血流感染患者血小板参数动态变化及其预后价值
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天津市卫生健康科技项目(KJ20092);天津医科大学第二医院青年科研基金(2019ydey28)。


Dynamic changes of platelet-related parameters in atients with bloodstream infection and its prognostic value
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    目的?观察血流感染(BSI)患者血小板参数动态变化,并探讨其预后价值。方法?回顾性研究2019年1月至2020年12月我院感染科和ICU收治的136例BSI患者,其中死亡组34例。采集患者人口统计学资料、临床资料和实验室检查数据,计算入院24 h内SOFA评分,收集患者5个时间节点/段(入院当天、BSI发生当天、BSI后1 d、BSI后2~4 d、BSI后5~7 d)的血小板参数数据。按住院结局将患者分生存组和死亡组,用Logistic回归分析MPV/PLT比值(MPR)与BSI临床结局的关联,绘制ROC曲线评价MPR对BSI的预后预测价值。结果?动态数据显示,BSI发生后第1天,2组患者PLT 均呈下降趋势,MPV均呈上升趋势;第2~4天,PLT逐渐回升,MPV逐渐降低;于第5~7 天,生存组PLT 回升至基线水平以上,MPV 降至基线水平,而死亡组PLT持续在较低水平(P<0.01),MPV(P=0.011)和MPR(P<0.01)维持在较高水平。ROC分析显示,BSI后第5~7天MPR(MPR5~7d)对BSI住院死亡具有中等预测价值(AUC=0.706;95%CI:0.605~0.795;P=0.014),联合入院SOFA评分能够提高预测效能(AUC=0.812;95%CI:0.720~0.884;P<0.01)。Logistic回归分析显示,校正SOFA评分后,MPR5~7d与BSI住院死亡风险独立相关(OR=1.155;95%CI:1.023~1.305;P=0.020)。结论?MPR5~7d与BSI住院死亡风险独立相关,对BSI预后具有中等预测价值,联合基线SOFA评分能够提高预测效能。

    Abstract:

    Objective?To observe the dynamic changes of platelet-related parameters in patients with bloodstream infection(BSI)and explore its prognostic value.Methods?A total of 136 BSI patients hospitalized in the Infection Department and ICU from January 2019 to December 2020 were retrospectively studied,in which 34 cases suffered mortality.The demographic,laboratory and clinical data of these patients were collected,and SOFA scores were calculated within 24 hours after admission.Platelet-related parameters were collected based on 5 time points/periods,i.e.,the day of admission,the day of BSI occurrence,the 1-day,the 2 to 4-days and the 5 to 7-days after BSI).All the patients were divided into 2 groups:survival and mortality group.Logistic regression models were constructed to analyze the correlation between MPV/PLT ratio(MPR)and BSI mortality,and ROC analysis was utilized to evaluate the prognostic value of MPR in BSI.Results?Dynamic data showed that PLT decreased,but mean platelet volume(MPV)increased in both groups on the 1st day after BSI occurrence.During the 2nd to 4th days,PLT increased and MPV decreased gradually.On the 5th to 7th day,PLT of the survivals raised over the baseline level and MPV decreased to the baseline level.In contrast,PLT in the mortality group remained at low level(P<0.01),while MPV(P=0.011)and MPR(P<0.01)sustained at high level.ROC analysis showed that MPR value on the 5th?to 7th day after BSI(MPR5-7d)had moderate predictive value for death of BSI patients during hospitalization(AUC=0.706;95%CI,0.605 to 0.795;P?=0.014).The combination of SOFA with MPR5-7d?could improve the prediction efficiency(AUC =0.812;95%CI,0.720 to 0.884;P<0.01).Logistic regression analysis showed that MPR5-7d?was independently associated with BSI mortality after adjustment for SOFA score(OR=1.155;95%CI,1.023 to 1.305;P=0.020).Conclusion?MPR5-7d?should associated with BSI mortality independently and show moderate predictive value for BSI outcome.The predictive efficiency may be improved when combined with baseline SOFA score.

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岳福仁,闫瑞振,魏志斌,宗晓龙,张静会.血流感染患者血小板参数动态变化及其预后价值[J].临床检验杂志,2021,39(7):495-499

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  • 收稿日期:2021-04-26
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  • 在线发布日期: 2021-09-09
  • 出版日期: 2021-07-28
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