血小板分布宽度作为脓毒症相关急性肾损伤的一种经济有效的标志物：一项回顾性横断面研究。
Platelet distribution width as a cost-effective marker for sepsis-associated acute kidney injury: A retrospective cross-section study.
作者信息
Yin Xuelian, Li Jiebin, Ren Enfeng, Zheng Yi, Zhao Hong, Zhang Jing, Du Qingxia
机构信息
Department of Emergency, The Affiliated Tongren Hospital of Capital Medical University, Beijing, China.
出版信息
PLoS One. 2025 May 13;20(5):e0321639. doi: 10.1371/journal.pone.0321639. eCollection 2025.
BACKGROUND
Sepsis-associated acute kidney injury (S-AKI) is a critical complication with high morbidity and mortality. The potential predictive role of platelet distribution width (PDW) in S-AKI remains to be elucidated, and its clinical implications in S-AKI are still not well understood.
OBJECTIVE
This study aims to determine whether platelet distribution width within 24 hours of admission could serve as a predictor of S-AKI in septic patients.
METHOD
A retrospective analysis of platelet indices in patients with sepsis at the Affiliated Tongren Hospital of Capital Medical University, a tertiary medical center, was conducted from 2015 to 2022. Patients with sepsis were divided into two groups: an S-AKI group and a non-AKI group based on the presence of S-AKI during hospital. Clinical characteristics and laboratory parameters at admission were compared between two groups. A Multivariate logistic regression analysis was conducted to identify risk factors for S-AKI in septic patients. Additionally, receiver operating characteristics (ROC) curve was employed to evaluate the predictive value of these indices for S-AKI in septic patients.
RESULT
A total of 410 patients with sepsis were included in the study, including 57 in S-AKI group and 353 in non-AKI group. The levels of PDW and average platelet volume were significantly higher in the S-AKI group compared to those in the non-AKI group. Furthermore, PDW exhibited a positive correlation with SOFA score, APACHE II score, and LDH levels (r = 0.273, r = 0.153, r = 0.233), yielding P-values <0.001, 0.008, and < 0.001 respectively. Multivariate logistic regression analysis identified PDW (OR = 1.324, 95% CI: 1.124-1.559, P = 0.001), SOFA scores (OR = 1.264, 95% CI: 1.011-1.579, P = .040) and LDH (OR = 1.005, 95% CI: 1.002-1.008, P = .002) as independent risk factors for S-AKI in sepsis patients. The area under curve (AUC) values for predicting S -AKI using PDW, SOFA, LDH, and combined SOFA-PDW metrics were found to be approximately equal to 0.696 (95% CI: 0.621-0.771, P = .000), 0.771 (95% CI: 0.706-0.837, P = .000) and 0.695 (95% CI: 0.611-0.780, P = .000), 0.799 (95% CI: 0.739-0.858) respectively.
CONCLUSION
PDW values on admission may serve as a useful potential indicator of disease severity and a potential parameter for predicting S-AKI.
背景
脓毒症相关急性肾损伤（S-AKI）是一种发病率和死亡率都很高的严重并发症。血小板分布宽度（PDW）在S-AKI中的潜在预测作用尚待阐明，其在S-AKI中的临床意义仍未得到充分理解。
目的
本研究旨在确定入院24小时内的血小板分布宽度是否可作为脓毒症患者发生S-AKI的预测指标。
方法
对首都医科大学附属同仁医院（一家三级医疗中心）2015年至2022年期间脓毒症患者的血小板指标进行回顾性分析。根据住院期间是否发生S-AKI，将脓毒症患者分为两组：S-AKI组和非AKI组。比较两组患者入院时的临床特征和实验室参数。进行多因素逻辑回归分析，以确定脓毒症患者发生S-AKI的危险因素。此外，采用受试者工作特征（ROC）曲线评估这些指标对脓毒症患者发生S-AKI的预测价值。
结果
本研究共纳入410例脓毒症患者，其中S-AKI组57例，非AKI组353例。S-AKI组的PDW和平均血小板体积水平显著高于非AKI组。此外，PDW与序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康状况评分系统II（APACHE II）评分及乳酸脱氢酶（LDH）水平呈正相关（r = 0.273、r = 0.153、r = 0.233），P值分别<0.001、0.008及<0.001。多因素逻辑回归分析确定PDW（比值比[OR]=1.324，95%置信区间[CI]：1.124 - 1.559，P = 0.001）、SOFA评分（OR = 1.264，95%CI：1.011 - 1.579，P = 0.040）和LDH（OR = 1.005，95%CI：1.002 - 1.008，P = 0.002）为脓毒症患者发生S-AKI的独立危险因素。使用PDW、SOFA、LDH及联合SOFA-PDW指标预测S-AKI的曲线下面积（AUC）值分别约为0.696（95%CI：0.621 - 0.771，P = 0.000）、0.771（95%CI：0.706 - 0.837，P = 0.000）、0.695（95%CI：0.611 - 0.780，P = 0.000）、0.799（95%CI：0.739 - 0.858）。
结论
入院时的PDW值可能是疾病严重程度的有用潜在指标及预测S-AKI的潜在参数。
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