平均血小板体积与血小板计数比值作为缺血性卒中后肺炎死亡率的实验室指标。
Mean platelet volume to platelet count ratio as a laboratory indicator of mortality in pneumonia following ischemic stroke.
作者信息
Nageeb Rania S, Abozaid Mohammed M N, Nageeb Ghada S, Omran Alaa A
机构信息
1Department of Neurology, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
2Department of Chest, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
出版信息
Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):27. doi: 10.1186/s41983-018-0028-9. Epub 2018 Sep 26.
BACKGROUND
Platelets have a vital role in antimicrobial host defenses. The objective of this study was to evaluate if increased mean platelet volume to platelet count (MPV/PC) ratio in acute ischemic stroke patients complicated with pneumonia was associated with increased mortality risk.
METHODS
The current study was conducted at Zagazig University Hospitals. It included 500 acute ischemic stroke patients classified as group 1 that included 51 patients complicated with pneumonia after admission and group 2 that included the remaining 449 patients. Clinical assessment was carried out to exclude comorbid medical illnesses likely to interfere with platelet function or morphology. Laboratory investigations including MPV/PC ratio and brain imaging were carried out for all patients.
RESULTS
There was a significant difference between both groups regarding age, National Institutes of Health Stroke Scale (NIHSS) score, and mortality within 30 days ( = 0.02, 0.03, 0.01). There was a significant difference between survivors and non-survivors of group 1 regarding to pneumonia severity index (PSI) classes IV and V ( = 0.01 and 0.02, respectively). Also, there was a significant difference regarding confusion, urea ≥ 7 mmol/L, respiratory rater ≥ 30 breaths/min, systolic blood pressure ≤ 90 mmHg or diastolic blood pressure ≤ 60 mmHg, and age ≥ 65 years at pneumonia occurrence (CURB-65) scores 3, 4, and 5 ( = 0.03, 0.02, and 0.01, respectively). Moreover, there was a significant difference regarding decreased GCS score at pneumonia occurrence, higher NIHSS scores, PSI, and higher MPV/PC ratio ( = 0.01, 0.01, 0.028, and 0.01, respectively). Age > 65 years, need for mechanical ventilation, GCS score of > 9, PSI class ≥ IV, CURB-65 scores ≥ 3, and increased MPV/PC ratio were all significantly associated with 30-day mortality in group 1 ( = 0.03, 0.01, 0.001, 0.04, 0.01, and 0.03, respectively). The predictors of 30-day mortality risk factors were GCS less than 9, increased MPV/PC ratio, and CURB-65 scores ≥ 3 ( = 0.001, 0.05, and 0.01, respectively).
CONCLUSIONS
Once pneumonia develops, MPV/PC ratio could be considered a significant laboratory indicator of 30-day mortality.
背景
血小板在抗菌宿主防御中起着至关重要的作用。本研究的目的是评估急性缺血性中风合并肺炎患者中平均血小板体积与血小板计数（MPV/PC）比值升高是否与死亡风险增加相关。
方法
本研究在扎加齐格大学医院进行。研究纳入了500例急性缺血性中风患者，分为两组：第1组包括51例入院后合并肺炎的患者，第2组包括其余449例患者。进行临床评估以排除可能干扰血小板功能或形态的合并内科疾病。对所有患者进行了包括MPV/PC比值和脑部成像在内的实验室检查。
结果
两组在年龄、美国国立卫生研究院卒中量表（NIHSS）评分和30天内死亡率方面存在显著差异（P分别为0.02、0.03、0.01）。第1组的幸存者和非幸存者在肺炎严重程度指数（PSI）IV级和V级方面存在显著差异（P分别为0.01和0.02）。此外，在出现肺炎时的意识模糊、尿素≥7 mmol/L、呼吸频率≥30次/分钟、收缩压≤90 mmHg或舒张压≤60 mmHg以及年龄≥65岁方面，CURB-65评分为3、4和5时也存在显著差异（P分别为0.03、0.02和0.01）。此外，在出现肺炎时格拉斯哥昏迷量表（GCS）评分降低、NIHSS评分较高、PSI以及MPV/PC比值较高方面也存在显著差异（P分别为0.01、0.01、0.028和0.01）。年龄>65岁、需要机械通气、GCS评分>9、PSI分级≥IV级、CURB-65评分≥3以及MPV/PC比值升高均与第1组的30天死亡率显著相关（P分别为0.03、0.01、0.001、0.04、0.01和0.03）。30天死亡风险因素的预测指标为GCS评分低于9、MPV/PC比值升高以及CURB-65评分≥3（P分别为0.001、0.05和0.01）。
结论
一旦发生肺炎，MPV/PC比值可被视为30天死亡率的重要实验室指标。
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