脓毒症合并急性肾损伤患者继发血小板减少症的危险因素分析

Risk factors of the thrombopenia in septic patients complicated with acute kidney injury

目的 通过探讨脓毒症合并急性肾损伤（AKI）患者继发血小板减少症（TP）的危险因素,为脓毒症的治疗提供临床依据.方法 选取自2012年1月至2016年12月在浙江省人民医院重症医学科（ICU）住院治疗的265例脓毒症合并AKI患者为研究对象,详细记录所有患者的基本信息,实验室检查、急性生理与慢性健康评分（APACHEII评分）、序贯器官衰竭（SOFA）评分、治疗措施,以及住院28 d生存结局.根据住院7 d是否发生TP分为TP组和非TP组.应用多因素Logistic回归分析寻找脓毒症合并AKI患者继发TP的危险因素.结果 265例患者,112例发生TP,153例未发生TP;TP组28 d病死率为47.3%（53/112）,非TP组为33.3%（51/153）,两组病死率差异具有统计学意义（χ^2=5.307,P〈0.05）. 单因素分析显示引起脓毒症合并AKI患者继发TP的危险因素为年龄、C-反应蛋白（CRP）、降钙素原（PCT）、APACHEII评分、SOFA评分、持续性肾脏替代治疗（CRRT）、肝素抗凝、休克、使用利奈唑胺和血流感染（P均〈0.05）.多因素Logistic回归分析发现年龄≥65岁[OR=4.53,95%可信区间（CI）1.23-9.24,P〈0.05]、接受CRRT（OR=5.24,95%CI 2.14-14.56,P〈0.01）、肝素抗凝（OR=4.56,95%CI 2.13-8.46,P〈0.01）、使用利奈唑胺（OR=2.35,95%CI 1.25-5.24,P〈0.01）、休克（OR=2.15,95%CI 1.03-4.96,P〈0.01）和血流感染（OR=4.26,95%CI .36~12.48,P〈0.01）是引起脓毒症合并AKI患者继发TP的独立危险因素.结论 临床上,对于合并这些危险因素的患者,应密切监测血小板计数,同时给予干预措施预防TP的发生.

Objective To investigate the risk factors of thrombopenia（TP）in septic patients complicated with acute kidney injury （AKI）.Methods Two hundred and sixty five septic patients complicated with AKI admitted in Intensive Care Unit ICU of Zhejiang Provincial People＇s Hospital during January 2012 and December 2016 were enrolled in the study.The clinical data, results of laboratory tests, Acute Physiology and Chronic Health Evaluation （APACHEII） scores, Sequential Organ Failure Assessment （SOFA） scores, therapeutic intervention, and 28-day mortality were documented.Among 265 patients, TP occurred within 7 days in 112 cases （TP group） and did not occur in 153 cases （non-TP group）.Multivariable Logistic regression analysis was performed to analyze the risk factors of TP.Results The 28-day mortality rate in TP group was higher in TP group than that in non-TP group （47.3% vs.33.3%, χ^2=5.307,P〈0.05）.Univariate analysis showed that age, C-reactive protein （CRP）, procalcitonin （PCT） and APACHEII score, SOFA score, continuous renal replacement therapy （CRRT）, heparin anticoagulation, shock, usage of linezolid and bloodstream infections were associated with TP in septic patients with AKI（all P〈0.05）.Multivariable Logistic regression analysis showed that age≥65 （OR=4.53, 95%CI 1.23-9.24,P〈0.05）, CRRT（OR=5.24,95%CI 2.14-14.56,P〈0.01）, heparin anticoagulation（OR=4.56,95%CI 2.13-8.46,P〈0.01）, usage of linezolid（OR=2.35,95%CI 1.25-5.24,P〈0.01）, shock（OR=2.15,95%CI 1.03-4.96,P〈0.01）and bloodstream infections（OR=4.26,95%CI 1.36-12.48,P〈0.01）were independent risk factors for septic patients with TP.Conclusion For septic patients with AKI having these risk factors, the platelet counts should be closely monitored, and intervention measures should be given to reduce the occurrence of TP.