危重症患者发生血小板减少症的危险因素以及预后
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摘要
目的探究危重症患者发生血小板减少症的危险因素以及预后,旨在为临床治疗危重症患者提供相应的经验。方法回顾性选取2016年5月—2018年5月期间在我院接受治疗的脓毒症合并血小板减少症患者128例,作为实验组。另回顾性选取2016年5月—2018年5月在本院接受治疗的脓毒症患者60例作为对照组。采用浏览历史病历收集患者的一般资料,主要包括年龄、实验室指标(血小板最低值、白细胞计数、C反应蛋白、降钙素原、白蛋白最低值、乳酸)多器官功能衰竭、APACHEⅡ评分≥25、未使用重组人血小板生成素、感染未控制及未输注血小板、PCT(procalcitonin,PCT降钙素原)、IL-6浓度、IL-8浓度等数据。单因素分析脓毒症合并血小板减少症的危险因素,单因素分析有统计学意义的则纳入多因素分析,采用Logistic回归模型。结果两组患者在白蛋白最低值、乳酸、白细胞计数的数据对比差异不具有统计学意义(P>0.05);实验组患者的血小板最低值、降钙素原、C反应蛋白的数据为(38.49±21.92)、(6.53±5.43)、(111.34±66.14),对照组患者的血小板最低值、降钙素原、C反应蛋白的数据为(191.23±55.73)、(3.46±2.62)、(56.43±45.23),两组患者的血小板最低值、降钙素原、C反应蛋白的数据比较差异具有统计学意义(P<0.05)。28 d累计生存率为44.4%,对照组为64.0%,提示脓毒症合并血小板减少患者入院28 d生存率较低于脓毒症未合并血小板减少患者(χ~2=12.329,P<0.05)。针对脓毒症合并血小板减少症患者的年龄、多器官功能衰竭、APACHEⅡ评分≥25、未使用重组人血小板生成素、感染未控制、未输注血小板等数据行单因素分析,结果显示:PCT、IL-6浓度、IL-8浓度、多器官功能衰竭、APACHEⅡ评分≥25分是脓毒症合并血小板减少症的危险因素。将单因素分析中具有统计学意义的PCT、IL-6浓度、IL-8浓度、多器官功能衰竭、APACHEⅡ评分≥25分数据纳入Logistic回归模型进行多因素分析,结果显示:年龄≥65岁、IL-6浓度、IL-8浓度、多器官功能衰竭是合并血小板减少症的独立危险因素。结论年龄≥65岁、脓毒症休克、多器官功能衰竭、IL-6浓度、IL-8浓度水平是脓毒症合并血小板减少症的独立危险因素。
Objective To explore the risk factors and prognosis of thrombocytopenia in critically ill patients,and to provide relevant experience for clinical treatment of critically ill patients. Methods A retrospective study of 128 patients with sepsis and thrombocytopenia who were treated in our hospital from May 2016 to May 2018 was performed as an experimental group.A retrospective selection of 60 patients with sepsis who were treated in our hospital from May 2016 to May 2018 was selected as a control group. The patient 's general information was collected by filling out the questionnaire,including age,laboratory indicators( lowest platelet value,white blood cell count,C-reactive protein,procalcitonin,lowest value of albumin minimum,lactic acid),multiple organ failure,APACHE II score≥25,no recombinant human thrombopoietin,uncontrolled and un-infused platelets,PCT( procalcitonin,PCT procalcitonin),IL-6 concentration,IL-8 concentration and other data.Univariate analysis was used to identify the risk factors of sepsis with thrombocytopenia. The factors with statistical significance of univariate analysis were included in the multivariate analysis by using logistic regression models.Results The comparison of laboratory index data between the two groups showed that there was no statistically significant difference in the minimum value of albumin,lactic acid and white blood cell count between the two groups. The lowest platelet value,procalcitonin and C reaction protein in the experimental group were 38.49± 21.92,6.53±5.43,and 111.34±66.14,respectively. And those in the control group were 191.23± 55.73,3.46± 2.62,and 56. 43 ± 45. 23,respectively. The differences in lowest platelet count,procalcitonin,and C-reactive protein between the two groups were statistically significant. The 28-day cumulative survival rate was in experimental groups was 44.4%,and it was 64.0% in the control group,the result suggested that the 28-day survival rate of patients with sepsis and thrombocytopenia was lower than that of patients with sepsis( χ~2= 12. 329,P < 0. 05).Univariate analysis of age,multiple organ failure,APACHEⅡ score≥25,no recombinant human thrombopoietin,uncontrolled infection,and un-transfused platelets in patients with sepsis and thrombocytopenia showed PCT,IL-6 concentration,IL-8 concentration,multiple organ failure,and APACHEⅡ score≥25 were risk factors for sepsis with thrombocytopenia. The factors with statistically significant in the univariate analysis were included in the logistic regression model for multivariate analysis.The results showed that the age over or equal to 65 years old,IL-6 concentration,IL-8 concentration,and multiple organ failure were independent risk factors for thrombocytopenia.Conclusions Age equal to or over 65 years old,septic shock,multiple organ failure,IL-6 concentration,IL-8 concentration are independent risk factors of sepsis combined with thrombocytopenia.
