血小板P选择素阳性表达对脓毒症患者预后的预测价值

Prognostic value of platelet P-selectin positive expression in patients with sepsis

目的评价脓毒症患者血液中血小板P选择素阳性表达率对脓毒症患者预后的预测价值。方法回顾性分析江苏大学附属医院重症监护室(ICU)2016年12月-2018年12月期间收治20例脓毒症和17例脓毒症休克患者临床资料;同时选取20例该院体检中心的健康体检人员作为对照组。比较3组患者血小板P选择素阳性表达率的差异;采用相关分析法判断血小板P选择素阳性表达率与患者预后的相关性;利用受试者工作特征(ROC)曲线评价血小板P选择素对脓毒症患者28天病死率的预测价值。结果脓毒症休克患者的血小板P选择素阳性率高于脓毒症组,亦高于对照组(F=55.578,P<0.01)。血小板P选择素阳性率与脓毒症患者ICU滞留时间成正性弱相关(r=0.367,P=0.025),与28天病死率成正性强相关(r=0.679,P=0.000)。ROC曲线提示,血小板P选择素预测脓毒症患者28天病死率的截断值为28.54%,AUC为0.928,95%CI为0.842~1.014,敏感性72.73%,特异性96.15%。结论血小板P选择素对脓毒症患者28天病死率具有较高的预测价值。

Objective To evaluate the prognostic value of platelet P-selectin positive expression rate in septic patients.Methods Twenty septic and seventeen septic shock patients admitted to a intensive care unit(ICU) of an affiliated hospital of Jiangsu University from December 2016 to December 2018 were retrospectively analyzed.Meanwhile,20 healthy volunteers in the physical examination center of the hospital were matched as a control group.The basic demographic data of the 3 groups were consistent and comparable.The difference of the positive expression rate of platelet P-selectin was compared among the three groups.The correlation between the positive expression rate of platelet P-selectin and prognosis of patients was determined by the correlation analysis.The predictive value of platelet P-selectin for 28-day mortality in patients was evaluated by using the receiver operating characteristic(ROC) curve.Results The platelet P-selectin positive expression rate in the patients with sepsis shock was significantly higher than that in the sepsis group and the control group(F=55.578,P<0.01).The correlation analysis suggested that the positive rate of platelet P-selectin was weakly positively correlated with the duration of ICU stay in the patients with sepsis(r=0.367,P=0.025),and strongly positively correlated with the 28-day mortality(r=0.679,P=0.000).The ROC curve indicated that the cut-off value of platelet P-selectin in predicting 28-day mortality of sepsis patients was 28.54%,AUC was 0.928,95%CI was 0.842-1.014,the sensitivity was 72.73%,and the specificity was 96.15%.Conclusion The increase of the positive expression rate of platelet P-selectin in sepsis will prolong the ICU retention time and increase the 28-day mortality.Moreover,platelet P-selectin has a high predictive value for 28-day mortality in patients with sepsis.