Zeng Yan, You Shisong, Yuan Ruili, Yue Shuhan, Zhang Jingwei
Department of Hematology, Chengdu Second People's Hospital, Chendu, China.
Department of BIood Transfusion, Chengdu Second People's Hospital, Chengdu, China.
PLoS One. 2025 Jun 5;20(6):e0323429. doi: 10.1371/journal.pone.0323429. eCollection 2025.
Multiple myeloma (MM) is a malignant blood disease characterized by the abnormal proliferation of immature plasma cells in the bone marrow. Changes in platelet counts (PLT) may significantly impact patient mortality. This study investigates the correlation between platelet counts and mortality rates in critically ill multiple myeloma patients admitted to the Intensive Care Unit (ICU).
A retrospective cohort study was conducted with 242 patients diagnosed with MM. Data on platelet count(PLT), red blood cell count(RBC), serum calcium levels, International Normalized Ratio (INR), Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), and comorbidities were collected. The study captured the highest and lowest values of laboratory data for patients during their ICU admission. Logistic regression analysis and smooth curve fitting technique were used for analysis. Subgroup analysis was applied to detect cross interactions. Sensitivity analysis was applied to detect consistency.
When the minimum PLT (PLT-min) were treated as a continuous variable at every 10 × 109/L, the multivariate logistic regression analysis revealed that decreased PLT-min levels was an independent risk factor for mortality rate of critically ill patients with MM [Odds ratio (OR)=0.94, 95% confidence interval (95% CI): 0.89‑0.99, p = 0.023]. Additionally, when PLT-min levels were categorized into tertiles as <95 × 109/L (group 1), 95-160 × 109/L (group 2), and >160 × 109/L (group 3), a decrease in PLT-min levels was also associated with an increasing trend in hospital mortality rate. Compared to group 1, the OR values of group 2 and group 3 were 0.40((95% CI:0.15-1.07, p = 0.069) and 0.30 (95% CI: 0.11‑0.82, p = 0.020). The relationship between PLT-min and in-hospital mortality was found to be nonlinear. Subgroup analysis showed no significant interactions. Similar results were obtained when analyzing the association of maximum PLT(PLT-max) and mortality rate.
In MM patients in ICU, both minimum and maximum PLT were significantly associated with an increased risk of in-hospital mortality in critical ill patients with MM. These findings are important and warrant further investigation.
多发性骨髓瘤（MM）是一种恶性血液病，其特征是骨髓中未成熟浆细胞异常增殖。血小板计数（PLT）的变化可能会显著影响患者死亡率。本研究调查了入住重症监护病房（ICU）的重症多发性骨髓瘤患者血小板计数与死亡率之间的相关性。
对242例确诊为MM的患者进行了一项回顾性队列研究。收集了血小板计数（PLT）、红细胞计数（RBC）、血清钙水平、国际标准化比值（INR）、序贯器官衰竭评估（SOFA）评分、简化急性生理学评分II（SAPS II）以及合并症的数据。该研究记录了患者在ICU住院期间实验室数据的最高值和最低值。采用逻辑回归分析和平滑曲线拟合技术进行分析。应用亚组分析来检测交叉相互作用。应用敏感性分析来检测一致性。
当将最低PLT（PLT-min）每10×10⁹/L作为连续变量处理时，多因素逻辑回归分析显示，PLT-min水平降低是重症MM患者死亡率的独立危险因素[比值比（OR）=0.94，95%置信区间（95%CI）：0.89 - 0.99，p = 0.023]。此外，当将PLT-min水平分为三分位数时，即<95×10⁹/L（第1组）、95 - 160×10⁹/L（第2组）和>160×10⁹/L（第3组），PLT-min水平降低也与医院死亡率的上升趋势相关。与第1组相比，第2组和第3组的OR值分别为0.40（95%CI：0.15 - 1.07，p = 0.069）和0.30（95%CI：0.11 - 0.82，p = 0.020）。发现PLT-min与院内死亡率之间的关系是非线性的。亚组分析未显示显著的相互作用。分析最高PLT（PLT-max）与死亡率的关联时也获得了类似结果。
在ICU的MM患者中，最低和最高PLT均与重症MM患者院内死亡风险增加显著相关。这些发现很重要，值得进一步研究。
