Observation And Evaluation Of Laboratory Indexes In Disseminated Intravascular Coagulation

Objective:1.To assess the sensitivity and specificity of APTT,PT,PLT,INR,FIB,D-D,TAT,TM,PIC,t-PAI.C for DIC diagnosis,and assess the value of them in DIC earlydiagnosis respectively and jointly,and find their best possible cut-off values.2.To propose their best possible cut-off values to minimize the sum of diagnostic misdiagnosis rate and missed diagnosis rate.Methods:We enrolled all the 143 patients who meet the criteria for the assessment of DIC in the first affiliated hospital of nanchang university from February 2017 to October2017.All patients under the same conditions were collected on day 1 of venous blood,the four indexes of PIC,t-PAI.C,TAT and TM were detected by high sensitivity chemiluminescence enzyme immunoassay,and the resultsof sixindicators of APTT,PT,PLT,INR,FIB and D-D were collected,evaluated thepatient's condition.According to the Chinese DIC scoring system(CDSS)diagnosticcriteria,finally,we divided them into DIC group(31 cases)and Non-DIC group(112 cases).Plasma concentrations of TAT,TM,PIC and t-PAI.C were measuredin the healthy control groups,andcollected the results of six indicators of APTT,PT,PLT,INR,FIB and D-D.Evaluation the sensitivity and specificity of all the indexes.Then picture the ROC of each index and count the AUC.SPSS 19.0 wasused to analyze the data,all data are expressedas mean±standard deviation.Setting P<0.05 was significant,the area under curve>0.5 is a valuable diagnosis.Results:There was no statistical difference in age and gender between the DIC group,the non-DIC group,and the healthy control group.There were statistically significant differences between three groups for the mean value of TM,TAT,PIC,PT,INR,APTT and D-D,the corresponding sensitivity and specificity were 77.42%and 55.36%,93.55%and 16.96%,77.42%and 35.71%,83.87%and 33.04%,77.42%and 43.75%,100%and36.6%,100%and 16.07%,the according AUC were 0.667,0.737,0.672,0.675,0.661,0.718 and 0.845,singly.There was statistical difference between the DIC group and the Non-DIC group,the DIC group and healthy control group for the mean value of PLT and FIB,there was no statistical differencebetween the Non-DIC group and healthy control group for the averagevalue ofPLT and FIB.The according sensitivity and specificity were 87.10%and 37.51%,35.48%and 75.89%,the according AUC of them were 0.714 and 0.651,singly.There were statistical difference between the DIC group and the healthy control group,the Non-DIC group and healthy control group for the averagevalue of t-PAI.C,there was no statistical difference between the Non-DIC groupand DICgroup for the average value of t-PAI.C.The according sensitivity and specificitywere 51.61%and 68.75%,the AUC of t-PAI.C was 0.694.The sensitivity of combined diagnosis of suitable indicators is acceptable,but the specificity is stillnot satisfactory.The optimal cut-off values of PLT,PT,INR,APTT,FIB,D-D,TM,TAT,PIC,t-PAI.C were 63.5x10~9/L,13.65s,1.21,32.45s,2.9g/L,5.41mg/L,14.15Tu/mL,16.85ng/mL,2.59ug/m L,9.35ng/mL,the according sensitivity and specificity were 65.2%and77.4%,64.5%and 65.2%,71%and 58.9%,96.8%and 42%,57.1%and 74.2%,100%and 53.6%,77.4%and 60.7%,64.5%and 75%,48.4%and 85.7%,83.9%and 58%.Conclusion:1.Compared with single index,D-D and APTT had the highest sensitivity in diagnosing DIC,followed by TAT;FIB had the highest specificity in diagnosing DIC,followed by t-PAI.C;PLT,APTT,D-D and TAT were of moderate value inthe early diagnosis of DIC,the D-D value was the highest,and the diagnostic value of PT,INR,FIB,TM,PIC,and t-PAI.C were low.2.Suitable indexess uniting tests will be beneficial for the diagnosis of DIC;the sensitivity of D-D+APTT combined is highest,and the specificity of D-D+TAT+APTT+PLT combined is the highest.The sum of sensitivity and specificity of D-D+TAT+APTT+PLT combined is the largest,and it is very necessary to establish a proper cut-off value for each indicator.