The Risk Factors Evaluation Of Thrombosis In A State Of Starvation And Dehydration

ObjectiveTo screen valuable predictors by evaluating the risk factors of thrombosis in a state of starvation and dehydration initially. To provide theoretical basis for taking precautionary measures to thrombosis during clinical therapy after similar accidents.MethodsTook miners rescued from 3.28 Wangjialing coal mine accident as our study subject. Collected all clinical information of the miners, including name, sex, age, basic disease, such as deep venous thrombosis (DVT), phlebitis/varicose, basic cardiopulmonary disease, diabetes, hypertension, systemic disease, malignant tumor and so on), vital signs, some blood physiological parameters at admission to the hospital and discharged from hospital, including the blood cell analysis, C-reactive protein(CRP), ferritin, bilirubin, uric acid (UA), coagulation test, urinalysis, urine volume and the result of lower extremity deep venous color Doppler flow imaging test(All subjects finished the test within 48-96h at admission to hospital).12 subjects with certain diseases that could affect coagulation and fibrinolysis system were excluded.103 subjects were enrolled into study. Input all above index into database established by SPSS 13.0 statistical package. Defined data as follows:each measured value of which was either within reference range (represented by value 1) or outside of reference range (represented by value 0). DefinedΔX as the value that the data of admission to the hospital minus those of discharged from hospital. CalculatedΔPV(%) according to Dill and Costill's formula:ΔPV(%)=100[HbA(1-HctB×10-2)]/HbB(1-HctA×10-2)]-100(the subscripts A and B referred to admission to hospital and discharged from hospital, respectively). Calculated body mass index (BMI):BMI=body weight (Kg)/height (m2). Took refeeding time(day) as horizontal axis, measured values of RBC, Hb and Hct as vertical axis drawing their changing curves to observe variable trends, respectively.Results1. Anthropometric measurement results A total of 103 subjects aged from 19 to 55 years were all males, with the average age of 38.8 years old. Heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure(DBP) at admission to the hospital were significantly higher than those of discharged from hospital(t=2.775～3.891,all P<0.05), yet weight of admission to hospital were lower than that of discharged from hospital (t=-2.118, P<0.05).ΔHR correlated positively withΔSBP andΔPV(%), respectively(r=0.401～0.329, P<0.05). No correlation was found betweenΔDBP andΔHR, also betweenΔPV(%) andΔDBP,ΔSBP, respectively(all P>0.05).2. The evaluation of hemoconcentrationΔPV(%) at admission to hospital decreased 15.8% compared with that of discharged from hospital after refeeding. All subjects felt thirsty in various degrees at the time of rescued. Mean urine volume on the first hospitalized day was 654.971ml. The result of urine specific gravity was 1.025. The count of RBC, Hb, Hct of admission to hospital were obviously higher than those of discharged from hospital, respectively(t=12.212～14.195, all P<0.001).ΔPV (%) correlated positively with A Hg,ΔRBC,ΔHct, respectively(r=0.692～0.901, all P<0.05).3. Inflammatory markers The count of WBC between 4×109/L and10×109/L accounted for 88.3%(91/103), while the abnormal count (below 4×109/L or above 10×109/L) accounted for 11.7%(12/103). The abnormality rate of CRP and high sensitivity C-reactive protein(hs-CRP) were separately 19.0%(8/42),42.9%(9/21). Comparing the abnormality rate of hs-CRP with that of WBC and CRP, they all showed differences, respectively (χ2=4.028, P<0.05;χ2=12.076, P<0.05). hsCRP showed the highest abnormality rate. Serum ferritin(SF) levels exceeding normal range accounted for 75.0%, yet serum ferri ion of all subjects were in normal range. No correlation existed between SF and ferri ion (P<0.05).4. The blood index associated with thrombosis Homocysteine(Hcy) at admission to hospital was higher than that of discharged from hospital (18.810±6.781vs. 9.215±4.817μmol/L, t=9.095, P< 0.001). There existed no differences in the group of normal BMI and abnormal BMI, smoking and non-smoking, age above 40 and below or equal to 40 years(all P>0.05).25.0% of subjects showed low folic acid(FA) level. Cholesterol was in normal range or decreased slightly in comparison with its reference range. It accounted for 9.6%(7/73) and 53.1%(17/32) as to abnormal triglyceride and lipoprotein(a), respectively. Compared with the group of non-smoking, more subjects showed raised Lp(a) level in the group of smoking (26/41 vs.11/32,χ2=6.064, P<0.05).47 (63.5%) subjects showed elevated uric acid (UA) level. No correlation existed betweenΔPV andΔUA (P>0.05).5. The result of coagulation test The level of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB) were all within normal range on the first hospitalized day. AntithrombinⅢ(AT-Ⅲ) and D-Dimer(DD) showing elevated accounted for 27.3%(9/33) and 16.3%(7/43), respectively. AT-Ⅲon admission to hospital was a little lower than that of discharged from hospital(t=-4.924,P<0.001). The number of subjects showing elevated DD on admission to hospital(7/43) was slightly lower than that of discharged from hospital (6/33)(P>0.05).6. Others Total bilirubin(TBIL), direct bilirubin(DBIL) and indirect bilirubin(IBIL) at admission to the hospital were higher when compared with those of discharged from hospital(t=-13.525～8.220, all P<0.001). The elevated level of IBIL was higher than that of DBIL (46.4% vs.33.6%). No correlation existed betweenΔPV andΔTBIL,ΔDBIL,ΔIBIL, respectively (all P>0.05).7. The result of lower extremity deep venous color Doppler flow imaging test Thrombosis were not found in all these 103 patients.Conclusion1. There existed some special conditions to promote development of thrombosis in a state of starvation and dehydration, such as inflammatory or microinflammatory reaction, disturbance of lipid metabolism, raised homocysteine levels and hyperuricemia and so on.2. Ferritin may serve as a kind of more sensitive assessment index of inflammatory reaction during the special living conditions of starvation and dehydration.3. Elevated bilirubin is considered as protective adaptive response during the special living conditions of starvation and dehydration.