ObjectiveTo investigate the application value of thrombelastography(TEG) in the diagnosis of neonatal disseminated intravascular coagulation (DIC).
MethodsFrom June to December 2018, a total of 49 newborns with neonatal DIC in the department of neonatology in Chengdu First People′s Hospital were included in DIC group (n=49). In the same period, a total of 50 non-DIC newborns whose symptoms were similar with DIC were selected as non-DIC group (n=50). Meanwhile, a total of 50 newborns with normal coagulation function in our hospital were selected as control group (n=50). Routine coagulation function detection, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen level (FIB), D dimer level, and TEG indexes as coagulation reaction time (R value), coagulation time (K value), coagulation angle (α angle), maximum thrombus amplitude (MA value), as well as platelet count were collected retrospectively and compared using variance analysis among the three groups, and the pairwise comparison was performed using least-significant difference(LSD) method. The relationship between the observation indexes of coagulation function and the occurrence of neonatal DIC was analyzed by Spearman′s correlation analysis. The diagnostic efficiency of each coagulation function observation index for neonatal DIC was determined by the receiver operating characteristic (ROC) curve method. Calculate the area under the curve (AUC), and use the maximum Youden index principle to determine the optimal critical value. The procedures followed in this study were in accordance with the standards established by the Ethics Committee of the Chengdu First People′s Hospital, and this study was approved by this committee (KT No.009 in 2018). Clinical research informed consent was obtained and signed from each individual′s guardian.
Results① The total differences of PT, APTT, FIB level, D dimer level, R value, K value, α angle, MA value and platelet count of newborns in the DIC group, non-DIC group and control group were statistically significant(F=160.79, 40.00, 15.30, 62.92, 431.29, 38.19, 95.85, 54.54, 95.60,P<0 .001). the above indicators of newborns in dic group were respectively compared with those in non-dic group (lsd-t=4.28, 9.17, 3.36, 35.80, 3.48, 2.39, 12.49 , 17.48, 82.96,P<0 .001) and control group (lsd-t=4.55, 19.70, 3.55, 39.90, 6.56, 3.20, 20.36, 19.80, 120.07,P<0 .001), the differences were also statistically significant. ② among the 49 newborns in the dic group, pt, aptt, d dimer level, r value, k value were positively correlated with the occurrence of neonatal dic (r=0.513,P<0 .001;r=0.321,P<0 .01;r=0.561 ,P<0 .001;r=0.608,P<0 .001;r=0.237,P=0.018); FIB level, α angle, MA value, platelet count and the occurrence of neonatal DIC were negatively correlated (r=—0.458,P<0 .001;r=—0.436,P<0 .001;r=—0.431,P<0 .001;r=—0.625,P<0 .001). ③ the roc-auc of r value for diagnosing neonatal dic was 0.919(95%CI: 0.874-0.963), which was the highest in these observation indexes. According to the principle of maximum Youden index, the best cut-off value of R value was 7.5 min, and the specificity was 90.0 %, the sensitivity was 67.4%, and the Youden index was 0.705. The sensitivity of D dimer level for diagnosing neonatal DIC was the highest(85.7%), the ROC-AVC was 0.892 (95%CI:0.836-0.947), the best cut-off value was 2 mg/L, specificity was 62.0%, and Youden index was 0.477.
ConclusionsTEG has clinical value in the diagnosis of neonatal DIC, and can be used as an supplementary means of routine coagulation function detection. The combination of the two methods can better guide clinical early intervention and accurate treatment of neonatal DIC.
