Study On The Diagnostic Value Of Thromboelastography In Detecting Coagulopathy Of Neonates With Sepsis

Objective: Through Thromboelastography(TEG)and Classical coagulation laboratory tests(CCTs)detected the coagulation function of neonates with sepsis admitted to our hospital,to investigate the diagnostic value of thromboelastography in detecting coagulation dysfunction in neonatal sepsis was explored,and provide certain reference for clinical diagnosis and treatment.Method: From December 2019 to December 2020,34 neonates with sepsis in Neonatal intensive care unit(NICU)were taken as the research objects.According to the Chinese diagnostic score system for disseminated intravascular coagulation(CDSS),infants were divided into normal coagulation group(CDSS score ≤2 points),non-dominant DIC group(2 points< CDSS score < 7 points)and DIC group(7 points ≤CDSS score).The CCTs indexes including activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),antithrombin Ⅲ(AT-III),international normalized ratio(INR),Fibrinogen(FIB),D-dimer,Fibrinogen and Fibrin Degradation Products(FDP),platelet count(PLT),and TEG indexes including R value,K value,Angel,MA value,coagulation comprehensive index(CI)and fibrinolysis rate(LY30),of three groups of newborns were analyzed.To compare the difference of TEG and CCTs in evaluating the coagulation function of septicemia neonates among groups;Spearman anecdotal correlation analysis was used to analyze the correlation between the two test indexes,and to analyze the abnormal MA value when the platelet count and fibrinogen concentration were abnormal.Using the receiver operating characteristics(ROC)curve method,the diagnostic efficacy of each coagulation function observation index on neonatal sepsis complicated with non-dominant DIC and DIC and the predictive efficacy on the outcome of infants discharged from hospital were analyzed.Results:1.76.47% of the 34 neonatal septicemia patients suffered from coagulation dysfunction,of which 61.54% were non-dominant DIC and38.46% were DIC.There was no significant difference in sex,age and gestational age among the three groups.2.Comparison of CCTs indexes among groups: D-dimer and FDP in DIC group were significantly higher than those in normal coagulation group(P <0.05),but there was no significant difference between normal coagulation group and non-dominant DIC group,non-dominant DIC group and DIC group(P > 0.05).Platelet counts in non-dominant DIC group and DIC group were significantly lower than those in normal coagulation group(P < 0.05),but there was no significant difference between DIC group and non-dominant DIC group(P > 0.05).There was no significant difference in PT,APTT,TT,INR,AT-III and FIB among the groups.3.Comparison of TEG indexes among groups: R value of non-dominant DIC group was significantly longer than that of normal coagulation group(P <0.05),and other indexes of TEG had no significant difference between the two groups.Except LY30,there were significant differences in all indexes of TEG between normal coagulation group and DIC group(P < 0.05).Except R value and LY30,other indexes of TEG were significantly different between non-dominant DIC group and DIC group(P < 0.05).4.Correlation analysis between TEG and CCTs: MA value is positively correlated with Platelet count(r=0.35,P = 0.04 < 0.05)and FIB(r=0.38,P =0.03 < 0.05).The ratio of abnormal MA value was 28.6% only when FIB concentration was abnormal,53.8% only when platelet count was abnormal,and 28.6% when both platelet count and FIB concentration were normal.5.Analysis of diagnostic efficacy of each coagulation index for neonatal sepsis complicated with non-dominant DIC: Only R value and platelet count have diagnostic efficacy(P < 0.05),ROC-AUC are 0.762 and 0.781,The sensitivity for the diagnosis of neonatal sepsis complicated with non-dominant DIC were 87.5% and 62.5%,the specificity were 62.5% and 100%.6.Comparing the diagnostic efficacy of each coagulation index for neonatal septicemia complicated with DIC,the ROC-AUC was MA value(0.821)> K value(0.813)> CI(0.794)> Angel(0.773)> FDP(0.748)>D-Dimer(0.725)> PLT(0.721),P <0.05.According to the principle of maximum Jordan index,the best critical value of MA value in diagnosing neonatal septicemia complicated with DIC is 60.65 mm,the sensitivity is70.0%,the specificity is 91.7%,and Jordan index is 0.62.7.Through ROC analysis,for the TEG index,only MA value can predict the outcome of neonatal septicemia when discharged from hospital,and ROC-AUC is 0.781(95% CI: 0.556 ～ 1.000)(P < 0.05).When 57.1mm is taken as the critical value,the sensitivity and specificity for predicting the discharge outcome are 89.3% and 66.7%.Conclusion:1.Compared with the classical coagulation laboratory tests,TEG can better identify the low degree of coagulation dysfunction in neonatal septicemia,and has certain diagnostic value in early monitoring of coagulation dysfunction in neonatal septicemia and diagnosis of DIC.2.TEG can evaluate the functions of platelets and fibrinogen.3.MA value of TEG can be used to evaluate the prognosis of neonatal septicemia.