Evaluating The Severity Of Disease And The Prognosis Of The Patients With Severe Sepsis By Different Diagnostic Criteria For Disseminated Intravascular Coagulation

Objective:To assess the value of the incidence and prognosis of disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS) judged by different diagnostic criteria for DIC in patients with severe sepsis and septic shock.Method:To collect the various physiological parameters and experimental indexes of246patients with severe sepsis and septic shock in first, third and seventh days of hospitalization, propose respectively International Society of Thrombosis and Homeostasis (ISTH) overt DIC and non-overt DIC Criteria, and Japanese Association for Acute Medicine (JAAM) Criteria to produce diagnostic score and sequential organ failure assessment (SOFA) score and Acute physiology and chronic health evaluation (APACHE II) score, observe the differences of the diagnose rate and diagnosis time in various diagnostic criteria for DIC, compare the differences of mortality rates, SOFA,APACHE II score and the values in various coagulation tests in DIC diagnosed groups, draw the receiver operating characteristic (ROC) curve of three diagnostic criteria for DIC, calculate area under the curve and measure the accuracy of judgment of each scoring system in the disease severity and prognosis of critical patients.Result:All three diagnostic criteria could reflect the occurrence and prognosis of multiple organ failure in critical patients to some extent. The mortality rates,SOFA score and APACHE II score of patients diagnosed by ISTH overt-DIC Criteria were the highest and the diagnosis time of them was the same as or later than that diagnosed by ISTH non-overt-DIC Criteria and JAAM DIC Criteria. In comparison of mortality rates, SOFA score in DIC diagnosed groups, there were not significant difference between JAAM Criteria and ISTH overt-DIC Criteria (P>0.05), whereas there were significant difference between ISTH non-overt-DIC Criteria and ISTH overt-DIC Criteria. However, there existed not marked difference in mortality rates and marked difference in SOFA score between JAAM DIC Criteria and ISTH non-overt DIC Criteria. And there were significant difference in APACHE II score between all positive groups in the three diagnostic criteria sets. The area under the receiver operating characteristic (ROC) curve of three diagnostic criteria for DIC were respectively ISTH overt-DIC criteria (0.739), ISTH non-overt DIC criteria (0.724) and JAAM DIC criteria (0.778), which showed significant difference in there groups. Moreover, FDP and D-dimer have the highest correlation with the occurrence of MODS and death in critical patients.Conclusion:For the diagnosis of DIC, ISTH overt-DIC Criteria had the highest specificity and less sensitivity, and ISTH non-overt DIC Criteria provided the highest sensitivity and less specificity, but JAAM DIC Criteria showed higher sensitivity and specificity, which was more accurate in the incidence and prognosis of MODS in critical patients and could be used as the first choice diagnostic criteria in early intervention therapy.