脓毒症患者入院时血小板计数及凝血指标对28天生存状况的预测价值

doi:10.3969/j.issn.1004-583X.2023.03.010

摘要/Abstract

摘要：

目的观察脓毒症患者入院时血小板计数(platelet count, PLT)及凝血指标,并分析二者对脓毒症患者28 d生存状况的预测价值。方法本研究为回顾性研究。收集2019年1月-2021年1月吴淞中心医院收治的91例脓毒症患者的临床资料。以患者入住重症监护病房首次确诊时间为研究起点,以患者28 d内生存状况作为研究终点。依据脓毒症患者28 d生存状况分为病死组( $n$ =31)与存活组( $n$ =60),分析入院时PLT、凝血指标对脓毒症患者28 d生存状况的预测价值。结果 91例脓毒症患者中,28 d内病死30例,病死率为32.97%。病死组入院时纤维蛋白原(fibrinogen,FIB)、PLT水平低于存活组,凝血酶原时间(prothrombin time, PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、D-二聚体(D-dipolymer,D-D)、快速序贯器官衰竭评分(Quick Sequential Organ Failure Assessment,qSOFA)评分、序贯器官衰竭评分(Sequential Organ Failure Assessment,SOFA)评分、急性生理学与慢性健康状况评分系统Ⅱ评分均高于存活组( $P$ <0.05)。Cox回归分析结果显示,FIB、PLT、PT、APTT、D-D可作为脓毒症患者28 d病死的独立风险因子( $P$ <0.05)。绘制受试者工作特征曲线结果显示,入院时FIB、PLT、PT、APTT、D-D预测脓毒症患者28 d生存状况的曲线下面积均>0.80,有一定预测价值。结论脓毒症患者入院时FIB、PLT、PT、APTT、D-D对预测患者28 d生存状态具有一定价值。

关键词: 脓毒症, 血小板计数, 凝血指标, 生存

Abstract:

Objective To measure platelet count (PLT) and coagulation indexes in sepsis patients at admission, and to analyze the predictive value of PLT and coagulation indexes in the 28-day survival of sepsis patients. Methods It was a retrospective study involving 91 sepsis patients admitted to Wusong Central Hospital from January 2019 to January 2021. The first diagnosis time of in the intensive care unit, and the survival statue within 28 days were considered as the starting and end point of the study, respectively. According to the 28-day survival status of sepsis patients, they were assigned into the death group ( $n$ =31) and the survival group ( $n$ =60). The predictive value of PLT and coagulation indexes in the 28-day survival status of sepsis patients was analyzed. Results There were 30/91 (32.97%) sepsis patients died within 28 days. The fibrinogen (FIB) and PLT levels in the death group were significantly lower than those in the survival group at admission, while the prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer (D-D), Quick Sequential Organ Failure Assessment (qSOFA) scores, Sequential Organ Failure Assessment (SOFA) scores, Acute Physiology and Chronic Health Assessment System II were significantly higher than those in the survival group (all $P$ <0.05). Cox regression analysis showed that FIB, PLT, PT, APTT and D-D were independent risk factors for 28-day mortality in sepsis patients (all $P$ <0.05). Receiver operating characteristic analysis showed that the area under the curve (AUC) of FIB, PLT, PT, APTT, and D-D at admission in predicting the 28-day survival of sepsis was larger than 0.80, indicating a certain predictive value. Conclusion The FIB, PLT, PT, APTT, and D-D have a certain value in predicting the 28-day survival status of sepsis patients.

Key words: sepsis, platelet count, coagulation index, survival

中图分类号:

R631

唐爱军, 汪丽韡. 脓毒症患者入院时血小板计数及凝血指标对28天生存状况的预测价值[J]. 临床荟萃, 2023, 38(3): 250-254.

