Rossetto Andrea, Kerner Simon, Ykema Ella, Allan Harriet E, Armstrong Paul C, Cole Elaine, Vulliamy Paul
Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.
Trauma Service, Barts Health National Health Service Trust, London, UK.
Res Pract Thromb Haemost. 2025 May 17;9(4):102890. doi: 10.1016/j.rpth.2025.102890. eCollection 2025 May.
Although significant thrombocytopenia is not a common feature of trauma patients in the first hours after injury, little is known about how severe trauma affects platelet count trajectories beyond the initial resuscitation phase and whether changes in platelet count are related to clinical outcomes such as multiple organ dysfunction syndrome and mortality.
To define the incidence, severity, and clinical significance of postinjury thrombocytopenia during critical care admission.
Trauma patients enrolled in a perpetual cohort study at a single level 1 trauma center between 2014 and 2023 who required critical care admission were included. Thrombocytopenia was classified as mild (100-149 × 10/L), moderate (50-99 × 10/L), and severe (<50 × 10/L). Multivariable regression analyses were used to investigate the drivers of thrombocytopenia and its association with outcomes of organ dysfunction, organ support, and mortality.
Among 803 trauma patients investigated, mild, moderate, and severe thrombocytopenia occurred in 285 (35%), 290 (36%), and 51 (6%), respectively, with the nadir mostly between 48 and 72 hours of their critical care stay. Age, injury severity, shock, admission coagulopathy, and total fluid administration within the first 24 hours were all independently associated with the development of moderate-severe thrombocytopenia. Thrombocytopenia of any severity was independently associated with renal and hepatic dysfunction, but not with cardiorespiratory dysfunction or mortality. Severe thrombocytopenia was also independently associated with prolonged need for organ support (odds ratio, 2.83; 95% CI, 1.07-7.45; = .04).
Thrombocytopenia is common in injured patients admitted to critical care, and severe forms are independently associated with a higher incidence of organ dysfunction and need for organ support.
尽管严重血小板减少在创伤患者受伤后的最初数小时内并非常见特征，但对于严重创伤在初始复苏阶段之后如何影响血小板计数轨迹，以及血小板计数的变化是否与多器官功能障碍综合征和死亡率等临床结局相关，人们了解甚少。
确定重症监护入院期间创伤后血小板减少的发生率、严重程度及临床意义。
纳入2014年至2023年期间在一家一级创伤中心参与一项永久性队列研究且需要重症监护入院的创伤患者。血小板减少分为轻度（100 - 149×10⁹/L）、中度（50 - 99×10⁹/L）和重度（<50×10⁹/L）。采用多变量回归分析来研究血小板减少的驱动因素及其与器官功能障碍、器官支持和死亡率结局的关联。
在803例接受调查的创伤患者中，轻度、中度和重度血小板减少分别发生在285例（35%）、290例（36%）和51例（6%），最低点大多出现在重症监护住院的48至72小时之间。年龄、损伤严重程度、休克、入院时凝血病以及最初24小时内的总液体输入量均与中重度血小板减少的发生独立相关。任何严重程度的血小板减少均与肾和肝功能障碍独立相关，但与心肺功能障碍或死亡率无关。严重血小板减少还与延长的器官支持需求独立相关（比值比，2.83；95%置信区间，1.07 - 7.45；P = 0.04）。
血小板减少在入住重症监护的受伤患者中很常见，严重形式与器官功能障碍的较高发生率和器官支持需求独立相关。
