脓毒症患者早期血小板减少对预后的预测价值

Value of early occurrence of thrombocytopenia in predicting prognosis of patients with sepsis

目的 探讨脓毒症患者早期发生血小板(Plt)减少对预后的预测价值。方法 回顾性分析334例脓毒症患者的临床资料,依据入ICU 28 d内的生存情况分为死亡组(72例)和存活组(262例)。比较两组的相关资料。采用多因素logistic回归分析脓毒症患者死亡的危险因素,绘制ROC曲线评估Plt减少、急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分和血乳酸对预后的预测价值。结果 与存活组相比,死亡组年龄大,入ICU 24 h时的血乳酸、降钙素原(PCT)、SCr水平、APACHEⅡ评分和SOFA评分升高,而氧合指数和第7天Plt计数降低(P<0.05)。Plt减少以及APACHEⅡ评分、SOFA评分、血乳酸水平升高是脓毒症患者死亡的独立危险因素。Plt减少、APACHEⅡ评分、SOFA评分和血乳酸水平预测脓毒症死亡的AUC分别为0.819、0.857、0.848和0.859(P<0.01)。Plt减少的约登指数为0.638,其预测脓毒症死亡的灵敏度为91.67%,特异度为72.14%。结论 脓毒症患者早期1周内发生Plt减少,对预后有较高的预测价值。

Objective To explore the value of early occurrence of thrombocytopenia in predicting the prognosis of the patients with sepsis.Methods The clinical data of 334 patients with sepsis were retrospectively analyzed, who were divided into two groups of A(died within 28 days after admission to ICU,72 cases) and B(survived within 28 days, 262 cases).The relevant data were compared between the two groups.Multivariate logistic regression was used to analyze the risk factors for the death of sepsis patients.ROC curves were drawn to evaluate the predictive value of Plt reduction, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment(SOFA) score, and blood lactic acid on prognosis.Results Compared with group B,the age was older, the levels of blood lactic acid, PCT,SCr, APACHEⅡ score, and SOFA score were higher, oxygenation index and Plt on the 7;day after admission to ICU were lower in group A(P<0.05).The decrease of Plt and the increases of APACHEⅡ score, SOFA score and blood lactic acid level were the independent risk factors for the death of the patients with sepsis.The AUCs of Plt reduction, APACHEⅡ score, SOFA score and blood lactic acid level in predicting the death were 0.819,0.857,0.848 and 0.859,respectively(P<0.01).The Youden index for Plt reduction was 0.6380 with the sensitivity and specificity for predicting the death were 91.67% and 72.14%,respectively.Conclusion The decrease of Plt within one week has high predictive value for the prognosis of the patients with sepsis.