血小板减少症及血小板变化过程对儿科重症监护病房治疗结果的影响。

Implications of thrombocytopenia and platelet course on pediatric intensive care unit outcomes.

作者信息

Krishnan Jambunathan, Morrison Wynne, Simone Shari, Ackerman Alice

机构信息

Division of Pediatric Critical Care (JK), Cardinal Glennon Childrens Medical Center, St. Louis University, St. Louis, MO, USA. jkrishnanpeds.umaryland.edu

出版信息

Pediatr Crit Care Med. 2008 Sep;9(5):502-5. doi: 10.1097/PCC.0b013e3181849af1.

DOI:10.1097/PCC.0b013e3181849af1

PMID:18679144

Abstract

INTRODUCTION

Thrombocytopenia has been shown to be an independent predictor of mortality and prolonged hospital length of stay in critically ill adults. Studies are lacking in the pediatric intensive care unit population. We evaluated the relationship between platelet counts at admission, platelet course, and outcomes.

HYPOTHESES

Thrombocytopenia at the time of admission to the pediatric intensive care unit is a risk factor for increased mortality and prolonged length of stay. 2) Thrombocytopenia at any point during pediatric intensive care unit stay is associated with increased mortality and length of stay. 3) Falling platelet counts during a pediatric intensive care unit course are associated with greater mortality and longer length of stay.

METHOD

Prospective observational study.

STUDY POPULATION

All patients admitted to a multidisciplinary tertiary care pediatric intensive care unit in a University Hospital over the course of a year. ANALYSIS OF DATA: Data were analyzed using logistic and linear regression.

RESULTS

Thrombocytopenia (platelet count <150 x 10/L) was present in 17.3% of pediatric intensive care unit patients on admission. Mortality was higher in thrombocytopenic patients (17.6% vs. 2.47%, p < 0.001). The median length of stay in the thrombocytopenia and nonthrombocytopenia groups was 4 days vs. 1.6 days, respectively (p < 0.001). The pediatric intensive care unit patients (25.3%) were thrombocytopenic at some point in their stay. They had higher mortality (17.1% vs. 0.9%, odds ratio [OR] 23.8, 95% confidence interval [CI] 5.2-108.6, p < 0.0005) and longer length of stay (median 6.6 days vs. 1.5 days, p < 0.0005) compared with those who were never thrombocytopenic. For every 10% fall in platelet count from the time of admission, the OR for mortality was 1.4 (95% CI 1.1-1.8) and the length of stay was longer (p < 0.0005). Patients with normal platelet counts at admission who later developed thrombocytopenia had increased mortality (OR 18.6, 95% CI 3.2-107.3) and longer length of stay (p < 0.0005) compared with those who did not develop thrombocytopenia.

CONCLUSION

Thrombocytopenia and falling platelet counts are associated with increased risk of mortality and length of stay in the pediatric intensive care unit.

摘要

引言

血小板减少已被证明是危重症成年患者死亡率和住院时间延长的独立预测因素。儿科重症监护病房人群的相关研究尚缺。我们评估了入院时血小板计数、血小板变化过程与预后之间的关系。

假设

1）儿科重症监护病房入院时血小板减少是死亡率增加和住院时间延长的危险因素。2）儿科重症监护病房住院期间任何时间点的血小板减少都与死亡率增加和住院时间延长相关。3）儿科重症监护病房病程中血小板计数下降与更高的死亡率和更长的住院时间相关。

方法

前瞻性观察研究。

研究人群

一所大学医院多学科三级护理儿科重症监护病房一年内收治的所有患者。数据分析：采用逻辑回归和线性回归分析数据。

结果

17.3%的儿科重症监护病房患者入院时存在血小板减少（血小板计数<150×10⁹/L）。血小板减少患者的死亡率更高（17.6%对2.47%，p<0.001）。血小板减少组和非血小板减少组的中位住院时间分别为4天和1.6天（p<0.001）。25.3%的儿科重症监护病房患者在住院期间的某个时间点出现血小板减少。与从未出现血小板减少的患者相比，他们的死亡率更高（17.1%对0.9%，比值比[OR]23.8，95%置信区间[CI]5.2 - 108.6，p<0.0005），住院时间更长（中位6.6天对1.5天，p<0.0005）。从入院时起血小板计数每下降10%，死亡的OR为1.4（95%CI 1.1 - 1.8），住院时间更长（p<0.0005）。入院时血小板计数正常但后来出现血小板减少的患者与未出现血小板减少的患者相比，死亡率增加（OR 18.6，95%CI 3.2 - 107.3），住院时间更长（p<0.0005）。