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首页> 外文期刊>Journal of Thoracic Disease >Early changes in coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation
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Early changes in coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation

机译：接受体外膜氧合的脓毒性休克患者凝血特性和乳酸水平的早期变化

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Background: To investigate the impact of coagulation profiles and lactate levels in patients with septic shock undergoing extracorporeal membrane oxygenation (ECMO). Methods: A retrospective analysis of coagulation profiles, including disseminated intravascular coagulation (DIC) score, before and during 48 h of ECMO support [on day 0 (pre-ECMO), day 1, and day 2], was conducted in patients with septic shock undergoing ECMO. Results: A total of 37 patients were included, and 15 (40.5%) patients survived. The initial DIC scores did not change in either the pre-ECMO overt-DIC (n=15) or non-overt-DIC (n=22) group after ECMO commencement. However, the DIC scores were significantly higher, at all three time-points, in nonsurvivors than in survivors. Additionally, the lactate levels improved considerably in the pre-ECMO nonovert- DIC group and in survivors during ECMO support, but not in the pre-ECMO overt DIC group or non-survivors. On a multivariate analysis, the pre-ECMO DIC score was significantly associated with hospital death [odds ratio (OR), 3.935; 95% confidence interval (CI), 1.170–13.230]. Receiver operating characteristic (ROC) curves revealed that the combination of pre-ECMO DIC score plus lactate level was the best predictor of hospital death (area under the curve, 0.879; 0.771–0.987); patients with combined scores 9.35 (the optimal cut-off) exhibited a three-fold higher mortality rate than did those with lower scores (81.8% vs . 26.7%, P=0.001). Conclusions: During the early period of ECMO support, the coagulation profiles and lactate levels exhibited different trajectories in survivors and non-survivors. Furthermore, the pre-ECMO DIC score plus lactate level was the best predictor of hospital death.
机译：背景：研究凝血特性和乳酸水平对感染性休克体外膜氧合（ECMO）患者的影响。方法：对败血病患者进行ECMO支持之前和期间48小时[第0天（ECMO之前），第1天和第2天]的凝血曲线，包括弥散性血管内凝血（DIC）评分进行回顾性分析。 ECMO遭受电击。结果：共纳入37例患者，其中15例（40.5％）存活。开始ECMO后，ECM之前的公开DIC组（n = 15）或非公开DIC（n = 22）组的初始DIC分数均未改变。但是，在所有三个时间点，非幸存者的DIC得分均明显高于幸存者。此外，在ECMO支持前的非显性DIC组和幸存者中，乳酸水平显着提高，但在ECMO支持前的非DIC组或非幸存者中乳酸水平没有改善。在多变量分析中，ECMO之前的DIC评分与医院死亡显着相关[比值比（OR），3.935; 95％置信区间（CI），1.170–13.230]。接受者操作特征（ROC）曲线显示，ECMO DIC评分前加乳酸水平是医院死亡的最佳预测指标（曲线下面积为0.879; 0.771-0.987）。得分> 9.35（最佳临界值）的患者的死亡率比得分较低的患者高三倍（81.8％vs. 26.7％，P = 0.001）。结论：在ECMO支持的早期，幸存者和非幸存者的凝血曲线和乳酸水平呈现出不同的轨迹。此外，ECMO前DIC评分加乳酸水平是医院死亡的最佳预测指标。

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