| Objective:Sepsis is an organ dysfunction caused by an imbalance in the body’s response to infection.In the process of sepsis,the appearance of blood coagulation disorder and whether can be corrected are independent factors affecting the prognosis of palients.But now the clinical diagnosis of disseminated intravascular coagulation is not in time,which has a great influence in the implementation of early treatment and improvement of prognosis.Therefore,this paper mainly studied the value and significance of four new coagulation items(TM,TAT,PIC,t-PAIC)in the early diagnosis of septic DIC.Methods:According to ISTH dignosis criteria,Sepsis patients chosed from hospital emergency ICU and central custody unit from September 2018 to December 2019 were divided into sepsis DIC group and non-DIC group,As well as the physical examination center health in one group.General data,blood routine,liver and kidney function,myocardial infarction index,coagulation index,etc.of the patients were collected,Blood was collected from sepsis patients at day 1,day 3,and day 7,as well as from healthy groups.The research used chemiluminescent immunoassay to detect the expression of TM,TAT,PIC and t-PAIC in blood samples from patients and healthy groups.SPSS software was used for independent sample T test for all the comparison data conforming to normal distribution,which was expressed as mean±standard.The application of mann-whitney test,which does not conform to normal distribution,is represented by median.TM,TAT,PIC,t-PAIC and SOFA scores(Sequential Organ Failure Assessinent)and APACHE Ⅱ scores(Acute Physiology and Chronic Health Score System Ⅱ)were analyzed by Pearson correlation analysis.The diagnostic value of TM,TAT,PIC and t-PAIC was analyzed using ROC and AUC.The diagnostic value of TM,TAT,PIC,t-PAIC for sepsis DIC was analyzed with the application of the subjects working characteristic curve(ROC)and the area under the curve(AUC),Result:1.A total of 38 sepsis patients were enrolled,15 in the sepsis DIC group and 23 in the sepsis non-DIC group.The mortality rate was 40%in the sepsis DIC group and 21.7%in the sepsis non-DIC group.AST,creatinine,d-dimer and BNP between the two groups of sepsis DIC group and sepsis non-DIC group were statistically significant on day 1(P<0.05),but not on day 3 and 7(P>0.05).CK-MB between the two groups was not statistically significant on day 1 and 3(P>0.05),and was statistically significant on day 7.The difference of APTT between the two groups on day 3 was statistically significant(P<0.05),and it was meaningless on day 1 and day 7(P>0.05).Platelets between the two groups were statistically significant on day 1 and 3,but not on day 7(P>0.05).The difference of TBIL and FiB between the two groups on day I,3 and 7 was statistically significant(P<0.05),the difference of SOFA score between the two groups on day 1 and 3 was statistically significant(P<0.05),and the difference on day 7 was not statistically significant(P>0.05)2.TM,PIC and t-PAIC in the sepsis group at day 1,3 and 7 were all higher than those in the sepsis non-DIC group and the healthy control group,with statistically significant differences(p<0.05).TAT showed statistically significant differcncc between the DIC group and the non-DIC group on day 3(p<0.05),and no statistically significant difference on day 1 and day 7(p>0.05).3.The area under the curve of TM at day 1,day 3 and day 7 was 0.736,0.884 and 0.888,respectively,in the sepsis DIC group and the sepsis non-DIC group.The highest sensitivity was 92.9%,and the highest specificity was 94.1%.The area under the curve of PIC on day 1,day 3 and day 7 was 0.677,0.768 and 0.840,respectively.The highest sensitivity was 72.7%,and the highest specificity was 89.5%.The areas of t-PAIC under the 1-day,3-day and 7-day curves were 0.776,0.829 and 0.834,respectively.The highest sensitivity was 92.3%,and the highest specificity was 88.2%.4.The area under the curve of the combined detection of TM,PIC and t-paic was 0.993,1.0 and 0.898 on day 1,day 3 and day 7,respectively,and the sensitivity and specificity reached 100%and 100%on day 3,respectively.5.TM,TAT,PIC,t-PAIC in sepsis DIC group were not correlated with PLT,D-D,PT,APTT.6.TM,TAT,PIC,t-PAIC in sepsis DIC group were not correlated with SOFA score and APACHEEII score.Conclusion:1.Compared with the combined ROC curve of TM,PIC,t-paic and TM,PIC and t-paic in the sepsis group and the sepsis non-dic group,the combined test showed greater AUC,higher sensitivity and specificity,and more effective diagnosis of DIC.2.TM,TAT,PIC and t-paic were not correlated with SOFA score and could not reflect the severity of organ damage.TM,TAT,PIC and t-paic were not correlated with APACHEII score and could not reflect acute physiology+chronic health status+age,that is,the degree of critical condition. |
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