Zhou Hui, Li Zhifeng, Liang Hui, Yan Zhengzheng
Department of Critical Care Medicine,Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Anesthesiology, Nanfang Hospital,Southern Medical University, Guangzhou, China.
Platelets. 2022 May 19;33(4):612-620. doi: 10.1080/09537104.2021.1970124. Epub 2021 Aug 27.
Thrombocytopenia is common in critical illness. But there are no studies that focus on thrombocytopenia and platelet recovery in Sepsis-3 patients. We employed a large database to identify sepsis based on Sepsis-3 criteria. Patients were grouped by nadir platelet count during ICU, propensity score matching was used to eliminate covariates imbalance, multivariable cox proportional hazard model was used for evaluating mortality. A total of 9709 patients were enrolled based on Sepsis-3, 1794 (18%) patients developed thrombocytopenia, with 858 (8.8%) exhibiting thrombocytopenia at ICU admission (prevalent), 891 (9.2%) developed thrombocytopenia during ICU stay (incident). In the incident thrombocytopenia group, survivors exhibited higher nadir platelet count, higher rate in platelet count recovery and shorter time to platelet recovery compared to non-survivors. Platelet recovery was not observed until 1 days (IQR, 1-2) after weaning of mechanical ventilation and 1 days (IQR, 1-3) after discontinuation of vasopressor in survivors of incident thrombocytopenia. Furthermore, thrombocytopenia was associated with longer duration of ICU length of stay, longer duration of mechanical ventilation and vasopressor use compared to no thrombocytopenia. Moderate (20-50 × 10/L) and severe (<20 × 10/L) thrombocytopenia group showed increased 28 days mortality compared to no thrombocytopenia, while the mortality rate between mild (51-100 × 10/L) and no thrombocytopenia group (≥100 × 10/L) showed no significant difference. Taken together these data revealed that thrombocytopenia occurred in 18% Sepsis-3 patients; platelet recovery occurred more frequent and earlier in survivors; platelet recovery was not observed until clinical improvement. Thrombocytopenia in Sepsis-3 demonstrated increased disease severity, and patients with platelet count <50 × 10/L showed increased 28 days mortality.
血小板减少症在危重症中很常见。但尚无研究聚焦于脓毒症3.0版（Sepsis-3）患者的血小板减少症及血小板恢复情况。我们利用一个大型数据库，根据脓毒症3.0版标准来识别脓毒症。患者按重症监护病房（ICU）期间的最低血小板计数进行分组，采用倾向评分匹配法消除协变量不平衡，使用多变量考克斯比例风险模型评估死亡率。基于脓毒症3.0版标准，共纳入9709例患者，1794例（18%）患者出现血小板减少症，其中858例（8.8%）在入住ICU时即有血小板减少症（为现患病例），891例（9.2%）在ICU住院期间出现血小板减少症（为新发病例）。在新发病例血小板减少症组中，与非幸存者相比，幸存者的最低血小板计数更高、血小板计数恢复率更高且血小板恢复时间更短。在新发病例血小板减少症的幸存者中，直到机械通气撤机后1天（四分位间距，1 - 2天）和血管活性药物停用后1天（四分位间距，1 - 3天）才观察到血小板恢复。此外，与无血小板减少症相比，血小板减少症与ICU住院时间延长、机械通气时间延长及血管活性药物使用时间延长有关。与无血小板减少症相比，中度（20 - 50×10⁹/L）和重度（<20×10⁹/L）血小板减少症组的28天死亡率升高，而轻度（51 - 100×10⁹/L）和无血小板减少症组（≥100×10⁹/L）之间的死亡率无显著差异。综合这些数据表明，18%的脓毒症3.0版患者出现血小板减少症；幸存者中血小板恢复更频繁且更早；直到临床改善才观察到血小板恢复。脓毒症3.0版中的血小板减少症表明疾病严重程度增加，血小板计数<50×10⁹/L的患者28天死亡率升高。
