血小板减少症患者入住重症监护病房的出血风险前瞻性评估。

Prospective evaluation of bleeding risk among thrombocytopenic patients admitted in intensive care unit.

机构信息

Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France.

Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France.

出版信息

J Crit Care. 2024 Feb;79:154405. doi: 10.1016/j.jcrc.2023.154405. Epub 2023 Aug 31.

DOI:10.1016/j.jcrc.2023.154405

PMID:37659243

Abstract

PURPOSE

Bleeding risk evaluation of thrombocytopenic patients admitted in ICU has been poorly investigated.

METHODS

A prospective observational study conducted in an 18-bed medical ICU. Consecutive patients with thrombocytopenia (<150 Giga/L) and no bleeding at admission were included.

RESULTS

Over one year, 91 patients were included, mainly men (63%), with an age of 61 [46-68] years and a SOFA score of 6 [3-8]. Twenty-three patients (25%) had an hemorrhagic event during ICU stay, mainly digestive (n = 9; 39%) and urological (n = 6; 26%). The time between ICU admission and bleeding was 8 [2-19] days. Almost half of bleeding events required vasopressor infusion and a hemostatic procedure. At admission, two variables were significantly different between the Bleeding and No-Bleeding groups: plasma urea level was significantly higher in the Bleeding group (9 [5.1; 13] vs. 13 [8.9; 31] mmol/L; p < 0.001) and the presence of skin purpura was associated with a 3-fold higher risk for bleeding during ICU stay (HR: 3.4 [1.3-8.3]; p < 0.05). In contrast, admission platelet count was not significantly different between the 2 groups (90 [32; 128] vs 62 [36; 103] G/L; p = 0.26).

CONCLUSION

Plasma urea levels and the presence of skin purpura are helpful in identifying thrombocytopenic patients at high-risk of bleeding during ICU stay.

摘要

目的

入住 ICU 的血小板减少症患者的出血风险评估研究甚少。

方法

这是一项在 18 张床位的内科 ICU 进行的前瞻性观察研究。连续纳入血小板减少症（<150Giga/L）且入院时无出血的患者。

结果

在一年时间内，共纳入 91 例患者，主要为男性（63%），年龄 61 [46-68] 岁，SOFA 评分为 6 [3-8]。23 例（25%）患者在 ICU 期间发生出血事件，主要为消化系统（n=9；39%）和泌尿系统（n=6；26%）。从 ICU 入院到出血的时间为 8 [2-19] 天。几乎一半的出血事件需要血管加压素输注和止血措施。入院时，两组间有两个变量有显著差异：出血组的血浆尿素水平明显更高（9 [5.1；13] vs. 13 [8.9；31]mmol/L；p<0.001），皮肤瘀点的存在与 ICU 期间出血的风险增加 3 倍相关（HR：3.4 [1.3-8.3]；p<0.05）。相反，两组入院时血小板计数无显著差异（90 [32；128] vs 62 [36；103]G/L；p=0.26）。