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网状血小板百分比升高与脓毒性休克患者死亡率增加相关。

An elevated percentage of reticulated platelet is associated with increased mortality in septic shock patients.

作者信息

Wu Qin, Ren Jianan, Hu Dong, Jiang Pengjun, Li Guanwei, Anjum Nadeem, Wang Gefei, Gu Guosheng, Chen Jun, Wu Xiuwen, Liu Song, Li Yuan, Zhao Yunzhao, Li Jieshou

机构信息

From the Department of General Surgery, Jinling Hospital, Medical School of Nanjing University (QW, JR, DH, GL, NA, GW, GG, JC, XW, SL, YL, YZ, JL); and Department of Hematology, First Affiliated Hospital of Nanjing University of Medicine, Nanjing, China (PJ).

出版信息

Medicine (Baltimore). 2015 May;94(19):e814. doi: 10.1097/MD.0000000000000814.

Abstract

Microcirculatory changes and coagulation disturbances are thought to play a key role in sepsis. Some evidence suggests that the percentage of reticulated platelets (RP%) may be a valuable and cost-effective sepsis screening parameter. This was a prospective study in surgical patients to investigate the potential value of RP% as a predictor of mortality in septic shock patients.This was a prospective study conducted in a surgical critical care center of a Chinese tertiary care hospital. Consecutive septic shock patients were enrolled at admission. Age- and sex-matched non-septic patients were recruited as control patients. RP% was determined by flow cytometry in 68 septic shock patients and 68 controls.Compared with survivors, septic patients who died presented with a significantly higher RP% (P < 0.001). The area under the receiver-operating characteristic curve for the RP% association with mortality was 0.867 (95 % CI 0.780-0.953, P < 0.001). Kaplan-Meier survival curves showed that mortality risk was significantly different when patients were stratified based on RP% (P < 0.001). This association was preserved in a multi-logistic regression analysis that included clinical confounders (P < 0.014).This prospective study demonstrates that increased RP% identifies septic shock patients who have a high risk of death. RP% has the potential to act as a marker for patient stratification in future clinical trials.

摘要

微循环变化和凝血功能障碍被认为在脓毒症中起关键作用。一些证据表明,网织血小板百分比(RP%)可能是一个有价值且经济高效的脓毒症筛查参数。这是一项针对外科患者的前瞻性研究,旨在探讨RP%作为脓毒性休克患者死亡率预测指标的潜在价值。

这是一项在中国一家三级甲等医院的外科重症监护中心进行的前瞻性研究。连续的脓毒性休克患者在入院时被纳入研究。招募年龄和性别匹配的非脓毒症患者作为对照。通过流式细胞术测定了68例脓毒性休克患者和68例对照的RP%。

与幸存者相比,死亡的脓毒症患者的RP%显著更高(P<0.001)。RP%与死亡率相关性的受试者工作特征曲线下面积为0.867(95%CI 0.780-0.953,P<0.001)。Kaplan-Meier生存曲线显示,根据RP%对患者进行分层时,死亡风险有显著差异(P<0.001)。在纳入临床混杂因素的多逻辑回归分析中,这种相关性依然存在(P<0.014)。

这项前瞻性研究表明,RP%升高可识别出死亡风险高的脓毒性休克患者。RP%有可能在未来的临床试验中作为患者分层的标志物。

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