Predictive Value Of Coagulation-related Parameters For The Progression Of Community-acquired Pneumonia To Sepsis

Objective: To investigate the predictive value of coagulation function in the progression of sepsis(Sepsis)in patients with community acquired pneumonia(CAP).Methods: A total of 267 adult CAP patients who were admitted to the First Respiratory Medicine and Critical Care Unit of Shengjing Hospital of China Medical University from January 2018 to June 2019 were retrospectively selected.According to the sepsis diagnostic criteria in the third international definition of sepsis and septic shock in 2016,the patients were divided into CAP group and Sepsis group.First,record the C-reactive protein(CRP),prothrombin time(PT),international The normalized ratio(International Normalized Ratio,INR),activated partial thromboplastin time(APTT),fibrinogen(Fib),and D-dimer(D-dimer)within 24 h after admission to our hospital were used to compare the differences between the two groups of patients.Secondly,Pearson correlation method was used to analyze the correlation between CRP levels and coagulation indexes in Sepsis patients.Thirdly,multivariate logistic regression analysis of indicators with statistical differences in single factor analysis;Finally,receiver receiver characteristic curve(ROC)was drawn to determine the diagnostic efficacy and optimal threshold of coagulation indexes on Sepsis.Results:1.Among the 267 patients,118 were Sepsis and 149 were CAP.The CRP,PT,APTT,INR,and DD levels in the Sepsis group were higher than those in the CAP group within 24 hours after admission(P<0.05),but Fib is not meaningful between the two groups.2.Pearson correlation analysis showed that CRP was positively correlated with PT,INR and D-dimer(r values were 0.366,0.358,0.329,respectively,P<0.01).3.Multivariate logistic regression analysis suggests that CRP,APTT and D-dimer are independent predictors of sepsis in CAP patients.4.The area under the ROC curve of CRP,PT,APTT,INR and D-dimer for diagnosis of sepsis were 0.682(sensitivity 0.669,specificity 0.658),0.5954(sensitivity 0.331,specificity 0.846),0.576(sensitivity).0.314,specificity 0.852),0.590(sensitivity 0.220,specificity 0.933),0.740(sensitivity 0.712,specificity 0.678).Conclusion:D-dimer is an independent predictor of sepsis in patients with CAP.When the level of D-dimer in patients with CAP alone is higher than 334 ug /L,it is more likely to progress to sepsis,and assists clinicians to adjust the diagnosis and treatment strategy in time and improve the prognosis of patients.