Department of Emergency Medicine, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China.
Department of Emergency Medicine, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, 518027, China.
Sci Rep. 2024 Sep 28;14(1):22535. doi: 10.1038/s41598-024-73717-w.
This study addresses the relationship between platelet count and 30-day in-hospital mortality in End-Stage Kidney Disease (ESRD) patients in the intensive care unit (ICU), a topic with limited existing evidence. Utilizing data from the US eICU-CRD v2.0 database (2014-2015), a retrospective cohort study was conducted involving 3700 ICU ESRD patients. We employed binary logistic regression, smooth curve fitting, and subgroup analyses to explore the association between platelet count and 30-day in-hospital mortality. The 30-day in-hospital mortality rate was 13.27% (491/3700), with a median platelet count of 188 × 10/L. After adjusting for covariates, we observed a relationship between platelet count and 30-day in-hospital mortality (OR = 0.98, 95% CI 0.97, 0.99). Subgroup analyses supported these findings. More importantly, a nonlinear association was detected, with an inflection point at 222 × 10/L. The effect sizes (OR) on the left and right sides of the inflection point were 0.94 (0.92, 0.96) and 1.03 (1.00, 1.05), respectively. The most significant finding of this study is the revelation of a nonlinear relationship between baseline platelet count and 30-day in-hospital mortality in ICU patients with ESRD. This discovery explicitly suggests that when ESRD patients are admitted to the ICU, a platelet level closer to 222 × 10⁹/L may predict a lower 30-day in-hospital mortality risk.
这项研究探讨了重症监护病房（ICU）终末期肾病（ESRD）患者血小板计数与 30 天院内死亡率之间的关系，这是一个现有证据有限的话题。本研究利用美国 eICU-CRD v2.0 数据库（2014-2015 年）中的数据，进行了一项回顾性队列研究，涉及 3700 名 ICU-ESRD 患者。我们采用二元逻辑回归、平滑曲线拟合和亚组分析来探讨血小板计数与 30 天院内死亡率之间的关系。30 天院内死亡率为 13.27%（491/3700），血小板计数中位数为 188×10/L。在调整了协变量后，我们观察到血小板计数与 30 天院内死亡率之间存在关联（OR=0.98，95%CI 0.97，0.99）。亚组分析支持这些发现。更重要的是，我们检测到了一个非线性的关联，拐点在 222×10/L。拐点左右两侧的效应大小（OR）分别为 0.94（0.92，0.96）和 1.03（1.00，1.05）。这项研究最重要的发现是揭示了 ICU-ESRD 患者基线血小板计数与 30 天院内死亡率之间的非线性关系。这一发现明确表明，当 ESRD 患者入住 ICU 时，血小板水平接近 222×10/L 可能预示着 30 天院内死亡率风险较低。
