血小板功能对脓毒症临床结局的早期预测价值

Early predictive value of platelet function for clinical outcome in sepsis.

作者信息

Cao Yan, Ma Wenfeng, Liu Zhengyu, Pei Yanfang, Zhu Yimin, Chen Fang, Zou Lianhong, Jiang Yu, Liu Xiehong, Huang Jie, Xiao Weiwei, Han Xiaotong

机构信息

Department of Emergency, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61 Western Jiefang Road, Changsha, Hunan 410005, China.

Department of Emergency, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China.

出版信息

J Infect. 2022 May;84(5):628-636. doi: 10.1016/j.jinf.2022.02.004. Epub 2022 Feb 10.

DOI:10.1016/j.jinf.2022.02.004

PMID:35150766

Abstract

OBJECTIVE

Sepsis is the leading course of morbidity and mortality in critically ill patients. This study aimed to evaluate the predictive value of the platelet aggregation for mortality in patients with sepsis. In addition, the relationship between impaired mitochondria and the platelet aggregation was explored.

METHOD

This was a prospective, observational cohort study. The platelet aggregation rate in response to adenosine diphosphate (ADP) was assessed. The primary outcome was 28-day mortality. Platelet mitochondrial parameters, including adenosine triphosphate(ATP), mitochondrial membrane potential (MMP) and mitochondrial permeability transition pore (mPTP) opening, were measured. Platelet mitochondrial ultrastructure was observed using transmission electron microscopy.

RESULTS

86 patients with 65 survivors and 21 non-survivors were enrolled. Platelets of non-survivors with sepsis were hyporesponsive to ADP, in terms of maximal aggregation rate (P < 0.001). Receiver operating characteristic curves analysis demonstrated that the AUC estimated 28-day mortality for platelet aggregation rate was 0.814. At the optimal cut-off value of 35.8% for platelet aggregation rate, the sensitivity was 86.2% and the specificity was 66.7%. Kaplan-Meier analysis showed that a platelet aggregation rate of less than 35.8% was associated closely with poor survival. After adjusting for lactate by Cox regression analysis, platelet aggregation rate was identified as an independent predictor for the probability of 28-day mortality. Compared with survivors, non-survivors showed a significant reduction in platelet ATP and MMP-index (both P < 0.001), and a remarkable increase in mPTP opening (P < 0.001). ATP and MMP-index were positively correlated with platelet aggregation rate (R square=0.75, R square=0.44, respectively).

CONCLUSION

Platelet aggregation rate could be an early predictive biomarker for mortality in sepsis. Impaired platelet mitochondrial activity affects platelet aggregation and correlates with the severity of sepsis.

摘要

目的

脓毒症是危重症患者发病和死亡的主要原因。本研究旨在评估血小板聚集对脓毒症患者死亡率的预测价值。此外，还探讨了线粒体功能障碍与血小板聚集之间的关系。

方法

这是一项前瞻性观察性队列研究。评估了血小板对二磷酸腺苷（ADP）的聚集率。主要结局是28天死亡率。测量了血小板线粒体参数，包括三磷酸腺苷（ATP）、线粒体膜电位（MMP）和线粒体通透性转换孔（mPTP）开放情况。使用透射电子显微镜观察血小板线粒体超微结构。

结果

共纳入86例患者，其中65例存活，21例死亡。脓毒症死亡患者的血小板对ADP反应低下，最大聚集率方面（P<0.001）。受试者工作特征曲线分析表明，血小板聚集率预测28天死亡率的曲线下面积（AUC）为0.814。血小板聚集率的最佳截断值为35.8%时，敏感性为86.2%，特异性为66.7%。Kaplan-Meier分析表明，血小板聚集率低于35.8%与生存率低密切相关。经Cox回归分析校正乳酸后，血小板聚集率被确定为28天死亡率概率的独立预测因素。与存活者相比，死亡者的血小板ATP和MMP指数显著降低（均P<0.001），mPTP开放显著增加（P<0.001）。ATP和MMP指数与血小板聚集率呈正相关（决定系数分别为0.75、0.44）。