基线血小板对中风和癌症患者死亡风险的影响：美国国家健康与营养检查调查（NHANES）数据库的横断面分析

The influence of baseline platelet on mortality risk in stroke and cancer patients: a cross-sectional analysis of the NHANES database.

作者信息

Pei Yuqi, Ouyang Wei, Qi Peiyun, Yan Zhongjie, Li Yaoru, Zhang Xiangjian, Zhang Cong, Cui Lili

机构信息

Department of Neurology, The Second Hospital of Hebei Medical University, NO.309 Zhonghuabei Street, Hebei, 050000, China.

College of Integrated Chinese and Western Medicine, Hebei Medical University, Shijiazhuang, 050000, Hebei, China.

出版信息

BMC Neurol. 2025 Jan 22;25(1):30. doi: 10.1186/s12883-025-04043-5.

DOI:10.1186/s12883-025-04043-5

PMID:39844121

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11752736/

Abstract

BACKGROUND

Platelet count and function may be closely related to survival and prognosis of stroke and cancer. However, little is known on the impact of platelet count on the patients with a history of stroke and cancer. This study aimed to examine the association between baseline platelet level and all-cause mortality in this population using a cross-sectional analysis.

METHODS

Participants with a history of stroke and cancer were selected from the database of the National Health and Nutrition Examination Survey from 2007 to 2018. A maximum selected rank statistic was conducted to determine platelet cutoff with the most significant association with mortality. The association between platelet and mortality was characterized visually using restricted cubic spline (RCS). Weighted multivariable Cox regression models were performed to evaluate the association between platelet count and mortality. Time-dependent receiver operating characteristic (ROC) analysis was conducted to assess the accuracy of platelet count in predicting mortality.

RESULTS

Forty-three (43/113, 38.05%) stroke patients with cancer were alive at a median follow-up of 42 months (interquartile range, 23-74 months). The RCS analysis demonstrated a linear relationship between platelet and mortality (nonlinear, p = 0.352). Mortality in higher-platelet group (> 209 × 10/L, n = 57) was decreased than lower-platelet group (≤ 209 × 10/L, n = 56) (Model 1 HR 0.43, 95% CI 0.24-0.77, p = 0.005) (Model 2 HR 0.58, 95% CI 0.35-0.96, p = 0.03). Subgroup analyses showed no significant interaction between platelet and age, sex, BMI, WBC and neutrophil. The areas under time-dependent ROC curve of the 1-, 2-, 3-, 4- and 5-year survival rates were 0.54, 0.55, 0.57, 0.53, 0.59 for mortality of stroke patients with cancer.

CONCLUSIONS

Lower platelet count may be an independent predictor of all-cause mortality in population with a history of stroke and cancer. This result may provide valuable insights for the long-term management in stroke patients with cancer.

摘要

背景

血小板计数和功能可能与中风和癌症的生存率及预后密切相关。然而，关于血小板计数对有中风和癌症病史患者的影响知之甚少。本研究旨在通过横断面分析来研究该人群中基线血小板水平与全因死亡率之间的关联。

方法

从2007年至2018年的美国国家健康与营养检查调查数据库中选取有中风和癌症病史的参与者。采用最大选定秩统计量来确定与死亡率关联最显著的血小板临界值。使用受限立方样条（RCS）直观地描述血小板与死亡率之间的关联。进行加权多变量Cox回归模型以评估血小板计数与死亡率之间的关联。进行时间依赖性受试者工作特征（ROC）分析以评估血小板计数预测死亡率的准确性。

结果

43名（43/113，38.05%）患有癌症的中风患者在中位随访42个月（四分位间距，23 - 74个月）时仍存活。RCS分析显示血小板与死亡率之间呈线性关系（非线性，p = 0.352）。血小板计数较高组（> 209×10⁹/L，n = 57）的死亡率低于血小板计数较低组（≤ 209×10⁹/L，n = 56）（模型1风险比0.43，95%置信区间0.24 - 0.77，p = 0.005）（模型2风险比0.58，95%置信区间0.35 - 0.96，p = 0.03）。亚组分析显示血小板与年龄、性别、体重指数、白细胞和中性粒细胞之间无显著交互作用。对于患有癌症的中风患者的死亡率，1年、2年、3年、4年和5年生存率的时间依赖性ROC曲线下面积分别为0.54、0.55、0.57、0.53、0.59。