多器官功能障碍综合征病人预后分析

Thrombocytopenia in patients with multiple organ dysfunction syndrome.

目的研究多器官功能障碍综合征（MODS）病人发生血小板缺乏的危险因素及其对预后的影响。方法对5家教学医院加强医疗病房（ICU）中1年内收治的366例MODS病人进行回顾性分析。记录病人的人口统计学资料、临床信息、急性生理和慢性健康评分（APACHEⅡ）及序贯性器官衰竭评分（SOFA）。主要研究终点为住院病死率。结果住院期间共有151例病人死亡（41．3％）。血小板缺乏[P=0．022，OR（比数比）=2．143，可信限（95％CI）1．114～4．121]，神经系统衰竭（P〈0．01，OR=6．033，95％CI3．164～11．506）和最高SOFA评分（P〈0．01，OR=1．215，95％CI1．112～1．328），是预后的独立危险因素。共有220例MODS病人（60．1％）发生血小板缺乏。ICU住院时间（P=0．023，OR=1．017，95％CI1．002～1．032）和最高SOFA评分（P〈0．01，OR：1．271，95％CI1．187～1．361）是发生血小板缺乏的独立危险因素，而最高SOFA评分（P〈0．01，OR=1．405，95％CI1．276～1．548）和继发性血小板缺乏（P〈0．01，OR=3．517，95％CI1．780～6．951）是伴有血小板缺乏的MODS病人死亡的独立危险因素。结论血小板缺乏在MODS病人中非常普遍，并导致住院病死率升高.

Objective To study the risk factor for thrombocytopenia in patients with multiple organ dysfunction syndrome （MODS） and the influence on patient outcome. Methods Three hundreds of sixty-six MODS patients admitted to 5 intensive care units within 1 year were analyzed retrospectively. The demographic characteristics, clinical information, acute physiology and chronic health evaluation （APACHE） IT score, and sequential organ failure assessment （SOFA） score were recorded upon review of patient record. The primary end point was hospital mortality. Results One hundred and fifty-one patients （41.3%） died during hospitalization. Thrombocytopenia （odds ratio [ OR] 2. 143,95% confidence interval [ 95% CI ] 1.114 - 4. 121, P = 0. 022） ,neurologic failure （ OR 6. 033,95% CI 3. 164 - 11. 506, P 〈 0. 001 ）, and maximum SOFA score （ OR 1. 215,95% CI 1. 112 - 1. 328, P 〈 0. 001 ） were significantly associated with hospital mortality. Two hundred and twenty MODS patients （60. 1% ） developed thrombocytopenia. ICU stay （OR 1. 017,95% CI 1. 002 - 1. 032, P = 0. 023） and maximum SOFA score （ OR 1. 271,95% CI 1. 187 - 1. 361, P 〈 0. 001 ） were significantly associated with development of thrombocytopenia, while maximum SOFA score （ OR 1. 405,95% CI 1. 276 - 1. 548, P 〈 0. 001 ） and secondary thrombocytopenia （ OR 3.517,95 % CI 1. 780 - 6.951, P 〈 0. 001 ） were independent risk factor for hospital mortality in MODS patients with thrombocytopenia. Conclusion Thrombocytopenia is very common in MODS patients, and is associated with increased hospital mortality.