Comparison of Illness Evaluation of Different Diagnostic Criteria for Disseminated Intravascular Coa

来源 :国际休克·脓毒症高峰论坛暨第九届中国病理生理学会休克专业委员会学术大会 | 被引量 : 0次 | 上传用户:oyocean1
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  Objective: To assess the value of the incidence and prognosis of disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS) judged by different diagnostic criteria for DIC in patients 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,propose respectively International Society of Thrombosis and Haemostasis (ISTH) overt DIC and non-overt DIC Criteria,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 diagnostic 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 patients.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 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 not significant difference between JAAM Criteria and ISTH overt Criteria (P>0.05),whereas there were significant 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 ROC curve of three diagnostic criteria for DIC were respectively 0.739,0.724 and 0.778,which showed significant difference in there groups.Conclusion: For the diagnosis of DIC,ISTH overt Criteria had the highest specificity and less sensitivity,and ISTH non-overt Criteria provided 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.
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