血流感染患者血小板参数动态变化及其预后价值  

Dynamic changes of platelet-related parameters in atients with bloodstream infection and its prognostic value

作　　者：岳福仁[1] 闫瑞振 魏志斌[1] 宗晓龙[2] 张静会[1] YUE Furen;YAN Ruizhen;WEI Zhibin;ZONG Xiaolong;ZHANG Jinghui(Clinical Laboratory,Baodi People′s Hospital,Tianjin 301800;Clinical Laboratory,the 2nd Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津市宝坻区人民医院检验科,天津301800 [2]天津医科大学第二医院检验科,天津300201

出　　处：《临床检验杂志》2021年第7期495-499,共5页Chinese Journal of Clinical Laboratory Science

基　　金：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)。

摘　　要：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(MPR5~7 d)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,MPR5~7 d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MPR5~7 d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。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 col-lected 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 re-mained 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(MPR5-7 d)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 MPR5-7 d could improve the prediction efficiency(AUC=0.812;95%CI,0.720 to 0.884;P<0.01).Logistic regression analysis showed that MPR5-7 d was independently associated with BSI mor-tality after adjustment for SOFA score(OR=1.155;95%CI,1.023 to 1.305;P=0.020).Conclusion MPR5-7 d should associated with BSI mortality independently and show moderate predictive value for BSI outcome.The predictive efficiency may be improved when com-bined with baseline SO

关 键 词：血流感染 血小板 平均血小板体积 血培养 SOFA评分 预后分析 

分 类 号：R446[医药卫生—诊断学]