Zampieri Fernando G, Ranzani Otavio T, Sabatoski Viviane, de Souza Heraldo Possolo, Barbeiro Hermes, da Neto Luiz Monteiro Cruz, Park Marcelo, Pinheiro da Silva Fabiano
Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil ; Laboratory of Medical Investigation 51 (LIM 51), Faculty of Medicine, University of São Paulo, São Paulo, Brazil ; Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
Ann Intensive Care. 2014 Jun 27;4:20. doi: 10.1186/s13613-014-0020-1. eCollection 2014.
Platelet activation and consumption are common in critically ill patients and are associated with poorer prognosis. Mean platelet volume is a simple surrogate for platelet activation, with higher MPV being associated with worse clinical condition on a large array of clinical diagnoses. We therefore aimed to investigate associations between changes in platelet count and mean platelet volume (MPV) with prognosis and inflammatory cytokine values in critically ill patients.
This study prospectively included 84 critically ill patients. Patients were stratified into four groups according to proportional changes in MPV (ΔMPV24h) and platelet count (ΔPlat24h) in the first 24 hours after admission. Mortality between groups was compared using the χ (2) test. Logistic regression was performed using hospital mortality as outcome and Simplified Acute Physiology Score (SAPS 3), ΔPlat24h and ΔMPV24h as covariates. Concentrations of the following inflammatory mediators were measured using Miliplex® technology: IL1β, IL6, IL8, IL10, epidermal growth factor, vascular endothelial growth factor, TNFα and IFNα. Cytokine concentrations were compared between groups using the Kruskal-Wallis test with Bonferroni correction.
Patients in whom MPV increased and platelet count decreased had higher mortality rates (46%). According to logistic regression, ΔMPV24h was independently associated with increased mortality (OR 1.28 per 1% increase; 95% CI 1.08 to 1.48). No strong associations between inflammatory mediators and changes in MPV and platelet count were found.
An increase in MPV after admission to an ICU is independently associated with higher hospital mortality.
血小板激活和消耗在危重症患者中很常见，且与较差的预后相关。平均血小板体积是血小板激活的一个简单替代指标，在大量临床诊断中，较高的平均血小板体积与更差的临床状况相关。因此，我们旨在研究危重症患者血小板计数和平均血小板体积（MPV）的变化与预后及炎症细胞因子值之间的关联。
本研究前瞻性纳入了84例危重症患者。根据入院后最初24小时内MPV（ΔMPV24h）和血小板计数（ΔPlat24h）的比例变化，将患者分为四组。使用χ²检验比较各组之间的死亡率。以医院死亡率为结局，以简化急性生理学评分（SAPS 3）、ΔPlat24h和ΔMPV24h作为协变量进行逻辑回归分析。使用Milliplex®技术测量以下炎症介质的浓度：IL1β、IL6、IL8、IL10、表皮生长因子、血管内皮生长因子、TNFα和IFNα。使用经Bonferroni校正的Kruskal-Wallis检验比较各组之间的细胞因子浓度。
MPV升高且血小板计数降低的患者死亡率较高（46%）。根据逻辑回归分析，ΔMPV24h与死亡率增加独立相关（每增加1%，OR为1.28；95%CI为1.08至1.48）。未发现炎症介质与MPV和血小板计数变化之间有强关联。
入住重症监护病房后MPV升高与较高的医院死亡率独立相关。
