Boechat Tiago de Oliveira, Silveira Maria Fernanda Baylão Bueno da, Faviere Wilian, Macedo Gerson Luiz de
Rev Bras Ter Intensiva. 2012 Mar;24(1):35-42.
To demonstrate an association between thrombocytopenia and platelet behavior in predicting mortality in septic patients.
Patients with criteria for sepsis at admission or at any time during hospitalization were selected; patients hospitalized for less than 24 hours were excluded. Thrombocytopenia was defined as a platelet count lower than 150.000/mm³, and recovery was defined as returning to levels above 150.000/mm³ after showing thrombocytopenia. We assessed the admission prognosis variables (APACHE II), platelet counts during the hospitalization and outcomes.
Of the 56 patients included, 34 developed thrombocytopenia during sepsis (Group 1) and had a 76.4% mortality rate. The mortality rate among patients not showing thrombocytopenia (Group 2) was 40.9% (RR 1.87; 95% CI 1.12 - 3.12; p = 0.0163). In 44.1% of Group 1 patients, the platelet counts drops by >50% compared with the admission counts; 93.3% of these patients eventually died (RR 1.48; 95% CI 0.93 - 2.36; p = 0.0528). Among the Group 1 patients showing recovered platelet counts, 53.3% survived; 100% of the patients with unrecovered thrombocytopenia died (RR 2.14; 95% CI 1.35 - 3.39; p = 0.0003). Among the patients with APACHE II scores > 22, the thrombocytopenic patients had an 81.8% mortality rate (p = 0.25), while no deaths occurred among the non-thrombocytopenic patients. For the patients with APACHE II scores ≤ 22, the mortality rate of the thrombocytopenic patients was 74% (p = 0.0741), versus 42.8% for the non-thrombocytopenic patients.
For this sample of septic patients, thrombocytopenia and its progression, defined as a >50% drop or failure to recover platelet count, were shown to be markers of poor prognosis.
证实血小板减少症与血小板行为在预测脓毒症患者死亡率方面的关联。
选取入院时或住院期间任何时间符合脓毒症标准的患者；排除住院时间少于24小时的患者。血小板减少症定义为血小板计数低于150,000/mm³，恢复定义为血小板减少症出现后血小板计数恢复至150,000/mm³以上。我们评估了入院预后变量（急性生理与慢性健康状况评分系统II）、住院期间的血小板计数及预后。
纳入的56例患者中，34例在脓毒症期间出现血小板减少症（第1组），死亡率为76.4%。未出现血小板减少症的患者（第2组）死亡率为40.9%（相对危险度1.87；95%可信区间1.12 - 3.12；p = 0.0163）。第1组44.1%的患者血小板计数与入院时相比下降超过50%；这些患者中93.3%最终死亡（相对危险度1.48；95%可信区间0.93 - 2.36；p = 0.0528）。在血小板计数恢复的第1组患者中，53.3%存活；血小板减少症未恢复的患者100%死亡（相对危险度2.14；95%可信区间1.35 - 3.39；p = 0.0003）。在急性生理与慢性健康状况评分系统II评分>22的患者中，血小板减少症患者死亡率为81.8%（p = 0.25），而未出现血小板减少症的患者无死亡。对于急性生理与慢性健康状况评分系统II评分≤22的患者，血小板减少症患者死亡率为74%（p = 0.0741），未出现血小板减少症的患者为42.8%。
对于该脓毒症患者样本，血小板减少症及其进展（定义为血小板计数下降超过50%或未恢复）被证明是预后不良的标志物。
