- 期刊
The Diagnosis and Clinical Outcomes of Patients with Sepsis-induced Disseminated Intravascular Coagulation in a Medical Intensive Care Unit
內科加護病房內敗血症引起的瀰漫性血管內血液凝結之病患的診斷及臨床預後的評估
摘要
Background: Disseminated intravascular coagulation (DIC) has been reported to play an important role in the development of multi-organ failure and death. However, there is no single available laboratory test sufficiently sensitive or specific to enable a diagnosis of DIC. Objective: To compare the outcomes of septic patients with overt and non-overt DIC diagnosed by a score system in a medical intensive care unit, and to determine the relationship between the DIC score and the number of organ failures. Method: The study population was recruited from a 37-bed medical intensive care unit (MICU) in a medical center. Patients who presented with sepsis while admitted to the MICU were included in this study. We divided these patients into 2 groups, the overt and non-overt DIC group, according to the DIC score. Baseline characteristics of the patients, ICU mortality rate, hospital mortality rate, 10-day mortality, 30-day mortality, duration of ICU stay, duration of hospital stay, and duration of mechanical ventilator support were compared between the 2 groups. The study also determined the correlation between the DIC score and the number of organ failures. Results: A total of 43 male and 16 female patients (a total of 59 patients) were included. Patients with overt DIC had a higher APACHE II score (28.3±11.4 vs. 22.9±8.7, p=0.045) and DIC score (6.1±1.3 vs. 2.2±1.2, p＜0.001) than those with non-overt DIC. The 30-day mortality rate (58.3% vs. 31.4%, p=0.040), ICU mortality rate (54.2% vs. 25.7%, p=0.026), and in-hospital mortality rate (62.5% vs. 28.6%, p=0.010) were significantly higher in the overt DIC patients. The number of organ failures in patients with overt DIC was significantly higher (4.2±1.3 vs. 2.3±1.2, p＜0.001). The organ failure number was positively correlated with the DIC score (r=0.66; p＜0.001). Conclusion: The septic patients with overt DIC had worse outcomes than those with non-overt DIC. The diagnosis of overt DIC is a warning sign and should prompt more intensive therapeutic strategies focusing on the underlying disease and complications.
並列摘要
Background: Disseminated intravascular coagulation (DIC) has been reported to play an important role in the development of multi-organ failure and death. However, there is no single available laboratory test sufficiently sensitive or specific to enable a diagnosis of DIC. Objective: To compare the outcomes of septic patients with overt and non-overt DIC diagnosed by a score system in a medical intensive care unit, and to determine the relationship between the DIC score and the number of organ failures. Method: The study population was recruited from a 37-bed medical intensive care unit (MICU) in a medical center. Patients who presented with sepsis while admitted to the MICU were included in this study. We divided these patients into 2 groups, the overt and non-overt DIC group, according to the DIC score. Baseline characteristics of the patients, ICU mortality rate, hospital mortality rate, 10-day mortality, 30-day mortality, duration of ICU stay, duration of hospital stay, and duration of mechanical ventilator support were compared between the 2 groups. The study also determined the correlation between the DIC score and the number of organ failures. Results: A total of 43 male and 16 female patients (a total of 59 patients) were included. Patients with overt DIC had a higher APACHE II score (28.3±11.4 vs. 22.9±8.7, p=0.045) and DIC score (6.1±1.3 vs. 2.2±1.2, p＜0.001) than those with non-overt DIC. The 30-day mortality rate (58.3% vs. 31.4%, p=0.040), ICU mortality rate (54.2% vs. 25.7%, p=0.026), and in-hospital mortality rate (62.5% vs. 28.6%, p=0.010) were significantly higher in the overt DIC patients. The number of organ failures in patients with overt DIC was significantly higher (4.2±1.3 vs. 2.3±1.2, p＜0.001). The organ failure number was positively correlated with the DIC score (r=0.66; p＜0.001). Conclusion: The septic patients with overt DIC had worse outcomes than those with non-overt DIC. The diagnosis of overt DIC is a warning sign and should prompt more intensive therapeutic strategies focusing on the underlying disease and complications.
延伸閱讀
- Su, W. L., Wu, Y. K., Chung, H. W., Yang, M. C., Huang, K. L., Chen, X. Y., Lan, C. C., Huang, C. Y., Huang, Y. C., Su, C. P., & Yan, H. C. (2016). 內科加護病房敗血症患者依臨床分類對適當抗生素的衝擊及病情預後的影響. 胸腔醫學, 31(6), 323-334. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201612-201611280042-201611280042-323-334
- 陳穎心、周韋翰、劉治民、葉育彰（2009）。加護病房戰勝敗血症臨床治療準則執行核對清單。重症醫學雜誌，10(1)，12-20。https://doi.org/10.30035/TCCM.200903.0003
- 鄭舒方、簡美芳、何佳璇（2015）。運用早期目標導向療法於初次入住加護病房敗血症病患之護理經驗。若瑟醫護雜誌，9(1)，96-106。https://www.airitilibrary.com/Article/Detail?DocID=1819026x-201507-201508070009-201508070009-96-106
- 林帛震（2022）。急診血流感染成人患者入住加護病房後的臨床結果之預測評分〔碩士論文，中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834/csmu202200149
- Yang, C. C., Shih, W. H., Lo, E. J., & Lo, C. J. (2022). 外科加護病房內使用紅血球血品之原因分析與改善方案. 輔仁醫學期刊, 20(1), 1-14. https://doi.org/10.53106/181020932022032001001