Wu Huai-Chueh Gem, Wu Huai-Shing, Cheng Chao-Neng, Chen Jiann-Shiuh, Chen Tsai-Yun, Li Chung-I, Shen Ching-Fen
Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Education Center, National Cheng Kung University Hospital, Tainan, Taiwan.
Front Med (Lausanne). 2022 Sep 2;9:940159. doi: 10.3389/fmed.2022.940159. eCollection 2022.
Patients with thrombocytopenia (platelet count <150 × 10/μL) often develop pulmonary hemorrhage (PH) after (SM) respiratory infection, resulting in a high respiratory failure rate and increased mortality. Developing an efficient method for early prediction of PH in these patients may improve survival. This study aimed to evaluate risk factors in PH and to develop an index measuring serial platelet deficit to predict PH in patients with SM respiratory infection. Data of patients with SM respiratory infection and thrombocytopenia treated in a tertiary university hospital during 2018-2020 were retrospectively retrieved from electronic medical records and analyzed. SM respiratory infection was defined as SM isolated from sputum, endotracheal suction, or bronchial alveolar lavage plus acute respiratory symptoms. Between PH and non-PH groups, clinical characteristics and laboratory parameters were collected and compared. The newly developed platelet dissimilarity index (d-index) was calculated by accumulating differences between the actual and the lowest normal level of the platelet count in each patient at different time points. Within 1,039 patients with positive SM culture, 437 cases matched the criteria and were analyzed. A total of 125 (28.6%) patients developed PH and 312 (71.4%) did not. The patients with PH had increased prothrombin time/international normalized ratio (PT/INR), lower platelet count, and higher platelet d-index. Multivariate analysis revealed that extreme thrombocytopenia (platelet count <50 × 10/μL) is a common independent risk factor in PH and mortality. The performance of platelet deficit and d-index varied between patients with different comorbidities. Performance of platelet deficit to predict PH is better in patients with hematology/oncology or liver disease (area under curve, 0.705-0.757), while d-index is better in patients with sepsis/treatment and various other groups (0.711-0.816). Prolonged and extreme thrombocytopenia is a determinant risk factor in PH in patients with SM respiratory infection. Given the complexity of causes of thrombocytopenia and associated comorbidities, different strategies should be applied when assessing the risk for PH.
血小板减少症（血小板计数<150×10⁹/μL）患者在发生严重急性呼吸综合征（SARS-CoV-2）相关呼吸道感染后常发生肺出血（PH），导致呼吸衰竭率高和死亡率增加。开发一种有效的方法来早期预测这些患者的PH可能会提高生存率。本研究旨在评估PH的危险因素，并开发一种测量连续血小板减少的指标来预测SARS-CoV-2相关呼吸道感染患者的PH。回顾性检索并分析了2018年至2020年在一所三级大学医院接受治疗的SARS-CoV-2相关呼吸道感染和血小板减少症患者的数据。SARS-CoV-2相关呼吸道感染定义为从痰液、气管内吸出物或支气管肺泡灌洗中分离出SARS-CoV-2加上急性呼吸道症状。收集并比较了PH组和非PH组的临床特征和实验室参数。通过累积每个患者在不同时间点血小板计数的实际水平与最低正常水平之间的差异来计算新开发的血小板差异指数（d指数）。在1039例SARS-CoV-2培养阳性的患者中，437例符合标准并进行了分析。共有125例（28.6%）患者发生PH，312例（71.4%）未发生。发生PH的患者凝血酶原时间/国际标准化比值（PT/INR）升高、血小板计数降低且血小板d指数升高。多因素分析显示，严重血小板减少症（血小板计数<50×10⁹/μL）是PH和死亡率的常见独立危险因素。血小板减少和d指数的表现因合并症不同的患者而异。血小板减少预测PH的性能在血液学/肿瘤学或肝病患者中更好（曲线下面积，0.705 - 0.757），而d指数在脓毒症/治疗患者和其他各种组中更好（0.711 - 0.816）。长期和严重血小板减少是SARS-CoV-2相关呼吸道感染患者发生PH的决定性危险因素。鉴于血小板减少的原因和相关合并症的复杂性，在评估PH风险时应采用不同的策略。