Objective To explore the risk factors and prognosis of thrombocytopenia in critically ill patients,and to provide relevant experience for clinical treatment of critically ill patients. Methods A retrospective study of 128 patients with sepsis and thrombocytopenia who were treated in our hospital from May 2016 to May 2018 was performed as an experimental group.A retrospective selection of 60 patients with sepsis who were treated in our hospital from May 2016 to May 2018 was selected as a control group. The patient 's general information was collected by filling out the questionnaire,including age,laboratory indicators( lowest platelet value,white blood cell count,C-reactive protein,procalcitonin,lowest value of albumin minimum,lactic acid),multiple organ failure,APACHE II score≥25,no recombinant human thrombopoietin,uncontrolled and un-infused platelets,PCT( procalcitonin,PCT procalcitonin),IL-6 concentration,IL-8 concentration and other data.Univariate analysis was used to identify the risk factors of sepsis with thrombocytopenia. The factors with statistical significance of univariate analysis were included in the multivariate analysis by using logistic regression models.Results The comparison of laboratory index data between the two groups showed that there was no statistically significant difference in the minimum value of albumin,lactic acid and white blood cell count between the two groups. The lowest platelet value,procalcitonin and C reaction protein in the experimental group were 38.49± 21.92,6.53±5.43,and 111.34±66.14,respectively. And those in the control group were 191.23± 55.73,3.46± 2.62,and 56. 43 ± 45. 23,respectively. The differences in lowest platelet count,procalcitonin,and C-reactive protein between the two groups were statistically significant. The 28-day cumulative survival rate was in experimental groups was 44.4%,and it was 64.0% in the control group,the result suggested that the 28-day survival rate of patients with sepsis and thrombocytopenia was lower than that of patients with sepsis( χ~2= 12. 329,P < 0. 05).Univariate analysis of age,multiple organ failure,APACHEⅡ score≥25,no recombinant human thrombopoietin,uncontrolled infection,and un-transfused platelets in patients with sepsis and thrombocytopenia showed PCT,IL-6 concentration,IL-8 concentration,multiple organ failure,and APACHEⅡ score≥25 were risk factors for sepsis with thrombocytopenia. The factors with statistically significant in the univariate analysis were included in the logistic regression model for multivariate analysis.The results showed that the age over or equal to 65 years old,IL-6 concentration,IL-8 concentration,and multiple organ failure were independent risk factors for thrombocytopenia.Conclusions Age equal to or over 65 years old,septic shock,multiple organ failure,IL-6 concentration,IL-8 concentration are independent risk factors of sepsis combined with thrombocytopenia.
引文
[1] Zallocco F,Osimani P,Carloni I,et al. Assessment of clinical outcome of children with sepsis outside the intensive care unit[J].Eur J Pediatr,2018,177(12):1775-1783.
[2]黄莉,姚红霞.糖皮质激素治疗初诊免疫性血小板减少症的疗效观察及预后影响因素分析[J].广西医学,2016,38(11):1578-1580,1584.
