Adelman Max W, Casarin Stefano, Kurian James, Miller William R, Connor Ashton, Hsu Enshuo, Sanghvi Aarjav A, Xu Jiaqiong, Auld Sara C, Jones Stephen L, Corry David B, Arias Cesar A, Nigo Masayuki
Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX, USA; Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Houston Methodist Hospital, Houston, TX, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
Center for Precision Surgery, Houston Methodist Research Institute, Houston, TX, USA; LaSIE, La Rochelle Université, La Rochelle, France; Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
Clin Microbiol Infect. 2025 Jul 29. doi: 10.1016/j.cmi.2025.07.021.
The objective of this study was to determine whether thrombocytopenia is independently associated with mortality in patients with bloodstream infections (BSIs) and compare the impact of platelets on mortality with that of white blood cells and neutrophils.
This retrospective cohort study used the following two U.S. cohorts of patients with BSIs: (1) patients at a multihospital network in the metropolitan Houston, Texas, area between July 01, 2016 and June 17, 2023, and (2) patients in the publicly available Medical Information Mart for Intensive Care (MIMIC)-IV database (2008-2022). We included patients who had their platelets checked in the 48 hours before positive blood culture collection. We created multivariable logistic regression models to determine whether 30-day in-hospital mortality was impacted by the degree of thrombocytopenia (severe [platelets <50 k/μL], moderate [50-99 k/μL], mild [100-149 k/μL], and none [≥150 k/μL]).
We included 21105 patients in the Houston cohort and 2710 in the MIMIC-IV cohort, and 30-day mortality in the Houston cohort was 12.0% (2524/21105) and was significantly associated with the platelet count. After controlling for confounders, the adjusted odds ratio (aOR) for 30-day mortality with severe thrombocytopenia was 4.66 (95% CI, 3.91-5.55); aOR for moderate thrombocytopenia was 2.61 (95% CI, 2.25-3.02); and aOR for mild thrombocytopenia was 1.55 (95% CI, 1.37-1.76), all compared with normal platelet counts (≥150 k/μL). The adjusted odds of death with severe thrombocytopenia were greater than those with neutropenia, leukopenia, or leukocytosis. Results were similar in multiple sensitivity analyses and in the MIMIC-IV cohort.
Thrombocytopenia was independently associated with mortality among patients with BSIs. Platelet counts can provide clinicians a readily available way to risk-stratify patients with BSI, and future research should examine the mechanisms by which platelets are protective in BSI.
本研究的目的是确定血小板减少症是否与血流感染（BSIs）患者的死亡率独立相关，并比较血小板对死亡率的影响与白细胞和中性粒细胞的影响。
这项回顾性队列研究使用了以下两个美国BSIs患者队列：（1）2016年7月1日至2023年6月17日期间德克萨斯州休斯顿大都市地区多医院网络的患者，以及（2）公开可用的重症监护医学信息数据库（MIMIC）-IV数据库（2008 - 2022年）中的患者。我们纳入了在血培养阳性采集前48小时内检查过血小板的患者。我们创建了多变量逻辑回归模型，以确定血小板减少程度（严重[血小板<50 k/μL]、中度[50 - 99 k/μL]、轻度[100 - 149 k/μL]和无[≥150 k/μL]）是否会影响30天院内死亡率。
我们在休斯顿队列中纳入了21105名患者，在MIMIC-IV队列中纳入了2710名患者，休斯顿队列中的30天死亡率为12.0%（2524/21105），且与血小板计数显著相关。在控制混杂因素后，严重血小板减少症患者30天死亡率的调整优势比（aOR）为4.66（95% CI，3.91 - 5.55）；中度血小板减少症的aOR为2.61（95% CI，2.25 - 3.02）；轻度血小板减少症的aOR为1.55（95% CI，1.37 - 1.76），所有这些均与正常血小板计数（≥150 k/μL）相比。严重血小板减少症患者的调整死亡几率高于中性粒细胞减少症、白细胞减少症或白细胞增多症患者。在多项敏感性分析和MIMIC-IV队列中结果相似。
血小板减少症与BSIs患者的死亡率独立相关。血小板计数可为临床医生提供一种对BSIs患者进行风险分层的简便方法，未来的研究应探讨血小板在BSIs中发挥保护作用的机制。
