Study On The Prognosis Evaluation Of Severe Patients With Coagulation Dysfunction By Thromboelastography And Conventional Coagulation Tests Combined With APACHE Ⅱ Score

ObjectiveTo evaluate the outcome of TEG and CCTs and APACHE Ⅱ score in severe patients with coagulation dysfunction.Methods:A total of 590 severe patients were included in this study,of which 287 patients with severe coagulation dysfunction were classified as study group and the other 303 patients as control group;the patients were further divided into death and survival groups according to the quality of disease prognosis.SPSS 22.0 software was used for statistical analysis,and APACHE Ⅱ,TEG,and CTTs was compared differences between the study group and the control group,the death group and the survival group using the t-test;using Spearson Correlation Analysis to analyze correlations between indicators in the Study Group,the prognostic predictive value of the indicator is analyzed using the ROC curve.Result(1)Baseline data comparison between study group and control group patients:there was no significant difference in sex and age between study group and control group patients(P>0.05).(2)Comparison between the study group and the control group:CI,MA,angle,Fg,PLT,PCT,lower than the control group,K,R,PT,APTT,TT,PDW,APACHE Ⅱscores were higher than the control group,all statistically significant(P<0.05).(3)Analysis of the association of coagulation index and APACHE Ⅱ score in the study group:APACHE Ⅱ score showed negative correlation between CI,MA,angle,and TT(r=-0.603,-0.682,-0.591,-0.589),positive correlation with K,R,PT,PDW(r=0.567,0.611,0.634,0.64,0.169),statistically significant(P<0.05);APACHE Ⅱ score had no significant correlation with APTT,Fg,PLT,PCT,MPV(P>0.05).(4)Correlation analysis between TEG and conventional coagulation index in the study group:TEG index R and PT and INR(r=0.14,0.24),Angle and CI and INR(r=-0.13、-0.15),statistically significant(P<0.05);no significant correlation(P>0.05).(5)Of the 287 patients with severe coagulation dysfunction in the study group,50 patients finally died(17.42%)after treatment,and 237 patients(82.58%)survived.CI in death group,MA,angle,Fg were lower than survival group,K,R,PT,APTT,TT were higher than survival group,all significant(P<0.05).(6)ROC curve analysis results of predicting death value:Individual markers PT,APTT,TT,Fg,INR,PLT were included in the coagulation tests included in this study,PCT,MPV,PDW,R,K,α angle,The accuracy of MA and CI in predicting death was medium,with INR being the highest;the corresponding P-values were all<0.05,and the difference was statistically significant.P1(CCTs)、P2(TEG)、P3(CCTs and TEG)、P4(CCTs and APACHE Ⅱ)、P5(TEG and APACHE Ⅱ))、P6(TEG,CCTs and APACHEⅡ)The P-value of the dissonant joint indicator was<0.05,and the difference was statistically significant,and its accuracy was medium;The AUC value of P6(0.797)is the highest,and the accuracy of predicting death is the highest,and when P6≥0.142,its sensitivity to predict patient death is 80.0%,and the specificity is 67.4%.Conclusion1.Both TEG and conventional coagulation indexes can be used as laboratory indicators to judge the coagulation function in severe patients in the ICU ward,but they can not be replaced by each other.The combination of the two can improve the diagnosis of coagulation dysfunction in severe patients the combination of TEG and four coagulation indicators is the best,which can improve the accuracy of the diagnosis of coagulation dysfunction.2.TEG has more good correlation with APACHE Ⅱ scores than conventional coagulation measures,and can better reflect the severity of patients with severe coagulopathy,but the combination can more accurately assess patient severity than a single use.The combination of the above indicators is more accurate to assess the severity of the patient’s condition than the single use,especially the combination of TEG and APACHE Ⅱ scores is the best,reflecting the more accurate condition.3.TEG,conventional indicators of coagulation and APACHE Ⅱ score had the highest accuracy in predicting the prognosis of patients with severe coagulation dysfunction.4.For patients with severe coagulopathy,various indicators of coagulation function should be comprehensively applied and should be observed dynamically,which is conducive to early effective intervention,guide clinical treatment work,to delay or block the development of disease course,reduce mortality rate,and improve prognosis,When P6≥0.142,its sensitivity for predicting patient death was 80.0%and specificity was 67.4%.