Fountain Eric M, Arepally Gowthami M
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Division of Hematology, DUMC, Rm 301 Alex H. Sands Bldg. Research Drive, Box 3486, Durham, NC, 27710, USA.
J Thromb Thrombolysis. 2017 May;43(4):429-436. doi: 10.1007/s11239-016-1467-8.
To determine incidence, risk factors, hematologic complications, and prognostic significance of thrombocytopenia in the general medicine population, we performed a single-institutional, retrospective study of all adult patients admitted to a general medical ward from January 1st, 2014 to December 31st, 2014 with hospital-acquired thrombocytopenia. Those with moderate thrombocytopenia, defined as a platelet count nadir of <100 × 10^9/L and/or a >50% relative decline, were compared to those with less severe thrombocytopenia. Of the 7420 patients admitted, 465 (6.3%) developed hospital-acquired thrombocytopenia. Infection and moderate thrombocytopenia were present in 56 and 23%, respectively. Severe sepsis and antibiotic use were both associated with moderate thrombocytopenia, and proton pump inhibitor use was statistically significant in both univariate and multivariate analysis. Hematologic complications were more frequent with moderate thrombocytopenia, including frequency of HIT testing and red blood cell transfusions. Outcome metrics including transfer to an intensive care unit (OR 6.78), death during admission (OR 6.85), and length of stay (10.6 vs. 5.1 days) were all associated with moderate thrombocytopenia. Thrombocytopenia is associated with poor prognosis, and the association between moderate thrombocytopenia and proton pump inhibitor use is relatively novel and should be validated in prospective studies.
为了确定普通内科患者血小板减少症的发病率、危险因素、血液学并发症及预后意义，我们对2014年1月1日至2014年12月31日入住普通内科病房且发生医院获得性血小板减少症的所有成年患者进行了一项单机构回顾性研究。将血小板计数最低点<100×10^9/L和/或相对下降>50%定义为中度血小板减少症的患者与血小板减少症较轻的患者进行比较。在7420例入院患者中，465例（6.3%）发生了医院获得性血小板减少症。感染和中度血小板减少症分别占56%和23%。严重脓毒症和抗生素使用均与中度血小板减少症相关，在单因素和多因素分析中，质子泵抑制剂的使用均具有统计学意义。中度血小板减少症患者血液学并发症更为常见，包括肝素诱导的血小板减少症检测频率和红细胞输注频率。包括转入重症监护病房（比值比6.78）、住院期间死亡（比值比6.85）和住院时间（10.6天对5.1天）在内的预后指标均与中度血小板减少症相关。血小板减少症与预后不良相关，中度血小板减少症与质子泵抑制剂使用之间的关联相对新颖，应在前瞻性研究中进行验证。
