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脓毒症诱导凝血病患者中脓毒症相关血小板减少症的危险因素

Risk Factors of Sepsis-Associated Thrombocytopenia among Patients with Sepsis Induced Coagulopathy.

作者信息

Cheng Jia-Jia, Liufu Rong, Zhuang Jian, Chen Miao-Yun

机构信息

Department of Intensive Care Unit, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China.

Department of Cardiovascular Intensive Care Unit, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

出版信息

Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241283166. doi: 10.1177/10760296241283166.

Abstract

The study aims to evaluate the prognosis and risk factors of sepsis-associated thrombocytopenia (SAT) among patients with coagulopathy, and to provide evidence of the relationship between adverse outcomes and potential risks. Patients with sepsis-associated coagulopathy were included in the study from January 2014 to December 2022. The primary outcome was sepsis-associated thrombocytopenia (platelet count less than 100 *10/L), which was evaluated by logistic regression models adjusted for demographic characteristics and comorbidities. Among patients in the SAT group, 54% developed severe SAT, while 16% of these patients recovered from thrombocytopenia. The in-hospital mortality rate was significantly higher in the SAT group compared to the non-SAT group (31% in SAT group vs 23.9% in non-SAT group, p = 0.029). Even after adjusting for age, gender, Charlson comorbidity, white blood cell, and Sequential Organ Failure Assessment score, the differences in mortality rate persisted (Odds Ratio 0.72, [95% Confidence Interval 0.52-0.92]). Correlation analyses revealed that prothrombin time (r = 0.08, p = 0.50), international normalized ratio (r = 0.08, p = 0.42), prothrombin activity (r = -0.06, p > 0.999), D-dimer (r = -0.02, p > 0.999), and inflammatory parameters such as C-reactive protein (r = -0.11, p = 0.37) were not significantly correlated with platelet counts. According to subgroup analyses, patients with lung infection complicated by SAT had slightly higher mortality (OR 0.66, [95% CI, 0.46 to 0.94]). Sepsis-associated coagulopathy indicates a subset of critical ill patients, with those experiencing thrombocytopenia at greater risk for in-hospital death compared to those without it.

摘要

本研究旨在评估凝血病患者中脓毒症相关性血小板减少症(SAT)的预后及风险因素,并为不良结局与潜在风险之间的关系提供证据。2014年1月至2022年12月期间,脓毒症相关性凝血病患者被纳入本研究。主要结局为脓毒症相关性血小板减少症(血小板计数低于100×10⁹/L),通过针对人口统计学特征和合并症进行调整的逻辑回归模型进行评估。在SAT组患者中,54%发生了严重SAT,而这些患者中有16%的血小板减少症得以恢复。与非SAT组相比,SAT组的院内死亡率显著更高(SAT组为31%,非SAT组为23.9%,p = 0.029)。即使在对年龄、性别、Charlson合并症、白细胞及序贯器官衰竭评估评分进行调整后,死亡率的差异仍然存在(比值比0.72,[95%置信区间0.52 - 0.92])。相关性分析显示,凝血酶原时间(r = 0.08,p = 0.50)、国际标准化比值(r = 0.08,p = 0.42)、凝血酶原活性(r = -0.06,p > 0.999)、D - 二聚体(r = -0.02,p > 0.999)以及炎症参数如C反应蛋白(r = -0.11,p = 0.37)与血小板计数均无显著相关性。根据亚组分析,肺部感染合并SAT的患者死亡率略高(比值比0.66,[95%置信区间,0.46至0.94])。脓毒症相关性凝血病表明是一组危重症患者,与未发生血小板减少症的患者相比,发生血小板减少症的患者院内死亡风险更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1294/11403687/c87d2d777600/10.1177_10760296241283166-fig1.jpg

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