Retrospective Study Of Rhubarb In The Treatment Of Spesis-induced Coagulopathy

Objective:In order to explore the therapeutic effect of Chinese rhubarb on patients with sepsis‐induced coagulopathy(SIC),we conducted a single-center retrospectively study,in which analyzed the cases of patients with sepsis‐induced coagulopathy treated with Chinese rhubarb and patients with sepsis‐induced coagulopathy without Chinese rhubarb.Methods:This study collected 238 patients with sepsis admitted to the Department of Critical Care Medicine of the 908th Hospital of the Joint Logistics Support Force of the People’s Liberation Army from January 2018 to December 2019.According to the inclusion criteria(patients with sepsis who meet SIC diagnostic criteria and had SIC score≥4)and exclusion criteria(age<18 years old,a large amount of clinical data was lost,known congenital coagulopathy,chronic liver and kidney dysfunction,and drug-induced abnormal coagulation function or thrombocytopenia)strictly,after sorting out,a total of 40 patients with SIC were included.The clinical data of 40patients with SIC were collected,including age,gender,SOFA score,DIC score,SIC score,acute physiology and chronic health assessment II score,infection site(including lung and respiratory system,abdomen and Digestive system,urinary system and others),systolic blood pressure,ICU mortality rate,ICU hospitalization time.On the other hand,we also collected the indicators on the pretreatment,1st,3rd,5th,and 7th days after taking the medication.Those indicators include white blood cell count,platelet count,C reaction protein,prothrombin time,activated partial thromboplastin time,fibrinogen,thrombin time,fibrin degradation products,D-dimer and thromboelastography.Finally,according to whether or not treated with Chinese rhubarb treatment,patients with SIC were divided into rhubarb treatment group(n=20)and control group(n=20).All indicators were statistically analyzed by SPSS22.0.Results:There was not statistically significantly different in the 90-day survival rate of patients with SIC between the Chinese rhubarb treatment group and the control group(P>0.05).The age,SOFA score,DIC score,SIC score,acute physiology and chronic health assessment II score,infection site,systolic blood pressure,mortality rate,hospitalization time were not statistically significantly different between the Chinese rhubarb treatment group and the control group(P>0.05).On the first day after taking the medication,there was also not statistically significantly different in the WBC,PLT,CRP,PT,APTT,FIB,TT,FDP,DD and TEG indicators(P>0.05).On the third day after taking the medication,the FIB level[(2.92±0.99)g/L]and the TEG-MA[(57.8±6.0)mm]of the Chinese rhubarb treatment group were significantly higher than the FIB level[(2.14±1.01)g/L]and the TEG-MA[(49.3±9.2)mm]of the control group(P<0.05),but other indicators were not statistically significant(P>0.05).On the fifth day after taking the medication,the TEG-MA[(59.5±9.0)mm]of the Chinese rhubarb treatment group was significantly higher than the TEG-MA[(46.9±16.4)mm]of the control group(P<0.05).However,other indicators were not statistically significant(P>0.05).On the seventh day after taking the medication,there was not statistically significantly different in coagulation indicators,TEG indicators,infection indicators and platelet count between the Chinese rhubarb treatment group and the control group(P>0.05).The generalized estimating equation(GEE)is an advanced statistical method that repeatedly measures individual longitudinal data in chronological order.In this study,a comprehensive analysis of GEE was used to show that PT[14.8(12.9-17.9)s],APTT[34.4(30.1-41.6)s],TT[15.9(14.4-17.2)s],FDP[13.7(8.1-26.9)μg/m L],DD[4.6(2.5-7.8)μg/m L],R[7.7(6.5-10.3)min],K[2.3(1.8-3.8)min],Angle[58.9(48.6-66.1)°],WBC[11.1(7.8-15.9)×10~9/L],PLT[90.0(64.8-182.8)×10~9/L],CRP[90.7(43.3-150.3)ng/d L]of the Chinese rhubarb treatment group and PT[15.7(13.8-17.7)s],APTT[35(31.3-42.4)s],TT[17(15.1-18.5)s],FDP[11.5(6.8-23.9)μg/m L],DD[3.9(2.4-7.2)μg/m L],R[8.0(6.2-9.8)min],K[2.7(1.8-4.5)min],Angle[54.6(44.8-63.9)°],WBC[10.2(6.9-15.6)×10~9/L],PLT[90.5(48.0-137.3)×10~9/L],CRP[83.4(53.8-126.9)ng/d L]of the control group are not statistically significant difference(P>0.05).The FIB level of the Chinese rhubarb treatment group is[(2.76±0.93)g/L]and the TEG-MA is[(56.45±9.99)mm].The FIB level of the control group is[(2.29±0.89)g/L]and TEG-MA is[(50.15±12.89)mm].In summary,the FIB level and TEG-MA of the Chinese rhubarb treatment group are significantly higher than those of the control group(P<0.05).Conclusion:Chinese rhubarb can increase the fibrinogen level and platelet function in patients with SIC,but it does not affect the 90-day survival rate of patients with SIC.