The clinical value of platelet function changes in trauma patients for prognosis judgment / 医学研究生学报

ABSTRACT

Objective The platelet function changes are closely related to the prognosis of trauma patients and the occurrence of coagulopathy. The purpose of this paper is to investigate the clinical value of platelet function changes in trauma patients for prognosis judgment. Methods The clinical data of 94 trauma patients admitted to the Department of Critical Care Medicine, 908th Hospital from July 2017 to February 2019 were retrospectively analyzed. According to the 90-day prognosis of patients, the patients were divided into survival group (n=80) and death group (n=14) to compare the traditional coagulation function indexes, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), fibrinogen degradation product (FDP), D-dimer, antithrombin II (I ATIII), thromboelastogram (TEG) index [coagulation reaction time (R), clot formation rate (K), clot formation kinetics (α angle), maximum clot strength (MA), etc.] and platelet aggregation function index [arachidonic acid (AA) platelet aggregation rate and adenosine diphosphate (ADP) Platelet aggregation rate]. The data was analyzed by receiver operating characteristic (ROC) curve analysis and Kaplan-Meier analysis. Results Compared with the survival group, the APPT, R value and K value prolonged significantly in the death group (P<0.05). However, the MA value，AA-induced and ADP-induced platelet aggregation decreased significantly in the death group (P<0.05). The ROC curve analysis showed that when the MA cut-off value was 42.05mm, the sensitivity, specificity, positive predictive value and negative predictive value were 83.8%, 71.4%, 58.3% and 94.2% respectively. When the cut-off value of AA platelet aggregation rate was 36.6%, the sensitivity, specificity, positive predictive value and negative predictive value were 57.5%, 85.7%, 75.5% and 93.8% respectively. When the cut-off value of ADP platelet aggregation rate was 29.3%, the sensitivity, specificity, positive predictive value and negative predictive value were 70%, 64.3%, 72.7% and 91.8% respectively. The death risk of patients with AA-induced aggregation rate < 36.6% was 4.37 times that of the patients with AA-induced platelet aggregation rate ≥ 36.6% (95% CI 1.34 to 10.98). The death risk of patients with ADP-induced aggregation rate < 29.3% was 3.674 times that of the patients with ADP-induced platelet aggregation rate ≥ 29.3% (95%CI1.385~ 12.880). The death risk of trauma patients with MA < 42.05 mm was 9.759 times that of the patients with MA ≥ 42.05 mm (95% CI 6.674 ~ 89.87). Conclusion The platelet function of trauma patients can be significantly impaired. When the MA, AA platelet aggregation rate and ADP platelet aggregation rate are lower, the mortality rate of trauma patients becomes higher. The platelet function index of MA, AA and ADP can be used to determine the prognosis of trauma patients.