Department of Nephrology, Peking University People's Hospital, Unit 10C in Ward Building, 11 Xizhimennan Street, Xicheng District, Beijing, 100044, China.
DOPPS Program Area, Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
Sci Rep. 2024 Nov 4;14(1):26572. doi: 10.1038/s41598-024-77718-7.
Our previous manuscript showed that thrombocytopenia predicts all-cause mortality in Chinese hemodialysis (HD) patients. Based on the role of platelets in coagulation, clot formation, and systemic inflammation, we speculate that high platelets increase risk of thrombo-embolic events, hence the mortality. However, research evidence is currently lacking. Therefore, we utilized data from a very large international cohort study to explore the association of platelet counts with mortality and cardiovascular (CV) death in hemodialysis (HD) patients. International data from 396 facilities enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 5 (2012-2015) were analyzed. Participants were divided into 3 groups according to their platelet counts (low: <100, normal: 100-300, high: >30010). Associations between platelet counts and all-cause and CV mortality were analyzed using Cox regression, adjusted for confounders. There were 13,631 patients with median age of 65 years old. Males accounted for 61.2%. Mean platelet count was 20510/L overall and ranged from 173 *10/L in China to 227 *10/L in Sweden. Overall, 2,348 (17.2%) patients died and 1017 (7.5%) died from CV disease. Both low (HR:1.48, 95% CI 1.21-1.80, p < 0.001) and high (HR:1.17, 95% CI 1.00- 1.35, p = 0.044) platelet counts were associated with higher all-cause mortality after adjustment for covariates; results for CV death were consistent. Platelet count has a U-shaped association with all-cause and CV mortality in HD patients, and thus may be used as an outcome predictor that is readily available among HD patients.
我们之前的研究表明，血小板减少症可预测中国血液透析（HD）患者的全因死亡率。基于血小板在凝血、血栓形成和全身炎症中的作用，我们推测高血小板会增加血栓栓塞事件的风险，进而导致死亡率增加。然而，目前缺乏相关研究证据。因此，我们利用来自一个非常大型的国际队列研究的数据，探讨了血小板计数与血液透析（HD）患者死亡率和心血管（CV）死亡的关系。对 Dialysis Outcomes and Practice Patterns Study（DOPPS）第五阶段（2012-2015 年）的 396 个参与机构的国际数据进行了分析。根据血小板计数（低：<100、正常：100-300、高：>30010）将参与者分为 3 组。使用 Cox 回归分析调整混杂因素后，分析血小板计数与全因死亡率和 CV 死亡率之间的关系。共有 13631 名患者，中位年龄为 65 岁，男性占 61.2%。总体平均血小板计数为 20510/L，范围从中国的 17310/L 到瑞典的 22710/L。共有 2348 例（17.2%）患者死亡，1017 例（7.5%）死于心血管疾病。在调整了混杂因素后，低（HR：1.48，95%CI 1.21-1.80，p<0.001）和高（HR：1.17，95%CI 1.00-1.35，p=0.044）血小板计数均与全因死亡率升高相关；CV 死亡的结果一致。血小板计数与 HD 患者的全因和 CV 死亡率呈 U 型相关，因此可用作 HD 患者中易于获得的预后预测指标。