[3] Marck RE,Montagne HL,Tuinebreijer WE,et al. Time course of thrombocytes in burn patients and its predictive value for outcome[J].J Int Soc Burn Injur,2013,39(4):714-722.
[4] Yao L,Liu B,Jiang L,et al.Association of cytotoxic T-lymphocyte antigen 4 gene with immune thrombocytopenia in Chinese Han children[J]. Hematology(Amsterdam,Netherlands),2019,24(1):123-128.
[5] Apostdopoulou E,Zikos D,Tseleis A,et al.Clinical outcomes and economic variables in critically ill patients with bloodstream infections[J].Health Sci J,2014,8(4)519-530.
[6]陈玙,王梅芳,程芳芳,等.老年原发免疫性血小板减少症患者临床特征及预后分析[J].首都医科大学学报,2018,39(2):277-281.
[7] Thiele T,Selleng K,Selleng S,et al. Thrombocy-topenia in the intensive care unit-diagnostic approach and management[J].Semin Hematol,2013,50(3):239-250.
[8]吕明恩,李洋,刘文洁,等.淋巴细胞绝对值对成人原发免疫性血小板减少症患者诊断后6个月内合并感染的预测意义[J].中华血液学杂志,2015,36(1):34-38.
[9] Erikson K,Ala-Kokko TI,Koskenkari J,et al.Elevated serum S-100βin patients with septic shock is associated with delirium[J].Acta Anaesth Scand,2019,63(1):69-73.
[10] Thiolliere F,Serre-Sapin AF,Reignier J,et al.Epidemiology and outcome of thrombocyto-penic patientsin the intensive care unit:results of a prospective multicenter study[J].Intensive Care Med,2013,39(8):1460-1468.
[11]黄莉,姚红霞.糖皮质激素治疗初诊免疫性血小板减少症的疗效观察及预后影响因素分析[J].广西医学,2016,38(11):1578-1580,1584.
[12]吕明恩,李洋,刘文洁,等.初诊淋巴细胞绝对值与儿童原发性免疫性血小板减少症预后的相关性[J].中华实用儿科临床杂志,2015,30(15):1147-1151.
[13]吕明恩,李洋,刘文洁,等.初诊淋巴细胞绝对值与儿童原发性免疫性血小板减少症预后的相关性[J].中华实用儿科临床杂志,2015,30(15):1147-1151.
[14] Gaertner F,Ahmad Z,Rosenberger G. Migrating platelets are mechano-scavengers that collect and bundle bacteria[J]. Cell,2017,171(6):1368-1382.
[15] Xiang B,Zhang G,Guo L,et al.Platelets protect from septic shock by inhibiting macrophage-dependent inflammation via the cyclooxygenase 1 signalling pathway[J]. Nat Commun,2013,4:2657.
[16] Lopez-Delgado JC,Rovira A,Esteve F,et al. Thrombocytopenia as a mortality risk factor in acute respiratory failure in H1N1 influenza[J].Swiss med wkly,2013,143:w13788.
[17] Xiang B,Zhang G,Guo L,et al.Platelets protect from septic shock by inhibiting macrophage-dependent inflammation via the cyclooxygenase 1 signaling pathway[J]. Nat Commun,2013,4:2657.
[18] Yin H,Stojanovic-Terpo A,Xu W,et al. Role for platelet glycoprotein Ib-IX and effects of its inhibition in endotoxemiainduced thrombosis, thrombocytopenia, and mortality[J].Arterioscler Thromb Vasc Biol,2013,33(11):2529-2537.
[19] Kraemer BF,Campbell RA,Schwertz H,et al.Bacteria differentially induce degradation of Bcl-x L,a survival protein,by human platelets[J].Blood,2012,120(25):5014-5020.
[20] Gründler K,Angstwurm M,Hilge R,et al. Platelet mitochondrial membrane depolarization reflects disease severity in patients with sepsis and correlates with clinical outcome[J].Crit Care,2014,18(1):R31.
