Time course of platelet counts in critically ill patients
Time course of platelet counts in critically ill patients
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DOI：
10.1097/00003246-200204000-00005
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发表时间：
2002-04-01
影响因子：
8.8
通讯作者：
Vincent, JL
中科院分区：
文献类型：
--
作者：
Akca, S;Haji-Michael, P;Vincent, JL
背景尽管重症监护室（ICU）中血小板减少症与预后较差相关，但血小板计数的时间进程与死亡率之间的确切关系尚未得到很好的定义。目的：描述血小板计数的时间进程与危重患者死亡率的关系。设计：一项前瞻性、多中心、观察性队列分析的子研究。来自欧洲、美国和澳大利亚的16个国家的40个ICU。患者：数据收集自1个月内所有ICU入院患者，不包括12岁以下患者和在ICU停留2周的患者。干预措施：无。测量。在整个ICU期间，每天收集血小板计数以及其他器官功能障碍指标。血小板减少定义为血小板计数<2周，187例（64%）存活。存活者和非存活者的血小板计数在入院后的第一天显著下降，在第4天达到最低点。在存活者中，血小板计数在第一周结束时恢复到入院值，并继续上升，到第9天显著大于入院值。在死亡者中，血小板计数在1周后也恢复到入院值，但随后血小板计数没有增加。第4天共有138例（54%）患者出现血小板减少，这些患者的死亡率高于其他患者（33% vs. 16%; p <0.05）。在第14天，51例（20%）患者出现血小板减少症，这些患者的死亡率高于其他患者（66% vs. 16%; p <0.05）。血小板减少症在第14天比第4天更少见（20%对54%; p <0.05），但在第14天血小板减少症患者的死亡率高于第4天血小板减少症患者（66%对33%; p <0.05）。第14天血小板计数相对增加的非血小板减少患者的ICU死亡率也显著低于第14天血小板计数相对增加的患者（11%对30%; p <0.05）。重症患者血小板计数的变化呈双相模式，这在幸存者和非幸存者中是不同的。晚期血小板减少症比早期血小板减少症更能预测死亡。血小板减少症后血小板计数的相对增加存在于幸存者中，而非非幸存者。虽然单次测量血小板计数对预测结果的价值不大，但血小板计数随时间的变化与患者结局相关。
Background. Although thrombocytopenia in the intensive care unit (ICU) is associated with a poorer outcome, the precise relationship between the time course of platelet counts and the mortality rate has not been well defined.Objective: To describe the time course of the platelet count in relation to the mortality rate in critically ill patients.Design: Substudy of a prospective, multicenter, observational cohort analysis.Setting., Forty ICUs in 16 countries from Europe, America, and Australia.Patients: Data were collected from all ICU admissions in a 1-month period, excluding patients younger than 12 yrs old and those who stayed in the ICU for 2 wks.Interventions: None.Measurements. Platelet counts were collected daily throughout the ICU stay, together with other measures of organ dysfunction. Thrombocytopenia was defined as a platelet count of 2 wks, 187 (64%) survived. The platelet count decreased significantly in the first days after admission to reach a nadir on day 4 in both survivors and nonsurvivors. In the survivors, the platelet count returned to the admission value by the end of the first week and continued to rise to become significantly greater than the admission value by day 9. In the nonsurvivors, the platelet count also returned to the admission value after 1 wk, but there was no subsequent increase in platelet count. A total of 138 (54%) patients had thrombocytopenia on day 4, and these patients had a greater mortality rate than the other patients (33% vs. 16%; p < .05). On day 14, 51 (20%) patients had thrombocytopenia, and these patients had a greater mortality rate than the other patients (66% vs. 16%; p < .05). Thrombocytopenia was less common on day 14 than on day 4 (20% vs. 54%; p < .05), but the mortality rate was greater in the thrombocytopenic patients on day 14 than those who were thrombocytopenic on day 4 (66% vs. 33%; p < .05). The ICU mortality rate of nonthrombocytopenic patients on day 14 was also significantly lower in patients with, than without, a relative increase in platelet count on day 14 (11% vs. 30%; p < .05).Conclusion. Platelet count changes in the critically ill have a biphasic pattern that is different in survivors and nonsurvivors. Late thrombocytopenia is more predictive of death than early thrombocytopenia. A relative increase in platelet count after thrombocytopenia was present in survivors but not in nonsurvivors. Although a single measured platelet count is of little value for predicting outcome, changes in platelet count over time are related to patient outcome.