| Objective Through monitoring the tissue factor(TF)and high mobility group box 1protein(HMGB1)in sepsis patients to explore the changes of the two in patients with sepsis coagulation dysfunction and their clinical significanceMaterials and Methods This prospective study was conducted to select patients in the emergency intensive care unit of the First Affiliated Hospital of Dalian Medical University between June 2019 and December 2020 in accordance with the Chinese guidelines for the emergency treatment of sepsis / septic shock(2018)and the2019 ISTH guideline recommendations:Diagnosis and management of sepsis‐induced coagulopathy and disseminated intravascular coagulation,the included patients with sepsis have septic coagulopathy marked as SIC group(n=32),the patients without septic coagulopathy were marked as non-SIC group(n=30).Ten healthy individuals were selected as normal controls.Using enzyme-linked immunosorbent method to TF and HMGB1 changes were monitored on days 1,3 and 7 after the patient’s diagnosis,and activated partial thrombin time(APTT),prothrombin time(PT),fibrinogen(Fib),international normalized ratio(INR),platelet plate count(PLT),D-dimer and APACHE II score,SOFA score and ISTH DIC score were collected.Compare the changes of the above indicators and scores in each group,look for the changes of HMGB1 and TF and coagulation-related indicators in sepsis,explore the clinical significance of the related changes,and explore the correlation between the indicators and the guiding significance of the prognosis of the disease.Continuous variable using mean ± Standard deviation or quartile.Independent sample t test was used for continuous variables of normal distribution,and Mann Whitney U test was used for continuous variables of non normal distribution.Correlations between variables TF and HMGB1 with APTT,PT and PLT and between HMGB1 and TF were assessed using Pearson’s test for continuous variables.Logistic regression analysis is used to screen out the indicators that are meaningful to the prognosis,and then the receiver opeartor characteristic curve(ROC curve)is drawn to determine the condition of the disease.Severity and prognosis are predicted,and the area under curve(AUC)is calculated.P<0.05 indicates that the difference is statistically significant.Results There were no statistically significant differences in age,sex,and site of infection between patients with and without SIC.There were 11 deaths(36.67%)in the non-SIC group and 15 deaths(46.87%)in the SIC group.DIC occurred in 10 cases(31.25%)in the SIC group within one week,and no DIC developed in the non-SIC group.The comparison of serum HMGB1,TF,APTT,PT,PCT,FIB,D-dimer,INR,Apache II score,SOFA score and ISTH DIC score showed that the SIC group and the non-SIC group were higher than the normal control group,the PLT values of the SIC and non-SIC groups were decreased compared with those of the normal control group(all P< 0.05).HMGB1,TF,INR,SOFA score and ISTH DIC score in SIC group at different time were higher than those in non-SIC group at the same time(all P <0.05).APACHE II scores,PT and PCT levels on days 1 and 3 were higher in the SIC group than in the non-SIC group at the same time(all P < 0.05).PLT values in the SIC group and the non-SIC group were lower than those in the SIC group(P <0.05).There was no statistical difference in APTT,FIB and D-dimer concentrations between the SIC and non-SIC groups(P > 0.05).In the SIC group,HMGB1 TF PT INR and SOFA scores at different time in the DIC group were significantly higher than those in the non-DIC group at the same period(all P <0.05);the APACHE II scores were higher in the DIC group than in the non-DIC group,however,only the increase on day 1 was statistically significant(P < 0.05);PLT values were lower in the DIC group than in the non-DIC group,only the decline on day 3 was statistically significant(P < 0.05).In the SIC group of patients,HMGB1 was positively correlated with Pt at different times(D1:r=0.528,P=0.003;D3:r=0.723,P<0.001;D7:r=0.648,P<0.001),HMGB1 was positively correlated with APTT on day 3 and 7(D3:r=0.442,P=0.018;D7:r=0.515,P=0.007),HMGB1 was correlated with PLT(r=0.409,P=0.025);there was a positive correlation between TF and PT at different time(D1:r=0.764,P<0.001;D3:r=0.843,P<0.001;D7:r=0.534,P=0.005),there was a positive correlation between TF and APTT on days 1 and 3(D1:r=0.639,P<0.001;D3:r=0.714,P<0.001),there was a correlation between TF and PLT on day 1(r=0.420,P=0.021).There was a linear correlation between serum HMGB1 and TF on days 1,3,and 7 in SIC patients(D1:r=0.533,P=0.005;D3:r=0.754,P<0.001;D7:r=0.706,P<0.001).Binary logistic regression analysis showed that HMGB1(area under ROC curve was 0.865 and0.902),TF(area under ROC curve was 0.844 and 0.916)and SOFA score(area under ROC curve was 0.792 and 0.794)were independent predictors of 28-day mortality in SIC patients on day 3 and 7.Conclusion In SIC patients,there was a positive correlation between HMGB1 and TF,HMGB1 and TF were correlated with PT and PLT,respectively,suggesting that HMGB1 and TF are associated with coagulation dysfunction in sepsis.HMGB1 and TF were higher in the SIC(septic coagulopathy)group than in the non-SIC group,and HMGB1 and TF were associated with the severity of coagulopathy in sepsis and could be used as early warning indicators of its severity.HMGB1 and TF levels have a reference significance for the prognosis of patients with SIC,which can be assessed by monitoring HMGB1 and TF serum levels. |
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