Prognostic analysis of critically ill patients with coagulation dysfunction by thrombelastogram and coagulation 4 items combined APACHEⅡ score
10.13303/j.cjbt.issn.1004-549x.2021.09.013
- VernacularTitle:血栓弹力图与凝血常规联合APACHEⅡ评分对凝血功能障碍重症患者的预后分析
- Author:
Shaochang LI
1
,
2
;
Tianyuan WANG
3
;
Ya SUN
4
;
Cuiling LI
4
;
Jinhai LUO
4
;
Piao LV
1
;
Huayou ZHOU
1
Author Information
1. Nanfang Hospital, Southern Medical University, GuangZhou 510400, China
2. Shenzhen Hospital, Southern Medical University
3. HuaZhong University of Science And Technology Union Shenzhen Hospital
4. Shenzhen Hospital, Southern Medical University
- Publication Type:Journal Article
- Keywords:
thrombelastogram;
coagulation four items;
APACHEⅡscore;
coagulation dysfunction;
critically ill patients
- From:
Chinese Journal of Blood Transfusion
2021;34(9):987-991
- CountryChina
- Language:Chinese
-
Abstract:
【Objective】 To explore the prognosis of critically ill patients with coagulation dysfunction using thrombelastogram(TEG) and coagulation four items combined with APACHEⅡ score. 【Methods】 From March 2017 to March 2020, 287 critically ill patients with coagulation dysfunction in our hospital were selected as the study group, and 303 patients with normal coagulation function during the same period were set as the control. The study group was divided into low-risk group(group A), intermediate-risk group(group B) and high-risk group (group C) based on the APACHEⅡ score, and into survival group and death group according to the prognosis. The difference of TEG, coagulation four items, and APACHEⅡ scores between the two groups were analyzed. The correlation and difference between TEG, coagulation four items and APACHE II score in the study group were analyzed. The ROC curve was drawn to analyze the prognostic predictive value of research indicators. 【Results】 Blood coagulation function related indicators in the study group fluctuated significantly: in comparison to the control, the CI value, MA value, and α angle were smaller, while the K time and R time were longer; among the coagulation four items, PT, APTT and TT were higher; Fg level was lower, and the APACHE Ⅱ score was higher(P<0.05). There were significant differences in relevant test index levels among patients with different degree of illness (APACHE Ⅱ score) in the study group. With the aggravation of the disease, the CI value, MA value, α angle, and TT continued to decrease, while K time, R time, APTT and PT showed a continuous increase trend (P<0.05). However, with the intensification of coagulation dysfunction, no significant increase or decrease was noticed in Fg(P>0.05). There were significant differences between the TEG and coagulation function related index levels in patients with different prognosis. Compared with the survivals, the CI value, MA value and α angle of the dead group were smaller, while the K time and R time were longer; and among the coagulation four items, PT, APTT, and TT were higher, the Fg level was lower, and the APACHEⅡ score was higher (P<0.05). The ROC curve showed that the corresponding AUC values of PT, APTT and INR were 0.701, 0.693 and 0.702, respectively, (P<0.05). The difference was statistically significant and had predictive value for death, but the accuracy was moderate.The combined indicators showed that the AUC values corresponding to APACHE Ⅱ score, P1, P2, P3, P4, P5, and P6 were 0.899, 0.751, 0.657, 0.759, 0.921, 0.921and 0.942, respectively, and the difference was statistically significant(P<0.05). The combined indicators have predictive value for death, except for P2<0.7, the rest were between 0.7~1.0, and the accuracy was P6>P4\\P5>APACHE Ⅱ score>P1>P2. 【Conclusion】 TEG, coagulation four items, and APACHE Ⅱ score can be used to assess the severity of patients with severe coagulation dysfunction. and the combined application of the 3 indicators are of high value in predicting the prognosis of such patients, and can provide reference for clinical formulation or adjustment of intervention programs to correct coagulation dysfunction.
