Prognostic significance of platelet count changes during hospitalization for community-acquired pneumonia
Prognostic significance of platelet count changes during hospitalization for community-acquired pneumonia
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DOI：
10.1080/09537104.2016.1219032
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发表时间：
2017-01-01
期刊：
影响因子：
3.3
通讯作者：
Shteinshnaider, Miriam
中科院分区：
文献类型：
--
作者：
Gorelik, Oleg;Izhakian, Shimon;Shteinshnaider, Miriam
社区获得性肺炎（CAP）住院期间血小板计数（PC）变化的预后意义尚未研究。根据Delta PC，对976名成年人因CAP住院期间的临床数据和出院后的全因死亡率进行了比较（出院时的PC减去入院时的PC）：组A（PC下降，Delta PC < -50 x 10（9）/l），B（稳定PC，Δ PC +/- 50 × 10（9）/l）和C（升高PC，Δ PC > 50 × 10（9）/l），并根据入院/出院时血小板减少症、正常PC和血小板增多症的存在。A、B和C组分别占患者的7.9%、46.5%和45.6%。入院/出院时，分别在12.8%/6.4%、84.1%/84.4%和3.1%/9.2%的患者中观察到血小板减少、PC正常和血小板增多。90天、3年和总计（中位随访54个月）死亡率显著较高：A组（40.3%、63.6%和72.7%），与B组相比（12.3%，31.5%和39.0%）和C（4.9%、17.3%和25.4%），p < 0.001;在出院时血小板减少的患者中与出院时PC正常（10.2%、26.9%和35.4%）和血小板增多症（8.9%、17.8%和24.4%）的患者相比，（27.4%、48.4%和51.6%），p < 0.001。入院时血小板减少、PC正常和血小板增多组的死亡率相当（p = 0.6）。在整个样本中，Δ PC每增加100 × 109/l强烈预测较低的死亡率（p < 0.001，相对风险0.73，95%置信区间0.64-0.83）。总之，PC的变化是常见的CAP住院患者。住院期间PC升高是生存率提高的有力预测因素，而PC下降则预示预后不良。对CAP住院期间PC变化的评估可能提供有用的预后信息。
The prognostic significance of platelet count (PC) changes during hospitalization for community-acquired pneumonia (CAP) has not been investigated. For 976 adults, clinical data during hospitalization for CAP and all-cause mortality following discharge were compared according to Delta PC (PC on discharge minus PC on admission): groups A (declining PC, Delta PC < -50 x 10(9)/l), B (stable PC, Delta PC +/- 50 x 10(9)/l), and C (rising PC, Delta PC > 50 x 10(9)/l), and according to the presence of thrombocytopenia, normal PC, and thrombocytosis on admission/discharge. Groups A, B, and C comprised 7.9%, 46.5%, and 45.6% of patients, respectively. On hospital admission/discharge, thrombocytopenia, normal PC, and thrombocytosis were observed in 12.8%/6.4%, 84.1%/84.4%, and 3.1%/9.2% of patients, respectively. The respective 90-day, 3-year, and total (median follow-up of 54 months) mortality rates were significantly higher: in group A (40.3%, 63.6%, and 72.7%), compared to groups B (12.3%, 31.5%, and 39.0%) and C (4.9%, 17.3%, and 25.4%), p < 0.001; and in patients with thrombocytopenia at discharge (27.4%, 48.4%, and 51.6%), compared to those with normal PC (10.2%, 26.9%, and 35.4%) and thrombocytosis (8.9%, 17.8%, and 24.4%) at discharge (p < 0.001). Mortality rates were comparable among groups with thrombocytopenia, normal PC, and thrombocytosis at admission (p = 0.6). In the entire sample, each 100 x 109/l increment of Delta PC strongly predicted lower mortality (p < 0.001, relative risk 0.73, 95% confidence interval 0.64-0.83). In conclusion, PC changes are common among CAP inpatients. Rising PC throughout hospitalization is a powerful predictor of better survival, while declining PC predicts poor outcome. Evaluation of PC changes during hospitalization for CAP may provide useful prognostic information.