[2]黄莉,姚红霞.糖皮质激素治疗初诊免疫性血小板减少症的疗效观察及预后影响因素分析[J].广西医学,2016,38(11):1578-1580,1584.
[3] Marck RE,Montagne HL,Tuinebreijer WE,et al. Time course of thrombocytes in burn patients and its predictive value for outcome[J].J Int Soc Burn Injur,2013,39(4):714-722.
[4] Yao L,Liu B,Jiang L,et al.Association of cytotoxic T-lymphocyte antigen 4 gene with immune thrombocytopenia in Chinese Han children[J]. Hematology(Amsterdam,Netherlands),2019,24(1):123-128.
[5] Apostdopoulou E,Zikos D,Tseleis A,et al.Clinical outcomes and economic variables in critically ill patients with bloodstream infections[J].Health Sci J,2014,8(4)519-530.
[6]陈玙,王梅芳,程芳芳,等.老年原发免疫性血小板减少症患者临床特征及预后分析[J].首都医科大学学报,2018,39(2):277-281.
[7] Thiele T,Selleng K,Selleng S,et al. Thrombocy-topenia in the intensive care unit-diagnostic approach and management[J].Semin Hematol,2013,50(3):239-250.
[8]吕明恩,李洋,刘文洁,等.淋巴细胞绝对值对成人原发免疫性血小板减少症患者诊断后6个月内合并感染的预测意义[J].中华血液学杂志,2015,36(1):34-38.
[9] Erikson K,Ala-Kokko TI,Koskenkari J,et al.Elevated serum S-100βin patients with septic shock is associated with delirium[J].Acta Anaesth Scand,2019,63(1):69-73.
[10] Thiolliere F,Serre-Sapin AF,Reignier J,et al.Epidemiology and outcome of thrombocyto-penic patientsin the intensive care unit:results of a prospective multicenter study[J].Intensive Care Med,2013,39(8):1460-1468.
[11]黄莉,姚红霞.糖皮质激素治疗初诊免疫性血小板减少症的疗效观察及预后影响因素分析[J].广西医学,2016,38(11):1578-1580,1584.
[12]吕明恩,李洋,刘文洁,等.初诊淋巴细胞绝对值与儿童原发性免疫性血小板减少症预后的相关性[J].中华实用儿科临床杂志,2015,30(15):1147-1151.
[13]吕明恩,李洋,刘文洁,等.初诊淋巴细胞绝对值与儿童原发性免疫性血小板减少症预后的相关性[J].中华实用儿科临床杂志,2015,30(15):1147-1151.
[14] Gaertner F,Ahmad Z,Rosenberger G. Migrating platelets are mechano-scavengers that collect and bundle bacteria[J]. Cell,2017,171(6):1368-1382.
[15] Xiang B,Zhang G,Guo L,et al.Platelets protect from septic shock by inhibiting macrophage-dependent inflammation via the cyclooxygenase 1 signalling pathway[J]. Nat Commun,2013,4:2657.
[16] Lopez-Delgado JC,Rovira A,Esteve F,et al. Thrombocytopenia as a mortality risk factor in acute respiratory failure in H1N1 influenza[J].Swiss med wkly,2013,143:w13788.
[17] Xiang B,Zhang G,Guo L,et al.Platelets protect from septic shock by inhibiting macrophage-dependent inflammation via the cyclooxygenase 1 signaling pathway[J]. Nat Commun,2013,4:2657.
[18] Yin H,Stojanovic-Terpo A,Xu W,et al. Role for platelet glycoprotein Ib-IX and effects of its inhibition in endotoxemiainduced thrombosis, thrombocytopenia, and mortality[J].Arterioscler Thromb Vasc Biol,2013,33(11):2529-2537.
[19] Kraemer BF,Campbell RA,Schwertz H,et al.Bacteria differentially induce degradation of Bcl-x L,a survival protein,by human platelets[J].Blood,2012,120(25):5014-5020.
[20] Gründler K,Angstwurm M,Hilge R,et al. Platelet mitochondrial membrane depolarization reflects disease severity in patients with sepsis and correlates with clinical outcome[J].Crit Care,2014,18(1):R31.