Difference Analysis Of Different Kinds Of Diseases DIC Diagnosed By Chinese 2017 Edition CDSS And Application Evaluation In Primary Hospital

BackgroundDisseminated Intravascular Coagulation(DIC)is a multi-basic disease that can cause damage to the microvascular endothelium system,activate the coagulation system,extensive microvascular thrombosis,secondary fibrinolysis,leading to bleeding and microcirculatory disorders.A series of pathological changes in the clinical syndrome.Due to the particularity of the different underlying diseases of DIC,the clinical manifestations and changes in various laboratory indicators are complex and diverse.It is difficult to make a diagnosis based on a single clinical manifestation or a single laboratory indicator,making the diagnosis of DIC necessary.Experience and laboratory conditions.Since the domestic DIC diagnostic standard was proposed in 1986,the Chinese expert consensus has been revised many times.However,due to the defects that some standards cannot be accurately quantified,the DIC diagnosis lacks objectivity and standardization.In recent years,scholars at home and abroad have gradually realized that the diagnosis of DIC by means of integral quantification will be more scientific,accurate and standardized.Foreign countries have developed a number of DIC diagnostic score system standards,mainly the standards set by the International Thrombosis and Hemostasis Association(ISTH)in 2001,the Japanese Ministry of Health and Welfare(JMHW)standards in 1983,and the JAAM scores proposed by the Japanese Society of Emergency Medicine in 2005.Standards,but these standards have their own advantages and disadvantages,and the academic community is still working hard to explore and research in this area.In 2017,Chinese experts once again revised the original DIC diagnostic criteria(the participation of our subject experts),and developed the 2017 China DIC Diagnostic Credit System(CDSS)based on national data and national conditions.The 2017 version of CDSS efficacy has been compared with the multi-center retrospective and prospective clinical evaluation of 1076 suspected cases in 18 large hospitals in China,confirming its superiority in terms of diagnostic sensitivity,specificity and prognosis over ISTH,JMHW and JAAM.However,there is no clinical evaluation of the 2017 version of CDSS in primary hospitals;there are no different types of underlying diseases(such as hematological tumors,solid tumors and non-neoplastic diseases)combined with DIC in the clinical observation analysis of the 2017 version of CDSS diagnostic differences.ObjectiveThe clinical evaluation of the 2017 version of CDSS in a primary hospital was made;the 2017 version of CDSS was used to diagnose and compare the differences and characteristics of different types of underlying diseases(hematological malignancies,solid tumors and non-malignant diseases)in clinical manifestations and laboratory indicators.MethodsAccess to the electronic medical record system by searching,Collection from January 2012 to December 2018 Yuxi People's Hospital in Yunnan Province(regional tertiary hospital)Clinical data and laboratory data of suspected DIC patients who met the inclusion and exclusion criteria.Inclusion criteria for the study subjects:1.)Age?14 years old,At least 28 days of follow-up,including death within 28 days and discharge within 28 days Cases with follow-up results;2.)Platelet count(PLT)<120×109/L;3.)Plasma prothrombin time measurement(PT)extended normal value>3 sec;4.)Fibrinogen assay(FIB)<1g/L;5.)Determination of fibrin(original)degradation products(FDP)>10?g/ml;Must meet at least 2 of the first and last four items.Exclusion criteria:1.)Age<14 years old;2.)thrombotic thrombocytopenic purpura(TTP);3.)primary fibrinolysis;4.)severe liver disease(Child-Pugh Class C);5.)Primary antiphospholipid syndrome(APS);6.)Those who are receiving anticoagulant therapy."Original clinical diagnosis DIC" definition:According to the final diagnosis of discharge,the diagnosis of DIC was performed.Clinical bleeding grading:Level 0:No bleeding symptoms;Grade 1:There are skin bleeding points,mild gums or nasal bleeding,erythroscopy positive for uretoscopy,and positive occult blood for stool;Grade 2:large skin ecchymosis and bleeding at the injection site,bleeding of the gums and/or nasal cavity,gross hematuria,melena,fundus hemorrhage,intracranial hemorrhage.Detection method:blood cell analysis,coagulation index detection Including:white blood cells(WBC);platelet count(PLT);plasma prothrombin time measurement(PT);activated partial thromboplastin time measurement(APTT);fibrinogen assay(FIB);fibrin(original)degradation product determination(FDP);D-dimer assay(DD)and the like.Quality control method:The testing items are all qualified by our hospital to participate in the inter-room quality assessment test of the clinical testing center of the Ministry of Health(involved in the quality control laboratory code:128019).Case inquiry method:(1)Check out the electronic cases of patients aged?14 years old who were treated in our hospital from January 2012 to December 2018.2756 patients with abnormal platelet and coagulation indicators and meeting the conditions of hospitalization for more than 28 days were collected.(2)A total of 206 patients with suspected DIC were detected according to the inclusion criteria and exclusion criteria in the 2756 patients collected.(3)Collect the clinical data and laboratory test data for the integrator.