血小板参数在老年脓毒症病情严重程度及预后评估中的作用研究

目的 探讨血小板参数与老年脓毒症病人病情严重程度以及预后的相关性。 方法 回顾性分析2013~2017年江苏省老年病医院重症监护病房收治的年龄≥60岁脓毒症病人的临床资料,根据病情严重程度分为脓毒症组、严重脓毒症组以及脓毒性休克组,根据病人28d预后情况分为生存组及死亡组,分析比较不同组别之间相关参数的差异,绘制受试者工作特征(ROC)曲线分析各血小板参数对病人28d预后(死亡)的预测价值。 结果 脓毒症组、严重脓毒症组及脓毒性休克组的血小板计数(PLT)、血小板压积(PCT)、血乳酸(Lac)、C反应蛋白(CRP)差异无统计学意义(P>0.05)。与脓毒症组相比,脓毒性休克组的平均血小板体积(MPV)、血小板分布宽度(PDW)、急性生理与慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)明显升高,严重脓毒症组的PDW、APACHEⅡ评分明显升高,且脓毒性休克组的PDW、APACHEⅡ评分、SOFA评分显著高于严重脓毒症组,差异均有统计学意义(P<0.05)。与生存组相比,死亡组的PLT及PCT明显降低,而MPV、PDW、APACHEⅡ评分、SOFA评分、WBC、CRP明显升高,差异均有统计学意义(P<0.05或P<0.01)。在血小板参数对28d预后预测价值分析中,ROC曲线下面积从高到低依次为PDW、MPV、PLT、PCT(0.778、0.768、0.757、0.756)。 结论 PDW可能是更为敏感反映老年脓毒症病人病情严重程度的血小板参数指标,PDW对于老年脓毒症病人28d死亡的预测价值最高。

The role of platelet parameters in assessing the severity and prognosis of elderly patients with sepsis

Objective To explore the correlation between platelet parameters and the severity and prognosis of the elderly patients with sepsis. Methods The clinical data of sepsis patients aged 60 years or older admitted to the intensive care unit of Jiangsu Geriatric Hospital from January 2013 to December 2017 were retrospectively analyzed. According to the severity of the disease, all the patients were divided into sepsis group, severe sepsis group and septic shock group. According to the prognosis of 28 days, all the patients were divided into survival group and death group. The differences of platelet parameters between different groups were analyzed and compared, and the predictive value of platelet parameters on 28-day prognosis (death) was analyzed by the receiver operating characteristic (ROC) curve. Results There were no significant differences in platelet count (PLT), plateletcrit (PCT),lactic acid (Lac) and C-reactive protein (CRP) among sepsis group, severe sepsis group and septic shock group (P>0. 05). Compared with the sepsis group, the mean platelet volume (MPV), platelet distribution width (PDW), acute physiology and chronic health status score (APACHE Ⅱ), sequential organ failure score (SOFA) were significantly higher in the septic shock group, and PDW, APACHE Ⅱ and SOFA were significantly higher in the severe sepsis group. Compared with the severe sepsis group, PDW, APACHE Ⅱ and SOFA were significantly higher in the septic shock group (P< 0. 05). Compared with the survival group, PLT and PCT in the death group were decreased significantly, while MPV, PDW, APACHE Ⅱ, SOFA, WBC and CRP were increased significantly (P<0. 05 or P<0. 01). In the prognostic value analysis of platelet parameters for 28-day prognosis, the areas under ROC curve from high to low were PDW, MPV, PLT, PCT (0. 778, 0. 768, 0. 757 and 0. 756, respectively). Conclusions PDW may be a more sensitive parameter to reflect the severity of the elderly patients with sepsis. PDW has the highest predictive value among all platelet parameters for 28-day mortality in the elderly patients with sepsis.