血小板参数与老年脓毒症病情严重程度的关系及对短期预后的预测作用

目的:探讨血小板参数与老年脓毒症患者病情严重程度的关系及对其短期预后的影响。方法:回顾性分析276例老年脓毒症患者的临床资料,其中脓毒症73例,严重脓毒症116例,脓毒性休克87例;比较3组入院时血小板参数差异,并记录276例患者28 d转归,多因素Cox回归分析脓毒症患者28 d预后不良的危险因素,ROC分析曲线显示各影响因素对老年脓毒症患者28 d预后的预测价值。结果:脓毒性休克组入院时血小板分布宽度(PDW)高于严重脓毒症组,且均高于脓毒症组,差异有统计学意义(P<0.05);脓毒性休克组平均血小板体积(MPV)高于脓毒症组(P<0.05),与严重脓毒症组比较差异无统计学意义(P>0.05);3组血小板计数(PC)比较差异无统计学意义(P>0.05)。276例患者中28 d共死亡62例(22.46%)为预后不良组,存活214例(77.54%)为预后良好组,单因素分析显示,预后良好组年龄、血肌酐(SCr)、凝血酶原时间、C反应蛋白、总胆红素、血乳酸、白细胞计数、降钙素原、APACHEⅡ评分、序贯器官衰竭评估(SOFA)评分、PDW、MPV均低于预后不良组,氧合指数、PC高于预后不良组(P<0.05);多因素Cox回归分析结果显示,PDW≥13.50%、SCr≥180.00μmol/L、APACHEⅡ评分≥22.50分、SOFA评分≥7.50分是老年脓毒症患者28 d死亡的独立危险因素;ROC分析曲线显示,PDW、SCr、APACHEⅡ、SOFA评分预测老年脓毒症患者死亡的AUC分别为0.823、0.658、0.766、0.727,且以PDW预测老年脓毒症患者28 d死亡的AUC最高。结论:脓毒症病情越严重,PDW升高越显著,PDW升高是老年脓毒症患者预后不良的危险因素,其水平变化可用于预测患者短期预后。

Relationship between platelet parameters and the severity of sepsis in the elderly and its predictive effect on short-term prognosis

Objective:To investigate the relationship between platelet parameters and the severity of sepsis in elderly patients and its influence on short-term prognosis.Method:The clinical data of 276 elderly patients with sepsis were retrospectively analyzed,including 73 cases of sepsis,116 cases of severe sepsis,and 87 cases of septic shock.The differences in platelet parameters at admission between the 3 groups were compared and 276 cases with 28 d outcomes were recorded.Multivariate cox regression analysis was performed to analyze the risk factors for poor prognosis in patients with sepsis at 28 d.ROC analysis curve showed the predictive value of each factor for prognosis in elderly patients with sepsis at 28 d.Result:The platelet distribution width(PDW)of the septic shock group was higher than that of the severe sepsis group and higher than that of the sepsis group(P<0.05).The average platelet volume(MPV)was higher than that in the sepsis group(P<0.05),and there was no significant difference compared with the severe sepsis group(P>0.05).There was no difference in platelet count(PC)between the three groups.Among the 276 patients,a total of 62 deaths(22.46%)at 28 days were the poor prognosis group,and 214 patients(77.54%)survived were the good prognosis group.Univariate analysis showed that the age,serum creatinine(SCr),prothrombin time,C-reactive protein,total bilirubin,blood lactic acid,white blood cell count,procalcitonin,APACHEⅡscore,sequential organ failure assessment(SOFA)score,PDW,MPV of the good prognosis group were lower than those with poor prognosis,and oxygenation index and PC were higher than those with poor prognosis(P<0.05).The results of multivariate Cox regression analysis showed that PDW≥13.50%,SCr≥180.00μmol/L,APACHEⅡ≥22.50 score s SOFA≥7.50 scores were independent risk factors for 28-day death in elderly sepsis patients;ROC analysis curves show that the AUC of PDW,SCr,APACHEⅡ,and SOFA scores predicting death in elderly sepsis patients were 0.823,0.658,0.766,0.727 respectively.The highest AUC was predicted by PDW at 28 days of death in elderly sepsis patients.Conclusion:The more severe the sepsis condition,the more significant the increase in PDW.PDW elevation is a risk factor for poor prognosis in elderly patients with sepsis,and its level change can be used to predict the short-term prognosis of patients.