Li Jiamei, Li Ruohan, Jin Xuting, Ren Jiajia, Du Linyun, Zhang Jingjing, Gao Ya, Liu Xiu, Hou Yanli, Zhang Lei, Song Zhenju, Song Jingchun, Wang Xiaochuang, Wang Gang
Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Laboratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Platelets. 2022 Nov 17;33(8):1168-1174. doi: 10.1080/09537104.2022.2066646. Epub 2022 Apr 29.
Platelets play important roles in thrombosis, hemostasis, inflammation, and infection. We aimed to evaluate the association between platelet count and its variation trend and prognosis of patient with infectious diseases in intensive care units (ICUs). This retrospective cohort study extracted 4,251 critically ill adult patients with infectious diseases from the eICU Collaborative Research Database, whose platelet counts were measured daily during the first 7 days after admission. In the survivors, platelet counts decreased in the first days after admission, reached a nadir on day 3, and then returned and continued to rise above the admission value. In non-survivors, the platelet counts decreased after admission, without a subsequent upturn. We defined three subgroups according to the nadir platelet counts within 7 days: ≤50, 50-130, and ≥130 × 10/L, corresponding to high, intermediate, and low ICU mortality. A decreased platelet count was associated with increased ICU mortality (intermediate vs. low: 1.676 [1.285-2.187]; high vs. low: 3.632 [2.611-5.052]). In conclusion, during the first 7 days, platelet counts decreased after ICU admission, while increased subsequently in the survivors but not in the non-survivors. ICU mortality risk increased as nadir platelet count decreased below 130 × 10/L, and further boosted when it reached below 50 × 10/L.
血小板在血栓形成、止血、炎症和感染过程中发挥着重要作用。我们旨在评估重症监护病房（ICU）中传染病患者的血小板计数及其变化趋势与预后之间的关联。这项回顾性队列研究从eICU协作研究数据库中提取了4251例患有传染病的成年重症患者，这些患者在入院后的前7天每天测量血小板计数。在幸存者中，血小板计数在入院后的头几天下降，在第3天达到最低点，然后回升并继续升至高于入院时的值。在非幸存者中，血小板计数在入院后下降，随后没有回升。我们根据7天内的最低血小板计数定义了三个亚组：≤50、50 - 130和≥130×10⁹/L，分别对应高、中、低ICU死亡率。血小板计数降低与ICU死亡率增加相关（中 vs. 低：1.676 [1.285 - 2.187]；高 vs. 低：3.632 [2.611 - 5.052]）。总之，在最初的7天内，ICU入院后血小板计数下降，而幸存者随后升高，非幸存者则不然。当最低血小板计数降至低于130×10⁹/L时，ICU死亡风险增加，当降至低于50×10⁹/L时，风险进一步升高。
