感染性心内膜炎重症患者血小板计数与28天死亡率之间的非线性关系：一项来自MIMIC IV数据库的回顾性队列研究

Non-linear relationship between platelet count and 28-day mortality in critically ill patients with infective endocarditis: a retrospective cohort study from MIMIC IV database.

作者信息

Huang Yingxiu, Ao Ting, Zhen Peng, Hu Ming

机构信息

Department of Infectious Disease, Beijing Luhe Hospital, Capital Medical University, Beijing, China.

出版信息

Front Cardiovasc Med. 2024 Nov 29;11:1458238. doi: 10.3389/fcvm.2024.1458238. eCollection 2024.

DOI:10.3389/fcvm.2024.1458238

PMID:39677035

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11638226/

Abstract

BACKGROUND

The relationship between platelet count and 28-day mortality in critically ill patients with infective endocarditis (IE) is currently not well established.

OBJECTIVE

This study aims to investigate the impact of platelet count on 28-day mortality in critically ill patients with infective endocarditis.

METHODS

A retrospective cohort study was conducted involving 450 participants diagnosed with infective endocarditis and admitted to intensive care units (ICU). Vital signs, laboratory parameters and comorbidity were collected for all participants to analyze the association between platelet count and 28-day mortality. In order to assess the independent association between platelet count and 28-day mortality, we employed multivariable cox hazard regression analyses and smooth curve fitting. A further analysis was conducted using a two-piecewise linear regression model to examine the nonlinear association between platelet count and in-hospital mortality.

RESULTS

A total of 450 critically ill patients with infective endocarditis were included in the study. The mean age was 57.4 years, and 64.2% were male. The overall 28-day mortality rate was 20%. A non-linear relationship was observed between platelet count and 28-day mortality. Two different slopes were identified, with correlations between platelet count and 28-day mortality in patients with IE differing significantly below and above the inflection point, which was approximately 141 K/µl. On the left side of the inflection point, the hazard ratio was 0.990 (hazard ratio: 0.990, 95% confidence interval: 0.982-0.997, = 0.006). However, on the right side of the inflection point, the hazard ratio increased marginally to 1.0004 (HR: 1.0004, 95% CI: 0.997-1.004, = 0.825). Notably, the association lacked statistical significance on the right side of the inflection point.

CONCLUSION

A nonlinear association between platelet count and 28-day mortality was observed in critically ill patients with infective endocarditis. The optimal platelet count associated with the lowest risk of 28-day mortality was above 141 k/µl.

摘要

背景

目前，感染性心内膜炎（IE）重症患者的血小板计数与28天死亡率之间的关系尚不明确。

目的

本研究旨在探讨血小板计数对感染性心内膜炎重症患者28天死亡率的影响。

方法

进行一项回顾性队列研究，纳入450例诊断为感染性心内膜炎并入住重症监护病房（ICU）的患者。收集所有参与者的生命体征、实验室参数和合并症，以分析血小板计数与28天死亡率之间的关联。为了评估血小板计数与28天死亡率之间的独立关联，我们采用多变量cox风险回归分析和平滑曲线拟合。使用两段式线性回归模型进行进一步分析，以检验血小板计数与住院死亡率之间的非线性关联。

结果

本研究共纳入450例感染性心内膜炎重症患者。平均年龄为57.4岁，男性占64.2%。总体28天死亡率为20%。观察到血小板计数与28天死亡率之间存在非线性关系。确定了两个不同的斜率，IE患者血小板计数与28天死亡率之间的相关性在拐点（约141 K/µl）以下和以上存在显著差异。在拐点左侧，风险比为0.990（风险比：0.990，95%置信区间：0.982-0.997，P = 0.006）。然而，在拐点右侧，风险比略微增加至1.0004（HR：1.0004，95%CI：0.997-1.004，P = 0.825）。值得注意的是，拐点右侧的关联缺乏统计学意义。