目的 探讨脓毒症患者单核细胞百分比水平与脓毒症性凝血病(sepsis-induced coagulopathy,SIC)发生的关系.方法 回顾性收集 2017 年 1 月～2022 年 7 月于上海交通大学医学院附属第六人民医院住院的脓毒症患者的临床信息,主要包括住院后 24h的血常规、血液生化、凝血指标、序贯器官衰竭评分、急性生理和慢性健康状况评分Ⅱ及临床转归等信息.根据入院第 1 天是否发生 SIC 将患者分为 SIC 组和非 SIC 组,比较两组患者的人口学特征、临床检验指标、病死率的差异.采用Spearman相关性分析评价单核细胞百分比与脓毒症患者凝血功能的关系.采用多因素 Logistic回归分析评价单核细胞百分比与SIC发生之间的关系.采用受试者工作特性(receiver operating characteristic,ROC)曲线和曲线下面积(area under the curve,AUC)评估单核细胞百分比对 SIC发生的预测价值.结果 本研究共纳入 125 例患者,中位年龄 68(49,81)岁,男性占 59.2%(74/125),病死率为 29.6%(37/125),SIC发生率为 78.4%(98/125).SIC 组的单核细胞百分比显著低于非 SIC 组[3.5(2.3,5.5)vs 5.5(4.2,7.8),P<0.05].单核细胞百分比与凝血酶原时间、国际标准化比值、活化部分凝血活酶时间及 D-二聚体均呈负相关(P<0.001).多因素 Logistic回归分析结果显示,单核细胞百分比是 SIC 发生的独立危险因素(OR = 0.729,95%CI:0.548～0.958,P =0.024).单核细胞百分比预测 SIC发生的 AUC 为 0.723(P<0.001),敏感度为 59.18%,特异性为 77.78%.结论 脓毒症患者单核细胞百分比与凝血功能存在相关性;单核细胞百分比降低是脓毒症患者发生 SIC 的独立危险因素,对预测 SIC有较高的特异性.
Correlation between the Percentage of Monocytes and Sepsis-induced Coagulopathy in Patients with Sepsis
Objective To explore the relationship between the percentage of monocytes and the occurrence of sepsis-induced coag-ulopathy(SIC)in patients with sepsis.Methods The clinical information of sepsis patients hospitalized in the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to July 2022 were collected retrospectively,mainly including blood routine,blood biochemistry,coagulation indicators,sequential organ failure assessment score,acute physiology and chronic health evaluation-Ⅱ score and the clinical outcome of disease within 24h after admission.The patients were divided into SIC group and non-SIC group according to whether developed SIC on the 1st day after admission.The differences of demographic characteris-tics,clinical laboratory parameters and mortality were compared between these two groups.Spearman correlation analysis was used to ex-plore the relationship between the percentage of monocytes and coagulation function in patients with sepsis.Multivariate Logistic regression analysis was used to explore the relationship between the percentage of monocytes and SIC.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value of the percentage of monocytes for SIC.Results A total of 125 patients were enrolled in this study,the median age was68(49,81)years,59.2%(74/125)were males,the mortality rate was 29.6%(37/125),and the incidence of SIC was78.4%(98/125).The percentage of monocytes in SIC group was significantly lower than that in non-SIC group(P<0.05).The percentage of monocytes was negatively correlated with prothrombin time,international nor-malized ratio,activated partial thromboplastin time and D-dimer(P<0.001).Multivariate Logistic regression analysis showed that the percentage of monocytes was an independent risk factor for SIC(OR =0.729,95%CI:0.548-0.958,P =0.024).The percentage of monocytes predicted the AUC of SIC was0.723(P<0.001),the sensitivity was 59.18%,and the specificity was 77.78%.Conclusion There was a correlation between the percentage of monocytes and coagulation function in patients with sepsis.The decrease in the percent-age of monocytes is an independent risk factor for SIC in patients with sepsis and has high specificity in predicting SIC.
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