血小板动态变化对体外膜肺氧合患者预后的预测价值分析

Prognostic value of platelet dynamic changes in patients with extracorporeal membrane oxygenation

目的探讨血小板动态变化对体外膜肺氧合(ECMO)支持下患者28 d预后的预测价值。方法回顾2017年1月至2020年12月来自南京医科大学第一附属医院急诊医学中心使用ECMO进行生命支持的60例患者。收集患者的基线资料,上机第1~7天血小板最低值,计算血小板变化值及变化率,根据ECMO上机后28 d生存状态分为存活组与死亡组,以血小板变化值及血小板变化率绘制受试者工作曲线(ROC),评估其对预后的预测价值。结果在接受VV-ECMO患者中,以第7天的血小板变化值及变化率对患者28 d结局预测效果最佳(AUC_(ΔPLT7)=0.772,P=0.016;AUC_(ΔPLT7%)=0.764,P=0.020),当血小板变化值以4×10^(9)/L为临界值时,敏感度为0.857,特异度为0.615,当血小板变化率以-28.99%为临界值时,敏感度为0.643,特异度为0.846;在接受VA-ECMO患者中,以第6天的血小板变化率对患者28 d结局预测效果最佳(AUC_(ΔPLT6%)=0.707,P=0.045),当血小板变化率以-26.19%为临界值时,敏感度为0.842,特异度为0.643。结论血小板动态变化与接受ECMO患者的28 d预后具有相关性,结合血小板变化值和变化率的临界值更能预测两种ECMO模式下患者的不良预后。

Objective To investigate the predictive value of platelet dynamics on the prognosis of 28-day in patients with extracorporeal membrane oxygenation(ECMO).Methods From January 2017 to December 2020,60 patients from the Emergency Medicine Center of the First Affi liated Hospital of Nanjing Medical University received ECMO for life support.The baseline data of the patients were collected,the minimum value of platelets on day 1-7 of the machine was calculated,and the platelet change value and change rate were calculated.The patients were divided into the survival group and death group according to the 28-day survival status after ECMO was installed,and the receiver operating curve(ROC)was drawn based on the platelet change value and change rate to evaluate its predictive value for prognosis.Results Among patients receiving VV-ECMO,the platelet change value and change rate on day 7 had the best prediction effect on the patient's 28-day outcome(AUC_(ΔPLT7)=0.772,P=0.016;AUC_(ΔPLT7%)=0.764,P=0.020),when the platelet change value was 4×10^(9)/L as the critical value,the sensitivity was 0.857,the specifi city was 0.615,and when the platelet change rate was-28.99%as the critical value,the sensitivity was 0.857,the specifi city was 0.615,and when the platelet change rate was-28.99%.The sensitivity was 0.643 with a specifi city of 0.846.In patients receiving VA-ECMO,the platelet change rate on day 6 predicted the best effect on the patient's 28-day outcome(AUC_(ΔPLT6%)=0.707,P=0.045).When the platelet change rate was-26.19% as the critical value,the sensitivity was 0.842 and the specifi city was 0.643.Conclusions Platelet dynamic changes of platelets are correlated with the 28-day prognosis of patients receiving ECMO,and the combination of platelet change value and the critical value of change rate can better predict the poor prognosis of patients in both ECMO modes.