The clinical implications of thrombocytopenia in adults with severe falciparum malaria: a retrospective analysis.
The clinical implications of thrombocytopenia in adults with severe falciparum malaria: a retrospective analysis.
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DOI：
10.1186/s12916-015-0324-5
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发表时间：
2015-04-24
期刊：
影响因子：
9.3
通讯作者：
Day NP
中科院分区：
文献类型：
--
作者：
Hanson J;Phu NH;Hasan MU;Charunwatthana P;Plewes K;Maude RJ;Prapansilp P;Kingston HW;Mishra SK;Mohanty S;Price RN;Faiz MA;Dondorp AM;White NJ;Hien TT;Day NP
血小板减少是成人严重恶性疟疾的常见发现，但其临床和预后作用尚不完全确定。对647例成人重度恶性疟疾患者的临床和实验室资料进行了回顾性分析，以确定患者入院时的血小板计数与随后的临床病程之间的关系。入院时血小板减少(血小板150 × 109/L)6 14例(94.9%)，血小板减少32 8例(5 0.7%)；入院时血小板计数与寄生虫生物量(根据血浆PfHRP2浓度估计，rS = −=0.28，P = 0.003)、微血管隔离程度(用正交偏振光谱成像测量，rS = −=0.31，P = =0.001)和疾病严重程度(患者符合世界卫生组织严重程度标准的次数，rS = −=0.21，P<；0.001)呈负相关。死亡患者入院时血小板计数较低(中位数：30(四分位数范围22至52) × 109/L与50(34至78) × 109/L；P<；0.001)，但不能独立于其他已建立的实验室和临床预后指标来预测预后。重度血小板减少(20 × 10 9/L)的39例患者(6%)比血小板计数高的患者更有可能死亡(优势比：5.0 0，95%可信区间：2.5 6~9.75)，但通过简单的床边临床评估可以更快地识别这些高危患者。入院时的血小板计数不能可靠地确定研究期间有大出血的50名患者(7.7%)。血小板减少是成年恶性疟疾患者病情严重程度的标志，但在预测、分类和管理方面的作用有限。
Thrombocytopenia is a common finding in adults with severe falciparum malaria, but its clinical and prognostic utility is incompletely defined. Clinical and laboratory data from 647 adults with severe falciparum malaria were analysed retrospectively to determine the relationship between a patient’s platelet count on admission to hospital and their subsequent clinical course. On admission, 614 patients (94.9%) were thrombocytopenic (platelet count <150 × 109/L) and 328 (50.7%) had a platelet count <50 × 109/L. The admission platelet count was inversely correlated with parasite biomass (estimated from plasma PfHRP2 concentrations, rs = −0.28, P = 0.003), the degree of microvascular sequestration (measured with orthogonal polarizing spectral imaging, rs = −0.31, P = 0.001) and disease severity (the number of World Health Organization severity criteria satisfied by the patient, rs = −0.21, P <0.001). Platelet counts were lower on admission in the patients who died (median: 30 (interquartile range 22 to 52) × 109/L versus 50 (34 to 78) × 109/L in survivors; P <0.001), but did not predict outcome independently from other established laboratory and clinical prognostic indices. The 39 patients (6%) with profound thrombocytopenia (platelet count <20 × 109/L) were more likely to die (odds ratio: 5.00, 95% confidence interval: 2.56 to 9.75) than patients with higher platelet counts, but these high-risk patients could be identified more rapidly with simple bedside clinical assessment. The admission platelet count did not reliably identify the 50 patients (7.7%) with major bleeding during the study. Thrombocytopenia is a marker of disease severity in adults with falciparum malaria, but has limited utility in prognostication, triage and management.
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影响因子：
3.7
作者：
Hanson J;Lee SJ;Mohanty S;Faiz MA;Anstey NM;Price RN;Charunwatthana P;Yunus EB;Mishra SK;Tjitra E;Rahman R;Nosten F;Htut Y;Maude RJ;Chau TT;Phu NH;Hien TT;White NJ;Day NP;Dondorp AM
通讯作者：
Dondorp AM
影响因子：
6.4
作者：
Grau, GE;Mackenzie, CD;Molyneux, ME
通讯作者：
Molyneux, ME
影响因子：
6.4
作者：
Maude, Richard J.;Silamut, Kamolrat;Dondorp, Arjen M.
通讯作者：
Dondorp, Arjen M.
影响因子：
3.3
作者：
Erhart, LM;Yingyuen, K;Wongsrichanalai, C
通讯作者：
Wongsrichanalai, C
间日疟原虫疟疾临床诊断患者的尸检特征：这种寄生虫的杀伤力有多大？
影响因子：
11.8
作者：
Lacerda, Marcus V. G.;Fragoso, Silvio C. P.;Bassat, Quique
通讯作者：
Bassat, Quique