Shome Durjoy K, Jaradat Ahmed, Mahozi Ahmed I, Sinan Ali S, Ebrahim Ali, Alrahim Mohammed, Ebraheem Mohammad S, Mansoor Eman J, Majed Kameela S, Azeez Pasha Sheikh A
Department of Pathology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
Indian J Crit Care Med. 2018 Aug;22(8):585-590. doi: 10.4103/ijccm.IJCCM_49_18.
In sickle cell disease (SCD) patients admitted for intensive care, evaluation of platelet counts in different types of sickle cell complications and its prognostic relevance are not well-studied. Illuminating these aspects were the objectives of this study.
A chart review of 136 adult SCD patients consecutively admitted to our Intensive Care Unit (ICU) was done. The prognosis on day 1 was assessed by Acute Physiology and Chronic Health Evaluation (APACHE II) and multiple organ dysfunction scores (MODS). Receiver operating characteristic (ROC) curves evaluated the ability of platelet counts, MODS, and APACHE II scores to predict survival.
The most common types of crises were severe pain ( = 53), acute chest syndrome ( = 40), and infection ( = 18); 17 patients were nonsurvivors. Platelet counts varied widely (range, 19-838 × 10/L) with thrombocytopenia ( = 30) and thrombocytosis ( = 11). Counts correlated directly with leukocytes and reticulocytes; inversely with lactate dehydrogenase, APACHE, and MODS scores. Areas under ROC curve for platelets, MODS, and APACHE scores to predict survival were 0.73, 0.85, and 0.93, respectively.
In severe sickle cell crisis thrombocytopenia is more common than thrombocytosis. In the ICU, day 1 platelet counts correlate inversely with prognostic scores and are significantly reduced in multi-organ failure and nonsurvivors. A platelet count above 175 × 10/L predicts patient survival with high specificity and positive predictive value but lacks sensitivity.
在因重症监护入院的镰状细胞病（SCD）患者中，不同类型镰状细胞并发症的血小板计数评估及其预后相关性尚未得到充分研究。阐明这些方面是本研究的目标。
对连续入住我们重症监护病房（ICU）的136例成年SCD患者进行了病历回顾。通过急性生理与慢性健康评估（APACHE II）和多器官功能障碍评分（MODS）评估第1天的预后。受试者工作特征（ROC）曲线评估血小板计数、MODS和APACHE II评分预测生存的能力。
最常见的危象类型为重度疼痛（n = 53）、急性胸部综合征（n = 40）和感染（n = 18）；17例患者死亡。血小板计数差异很大（范围为19 - 838×10⁹/L），存在血小板减少症（n = 30）和血小板增多症（n = 11）。计数与白细胞和网织红细胞直接相关；与乳酸脱氢酶、APACHE和MODS评分呈负相关。血小板、MODS和APACHE评分预测生存的ROC曲线下面积分别为0.73、0.85和0.93。
在严重镰状细胞危象中，血小板减少症比血小板增多症更常见。在ICU中，第1天的血小板计数与预后评分呈负相关，在多器官功能衰竭和死亡患者中显著降低。血小板计数高于175×10⁹/L可高度特异性和阳性预测值预测患者生存，但缺乏敏感性。
