| Objective: To explore the early diagnostic value and prognostic analysis of the ratio of fibrinogen to C-reactive protein,red blood cell distribution width and platelet count in sepsis with disseminated intravascular coagulation.Methods: The general clinical data of hospitalized patients in The Second Hospital of Dalian Medical University from January 1,2010 to January 1,2022 were collected by using the medical record retrieval system,and a retrospective analysis was carried out.Finally,1792 patients were included.Collect general information,past medical history and laboratory indicators of patients.General information includes sex,age and infection site;White Blood Cell(WBC),Neutrophil(NEU),Total Bilirubin(TBil),Creatinine(Cr),C-reactive protein(CRP),procalcitonin(PCT),Lactic acid(LAC),Platelet(PLT),Activated partial thromboplastin time(APTT),Prothrombin time(PT),international normalized ratio(INR),fibrinogen(FIB),D-dimer(DD),platelet distribution width(PDW),red blood cell volume distribution width(RDW),body temperature,pulse,blood pressure,respiration,Mean arterial pressure(MAP),Sequential Organ Failure Assessments(SOFA),International Society of Thrombosis and Hemostasis(ISTH),diffuse intravascular coagulation(DIC),mortality,fibrinogen to C-reactive protein ratio(FCR)Red blood cell distribution width to platelet count ratio(RPR).According to the diagnostic criteria of sepsis and septic shock and the ISTH score system,they were divided into four groups: sepsis without DIC group,sepsis with DIC group,septic shock without DIC group,and septic shock with DIC group.The general clinical data and laboratory indicators of each group were compared.According to the ISTH over-DIC integral system,it is divided into non-DIC group and combined DIC group.FCR and RPR are compared,and the best cut-off point value of the best FCR and PRP diagnosis is determined through the receiver operator characteristic curve(ROC).Then Kappa consistency test analysis is performed to test the consistency of FCR,RPR and ITSH diagnosis of DIC.Observation end point: count the number of deaths and calculate the death rate.Cox proportional risk model is constructed for single factor and multiple factor analysis.First,the factors that can affect mortality are analyzed by single factor analysis,and the influencing factors with P<0.1 are selected and the proportional risk hypothesis judgment is made.Then the selected factors were analyzed by multiple factors to determine whether FCR and PRR were independent influencing factors for predicting death.Finally,the ROC curve is drawn to determine the best cut-off point value for predicting death.P<0.05 has statistical significance.Result:Baseline:1.Comparison of general clinical characteristics of sepsis without DIC group,sepsis with DIC group,septic shock without DIC group,and septic shock with DIC group.Compared with the general clinical characteristics of the four groups,there were significant differences in the distribution of gender,WBC,NEU,CRP,PCT,SOFA,PLT,Fib,INR,D-D,RDW,RPR,FCR,respiratory system infection,urinary system infection,abdominal infection,infection of more than two parts,history of coronary heart disease,history of diabetes,history of hypertension,,and the differences were statistically significant(P<0.05);However,there was no significant difference in the distribution of age,LAC,SCR,MAP,APTT,PT,Tbil,PDW,hematological system infection,COPD history,ischemic stroke history,etc.(P>0.05).2.Comparison of differences in FCR and RPR between non-DIC group and combined DIC group.Comparing the FCR and RPR of the two groups,the results showed that there were significant differences in FCR and RPR between the two groups,and the differences were statistically significant(P<0.05).3.Draw ROC curve to determine the best cut-off point value of FCR and RPR diagnosis When the RPR>0.146,it is the best cut-off value for the diagnosis of patients with DIC.The sensitivity is 0.782,the specificity is 0.708,and the AUC under the curve is 0.795(95% CI: 0.761-0.829,P<0.001).The Yoden is 0.490;When the FCR<23,it is the best cut-off value for diagnosis of patients with DIC.The sensitivity is 0.900,the specificity is 0.869,and the AUC under the curve is 0.952(95% CI: 0.940-0.964,P<0.001).The Yorden is 0.769.4.Consistency analysis of the effectiveness of FCR,RPR and ITSH integrated diagnosis DICCompare the consistency of RPR,FCR and ITSH,Kappa=0.484,0.582,both p<0.001,indicating that the effectiveness of RPR and FCR in diagnosing DIC is consistent with that of ITSH.Observe the end point:1.Mortality statisticsA total of 735 patients died,with a total mortality rate of 41%.Among them,th-ere were45 patients without DIC in sepsis,with a mortality rate of 31.8%;Sep-sis complicated with DIC 36 cases,the mortality rate was 55.4%;There were non-DIC 338 cases of septic shock,the mortality was 43.2%;There were 16 cases of septic shock complicated with DIC,and the mortality was 66.7%.There were statistical differences among the four groups(=31.47,P<0.001).2.Correlation between RPR,FCR and mortalitySpearman correlation results showed that the correlation coefficients of RPR,FCR and mortality were 0.515 and 0.436 respectively,both P<0.001,significantly correlated.Cox regression analysis:Univariate analysis showed that age,WBC,NEU,SOFA,PLT,RPR,FCR,urinary system infection,and history of coronary heart disease were the influencing factors of mortality(P<0.1).All variables meet the proportional risk hypothesis test.Multivariate analysis showed that RPR was an independent risk factor affecting the occurrence of mortality,HR was 2.397(95% CI: 1.117-5.141),the difference was statistically significant(P<0.05).It was also found that age(HR1.061,95% CI: 1.025-1.099),urinary system infection(HR2.171,95% CI: 1.942-4.410),and SOFA score(HR1.067,95% CI: 1.003-1.134)were also independent risk factors affecting mortality,and the difference was statistically significant(P<0.05).Draw ROC curve to determine AUC and cut-off value of predicted death According to the results of Cox multivariate regression analysis,the ROC curve was drawn for the prognosis of patients with DIC.The results showed that when RPR>0.241 was the best threshold for judging the prognosis of patients,the sensitivity was 0.925,the specificity was 0.557,and AUC was 0.814(95% CI: 0.760-0.868,P<0.001).Conclusion: FCR and RPR can be used as early diagnostic indicators in patients with sepsis with DIC.The ROC curve analysis showed that the best critical value of FCR and RPR in diagnosis of sepsis with DIC was 23 and 0.146,respectively.RPR is an independent risk factor that affects the occurrence of mortality.The area under the ROC curve for predicting the death of patients is 0.814,and the optimal critical value is0.241. |
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