Thrombocytopenia and platelet count recovery in patients with sepsis-3: a retrospective observational study
Thrombocytopenia and platelet count recovery in patients with sepsis-3: a retrospective observational study
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DOI：
10.1080/09537104.2021.1970124
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发表时间：
2021-08-29
期刊：
影响因子：
3.3
通讯作者：
Yan, Zhengzheng
中科院分区：
文献类型：
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作者：
Zhou, Hui;Li, Zhifeng;Yan, Zhengzheng
血小板减少症常见于危重疾病。但目前尚无针对 Sepsis-3 患者血小板减少和血小板恢复的研究。我们使用大型数据库根据 Sepsis-3 标准来识别脓毒症。 ICU期间根据最低血小板计数对患者进行分组，使用倾向评分匹配来消除协变量不平衡，使用多变量cox比例风险模型来评估死亡率。根据脓毒症-3 共有 9709 名患者入组，其中 1794 名（18%）名患者出现血小板减少症，其中 858 名（8.8%）名患者在 ICU 入院时出现血小板减少症（普遍），891 名（9.2%）名患者在 ICU 住院期间出现血小板减少症（事件）。在发生血小板减少症组中，与非幸存者相比，幸存者表现出较高的最低血小板计数、较高的血小板计数恢复率和较短的血小板恢复时间。血小板减少症幸存者在机械通气撤机后 1 天（IQR，1-2）和停止升压药后 1 天（IQR，1-3）才观察到血小板恢复。此外，与无血小板减少症相比，血小板减少症与更长的 ICU 住院时间、更长的机械通气和血管加压药使用时间相关。中度（20-50×10（9）/L）和重度（= 100×10（9）/L）没有显着差异。综合这些数据显示，18% 的脓毒症 3 级患者出现血小板减少症；幸存者的血小板恢复发生得更频繁、更早；直到临床改善才观察到血小板恢复。 Sepsis-3 中的血小板减少症表明疾病严重程度增加，并且患者的血小板计数
Thrombocytopenia is common in critical illness. But there are no studies that focus on thrombocytopenia and platelet recovery in Sepsis-3 patients. We employed a large database to identify sepsis based on Sepsis-3 criteria. Patients were grouped by nadir platelet count during ICU, propensity score matching was used to eliminate covariates imbalance, multivariable cox proportional hazard model was used for evaluating mortality. A total of 9709 patients were enrolled based on Sepsis-3, 1794 (18%) patients developed thrombocytopenia, with 858 (8.8%) exhibiting thrombocytopenia at ICU admission (prevalent), 891 (9.2%) developed thrombocytopenia during ICU stay (incident). In the incident thrombocytopenia group, survivors exhibited higher nadir platelet count, higher rate in platelet count recovery and shorter time to platelet recovery compared to non-survivors. Platelet recovery was not observed until 1 days (IQR, 1-2) after weaning of mechanical ventilation and 1 days (IQR, 1-3) after discontinuation of vasopressor in survivors of incident thrombocytopenia. Furthermore, thrombocytopenia was associated with longer duration of ICU length of stay, longer duration of mechanical ventilation and vasopressor use compared to no thrombocytopenia. Moderate (20-50 x 10(9)/L) and severe (= 100 x 10(9)/L) showed no significant difference. Taken together these data revealed that thrombocytopenia occurred in 18% Sepsis-3 patients; platelet recovery occurred more frequent and earlier in survivors; platelet recovery was not observed until clinical improvement. Thrombocytopenia in Sepsis-3 demonstrated increased disease severity, and patients with platelet count