Predictive value of early platelet count dynamic changes for prognosis of sepsis patients / 中华急诊医学杂志

ABSTRACT

Objective:To explore the value of early dynamic changes of platelet count (PLT) in evaluating the prognosis of sepsis patients.Methods:A retrospective study was conducted to select sepsis patients admitted to the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 2013 to December 2017. The sepsis patients were divided into the survival group and death group according to the 28-day prognosis after EICU admission. The basic and clinical data of the two groups of patients were compared, and the risk factors for the 28-day prognosis of sepsis patients were screened, and the value of platelet change (&Delta;PLT) in the prognosis of sepsis was evaluated.Results:A total of 549 sepsis patients were included, 184 died within 28 days, and 365 survived, with a 28-day mortality rate of 33.5%. Compared with the survival group, the death group had a higher proportion of males, were older, and had more chronic diseases and tumors such as chronic obstructive pulmonary disease (COPD); simplified acute physiology score Ⅱ (SAPS-Ⅱ), sequential organ failure score (SOFA), procalcitonin, C-reactive protein, blood urea nitrogen, fibrinogen, and mean arterial pressure were lower, the PLT was lower on d1-5, the value of &Delta;PLT d2-5 were decreased more significantly, and the platelet to lymphocyte ratio (PLR) value was higher, and the difference was statistically significant ( P<0.05). However, there was no significant difference in mean platelet volume and platelet distribution width between the two groups (all P>0.05). Multivariate logistic regression analysis showed that COPD ( OR=4.167, 95% CI 1.769-9.815, P<0.001), malignant tumor ( OR=1.815, 95% CI 1.034-3.817, P=0.038), SAPS-Ⅱ score ( OR=1.071, 95% CI 1.046-1.096, P<0.001), SOFA score ( OR=1.060, 95% CI 1.001-1.021, P=0.041), and PLR value ( OR=1.001, 95% CI 1.001-1.002, P<0.001) were independent risk factors affecting the 28-day prognosis of sepsis patients. PLT d1 ( OR=0.996, 95% CI 0.995-0.998, P<0.001) was a protective factor for better prognosis in sepsis patients. The ROC curve analysis showed that the SAPS-Ⅱ score and SOFA score could predict the 28-day ICU prognosis of sepsis patients, and the SAPS-Ⅱ score had the largest area under the ROC curve (AUC=0.726). The AUC (0.678) of &Delta;PLT d4 was greater than those of the other days. When the optimal critical value was -26.5×10 9/L, the sensitivity was 57.8% and the specificity was 71.7%. Conclusions:The early dynamic changes of PLT are closely related to the prognosis of sepsis patients, which is worthy of clinical reference and promotion.