Comparison Of Antithrombin Level Between Sepsis And Trauma Patients With The Same ISTH Score

Objective: Sepsis and major bleeding are two important causes of coagulopathy.Studies have shown that DIC caused by these two causes show different trends in coagulation parameters and clinical course.ATIII is an important component of the coagulation system and a crucial physiological anticoagulant.The ATIII levels are different in patients with DIC caused by different causes.This study is intended to further compare the coagulation parameters of patients with sepsis and major blood loss,especially the trend of ATIII,and to reflect the differences in coagulopathy caused by two different causes.Methods: According to the inclusion and exclusion criteria,92 cases of sepsis and 72 cases of major blood loss treated in the intensive care unit(ICU)of the First Affiliated Hospital of China Medical University from January 2017 to September 2018 were included.The general conditions of patients including age,gender and underlying disease were collected.Coagulation indicators(including platelets,PT,APTT,Fib,D-D,FDPs and ATIII),the indicators of the severity of the disease and prognostic indicators(including SOFA,APACHE2 score,shock or not,ICU mortality and length of stay in the ICU)were also collected.The analysis was performed using SPSS statistical software,and the measurement data was expressed as mean ± standard deviation.Inter-group data analysis was performed using the t test.Since the data related to this study are time-series unstable data and repeated measurement data,which are longitudinal data,it is suitable to apply the generalized estimation equation GEE.So we used GEE to complete statistical analysis.Results: ATIII levels in patients with sepsis and major bleeding were lower than normal at the time of inclusion and after 24 hours.Compared with patients with ISTH scores of 4 or more,the level of AT? was not different at the time of inclusion.The difference was statistically significant after 24 hours.The level of ATIII in patients with major blood loss was higher than that of sepsis patients.The ATIII level at 24 hours after inclusion in patients with sepsis was not statistically different from that at the time of inclusion.The ATIII level at 24 hours after inclusion of patients with major blood loss was statistically different from that at the time of diagnosis and showed an upward trend.Regardless of sepsis or traumatic blood loss,the SOFA and APACHE2 scores at the time of inclusion were not statistically different from the 24 hours after inclusion.The ISTH score after 24 hours from inclusion was lower.After comparing with different scores,the ATIII levels were not statistically different after 24 hours of diagnosis in patients with ISTH score of 5and 6.However,after comparing patients with an ISTH score of 4,a statistical difference occurred.This suggests this difference in ATIII level may be more pronounced in patients with lower ISTH score.Conclusion: ATIII levels showed different trends in patients with major blood loss and sepsis.When comparing patients with sepsis and major blood loss with an ISTH score of 4 or more,the level of ATIII was not different at the time of inclusion.The difference was statistically significant after 24 hours.The level of ATIII in patients with major blood loss was higher than that of patients with sepsis.This difference may be related to the rapid resolution of the primary disease in patients with major blood loss and the rapid recovery of coagulation parameters.This difference may be more pronounced in patients with lower ISTH score after comparison by different scores.