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737例成人重症监护病房患者的血小板减少症:一项关于相关因素、药物、血小板输注及临床结局的真实世界研究。

Thrombocytopenia in 737 adult intensive care unit patients: A real-world study of associated factors, drugs, platelet transfusion, and clinical outcome.

作者信息

Zhang Man-Ka, Xu Tian-Qi, Zhang Xiao-Jing, Rao Zhi-Guo, He Xiao-Xu, Wu Mei-Qing, Li Zhou-Ping, Liu Yin, Yang Jing-Cheng, Gong Yi-Fan, Tang Ming, Xue Xiao-Yan

机构信息

Intensive Care Unit, Aerospace Central Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China.

出版信息

SAGE Open Med. 2020 Oct 7;8:2050312120958908. doi: 10.1177/2050312120958908. eCollection 2020.

Abstract

OBJECTIVE

We aimed to identify and represent factors associated with thrombocytopenia in intensive care unit, especially the pathogens and drugs related to severe and extremely thrombocytopenia. Then, we aim to compare the mortality of platelet transfusion and non-transfusion in patients with different degrees of thrombocytopenia.

METHODS

We identified all thrombocytopenic patients in intensive care unit by using platelet-specific values and then extracted electronic health records from our Hospital Information System. Data were statistically analyzed with t test, chi-square test, and logistic regression.

RESULTS

We found that infections (32.7%) were the most frequent cause associated with thrombocytopenia, followed by sepsis shock (3.93%) and blood loss (2.99%). Meanwhile, antifungals ( = 0.002) and bacterial infection ( = 0.037) were associated with severe and extremely severe thrombocytopenia. Finally, we found that the mortality of platelet transfusion and non-transfusion in patients was statistically significant for patients with platelet counts between 30 and 49/nL (χ = 9.719,  = 0.002).

CONCLUSION

Infection and sepsis emerged as two primary factors associated with thrombocytopenia in intensive care unit. Meanwhile, antifungals and bacterial infection were associated with platelet counts less than 49/nL. Finally, platelet transfusion may be associated with reduced mortality in patients with platelet counts between 30 and 49/nL.

摘要

目的

我们旨在识别并呈现重症监护病房中与血小板减少相关的因素,尤其是与严重和极严重血小板减少相关的病原体和药物。然后,我们旨在比较不同程度血小板减少患者接受血小板输注和未接受血小板输注的死亡率。

方法

我们通过使用血小板特异性值识别重症监护病房中的所有血小板减少患者,然后从我们的医院信息系统中提取电子健康记录。数据采用t检验、卡方检验和逻辑回归进行统计分析。

结果

我们发现感染(32.7%)是与血小板减少相关的最常见原因,其次是脓毒症休克(3.93%)和失血(2.99%)。同时,抗真菌药物(P = 0.002)和细菌感染(P = 0.037)与严重和极严重血小板减少相关。最后,我们发现血小板计数在30至49/μL之间的患者接受血小板输注和未接受血小板输注的死亡率具有统计学意义(χ² = 9.719,P = 0.002)。

结论

感染和脓毒症是重症监护病房中与血小板减少相关的两个主要因素。同时,抗真菌药物和细菌感染与血小板计数低于49/μL相关。最后,血小板输注可能与血小板计数在30至49/μL之间的患者死亡率降低有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6e72/7564627/7bdac3eaba6a/10.1177_2050312120958908-fig1.jpg

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