差异。结果①脓毒性休克患者中,生存组的ISTH评分低于死亡组,分别为3(2,5)和4(3,6),差异有统计学意义(P=0.049);但生存组和死亡组的JAAM评分、CDICS评分差异均无统计学意义(P>0.05);②脓毒性休克患者中,ISTH评分、JAAM评分、CDICS评分与APACHEⅡ评分、SOFA评分均具有一定的相关性,r值分别为0.335、0.434、0.444(vs.APACHEⅡ评分)和0.443、0.559、0.632(vs.SOFA评分);③以不同DIC评分为DIC诊断标准,DIC组和NODIC组死亡构成比差异无统计学意义(P>0.05),但DIC组的危重度(APACHEⅡ评分)和器官功能损伤程度(SOFA评分)均明显高于NODIC组(P<0.05);④采用ROC曲线分析三种DIC评分预测脓毒性休克28d病死率,曲线下面积分别为0.626、0.578、0.613。结论ISTH评分、JAAM评分、CDICS评分有助于评估脓毒性休克患者的器官功能损伤和危重程度,但对28d病死率的预测价值欠佳,CDICS评分应用于脓毒性休克时与ISTH评分、JAAM评分具有类似的评估价值。Objective To investigate the value of three DIC scores :The International Society of Thrombisis and Hemostasis (ISTH),Japanese Association for Acate Medicin (JAAM)and Cheinese disseminated intravascular coagulation scoring(CDICS)in assessing organ dysfunction and prognosis in septic shock.Methods This retrospective,observational study recruited 96 septic shock patients admitted to our ICU.The patients diagnosed from three criteria (ISTH score,JAAM score,and CDICS score)were classified into DIC and NODIC groups.Clinical data and 28 -day mortality were compared. Results ①There was significant difference in ISTH scores between survival and death groups [3 (2,5) vs 4(3,6)],respectively,P =0.049],but no difference in JAAM scores and CDICS scores.②There was weak correlation between ISTH/JAAM/CDICS score and APACHE Ⅱ or SOFA score,r values were 0.335,0.434,0.444 (vs APACHE 11 )and 0.443,0.559,0.632 (vs SOFA);③There was no difference in the 28 -day mortality between the DIC group and NODIC group,but APACHE 11 score and SOFA score of DIC group were significantly higher than NODIC group (P <0.05 );④ROC curve analysis showed that the AUC area of the three different DIC scores predicted 28 -day mortality in septic shock were 0.626,0.578,and 0.613,respectively.Conclusion Three different DIC scores (ISTH score,JAAM score,CDICS score)are helpful in assessing organ dysfunction and severity in septic shock,but useless to assess of 28 -day mortality.

关 键 词：脓毒性休克 弥漫性血管内凝血(DIC) DIC评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]