血小板输注阈值对脓毒症患者结局的影响：MIMIC-IV 数据库分析。

Impact of Platelet Transfusion Thresholds on Outcomes of Patients With Sepsis: Analysis of the MIMIC-IV Database.

机构信息

Department of Emergency, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

出版信息

Shock. 2022 Apr 1;57(4):486-493. doi: 10.1097/SHK.0000000000001898.

DOI:10.1097/SHK.0000000000001898

PMID:34966069

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8906242/

Abstract

BACKGROUND

The benefits of platelet thresholds for transfusion remain unclear. This study assessed the effect of two transfusion thresholds on the survival outcomes of patients with sepsis and thrombocytopenia.

METHODS

In this retrospective cohort study, data of patients with sepsis admitted to an intensive care unit (ICU) and who had received platelet transfusion were extracted from the Medical Information Mart for Intensive Care IV database. Patients were classified into the lower-threshold group (below 20,000/μL) and higher-threshold group (20,000-50,000/μL), based on thresholds calculated from their pretransfusion platelet count. The endpoints included 28- and 90-day mortality, red blood cell (RBC) transfusion, ICU-free days, and hospital-free days.

RESULTS

There were 76 and 217 patients in the lower-threshold and higher-threshold groups, respectively. The higher-threshold group had a higher rate of surgical ICU admission (35.0% vs. 9.2%) and lower quick Sequential Organ Failure Assessment (qSOFA) score than the lower-threshold group. In the higher-threshold group, 94 (43.3%) and 132 (60.8%) patients died within 28 and 90 days, compared to 51 (67.1%) and 63 (82.9%) patients in the lower-threshold group (adjusted odds ratio, 1.96; 95% confidence interval, 1.16 to 3.03; P = 0.012; adjusted odds ratio, 2.04; 95% confidence interval, 1.16 to 3.57; P = 0.012, respectively). After stratification by mortality risk, the subgroup analysis showed a consistent trend favoring higher-threshold transfusion but reached statistical significance only in the low-risk group. There were no differences in red blood cell transfusion, ICU-free days, and hospital-free days between the groups. The E-value analysis suggested robustness to unmeasured confounding.

CONCLUSIONS

In patients with sepsis and thrombocytopenia, platelet transfusion at a higher threshold was associated with a greater reduction in the 28- and 90-day mortalities than that at a lower threshold.

摘要

背景

血小板输注阈值的益处仍不清楚。本研究评估了两种不同的血小板输注阈值对伴有脓毒症和血小板减少症患者的生存结局的影响。

方法

本回顾性队列研究从医疗信息重症监护 IV 数据库中提取了入住重症监护病房（ICU）并接受血小板输注的脓毒症患者的数据。根据患者输注前血小板计数计算的阈值，将患者分为较低阈值组（<20,000/μL）和较高阈值组（20,000-50,000/μL）。终点包括 28 天和 90 天死亡率、红细胞（RBC）输注、ICU 无天数和住院无天数。

结果

较低阈值组和较高阈值组分别有 76 例和 217 例患者。与较低阈值组相比，较高阈值组中手术 ICU 入院率更高（35.0% vs. 9.2%），快速序贯器官衰竭评估（qSOFA）评分更低。在较高阈值组中，分别有 94（43.3%）和 132（60.8%）例患者在 28 天和 90 天内死亡，而较低阈值组中分别有 51（67.1%）和 63（82.9%）例患者死亡（调整后优势比，1.96；95%置信区间，1.16 至 3.03；P=0.012；调整后优势比，2.04；95%置信区间，1.16 至 3.57；P=0.012）。按死亡率风险分层后，亚组分析显示，较高阈值输血组的趋势一致，但仅在低危组有统计学意义。两组间 RBC 输注、ICU 无天数和住院无天数无差异。E 值分析表明，该研究结果对未测量的混杂因素具有稳健性。