ABSTRACT
Objective To explore the predictive values of procalcitonin (PCT) and lactate combined with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score for disseminated intravascular coagulation (DIC) in patients with septic shock. Methods The clinical data of 164 patients with septic shock admitted to the Department of Critical Care Medicine of Shenzhen Second People's Hospital from January 1, 2015 to December 30, 2018 were analyzed retrospectively. According to International Society on Thrombosis and Haemostasis (ISTH) scoring criteria, the patients were divided into DIC group (n=58, 35.4%) and non-DIC group (n=106, 64.6%). Comparing the differences in clinical data of patients, we can establish a ROC curve to determine the sensitivity and specificity of DIC patients with septic shock for PCT, lactate and APACHE Ⅱ score, and calculate the best cut-off point. Results The AUC of PCT in predicting septic shock with DIC was 0.701(95% CI 0.619-0.784, P<0.001), the cut-off was 41.18 ng/ml, the sensitivity and specificity were 60.34% and 72.64%, respectively. The AUC of lactate was 0.669(95% CI 0.579-0.759, P<0.001), the cut-off was 4.2 mmol/L, the sensitivity and specificity were 51.70% and 77.40%, respectively. The AUC of APACHE Ⅱ was 0.643(95% CI 0.550-0.736, P=0.002), the cut-off of APACHE Ⅱ score was 28.5, the sensitivity and specificity were 53.45% and 74.53%, respectively. The AUC of the three parameters combined was 0.772(95% CI 0.697-0.848, P<0.001), the sensitivity and specificity were 65.50% and 80.20% respectively. Conclusions PCT, lactate and APACHE Ⅱ score can be used to predict the early diagnosis of disseminated intravascular coagulation induced by septic shock, and the combination of the three parameters can improve the accuracy of early prediction.