Antithrombin III for early diagnosis of DIC in sepsis patients: a retrospective analysis with 445 patients

Abstract

To investigated the role of antithrombin III (AT-III) levels in the early diagnosis of disseminated intravascular coagulation (DIC) in patients with sepsis and the predictive effect of AT-III on the development of DIC. A retrospective study was conducted. Patients admitted to intensive care unit (ICU) of the First Affiliated Hospital of China Medical University from January to December in 2015 were enrolled. The patients were divided into sepsis group and non-sepsis group according to the diagnostic criteria of sepsis. In addition, sepsis patients were divided into 3 subgroups according to the international society on thrombosis and haemostasis (ISTH) scores on the first day: overt DIC (ISTH ≥ 5), non-overt DIC (ISTH 1-4) and none DIC group (ISTH = 0). Blood routine test, prothrombin time (PT), fibrinogen (Fib), D-dimer, fibrin degradation products (FDP), acute physiology and chronic health evaluation II (APACHE II) scores, sequential organ failure assessment (SOFA) scores and ISTH scores were recorded on the first ICU day. AT-III was recorded during 7 days. The differences were compared among these 3 groups. Correlations of AT-III with various parameters were calculated by using Pearson correlation analysis in sepsis group and overt DIC group. Receiver operating characteristic (ROC) curves for diagnosis of DIC with AT-III, AT-III+PT were drawn to evaluate the diagnostic efficiency. The AT-III levels of DIC patients were compared between early-onset DIC and late-onset DIC during their ICU stay. The change of AT-III levels with time and prognosis in patients with early-onset DIC was compared between groups. Totally 445 patients were recruited, with 138 patients in sepsis group, and 307 in non-sepsis group. There were 20 patents diagnosed with overt DIC on the first ICU day, 115 patients non-overt DIC and 3 patients of none DIC. Twenty-five sepsis patients were diagnosed overt DIC during the ICU days. AT-III level in sepsis patients on the first ICU day were lower than that in non-sepsis patients [(55.29±13.92)% vs. (76.54±12.31)%, P < 0.01]. Patients with overt DIC had a lower AT-III level than non-overt DIC or none DIC patients [(43.85±13.00)% vs. (56.95±13.03)%, (68.00±16.52)%, both P < 0.05]. It was shown by Pearson correlation analysis that AT-III level of sepsis patients on the first ICU day was negatively correlated to ISTH score and PT (r value were -0.467, -0.654, both P < 0.01). AT-III level of overt DIC patient on the first ICU day was negatively correlated with PT (r = -0.675, P = 0.001). It was shown by ROC curve that area under ROC curve (AUC) of AT-III combined with PT for diagnosis overt DIC in sepsis patients was higher than that of AT-III or PT alone (0.843 vs. 0.763, 0.834), the sensitivity 90.0%, specificity 73.7%. The cut-off value for overt DIC diagnosis in sepsis patients of AT-III level alone was 48.5%, sensitivity was 78.0%, specificity was 70.0%. On the first ICU day, AT-III level was risen when ISTH score improved in patients with sepsis. There was similar change of AT-III level between patients with early-onset DIC and late-onset DIC. AT-III level increased with DIC improvement. AT-III level can be used for diagnosing sepsis-associated overt DIC independently or with a combination of PT. When ISTH score improved, AT-III level was risen in patients with sepsis associated DIC.