Diagnostic utility of combined coagulation and inflammatory biomarkers in sepsis stratification: A retrospective study

IF 2.9 3区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Clinica Chimica Acta Pub Date : 2025-08-18 DOI:10.1016/j.cca.2025.120558

Zhenzhen Ding , Qian Li , Chunyan Ma , Hang Li

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引用次数: 0

Abstract

Objective

The aim of this study is to evaluate the diagnostic utility of coagulation parameters—prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-Dimer (D-D), prothrombin time activity (PTA), and international normalized ratio (INR) —in combination with inflammatory markers, including procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), systemic inflammation index (SII), and lymphocyte-C-reactive protein ratio (LCR), for stratifying sepsis severity.

Methods

This retrospective study included 123 patients diagnosed with sepsis and confirmed by positive blood cultures between October 2020 and October 2024. A control group comprising 50 healthy individuals undergoing routine physical examinations was also included. Clinical data were collected and analyzed using SPSS 25.0. The sensitivity, specificity, receiver operating characteristic (ROC) curves, and area under the curve (AUC) values of each indicator were calculated to evaluate their diagnostic value.

Results

No statistically significant differences were observed in baseline demographic or clinical characteristics between the sepsis and control groups (p > 0.05). Significant differences were identified between the groups in PT, APTT, D-D, PTA, INR, and CRP values (p < 0.05).The correlation coefficients between different grades of sepsis (shock and non-shock) and PT, APTT,DD,INR,PTA,LCR, CRP were r = 0.328,r = 0.254,r = 0.272,r = 0.347,r = -0.331,r = -0.179,r = 0.200, respectively. P < 0.05 is statistically significant,It is suggested that the classification is positively correlated with PT,APTT,DD,INR and CRP. PTA and LCR are negatively correlated, but the correlation in hierarchical diagnosis is low. Compared with sepsis group, the area under the curve (AUC) of coagulation index and inflammatory index in septic shock group was calculated. The area under the curve of PT in coagulation index was 0.695, the sensitivity was 53.2 %, and the specificity was 82.9 %. The area under the APTT curve was 0.651, the sensitivity was 66.0 %, and the specificity was 64.5 %. The area under the DD curve was 0.662, the sensitivity was 76.6 %, and the specificity was 57.9 %. Among the inflammatory indicators, the area under the CRP curve was 0.619, with a sensitivity of 63.8 % and a specificity of 63.2 %. ROC analysis revealed that the AUC of LCR in the septic shock group was 0.604, with a sensitivity of 66.0 % and specificity of 57.9 %. Combined detection of PT, LCR, and DD yielded an AUC of 0.8705, with a sensitivity of 74.5 % and specificity of 68.8 %.

Conclusion

Combined detection of coagulation markers such as PT with inflammatory markers including LCR, and DD may enhance the diagnostic accuracy for stratifying sepsis severity and identifying progression to septic shock.

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联合凝血和炎症生物标志物在败血症分层中的诊断效用：一项回顾性研究

目的评价凝血参数凝血酶原时间（PT）、活化部分凝血活素时间（APTT）、纤维蛋白原（FIB）、d -二聚体（D-D）、凝血酶原时间活性（PTA）和国际标准化比值（INR）与降钙素原（PCT）、c反应蛋白（CRP）、白细胞介素-6 （IL-6）、全身炎症指数（SII）、淋巴细胞- c反应蛋白比（LCR）等炎症标志物的诊断价值。用于脓毒症严重程度的分层。方法回顾性研究纳入2020年10月至2024年10月期间诊断为败血症并经血培养阳性证实的123例患者。对照组包括50名接受常规体检的健康人。收集临床资料，采用SPSS 25.0软件进行分析。计算各指标的敏感性、特异性、受试者工作特征曲线（ROC）和曲线下面积（AUC）值，评价其诊断价值。结果败血症组与对照组在基线人口学及临床特征方面无统计学差异（p > 0.05）。PT、APTT、D-D、PTA、INR、CRP值组间比较差异有统计学意义（p < 0.05）。不同程度脓毒症（休克和非休克）与PT、APTT、DD、INR、PTA、LCR、CRP的相关系数分别为r = 0.328、r = 0.254、r = 0.272、r = 0.347、r = -0.331、r = -0.179、r = 0.200。P <； 0.05有统计学意义，提示分型与PT、APTT、DD、INR、CRP呈正相关。PTA与LCR呈负相关，但分级诊断相关性较低。与脓毒症组比较，计算脓毒症休克组凝血指数和炎症指数曲线下面积（AUC）。凝血指数PT曲线下面积为0.695，敏感性为53.2%，特异性为82.9%。APTT曲线下面积为0.651，敏感性为66.0%，特异性为64.5%。DD曲线下面积为0.662，敏感性为76.6%，特异性为57.9%。炎症指标中，CRP曲线下面积为0.619，敏感性63.8%，特异性63.2%。ROC分析显示，感染性休克组LCR的AUC为0.604，敏感性为66.0%，特异性为57.9%。PT、LCR和DD联合检测AUC为0.8705，敏感性为74.5%，特异性为68.8%。结论PT等凝血标志物与LCR、DD等炎症标志物联合检测可提高脓毒症严重程度分级和脓毒症休克进展的诊断准确性。

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来源期刊

Clinica Chimica Acta 医学-医学实验技术

CiteScore

10.10

自引率

2.00%

发文量

1268

审稿时长

23 days

期刊介绍： The Official Journal of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Clinica Chimica Acta is a high-quality journal which publishes original Research Communications in the field of clinical chemistry and laboratory medicine, defined as the diagnostic application of chemistry, biochemistry, immunochemistry, biochemical aspects of hematology, toxicology, and molecular biology to the study of human disease in body fluids and cells. The objective of the journal is to publish novel information leading to a better understanding of biological mechanisms of human diseases, their prevention, diagnosis, and patient management. Reports of an applied clinical character are also welcome. Papers concerned with normal metabolic processes or with constituents of normal cells or body fluids, such as reports of experimental or clinical studies in animals, are only considered when they are clearly and directly relevant to human disease. Evaluation of commercial products have a low priority for publication, unless they are novel or represent a technological breakthrough. Studies dealing with effects of drugs and natural products and studies dealing with the redox status in various diseases are not within the journal''s scope. Development and evaluation of novel analytical methodologies where applicable to diagnostic clinical chemistry and laboratory medicine, including point-of-care testing, and topics on laboratory management and informatics will also be considered. Studies focused on emerging diagnostic technologies and (big) data analysis procedures including digitalization, mobile Health, and artificial Intelligence applied to Laboratory Medicine are also of interest.