Abstract：Objective: To investigate the value of thrombologram parameters combined with International normalized ratio (INR) and D-dimer (D-D) levels in the early diagnosis of sepsis with diffuse intravascular coagulation (DIC). Methods: A total of 179 sepsis patients admitted to our hospital from January 2021 to January 2023 were included in the study.They were divided into two groups:a non-DIC group (87 cases) and a DIC group (92 cases).All subjects underwent measurements of thromboelastogram parameters,INR,and D-D levels.Differences in thromboelastogram parameters,INR,and D-D levels between the two groups were compared,and their expression in different grades and stages of DIC patients was analyzed.Factors influencing sepsis with DIC,the correlation between thromboelastogram parameters and INR,D-D,and the diagnostic value for sepsis with DIC were analyzed. Results: In the DIC group,coagulation reaction time (R value),coagulation formation time (K value),INR,and D-D were higher than in the non-DIC group.Coagulation angle (α Angle),maximum amplitude (MA value),and comprehensive coagulation index (CI value) were lower in the DIC group compared to the non-DIC group.These differences were statistically significant (P<0.05).Dominant DIC patients had higher R value,K value,INR,and D-D levels compared to pre-DIC patients,while α Angle,MA value,and CI value were lower in the dominant DIC group compared to the pre-DIC group.These differences were statistically significant (P<0.05).Patients in the fibrinolysis stage had higher R value,K value,INR,and D-D levels compared to patients in the low-coagulation and high-coagulation stages.In contrast,α Angle,MA value,and CI value were lower in the fibrinolysis stage compared to the low-coagulation and high-coagulation stages.These differences were statistically significant (P<0.05).Multivariate Logistic regression analysis revealed that the number of infected sites,septic shock,organ failure,SOFA score,APACHE Ⅱ score,R value,K value,α Angle,MA value,CI value,INR,and D-D were all risk factors for sepsis with DIC (P<0.05).Pearson test showed that R value and K value were positively correlated with INR and D-D (P<0.05),while α Angle,MA value,and CI value were negatively correlated with INR and D-D levels (P<0.05).ROC curve analysis indicated that the diagnostic efficacy of thromboelastogram parameters combined with INR and D-D in sepsis with DIC was superior to single diagnosis.The diagnostic AUC was 0.943,with sensitivity and specificity at 92.30% and 87.93%,respectively.In a 28-day prognostic follow-up of 92 sepsis patients with DIC,36 patients died within the 28 days,resulting in a high mortality rate. Conclusion: The combination of thromboelastogram parameters with INR and D-D can accurately diagnose sepsis with DIC,providing support for accurate clinical diagnosis and treatment and reducing prognostic mortality.
闫冬梅, 汪辉. 血栓弹力图参数联合INR D-D水平对脓毒血症伴DIC早期诊断的价值分析[J]. 河北医学, 2023, 29(11): 1896-1902.
YAN Dongmei, WANG Hui. Value Analysis of Thromboelastogram Parameters Combined with INR and D-D Levels in the Early Diagnosis of Sepsis with DIC. HeBei Med, 2023, 29(11): 1896-1902.
2023, Vol. 29 
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