血小板计数和指数在儿童脓毒症死亡率预测中的应用。
The Use of Platelet Count and Indices as Prognostic Factors for Mortality in Children with Sepsis.
机构信息
Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Department of Paediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
出版信息
Iran J Med Sci. 2024 Aug 1;49(8):494-500. doi: 10.30476/IJMS.2023.99084.3113. eCollection 2024 Aug.
BACKGROUND
Sepsis is still one of the leading causes of mortality and morbidity in children worldwide. Consumptive coagulopathy and suppression of thrombopoiesis in the bone marrow resulting from immune dysregulation are pathological mechanisms that cause thrombocytopenia in sepsis. Platelet count (PLT) and indices, such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) are markers of platelet activation and are strongly influenced by platelet morphology and proliferation kinetics. We aimed to study the use of platelet count and indices as predictors of mortality in children with sepsis.
METHODS
This is a cross-sectional study of 45 children diagnosed with sepsis on admission at Haji Adam Malik Hospital, Medan, North Sumatra, Indonesia, between October and November 2022. Blood samples were drawn upon admission, and platelet count and indices were then determined for all children. Subjects were followed up till discharge from hospital or death. Receiver Operating Characteristic (ROC) curve analysis of platelet parameters was done to determine the area under the curve (AUC), optimal cut-off value, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting mortality in children with sepsis. Using the cut-off values from ROC curve analysis, the odds ratio with 95% confidence interval was calculated using multiple logistic regression analyses. A P value less than 0.05 was considered statistically significant.
RESULTS
MPV, PDW, and PDW/PLT were significantly higher in non-survivors than survivors (P=0.04, P=0.02, and P=0.04, respectively). ROC curve analysis showed that PDW had the largest AUC (0.708 [95% CI=0.549-0.866]) with a cut-off value of 14.1%, sensitivity of 63.6%, and specificity of 82.6%. PDW was also the only parameter that significantly affected the outcome of children with sepsis. PDW≥14.1% at admission increases the risk of mortality by 5.7 times.
CONCLUSION
Admission PDW is a fast and specific tool to predict the outcome of children with sepsis.
背景
败血症仍然是全球儿童死亡和发病的主要原因之一。免疫失调导致的消耗性凝血病和骨髓中血小板生成抑制是导致败血症血小板减少的病理机制。血小板计数（PLT）和平均血小板体积（MPV）、血小板分布宽度（PDW）和血小板压积（PCT）等指标是血小板活化的标志物，强烈受血小板形态和增殖动力学的影响。我们旨在研究血小板计数和指标作为败血症儿童死亡率预测指标的作用。
方法
这是一项在印度尼西亚北苏门答腊棉兰的 Haji Adam Malik 医院于 2022 年 10 月至 11 月期间入院的 45 名败血症患儿的横断面研究。所有患儿入院时均抽取血样，然后测定血小板计数和指标。对患儿进行随访，直至出院或死亡。对血小板参数进行受试者工作特征（ROC）曲线分析，以确定曲线下面积（AUC）、最佳截断值、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），以预测败血症患儿的死亡率。使用 ROC 曲线分析的截断值，使用多因素逻辑回归分析计算优势比及其 95%置信区间。P 值小于 0.05 被认为具有统计学意义。
结果
非幸存者的 MPV、PDW 和 PDW/PLT 显著高于幸存者（P=0.04、P=0.02 和 P=0.04）。ROC 曲线分析显示 PDW 的 AUC 最大（0.708[95%CI=0.549-0.866]），截断值为 14.1%，敏感性为 63.6%，特异性为 82.6%。PDW 也是唯一显著影响败血症患儿结局的参数。入院时 PDW≥14.1%可使死亡率增加 5.7 倍。
结论
入院 PDW 是预测败血症患儿结局的快速、特异工具。
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