ICU脓毒症患者弥散性血管内凝血发生风险及28天死亡风险的危险因素研究

Risk factors of disseminated intravascular coagulation and 28-day mortality in ICU patients with sepsis

摘要:

目的 探讨重症医学病房（ICU）脓毒症并发弥散性血管内凝血（DIC）的风险及28 d死亡风险的危险因素。方法 收集2023年1月—2024年12月山东省聊城市人民医院ICU收治的271例脓毒症患者的临床资料，其中发生DIC的患者共103例，发生率为38.01%。根据脓毒症并发DIC患者28 d生存情况将其分为生存组与死亡组。比较两组患者的一般资料及实验室指标；采用多因素逐步Logistic回归模型分析脓毒症并发DIC患者28 d预后不良的危险因素；绘制受试者工作特征（ROC）曲线分析急性生理学与慢性健康状况评价Ⅱ（APACHE Ⅱ）评分、D-二聚体（D-D）、血栓调节蛋白（TM）、乳酸（Lac）、血小板计数（PLT）、可溶性血小板内皮黏附分子-1（sPECAM-1）预测脓毒症并发DIC患者28 d预后不良的价值。结果 生存组APACHE Ⅱ评分、D-D、TM、Lac、sPECAM-1水平均低于死亡组（P < 0.05），PLT水平高于死亡组（P < 0.05）。APACHE Ⅱ评分高［O^R =1.492（95% CI：1.067，2.086）］、D-D水平高［O^R =1.956（95% CI：1.225，3.123）］、TM水平高［O^R =2.031（95% CI：1.316，3.134）］、Lac水平高［O^R =2.274（95% CI：1.492，3.466）］、PLT水平高［O^R =1.765（95% CI：1.059，2.942）］、sPECAM-1水平高［O^R =1.826（95% CI：1.166，2.866）］均为脓毒症并发DIC患者28 d死亡的危险因素（P <0.05）。ROC曲线分析结果显示，APACHE Ⅱ评分、D-D、TM、Lac、PLT、sPECAM-1预测脓毒症并发DIC患者28 d预后不良的敏感性分别为75.9%（95% CI：0.516，0.994）、89.7%（95% CI：0.724，0.910）、79.3%（95% CI：0.536，0.889）、72.4%（95% CI：0.633，0.792）、75.9%（95% CI：0.602，0.790）、82.8%（95% CI：0.638，0.914），特异性分别为71.6%（95% CI：0.497，0.842）、82.4%（95% CI：0.693，0.941）、94.6%（95% CI：0.774，0.982）、94.6%（95% CI：0.810，0.962）、68.9%（95% CI：0.551，0.715）、77.0%（95% CI：0.636，0.839）。结论 APACHE Ⅱ评分、D-D、TM、Lac、PLT、sPECAM-1是脓毒症并发DIC患者28 d死亡的危险因素。

Abstract:

Objective To investigate the risk factors for disseminated intravascular coagulation (DIC) and 28-day mortality in sepsis patients admitted to the intensive care unit (ICU).Methods Clinical data of 271 sepsis patients admitted to the ICU of Liaocheng People’s Hospital from January 2023 to December 2024 were retrospectively analyzed. Among them, 103 patients (38.01%) developed DIC. These DIC patients were divided into survival (n = 58) and death (n = 45) groups based on 28-day outcomes. Demographic data and laboratory indicators (APACHE II score, D-dimer [D-D], thrombomodulin [TM], lactate [Lac], platelet count [PLT], and soluble platelet endothelial cell adhesion molecule-1 [sPECAM-1] ) were compared. Multivariate stepwise logistic regression was used to identify risk factors for 28-day mortality. Receiver operating characteristic (ROC) curves evaluated the predictive value of these indicators.Results The survival group had significantly lower APACHE II scores, D-D, TM, Lac, and sPECAM-1 levels, but higher PLT levels than the death group (P < 0.05). Elevated APACHE II score (O^R = 1.492, 95% CI: 1.067, 2.086), D-D (O^R = 1.956, 95% CI: 1.225, 3.123), TM (O^R = 2.031, 95% CI: 1.316, 3.134), Lac (O^R = 2.274, 95% CI: 1.492, 3.466), PLT (O^R = 1.765, 95% CI: 1.059, 2.942), and sPECAM-1 (O^R = 1.826, 95% CI: 1.166, 2.866) were independent risk factors for 28-day mortality (P < 0.05). ROC analysis showed sensitivities of 75.9% (APACHE II), 89.7% (D-D), 79.3% (TM), 72.4% (Lac), 75.9% (PLT), and 82.8% (sPECAM-1), with specificities of 71.6%, 82.4%, 94.6%, 94.6%, 68.9%, and 77.0%, respectively.Conclusion APACHE II score, D-D, TM, Lac, PLT, and sPECAM-1 are significant risk factors for 28-day mortality in sepsis patients with DIC.