Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
BMC Cardiovasc Disord. 2024 Jul 22;24(1):379. doi: 10.1186/s12872-024-04041-4.
Further research is needed to assess the risk and prognosis after valve replacement surgery in elderly patients. This study aims to assess the prognostic value of platelet levels following valve replacement in elderly patients.
A retrospective analysis was conducted on 3814 elderly individuals who underwent valve replacement surgery, categorized into quartiles based on postoperative platelet levels. Univariate and multiple regression analysis were used to assess the risk factors associated with postoperative platelet levels and in-hospital death.The Receiver Operating Characteristic (ROC) curve was utilized to establish the postoperative platelet level threshold indicative of in-hospital mortality risk, while the Kaplan-Meier curve compared the one-year postoperative survival among patients with differing postoperative platelet levels.
The low postoperative platelet levels group had a higher incidence of massive bleeding (> 400 ml), necessitating platelet transfusion and prolonged cardiopulmonary bypass during surgery (P < 0.001). However, postoperative occurrences of heart failure and stroke did not achieve statistical significance (P > 0.05). Multivariate regression analysis disclosed an association between postoperative platelet levels and in-hospital death (OR: 2.040, 95% CI: 1.372-3.034, P < 0.001). Over the one-year follow-up, patients with low platelet levels postoperatively had poorer overall survival than patients with higher platelet levels (P < 0.001) CONCLUSION: Postoperative platelets can serve as a prognostic indicator after valve surgery in elderly patients as a simple and easily available biochemical indicator. Enhanced monitoring and management postoperative platelet level in the elderly may be beneficial to improve the survival outcome of patients.
需要进一步研究来评估老年患者瓣膜置换手术后的风险和预后。本研究旨在评估老年患者瓣膜置换术后血小板水平的预后价值。
对 3814 名接受瓣膜置换手术的老年患者进行回顾性分析，根据术后血小板水平分为四组。采用单因素和多因素回归分析评估与术后血小板水平相关的危险因素和院内死亡。利用受试者工作特征（ROC）曲线确定术后血小板水平提示院内死亡风险的阈值，同时通过 Kaplan-Meier 曲线比较不同术后血小板水平患者的一年术后生存率。
低术后血小板水平组大出血（>400ml）发生率较高，需要血小板输注和手术中体外循环时间延长（P<0.001）。然而，术后心力衰竭和中风的发生率无统计学意义（P>0.05）。多因素回归分析显示术后血小板水平与院内死亡相关（OR：2.040，95%CI：1.372-3.034，P<0.001）。在一年的随访中，术后血小板水平较低的患者总生存率低于血小板水平较高的患者（P<0.001）。
术后血小板可作为老年患者瓣膜手术后的预后指标，是一种简单且易于获得的生化指标。加强对老年患者术后血小板水平的监测和管理可能有助于改善患者的生存结局。
