COAGULOPATHY PARAMETERS PREDICTIVE OF OUTCOMES IN SEPSIS-INDUCED ACUTE RESPIRATORY DISTRESS SYNDROME: A SUBANALYSIS OF THE TWO PROSPECTIVE MULTICENTER COHORT STUDIES

被引：0

作者：

Matsuoka, Tadashi ^{[1
]}

Fujishima, Seitaro ^{[2
]}

Sasaki, Junchi ^{[1
]}

Gando, Satoshi ^{[3
,4
]}

Saitoh, Daizoh ^{[5
]}

Kushimoto, Shigeki ^{[6
]}

Ogura, Hiroshi ^{[7
]}

Abe, Toshikazu ^{[8
,9
]}

Shiraishi, Atsushi ^{[10
]}

Mayumi, Toshihiko ^{[11
]}

Kotani, Joji ^{[12
]}

Takeyama, Naoshi ^{[13
]}

Tsuruta, Ryosuke ^{[14
]}

Takuma, Kiyotsugu ^{[15
]}

Yamashita, Norio ^{[16
]}

Shiraishi, Shin-ichiro ^{[17
]}

Ikeda, Hiroto ^{[18
]}

Shiino, Yasukazu ^{[19
]}

Tarui, Takehiko ^{[20
]}

Nakada, Taka-aki ^{[21
]}

Hifumi, Toru ^{[22
]}

Otomo, Yasuhiro ^{[23
]}

Okamoto, Kohji ^{[24
]}

Sakamoto, Yuichiro ^{[25
]}

Hagiwara, Akiyoshi ^{[26
]}

Masuno, Tomohiko ^{[27
]}

Ueyama, Masashi ^{[28
,29
]}

Fujimi, Satoshi ^{[30
]}

Yamakawa, Kazuma ^{[30
]}

Umemura, Yutaka ^{[7
]}

机构：

[1] Keio Univ, Sch Med, Dept Emergency & Crit Care Med, Tokyo, Japan

[2] Keio Univ, Sch Med, Ctr Prevent Med, 35 Shinanomachi,Shinkjuku, Tokyo 1648582, Japan

[3] Hokkaido Univ, Grad Sch Med, Div Acute & Crit Care Med, Dept Anesthesiol & Crit Care Med, Sapporo, Japan

[4] Sapporo Higashi Tokushukai Hosp, Dept Acute & Crit Care Med, Sapporo, Japan

[5] Natl Def Med Coll, Res Inst, Div Traumatol, Saitama, Japan

[6] Tohoku Univ, Div Emergency & Crit Care Med, Grad Sch Med, Sendai, Japan

[7] Osaka Univ, Dept Traumatol & Acute Crit Med, Grad Sch Med, Suita, Japan

[8] Juntendo Univ, Dept Gen Med, Tokyo, Japan

[9] Univ Tsukuba, Hlth Serv Res & Dev Ctr, Tsukuba, Japan

[10] Kameda Med Ctr, Emergency & Trauma Ctr, Kamogawa, Japan

[11] Univ Occupat & Environm Hlth, Sch Med, Dept Emergency Med, Kitakyushu, Japan

[12] Kobe Univ, Grad Sch Med, Dept Surg Related, Div Disaster & Emergency Med, Kobe, Japan

[13] Aichi Med Univ Hosp, Adv Crit Care Ctr, Nagakute, Japan

[14] Yamaguchi Univ, Adv Med Emergency & Crit Care Ctr, Ube, Japan

[15] Kawasaki Municipal Hosp, Emergency & Crit Care Ctr, Kawasaki, Kanagawa 2100013, Japan

[16] Kurume Univ, Sch Med, Dept Emergency & Crit Care Med, Kurume, Japan

[17] Aizu Chuo Hosp, Dept Emergency & Crit Care Med, Aizu Wakamatsu, Japan

[18] Teikyo Univ, Sch Med, Trauma & Resuscitat Ctr, Dept Emergency Med, Tokyo, Japan

[19] Kawasaki Med Sch, Dept Acute Med, Kurashiki, Japan

[20] Kyorin Univ, Dept Emergency Med Care, Fac Hlth Sci, Mitaka, Japan

[21] Chiba Univ, Grad Sch Med, Dept Emergency & Crit Care Med, Chiba, Japan

[22] St Lukes Int Hosp, Dept Emergency & Crit Care Med, Tokyo, Japan

[23] Tokyo Med & Dent Univ, Med Hosp, Trauma & Acute Crit Care Ctr, Tokyo, Japan

[24] Kitakyushu City Yahata Hosp, Ctr Gastroenterol & Liver Dis, Dept Surg, Kitakyushu, Japan

