脓毒症早期血小板容积指数对脓毒症患者预后价值的研究

The value of platelet volume indices in early period as prognostic indicators of sepsis

目的探讨脓毒症患者早期血小板容积指数[平均血小板体积(MPV)、血小板体积分布宽度(PDW)]评估脓毒症患者28 d全因死亡风险的预测能力。方法回顾2015年1月至2017年1月重症医学科脓毒症患者数据,根据其28 d生存状况分为存活组及死亡组。对比两组患者诊断脓毒症后48 h内的基础指标、生化指标、血小板容积指数、查尔森合并症指数、格拉斯哥昏迷评分(GCS)、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分等是否存在差异,通过COX多因素回归分析脓毒症早期血小板指数对患者死亡风险的预后价值,进一步通过受试者工作特征(ROC)曲线分析对比相关因素的预后价值。结果共入选209例脓毒症患者,存活组(137例)与死亡组(72例)比较,平均动脉压、血小板计数、MPV、PDW、pH、血肌酐、胆红素、肌钙蛋白、凝血酶原时间、GCS评分存在显著差异。COX多因素风险分析结果提示PDW(HR=1.068,95%CI 1.002~1.139,P=0.043)为独立的风险因素,其ROC曲线下面积为0.762(95%CI 0.694~0.831),当PDW>18.65%时预测28 d全因死亡风险的敏感性为86%,特异性为63%。结论脓毒症患者早期血小板容积指数增高提示远期死亡风险增加,PDW指标变化有助于评估脓毒症患者28 d预后。

Objective To investigate the prognostic value of platelet volume indices [mean platelet volume(MPV) and platelet distribution width(PDW)] in early period for patients with sepsis. Methods This retrospective study was conducted in a general ICU at a University Hospital from January 2015 to January 2017. Patients with sepsis were divided into a survival group and a death group according to 28-day prognosis. The demographic and clinical data were recorded and analyzed, including platelet indices, Charlson comorbidity index, Glasgow Coma Scale(GCS) score and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score. Multivariable COX proportional hazard ratio model was used to evaluate the 28-day mortality risk, and receiver operating characteristic(ROC) curve were used to evaluate the value of platelet volume indices. Results A total of 209 patients were enrolled in this study. Mean arterial pressure, pH, platelet count, serum creatinine, bilirubin, troponin I, prothrombin time, GCS score and platelet volume indices showed significant differences between the survival group(n=137) and the death group(n=72)(all P<0.05).Multivariable COX regression analysis revealed that the PDW was independently associated with 28-day mortality in sepsis(HR=1.068, 95%CI 1.002-1.139, P=0.043). The area under the ROC curve of PDW was 0.762(95%CI 0.694-0.831),with a sensitivity of 86% and a specificity of 63% at a cut-off value of 18.65%. Conclusion PDW can be used as a powerful prognostic indicator in patients with sepsis following 28-day.