Predictive values of platelet count and coagulation index in the 28-day survival of sepsis patients

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

Abstract

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

CLC Number:

R631

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.03.010

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

Figures/Tables 5

Fig. 1 Cumulative survival curve of 91 patients with sepsis

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

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

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

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

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

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

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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