血小板联合D-二聚体对脓毒症预后的评估价值

目的:探讨血小板（PLT）联合D-二聚体(D-D)对脓毒症预后的评估价值。方法:收集2016年1月到2019年3月在天津市第一中心医院重症监护病房（ICU）的脓毒症病例214例，记录收住24 h内PLT和D-D等数据，根据28 d预后分为生存组和死亡组，分别比较生存组和死亡组PLT和D-D差异，用Logistic回归分析确定脓毒症预后独立危险因素，组建PLT联合D-D的新组合，绘制受试者工作特征（ROC）曲线，评估PLT联合D-D对脓毒症预后的判断价值。结果:（1）与生存组比较，死亡组PLT降低（t=8.167，P＜0.01），D-D升高（t=-8.924，P＜0.01），差异均具有统计学意义。（2）Logistic回归分析显示PLT、D-D为脓毒症预后的独立危险因素。（3）PLT联合D-D评估脓毒症28 d预后的曲线下面积（AUC）为0.872，大于单独使用PLT、D-D的AUC（0.804、0.788）,并且PLT联合D-D的灵敏度、特异度、阳性预测值和阴性预测值均高于单独指标。结论:PLT、D-D是评价脓毒症预后的独立危险因素；PLT联合D-D判断脓毒症预后的能力大于单一指标，具有更高的临床价值。

Prognostic value of platelet combined with D-dimer in sepsis

Objective: To evaluate the prognostic value of platelet (PLT) combined with D-dimer (D-D) in sepsis. Methods: 214 cases of sepsis in intensive care unit(ICU) of Tianjin First Center Hospital from January 2016 to March 2019 were collected. The data of PLT and D-D in 24 h were recorded. According to the prognosis of 28 d, they were divided into survival group and death group. The differences of PLT and D-D between survival group and death group were compared, and the independent risk factors of sepsis prognosis were determined by Logistic regression analysis. Receiver operating characteristic(ROC) curve was drawn, and the prognostic value of PLT and D-D in sepsis were evaluated after established a new combination of PLT and D-D. Results:（1）Compared with survival group, PLT in death group decreased(t=8.167, P < 0.01), D-D increased(t=-8.924, P < 0.01). The differences were statistically significant. （2）Logistic regression analysis showed that PLT and D-D were independent risk factors for sepsis prognosis. （3）The area under the curve(AUC) of 28 d prognosis of sepsis assessed by PLT combined with D-D was 0.872, which was larger than that of AUC(0.804, 0.788) using PLT and D-D alone, and the sensitivity, specificity, positive predictive value and negative predictive value of PLT combined with D-D were higher than those of individual indicators. Conclusion: PLT and D-D are independent risk factors for evaluating the prognosis of sepsis. PLT combined with D-D is more effective than single index in judging the prognosis of sepsis and has higher clinical value.