Tang Aijun, Wang Liwei. Predictive values of platelet count and coagulation index in the 28-day survival of sepsis patients[J]. Clinical Focus, 2023, 38(3): 250-254.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.03.010

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I3/250

图/表 5

图1 91例脓毒症患者累积生存曲线

Fig. 1 Cumulative survival curve of 91 patients with sepsis

表1 两组临床资料比较

Tab.1 Comparison of clinical data between the two groups

组别	例数		性别(例)		年龄 ( $x -$ ±s,岁)		疾病程度(例)				感染部位(例)						合并高血压(例)			合并糖尿病(例)
组别	例数		男	女	年龄 ( $x -$ ±s,岁)		脓毒症		脓毒症休克		呼吸道			腹腔	泌尿道或其他		有	无		有	无
病死组	30		14	16	58.53±3.21		25		5		17			9	4		6	24		5	25
存活组	61		34	27	58.98±3.24		52		9		30			24	7		13	48		10	51
统计值			χ²=0.664		$t$ =0.625		χ²=0.005				χ²=0.760						χ²=0.021			χ²=0.072
$P$ 值			0.415		0.534		0.812				0.684						0.885			0.974
组别		呼吸频率 ( $x -$ ±s,次/min)				PLT [ $M$ (P25,P75),×10⁹/L]				PT ( $x -$ ±s,s)			FIB [ $M$ (P25,P75),g/L]				D-D ( $x -$ ±s,mg/L)			APTT ( $x -$ ±s,s)
病死组		20.05±1.35				69.10(53.02,87.48)				18.98±2.78			1.96(1.58,2.43)				11.11±1.69			50.66±3.88
存活组		20.25±1.29				101.70(84.97,128.97)				14.94±1.60			2.68(2.18,3.40)				8.28±1.56			46.71±2.56
统计值		$t$ =0.685				$Z$ =7.691				$t$ =8.794			$Z$ =4.854				$t$ =7.914			$t$ =5.801
$P$ 值		0.495				<0.001				<0.001			<0.001				<0.001			<0.001
组别	qSOFA评分 ( $x -$ ±s,分)					SOFA评分 ( $x -$ ±s,分)		APACHEⅡ评分 ( $x -$ ±s,分)				机械通气时间 ( $x -$ ±s,d)				连续性肾脏替代治疗持续时间 ( $x -$ ±s,d)			抗生素使用时间 ( $x -$ ±s,d)
病死组	1.38±0.37					9.57±3.35		30.18±7.14				4.47±0.73				10.63±1.87			11.40±2.13
存活组	1.02±0.29					6.21±2.74		22.73±6.73				4.28±0.66				9.89±1.81			10.85±1.96
统计值	$t$ =5.072					$t$ =5.103		$t$ =4.866				$t$ =1.231				$t$ =1.836			$t$ =1.216
$P$ 值	<0.001					<0.001		<0.001				0.222				0.070			0.227

表1 两组临床资料比较

Tab.1 Comparison of clinical data between the two groups

组别	例数		性别(例)		年龄 ( $x -$ ±s,岁)		疾病程度(例)				感染部位(例)						合并高血压(例)			合并糖尿病(例)
组别	例数		男	女	年龄 ( $x -$ ±s,岁)		脓毒症		脓毒症休克		呼吸道			腹腔	泌尿道或其他		有	无		有	无
病死组	30		14	16	58.53±3.21		25		5		17			9	4		6	24		5	25
存活组	61		34	27	58.98±3.24		52		9		30			24	7		13	48		10	51
统计值			χ²=0.664		$t$ =0.625		χ²=0.005				χ²=0.760						χ²=0.021			χ²=0.072
$P$ 值			0.415		0.534		0.812				0.684						0.885			0.974
组别		呼吸频率 ( $x -$ ±s,次/min)				PLT [ $M$ (P25,P75),×10⁹/L]				PT ( $x -$ ±s,s)			FIB [ $M$ (P25,P75),g/L]				D-D ( $x -$ ±s,mg/L)			APTT ( $x -$ ±s,s)
病死组		20.05±1.35				69.10(53.02,87.48)				18.98±2.78			1.96(1.58,2.43)				11.11±1.69			50.66±3.88
存活组		20.25±1.29				101.70(84.97,128.97)				14.94±1.60			2.68(2.18,3.40)				8.28±1.56			46.71±2.56
统计值		$t$ =0.685				$Z$ =7.691				$t$ =8.794			$Z$ =4.854				$t$ =7.914			$t$ =5.801
$P$ 值		0.495				<0.001				<0.001			<0.001				<0.001			<0.001
组别	qSOFA评分 ( $x -$ ±s,分)					SOFA评分 ( $x -$ ±s,分)		APACHEⅡ评分 ( $x -$ ±s,分)				机械通气时间 ( $x -$ ±s,d)				连续性肾脏替代治疗持续时间 ( $x -$ ±s,d)			抗生素使用时间 ( $x -$ ±s,d)
病死组	1.38±0.37					9.57±3.35		30.18±7.14				4.47±0.73				10.63±1.87			11.40±2.13
存活组	1.02±0.29					6.21±2.74		22.73±6.73				4.28±0.66				9.89±1.81			10.85±1.96
统计值	$t$ =5.072					$t$ =5.103		$t$ =4.866				$t$ =1.231				$t$ =1.836			$t$ =1.216
$P$ 值	<0.001					<0.001		<0.001				0.222				0.070			0.227

