| Background: The purpose of this study was to explore the characteristics of bleeding and coagulation changes in elderly patients with sepsis and the differences between elderly patients and non-elderly patients,and to explore its clinical significance.Materials and methods: This study was a prospective study.Patients with sepsis admitted to the Department of severe Medicine of the first affiliated Hospital of China Medical University from September 1,2018 to November 31,2020 were divided into two groups according to their age.The age < 65 years old is the non-elderly group,the age ≥ 65 years old is the elderly group.The general data,prognosis and survival data of the patients were collected,and the indexes of coagulation,inflammation,DIC and disease severity were collected on the 1st,3rd and 7th day after diagnosis of sepsis(SOFA score after excluding platelet count score and APACHEII score after age score correction).First of all,the general data and prognosis of elderly and non-elderly patients were compared.Furthermore,the changes of coagulation index,DIC occurrence and disease severity were compared between the two groups at different time points,and the characteristics of bleeding and coagulation indexes and disease severity with time in each group were longitudinally compared.After further stratification of elderly patients by age,the differences of coagulation indexes in different age groups of elderly patients with sepsis were compared.The differences of bleeding and coagulation indexes between the two groups were compared under the same disease severity and the same 28-day survival outcome,and the difference of DIC score between the two groups under the condition of the same disease severity and 28-day prognosis.The changes of inflammatory indexes were further compared between the two groups at each time point,and the correlation between inflammatory indexes and coagulation indexes was compared.Results:A total of 568 patients with sepsis were included in this study,including 264 patients in the non-elderly group,304 patients in the elderly group and 264 patients in the non-elderly group.In the general data,there were significant differences in the infection site,the source of the patients and the underlying diseases between the two groups.The incidences of DIC,septic shock and multiple organ dysfunction in the elderly group during ICU were lower than those in the non-elderly group,but the mortality in ICU,in hospital and long-term was higher than that in the non-elderly group.The incidence of sepsis complicated with DIC was less in elderly patients than in non-elderly patients,and the incidence of DIC in elderly group was also lower than that in non-elderly group.The prognostic indexes were correlated with length of stay,length of stay in ICU,90-day prognosis and 120-day prognosis.On the first day after the diagnosis of sepsis,the changes of blood coagulation function and organ function damage in the elderly group were slighter than those in the non-elderly group,which showed that the prolongation time of PT in the elderly group was shorter than that in the non-elderly group,and the levels of FIB and FDPs in the elderly group were lower than those in the non-elderly group [PT(s): 16.3(15.1-18.2)vs.16.7(15.4-19.4),P=0.026;FIB(ug/m L): 3.42 vs.4.36,0.003.FDPs(ug/m L): 12.05,15.33(8.4831.58),DIC score was lower [ISTH score: 2(2-3)vs 3(2-4),P< 0.001),JAAM score: P 2(1-4)vs 3(1-4),P < 0.001 ],and SOFA score was lower after correction [7(4-9)vs 7(5-9),P=0.033].The scores of ISTH and JAAM in the elderly group were lower than those in the non-elderly group.Further stratified analysis of elderly patients by age showed that there was no significant difference in blood coagulation indexes and the incidence of DIC with age.It’s not obvious.In abdominal infection,the elderly group showed the prolongation of PT and APTT and the decrease of FIB level in the early stage of sepsis.There was no significant difference in blood coagulation indexes among septic patients with pulmonary infection,elderly group and non-elderly group.Compared with the corrected SOFA score after removing the platelet fraction,there was a difference in the changes of blood coagulation indexes between the elderly and non-elderly patients with mild organ function injury in the early stage of sepsis,which showed that the levels of FIB and D-dimer in the elderly patients were lower than those in the non-elderly patients under different organ function injuries.The DIC score was also different between the two groups in the early stage of sepsis,and the elderly patients were aggravated with the organ function damage.The scores of ISTH and JAAM were lower than those of non-elderly patients,and there was no significant difference in blood coagulation function among elderly patients with sepsis under different disease severity.Under the same disease severity,the changes of bleeding and coagulation in the early stage of sepsis in elderly patients were mild,and the changes of FIB,D-dimer and DIC scores were relatively small.In 28 days with different prognostic outcomes,on the first day of diagnosis of sepsis,the levels of PT,FIB,D-dimer and DIC scores in elderly patients were lower than those in non-elderly group on the first day of diagnosis of sepsis.[PT(s): 15.9(14.9-17.5)vs.16.5(15.2-18.4),P=0.031;FIB(g/L): 4.42(3.12-55.73)vs.5.01(3.39-6.86);D-D(ug/m L): 3.36(2.15-5.53)vs 4.16(2.43-8.22);P=0.020] and DIC were lower than those in the non-elderly group.Among the patients who died within 28 days,there was no significant difference in bleeding and coagulation indexes,and the DIC score in the elderly group was still lower than that in the non-elderly group in the early stage of sepsis.Among the septic patients with the same prognosis and the same organ function damage score,the elderly patients with DIC score were lower and lighter than those with blood coagulation score.The comparison of inflammatory indexes showed that the level of CRP in the elderly group was significantly lower than that in the non-elderly group on the first day of diagnosis of sepsis [CRP(mg/L): 131.40(75.40-191.90)vs 188.80(113.35-244.40),P< 0.001],and there was a significant correlation between CRP and FIB [r=0.531,P <0.001].Conclusion:This study suggests that there is a significant difference in the changes of bleeding and coagulation indexes between elderly and non-elderly patients with sepsis.Compared with non-elderly patients,the changes of bleeding and coagulation function and organ function damage in the elderly group were slighter in the early stage of sepsis,but the mortality was higher.The changes of coagulation indexes in elderly and non-elderly patients with sepsis were consistent with the degree of inflammatory reaction. |
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