(4)Among 206 patients with suspected DIC,the diagnosis of DIC based on the final diagnosis of discharge was defined as"original clinical diagnosis of DIC",a total of 27 cases(27/206,13.11%).Research method:A retrospective analysis method was used to diagnose the suspected DIC cases collected using the 2017 edition of the CDSS standard(diagnosis of bleeding performance and laboratory index acquisition time for the first time to achieve CDSS score diagnostic criteria or test results within the last 48 hours)Hepatic tumors,solid tumors,and non-neoplastic diseases with DIC were compared in groups,and their bleeding performance,laboratory parameters,and 28-day mortality were compared.Statistical processing of all data.Prospective dynamic observation:From June 2017 to December 2018,the admission cases of the emergency department and hematology department of Yuxi People's Hospital of Yunnan Province were found to be included in the dynamic observation cases when they met one of the above inclusion criteria,and were counted daily according to the 2017 CDSS standard.Once,for at least 14 consecutive days(the 14th did not reach the diagnosis of DIC,the patient temporarily withdrew from the observation,and then reached the inclusion criteria,can be included again),when the case is diagnosed with DIC,then the dynamic score of more than 7 days and treatment,observe the points Change and prognosis.Take the same department in the same period without the 2017 version of the CDSS standard and discharge the diagnosis of DIC(?)patients and the 2017 version of the CDSS retrospective diagnosis of DIC(+)patients to compare,compare their 28-day mortality.And make an objective evaluation of the application of the 2017 edition of CDSS in primary hospitals.Statistical methods:Statistical analysis was Performed:using SPSS 20.0 statistical software.The count data was expressed as a percentage.The X2 test was used.The normal distribution measurement data was expressed as X±s,and the t-test was used.The skewed distribution measurement data was M(P25,P75)indicates that the rank sum test was used,and P<0.05 was considered statistically significant.Results1.General information of the case and the type of primary disease:206 cases of suspected DIC cases were collected,206 cases of suspected DIC patients were between 16 and 91 years old(median age 61.5 years),142 males,females 64 cases.There were 30 cases of hematologic tumors,41 cases of solid tumors,and 135 cases of non-tumor diseases.2.The diagnosis of the new CDSS in 2017:The diagnostic rate of DIC(+)in 206 patients with suspected DIC(40.78%)and the diagnostic rate of DIC(+)in patients with hematologic tumor,solid tumor and non-tumor disease were significantly higher than those of the original clinical diagnosis of DIC(+).The rate of(13.11%)(P<0.01);the positive rates of DIC in the three groups of suspected patients were 73.33%,65.85%and 25.93%,respectively.The positive rate of DIC in the tumor group was significantly higher than that in the non-tumor disease group(P<0.01).The proportion of DIC in the three groups of primary disease with AML-M3,liver cancer,trauma surgery and severe infection was higher.3.Bleeding performance:bleeding and severe bleeding(grade 2 bleeding)incidence:blood tumor DIC(+)group bleeding rate,grade 2 bleeding rate were higher than the solid tumor DIC(?)group,but there was no statistical significance(P>0.05);the incidence of hemorrhage in the non-neoplastic disease DIC(+)group was higher than that in the tumor DIC(+)group(85.71%vs 65.31%,P=0.036),and the grade 2 bleeding rate was not different from the tumor DIC(+)group(57.14%vs 59.18%).Bleeding site:blood tumor DIC(+)group with skin and mucous membrane defects,ecchymosis more common;solid tumor DIC(+)group with gastrointestinal bleeding more common;non-neoplastic disease DIC(+)group with urinary tract and gastrointestinal bleeding more common.4.Laboratory parameters:WBC:The blood tumor DIC(+)group was higher than the solid tumor DIC(+)group(P = 0.006);the tumor DIC(?)group was higher than the non-tumor disease DIC(?)group(P = 0.040).Platelet:ratio of platelets<50×109/L:blood tumor DIC(?)group was higher than solid tumor DIC(?)group(P=0.017);tumor DIC(?)group was higher than non-tumor disease DIC(+)group(P=0.000).Comparison between platelet groups:The reduction of blood tumor DIC(+)group was significantly higher than that of solid tumor DIC(+)group(P = 0.003);the tumor DIC(?)group was significantly lower than the non-tumor disease DIC(+)group(P = 0.009).The APTT prolongation in the solid tumor DIC(+)group was significantly higher than that in the blood tumor DIC(+)group(P = 0.009).The APTT prolongation in the non-neoplastic disease DIC(+)group was significantly higher than that in the tumor DIC(+)group(P = 0.000).5.28-day all-cause mortality:CDSS diagnosis of DIC(?)patients with 28-day mortality rate of 79.76%,significantly higher than DIC(-)patients 64.75%(P = 0.02);solid tumor DIC(+)group 28-day mortality(85.19%)may be higher than the blood tumor DIC(+)group(63.64%,P = 0.081);the non-tumor disease DIC(+)group 28-day mortality(85.71%)is similar to the tumor DIC(+)group(75.51%,P = 0.271)·The 2017 CDSS diagnosis DIC(+)group(79.76%)was higher than the original clinical diagnosis DIC(+)group(70.37%),blood tumor,solid tumor,non-tumor disease DIC(+)patients(63.64%,85.19%,85.71%)Although they were higher than the original clinical diagnosis of each group of DIC(?)patients(50.00%,60.00%,77.78%),but no statistically significant.6.The 28-day all-cause mortality(62.50%)in the 2017 CDSS diagnosis DIC(+)dynamic observation group was significantly lower than that in the retrospective CDSS diagnosis DIC(?)group(88.89%,P=0.027),and may also be lower than the original clinical diagnosis DIC(?)group(86.67%),but the difference was not statistically significant(P=0.103).Conclusions1.China 2017 CDSS can significantly improve the clinical DIC diagnosis rate in the primary hospitals,and the diagnostic performance is good and easy.In particular,the dynamic observation application may improve the targeted treatment and clinical management of DIC in primary hospitals,thereby reducing the 28-day all-cause mortality of DIC patients.2.Retrospective analysis of the differences in the diagnostic indicators of Chinese 2017 CDSS in three types of suspected cases of hematological,solid and non-malignant diseases,showing that the diagnostic rate of DIC in hematological malignancies and solid tumors is significantly higher than that in non-malignant disease;The incidence of bleeding,bleeding sites,and laboratory indicators such as WBC,PLT,and APTT have certain differences.