脓毒症相关弥散性血管内凝血的病理生理学、诊断和治疗。

IF 3.8 2区 医学 Q1 CRITICAL CARE MEDICINE
Toshiaki Iba, Julie Helms, Jean Marie Connors, Jerrold H Levy
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引用次数: 5

摘要

背景:国际血栓与止血学会(ISTH)于2001年发布了明显弥散性血管内凝血(DIC)诊断标准。从那时起,DIC被理解为终末期消耗性凝血病,而不是治疗目标。然而,DIC不仅仅是一种失代偿性凝血障碍,还包括凝血系统激活的早期阶段。因此,ISTH最近发布了脓毒症诱导凝血病(SIC)标准,可以用现成的生物标志物诊断代偿期凝血病。主体:DIC是一种基于实验室的诊断,由于各种危急情况,尽管败血症是最常见的基础疾病。脓毒症相关DIC的病理生理是多因素的,除了抑制纤维蛋白溶解的凝血激活外,多种炎症反应是由活化的白细胞、血小板和血管内皮细胞发起的,作为血栓炎症的一部分。虽然ISTH建立了明显的DIC诊断标准来诊断DIC的晚期,但需要额外的标准来检测DIC的早期阶段,以考虑潜在的治疗。因此,ISTH于2019年引入了易于使用的SIC标准,仅需要血小板计数、凝血酶原时间-国际标准化比率和序贯器官衰竭评估评分。SIC评分可用于评估疾病严重程度和确定潜在治疗干预的时机。治疗脓毒症相关DIC的主要缺点之一是除了治疗潜在感染之外缺乏特异性治疗方法。迄今为止的临床试验都失败了,因为包括了没有凝血障碍的患者。然而,除了感染控制,抗凝治疗将是脓毒症相关DIC的选择。因此,肝素、抗凝血酶和重组凝血调节蛋白的疗效有待于在未来的临床研究中进一步验证。结论:有必要开发一种新的治疗策略来治疗败血症相关性DIC,并改善预后。因此,我们建议使用SIC评分系统筛选和监测DIC。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The pathophysiology, diagnosis, and management of sepsis-associated disseminated intravascular coagulation.

The pathophysiology, diagnosis, and management of sepsis-associated disseminated intravascular coagulation.

The pathophysiology, diagnosis, and management of sepsis-associated disseminated intravascular coagulation.

The pathophysiology, diagnosis, and management of sepsis-associated disseminated intravascular coagulation.

Background: The International Society on Thrombosis and Haemostasis (ISTH) released overt disseminated intravascular coagulation (DIC) diagnostic criteria in 2001. Since then, DIC has been understood as the end-stage consumptive coagulopathy and not the therapeutic target. However, DIC is not merely a decompensated coagulation disorder, but also includes early stages with systemic activation in coagulation. Thus, the ISTH has recently released sepsis-induced coagulopathy (SIC) criteria that can diagnose compensated-phase of coagulopathy with readily available biomarkers.

Main body: DIC is a laboratory-based diagnosis due to various critical conditions, although sepsis is the most common underlying disease. The pathophysiology of sepsis-associated DIC is multifactorial, and in addition to coagulation activation with suppressed fibrinolysis, multiple inflammatory responses are initiated by activated leukocytes, platelets, and vascular endothelial cells as part of thromboinflammation. Although overt DIC diagnostic criteria were established by ISTH to diagnose the advanced stage of DIC, additional criteria that can detect an earlier stage of DIC were needed for potential therapeutic considerations. Accordingly, the ISTH introduced SIC criteria in 2019 that are easy to use and require only platelet count, prothrombin time-international normalized ratio, and Sequential Organ Failure Assessment Score. SIC score can be used to evaluate disease severity and determine the timing of potential therapeutic interventions. One of the major disadvantages in treating sepsis-associated DIC is the lack of availability of specific therapeutic approaches beyond treating the underlying infection. Clinical trials to date have failed because included patients who were not coagulopathic. Nevertheless, in addition to infection control, anticoagulant therapy will be the choice for sepsis-associated DIC. Therefore, the efficacy of heparin, antithrombin, and recombinant thrombomodulin has to be proven in future clinical studies.

Conclusion: It is necessary to develop a novel therapeutic strategy against sepsis-associated DIC and improve the outcomes. Consequently, we recommend screening and monitoring DIC using SIC scoring system.

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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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