不同病情严重程度脓毒症患者凝血功能的变化及对预后的影响

Alterations in coagulation function among sepsis patients of different severity and their effects on the prognosis

摘要:

目的 探讨不同病情严重程度脓毒症患者凝血功能的变化，并分析影响脓毒症合并凝血功能障碍患者预后的危险因素。方法 选取2019年7月—2022年11月中南大学湘雅医学院附属海口医院收治的132例脓毒症患者作为观察组。根据疾病严重程度分为脓毒症组（71例）、脓毒性休克组（61例）；另取同期该院健康体检者90例作为对照组，比较不同组别凝血功能指标凝血酶时间（TT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）的差异，通过脓毒症相关凝血病（SAC）评分标准评估观察组患者凝血功能障碍发生情况，将脓毒症合并凝血功能障碍患者依据其28 d生存情况分为生存组与死亡组，通过多因素逐步Logistic回归模型分析患者预后影响因素。结果 观察组APTT、PT、TT时间长于对照组（P <0.05），FIB水平低于对照组（P <0.05）。脓毒性休克组APTT、PT、TT时间长于脓毒症组（P <0.05），FIB水平低于脓毒症组（P <0.05）。脓毒性休克组患者凝血功能障碍发生率为68.85%高于脓毒症组患者的42.25%（P <0.05）。依据患者入院后28 d转归情况，脓毒症未合并凝血功能障碍患者预后优于脓毒症合并凝血功能障碍患者（P <0.05）。多因素逐步Logistic回归分析结果显示，血小板计数［O^R=0.988（95% CI：0.980，0.996）］、白蛋白［O^R=0.962（95% CI：0.939，0.985）］是脓毒症合并凝血功能障碍患者生存的保护因素（P <0.05）；乳酸［O^R=1.219（95% CI：1.079，1.376）］、急性生理学和慢性健康状况评估Ⅱ评分［O^R=1.347（95% CI：1.105，1.642）］、SAC评分［O^R=1.319（95% CI：1.108，1.571）］、脓毒症相关性器官功能衰竭评价评分［O^R=3.028（95% CI：1.689，5.431）］是脓毒症合并凝血功能障碍患者死亡的危险因素（P <0.05）。结论 脓毒症患者机体凝血系统紊乱，随着病情加重，患者发生凝血功能障碍的风险也随之增加，且机体凝血功能障碍严重情况在一定程度上影响患者预后。

Abstract:

Objective To investigate the alterations in coagulation function among sepsis patients of different severity, and to analyze the prognostic risk factors for sepsis patients with coagulation dysfunction.Methods A total of 132 patients with sepsis in our hospital from July 2019 to November 2022 were included in the observation group. According to the severity of the disease, they were divided into sepsis group (n = 71) and septic shock group (n = 61). Another 90 healthy people who underwent health checkup in our hospital during the same period were included in the control group. The thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) and the level of fibrinogen (FIB) were compared among different groups. The condition of coagulation dysfunction in the observation group was assessed by the sepsis-associated coagulopathy (SAC) score. The sepsis patients with coagulation dysfunction were divided into survival group and death group according to their 28-day survival, and the prognostic factors were determined via multivariable Logistic regression analysis.Results APTT, PT and TT in the observation group were longer than those in the control group, and the level of FIB in the observation group was lower than that in the control group (P < 0.05). APTT, PT and TT in the septic shock group were longer than those in the sepsis group, and the level of FIB in the septic shock group was lower than that in the sepsis group (P < 0.05). The incidence of coagulation dysfunction in the septic shock group was 68.85%, which was higher than 42.25% in the sepsis group (P < 0.05). According to the 28-day outcome of patients after admission, the prognosis of sepsis patients without coagulation dysfunction was better than sepsis patients with coagulation dysfunction (P < 0.05). Multivariable Logistic regression analysis showed that the platelet count [O^R = 0.988 (95% CI: 0.980, 0.996) ] and the level of albumin [O^R = 0.962 (95% CI: 0.939, 0.985) ] were protective factors for the survival of patients with sepsis complicated with coagulation dysfunction (P < 0.05). The level of lactic acid [O^R = 1.219 (95% CI: 1.079, 1.376) ], the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score [O^R = 1.347 (95% CI: 1.105, 1.642) ], the SAC score [O^R = 1.319 (95% CI: 1.108, 1.571) ] and the Sequential Organ Failure Assessment (SOFA) score [O^R = 3.028 (95% CI: 1.689, 5.431) ] were risk factors for death in patients with sepsis complicated with coagulation dysfunction (P < 0.05).Conclusions The coagulation system is disordered in sepsis patients. As the condition gets severer, the risk for coagulation dysfunction is higher in patients with sepsis. Besides, the severity of coagulation dysfunction may affect the prognosis of sepsis patients to some extent.