平均血小板体积血小板计数及两者比值对尿源性脓毒症预后的预测价值

The predictive value of PLT,MPV and MPV/PLT in urosepsis

目的探讨平均血小板体积(MPV)、血小板计数(PLT)及两者比值(MPV/PLT)对尿源性脓毒症患者28 d死亡风险的预测价值。方法回顾性分析2017年1月至2019年4月安徽医科大学附属六安医院急诊科收治的86例尿源性脓毒症患者临床资料。依据患者28 d存活状况分为生存组(n=64)和死亡组(n=22)。同时选我院健康体检者30例作为对照组。比较各组临床指标:收缩压(SBP)、氧合指数(PaO2/FiO2)、C-反应蛋白(CRP)、血白细胞计数(WBC)、血乳酸(Lac)、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、快速序贯器官衰竭评分(qSOFA评分)、SOFA评分、D-二聚体、降钙素原(PCT)、脑钠肽(BNP)等,并分别记录患者入院时(0 h)和入院24 h PLT、MPV及MPV/PLT。采用受试者工作特征曲线评估各项指标对尿源性脓毒症患者28 d死亡风险的临床预测价值,多因素Logistic回归分析确定患者死亡危险因素。结果对照组PLT>生存组PLT-0 h>死亡组PLT-0 h;对照组MPV、MPV/PLT <生存组MPV-0 h、MPV/PLT-0 h <死亡组MPV-0 h、MPV/PLT-0 h;死亡组SBP、PaO2/FiO2低于生存组,死亡组Lac、D-二聚体、PCT、BNP、APACHEⅡ评分、SOFA评分、qSOFA评分、MPV-24 h、MPV/PLT-24 h高于生存组,差异均有统计学意义(P <0.05)。MPV-24 h预测尿源性脓毒症患者死亡风险的曲线下面积(AUC)为0.888,当最佳截断值为12.1 fl时,敏感度为72.7%,特异度为98.4%。APACHEⅡ评分预测患者死亡风险的AUC为0.914,当最佳截断值为18分时,敏感度为81.8%,特异度为82.8%。MPV-24 h和APACHEⅡ评分是尿源性脓毒症患者28 d死亡的独立危险因素(均P <0.05)。结论PLT、MPV及MPV/PLT均可评估尿源性脓毒症患者预后,且MPV-24 h对尿源性脓毒症患者28 d死亡风险具有良好的预测价值,可作为有效而简便的评估指标。

Objective To explore the application value of platelet(PLT) count,mean platelet volume(MPV) and MPV/PLT in predicting 28-day mortality risk in the patients with urosepsis.Methods The clinical data of 86 patients with urosepsis admitted to the emergency department of Liu’an Hospital affiliated to Anhui Medical University from January 2017 to April 2019 were retrospectively analyzed.The patients with urosepsis were divided into the survival group(n=64) and the death group(n=22) according to the survival status after 28 days(including post-discharge follow-up).At the same time,30 healthy people in the physical examination center of our hospital were selected as the control group.The clinical indexes of each group were compared,and PLT,MPV and MPV/PLT were recorded at the time of admission(0 h),24 hours after admission(24 h).The receiver operating characteristic(ROC) curve were drawn to evaluate the predictive value of each index in 28-day mortality risk in the patients with urosepsis,and the multivariate Logistic regression analysis was used to determine the risk factors of death in the patients with urosepsis.Results The PLT-0 h in the death group was lower than that in the survival group and control group,and the PLT-0 h in the survival group was lower than that in the control group;The MPV-0 h,MPV/PLT-0 h in the death group were higher than those in the survival group and control group,and the MPV-0 h,MPV/PLT-0 h in the survival group were higher than those in the control group.The systolic blood pressure(SBP) and oxygenation index(PaO2/FiO2) of the death group were lower than those of the survival group,the blood lactate(Lac),D-dimer,PCT,BNP,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,quick sequential organ failure assessment(qSOFA) score,sequential organ failure assessment(SOFA),MPV-24 h,MPV/PLT-24 h of the death group were higher than those of the survival group,and the difference was statistically significant(P <0.05).MPV-24 h and APACHE Ⅱ scores had high predictive value for the risk of death in the patients with urosepsis.The area under the curve(AUC) of MPV-24 h for predicting the risk of death in the patients with urosepsis was 0.888.When the optimal cutoff value was 12.1 fl,the sensitivity was 72.7% and the specificity was 98.4%;The AUC of APACHE Ⅱ score for predicting the risk of death in the patients with urosepsis was 0.914.When the optimal cut-off value was 18,the sensitivity was 81.8% and the specificity was 82.8%.MPV-24 h and APACHE Ⅱ scores were independent risk factors for 28-day mortality in the patients with urosepsis(P <0.05).Conclusion PLT,MPV and MPV/PLT can evaluate the prognosis of patients with urosepsis,and MPV-24 h has a good predictive value for the 28-day mortality in the patients with urosepsis,which can be used as an effective and simple indicator for prognosis evaluation.