Moreau Delphine, Timsit Jean-François, Vesin Aurélien, Garrouste-Orgeas Maité, de Lassence Arnaud, Zahar Jean-Ralph, Adrie Christophe, Vincent François, Cohen Yves, Schlemmer Benoît, Azoulay Elie
Medical ICU, Saint Louis Teaching Hospital, 1 Ave Claude Vellefaux, 75010 Paris, France.
Chest. 2007 Jun;131(6):1735-41. doi: 10.1378/chest.06-2233. Epub 2007 May 2.
Thrombocytopenia is common in ICU patients. The objective of this study was to evaluate possible links between declining platelet counts early in the ICU stay and survival.
All patients who were admitted to the ICU for at least 5 days and had no thrombocytopenia at the time of admission were included in the study. A multivariable logistic regression model, with hospital mortality as the outcome variable, was built.
We included 1,077 patients in the study. At ICU admission, the median platelet count was not significantly different in survivors (256 x 10(9) cells/L; interquartile range [IQR], 206 to 330 x 10(9) cells/L) and nonsurvivors (262 x 10(9) cells/L; 211 to 351 x 10(9) cells/L). Median simplified acute physiology scores II (SAPS II) at ICU admission was worse in nonsurvivors than in survivors (50 [IQR, 37 to 63] vs 37 [IQR, 27 to 48], respectively; p < 0.0001), as was the mean (+/- SD) sequential organ failure assessment (SOFA) score on day 3 (6.3 +/- 3.24 vs 4 +/- 2.8, respectively; p < 0.0001). Absolute platelet counts were lowest on day 4, but differed significantly between survivors and nonsurvivors only on day 7. Conversely, any percentage decline in platelet counts from 10 to 60% on day 4 was significantly associated with mortality. By multivariable analysis, a 30% decline in platelet count independently predicted death (odds ratio, 1.54; 95% confidence interval, 1.12 to 2.14; p = 0.008), in addition to increasing or stable SOFA scores from ICU admission to day 4, older age, male gender, ICU admission for coma, worse SAPS II score at ICU admission, transfer from another ward, and comorbidity.
In patients who spend > 5 days in the ICU and have normal platelet counts at ICU admission, a decline in platelet counts provides prognostic information. This parameter deserves to be included in new scoring systems.
血小板减少症在重症监护病房（ICU）患者中很常见。本研究的目的是评估ICU住院早期血小板计数下降与生存率之间的可能联系。
纳入所有入住ICU至少5天且入院时无血小板减少症的患者。构建以医院死亡率为结局变量的多变量逻辑回归模型。
我们纳入了1077例患者进行研究。在ICU入院时，幸存者（256×10⁹个细胞/L；四分位间距[IQR]，206至330×10⁹个细胞/L）和非幸存者（262×10⁹个细胞/L；211至351×10⁹个细胞/L）的血小板计数中位数无显著差异。ICU入院时非幸存者的简化急性生理学评分II（SAPS II）中位数比幸存者更差（分别为50[IQR，37至63]对37[IQR，27至48]；p<0.0001），第3天的平均（±标准差）序贯器官衰竭评估（SOFA）评分也是如此（分别为6.3±3.24对4±2.8；p<0.0001）。血小板绝对计数在第4天最低，但仅在第7天幸存者和非幸存者之间存在显著差异。相反，第4天血小板计数下降10%至60%与死亡率显著相关。通过多变量分析，除了从ICU入院到第4天SOFA评分增加或稳定、年龄较大、男性、因昏迷入住ICU、ICU入院时SAPS II评分较差、从另一个病房转入以及合并症外，血小板计数下降30%可独立预测死亡（比值比，1.54；95%置信区间，1.12至2.14；p = 0.008）。
在入住ICU超过5天且入院时血小板计数正常的患者中，血小板计数下降提供了预后信息。该参数值得纳入新的评分系统。