表2 各主要指标与脓毒症患者28 d生存状况关系的Cox回归分析

Tab.2 Cox regression analysis of the relationship between main indicators and 28-day survival status of patients with sepsis

项目	回归系数	标准误	Wald χ²值	$P$ 值	$H R$ 值	95% $C I$
项目	回归系数	标准误	Wald χ²值	$P$ 值	$H R$ 值	下限	上限
PLT	-0.075	0.016	21.489	0.000	0.928	0.899	0.958
PT	0.258	0.072	13.010	0.0001	1.294	1.125	1.489
FIB	-0.906	0.307	8.698	0.003	0.404	0.221	0.738
D-D	0.350	0.103	11.496	0.001	1.419	1.159	1.737
APTT	0.307	0.059	27.361	0.000	1.360	1.212	1.525

表2 各主要指标与脓毒症患者28 d生存状况关系的Cox回归分析

Tab.2 Cox regression analysis of the relationship between main indicators and 28-day survival status of patients with sepsis

项目	回归系数	标准误	Wald χ²值	$P$ 值	$H R$ 值	95% $C I$
项目	回归系数	标准误	Wald χ²值	$P$ 值	$H R$ 值	下限	上限
PLT	-0.075	0.016	21.489	0.000	0.928	0.899	0.958
PT	0.258	0.072	13.010	0.0001	1.294	1.125	1.489
FIB	-0.906	0.307	8.698	0.003	0.404	0.221	0.738
D-D	0.350	0.103	11.496	0.001	1.419	1.159	1.737
APTT	0.307	0.059	27.361	0.000	1.360	1.212	1.525

表3 入院时PLT、凝血指标预测脓毒症患者28 d生存状况的价值分析

Tab.3 Value analysis of PLT and coagulation indexes in predicting the 28-day survival status of patients with sepsis at admission

指标	AUC	标准误	95% $C I$		敏感度	特异度	约登指数	界值
指标	AUC	标准误	下限	上限	敏感度	特异度	约登指数	界值
PLT	0.838	0.043	0.755	0.922	0.533	0.984	0.517	69.455
PT	0.889	0.044	0.802	0.976	0.733	0.984	0.717	17.565
FIB	0.805	0.047	0.712	0.898	0.532	0.934	0.467	1.980
D-D	0.891	0.036	0.820	0.962	0.833	0.836	0.669	9.740
APTT	0.805	0.052	0.703	0.907	0.633	0.885	0.518	49.775

表3 入院时PLT、凝血指标预测脓毒症患者28 d生存状况的价值分析

Tab.3 Value analysis of PLT and coagulation indexes in predicting the 28-day survival status of patients with sepsis at admission

指标	AUC	标准误	95% $C I$		敏感度	特异度	约登指数	界值
指标	AUC	标准误	下限	上限	敏感度	特异度	约登指数	界值
PLT	0.838	0.043	0.755	0.922	0.533	0.984	0.517	69.455
PT	0.889	0.044	0.802	0.976	0.733	0.984	0.717	17.565
FIB	0.805	0.047	0.712	0.898	0.532	0.934	0.467	1.980
D-D	0.891	0.036	0.820	0.962	0.833	0.836	0.669	9.740
APTT	0.805	0.052	0.703	0.907	0.633	0.885	0.518	49.775

图2 入院时PLT、凝血指标对脓毒症患者28 d生存状况预测价值的ROC曲线

Fig.2 ROC curve of predictive value of PLT and coagulation indexes on 28-day survival of patients with sepsis at admission

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