[A reevaluation of diagnostic efficacy of International Society of Thrombosis and Haemostasis and Japanese Association for Acute Medicine criteria for the diagnosis of sepsis disseminated intravascular coagulation].

Objective: To reevaluate the diagnostic efficacy of International Society of Thrombosis and Haemostasis (ISTH) and Japanese Association for Acute Medicine (JAAM) criteria for sepsis disseminated intravascular coagulation (DIC). Methods: A total of 769 patients diagnosed as sepsis were enrolled in our study. Blood samples were collected within the first hour in ICU and the index of coagulation was detected. The correlation between the conventional coagulation index and the acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores was analyzed. The sensitivity and specificity of diagnostic efficacy were analyzed by receiver operating characteristic (ROC) curve. Results: In the 769 cases, 95 cases (12.35%) conformed to the standard of ISTH and 271 cases (35.24%) were in accordance with the standard of JAAM. Prolonged prothrombin time (PT) was seen in 726 cases (94.41%). Activated partial thromboplastin time (APTT) was prolonged in 434 cases (56.44%). Plasma fibrinogen (Fib) was decreased in 94 cases (12.22%) and increased in 365 cases(47.46%). Platelet (PLT) count decreased in 158 cases (20.55%). D-dimer was elevated in 759 cases (98.70%). Fibrin degradation product (FDP) was increased in 724 cases (94.15%). PT, APTT, D-dimer, FDP, PLT were correlated with APACHE Ⅱ(r value were 0.259, 0.348, 0.319, 0.289,-0.275, all P values<0.05) and SOFA score(r values were 0.409, 0.445, 0.407, 0.411,-0.526, respectively, all P values<0.05). The areas under the curve (AUCs) in the ISTH standard from high to low were accordingly PT (0.813), FDP (0.792), PLT (0.746), Fib (0.563). The AUCs from high to low were FDP (0.844), PLT (0.716), and PT (0.660), respectively in the JAAM standard. Under the criteria of ISTH, the diagnostic sensitivities of PT, PLT, Fib and FDP were 92.63%, 67.37%, 9.47%, 98.95%, respectively, and specificities as 53.56%, 86.05%, 99.26% and 33.38%% respectively. As to the JAAM criteria, the diagnostic sensitivities of PT, PLT, and FDP were 74.54%, 52.77%, 91.51% and specificities as 51.61%, 84.94%, 40.76% respectively. Conclusions: According to the ISTH and JAAM diagnostic criteria, the diagnostic efficacy of PT and PLT is relatively high, which is associated with the severity of DIC. D-dimer and FDP have the high sensitivity but the specificity is poor. The diagnostic specificity of Fib is good, yet with low sensitivity and poor overall efficacy.目的：评估国际血栓与止血委员会（ISTH）、日本危重病协会（JAAM）制定的弥漫性血管内凝血诊断标准中，各项参数对脓毒症弥漫性血管内凝血（DIC）的诊断效能。 方法：纳入诊断为脓毒症患者769例，留取入ICU第1小时血标本检测血小板计数（PLT）、凝血酶原时间（PT）、活化的部分凝血活酶时间（APTT）、纤维蛋白原（Fib）、D-二聚体、纤维蛋白（原）降解产物（FDP）等。对上述指标与急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）、序贯器官衰竭评分（SOFA）进行相关性分析。绘制接受者操作特性（ROC）曲线，计算其敏感度和特异度。 结果：769例脓毒症患者，符合ISTH制定的DIC诊断标准（以下简称ISTH标准）者95例（12.35%），符合JAAM制定的DIC诊断标准（以下简称JAAM标准）者271例（35.24%）。PT>13.7 s者726例（94.41%）；APTT>43.5 s者434例（56.44%）；Fib<2 g/L者94例（12.22%），>4 g/L者365例（47.46%）；PLT<100×10(9)/L者158例（20.55%）；D-二聚体>0.5 mg/L者759例（98.70%）；FDP>5 mg/L者724例（94.15%）。PT、APTT、D-二聚体、FDP、PLT与APACHEⅡ存在相关性（r值分别为0.259、0.348、0.319、0.289、-0.275，P值均<0.05），与SOFA评分存在相关性（r值分别为0.409、0.445、0.407、0.411、-0.526，P值均<0.05）。符合ISTH标准的ROC曲线下面积（AUC），PT为0.813，FDP为0.792，PLT为0.746，Fib为0.563。符合JAAM标准的AUC(ROC)，FDP为0.844，PLT为0.716，PT为0.660。符合ISTH标准，PT、PLT、Fib、FDP诊断脓毒症所致DIC的敏感度分别为92.63%、67.37%、9.47%、98.95%，特异度分别为53.56%、86.05%、99.26%、33.38%。符合JAAM标准，PT、PLT、FDP诊断脓毒症所致DIC的敏感度分别为74.54%、52.77%、91.51%，特异度分别为51.61%、84.94%、40.76%。 结论：符合ISTH和JAAM标准，PT、PLT诊断效能较高，与疾病的严重程度相关。D-二聚体和FDP敏感度高，但特异度较差；Fib特异度高，但敏感度差，整体诊断效能较低。.