[25] Saga Univ Hosp, Emergency & Crit Care Med, Saga, Japan

[26] Natl Ctr Global Hlth & Med, Ctr Hosp, Tokyo, Japan

[27] Nippon Med Sch, Dept Emergency & Crit Care Med, Tokyo, Japan

[28] Chukyo Hosp, Japan Community Healthcare Org, Dept Trauma, Crit Care Med, Nagoya, Japan

[29] Chukyo Hosp, Japan Community Healthcare Org, Burn Ctr, Nagoya, Japan

[30] Osaka Gen Med Ctr, Div Trauma & Surg Crit Care, Osaka, Japan

来源：

SHOCK | 2024年 / 61卷 / 01期

关键词：

Acute respiratory distress syndrome; coagulopathy; prothrombin time prolongation; sepsis; thrombocytopenia; ARDS-acute respiratory distress syndrome; MODS-multiple-organ dysfunction syndrome; DIC-disseminated intravascular coagulation; FORECAST study-Focused Outcomes Research on Emergency Care for Acute Respiratory Distress Syndrome; Sepsis; and Trauma study; JAAM-Japanese Association for Acute Medicine; ICU-intensive care unit; SPICE study-Sepsis Prognostication in Intensive Care Unit and Emergency Room study; UMIN-CTR-University Hospital Medical Information Network Clinical Trials Registry; SOFA-Sequential (Sepsis-related) Organ Failure Assessment; VFD-ventilator-free days; IFD-intensive care unit-free days; PT-prothrombin time; APTT-activated partial thromboplastin time; OR-odds ratio; TEP-thrombocytopenia and elongated prothrombin time; DISSEMINATED INTRAVASCULAR COAGULATION; ACUTE LUNG INJURY; SUBPHENOTYPES; DEFINITIONS; EFFICACY; CRITERIA; SAFETY; ARDS; PATHOGENESIS; MANAGEMENT;

D O I：

10.1097/SHK.0000000000002269

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Although coagulopathy is often observed in acute respiratory distress syndrome (ARDS), its clinical impact remains poorly understood. Objectives: This study aimed to clarify the coagulopathy parameters that are clinically applicable for prognostication and to determine anticoagulant indications in sepsis-induced ARDS. Method: This study enrolled patients with sepsis-derived ARDS from two nationwide multicenter, prospective observational studies. We explored coagulopathy parameters that could predict outcomes in the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) cohort, and the defined coagulopathy criteria were validated in the Sepsis Prognostication in Intensive Care Unit and Emergency Room-Intensive Care Unit (SPICE-ICU) cohort. The correlation between anticoagulant use and outcomes was also evaluated. Results: A total of 181 patients with sepsis-derived ARDS in the FORECAST study and 61 patients in the SPICE-ICU study were included. In a preliminary study, we found the set of prothrombin time-international normalized ratio >= 1.4 and platelet count <= 12 x 104/mu L, and thrombocytopenia and elongated prothrombin time (TEP) coagulopathy as the best coagulopathy parameters and used it for further analysis; the odds ratio (OR) of TEP coagulopathy for in-hospital mortality adjusted for confounding was 3.84 (95% confidence interval [CI], 1.66-8.87; P = 0.005). In the validation cohort, the adjusted OR for in-hospital mortality was 32.99 (95% CI, 2.60-418.72; P = 0.002). Although patients without TEP coagulopathy showed significant improvements in oxygenation over the first 4 days, patients with TEP coagulopathy showed no significant improvement (Delta PaO2/FiO2 ratio, 24 +/- 20 vs. 90 +/- 9; P = 0.026). Furthermore, anticoagulant use was significantly correlated with mortality and oxygenation recovery in patients with TEP coagulopathy but not in patients without TEP coagulopathy. Conclusion: Thrombocytopenia and elongated prothrombin time coagulopathy is closely associated with better outcomes and responses to anticoagulant therapy in sepsis-induced ARDS, and our coagulopathy criteria may be clinically useful.

引用

页码：89 / 96

页数：8

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