血小板减少与接受连续性肾脏替代治疗急性肾损伤患者短期预后的相关性

目的分析接受连续性肾脏替代治疗(CRRT)的急性肾损伤(AKI)患者血小板(PLT)减少与其短期预后的相关性.方法回顾性分析2016年1月至2019年2月南通大学附属医院ICU收治的130例诊断为AKI且接受CRRT患者的临床资料,根据院内预后分为存活组(n=72)和死亡组(n=58),单因素分析比较两组临床数据差异.多因素Logistic回归分析患者死亡的独立危险因素.绘制受试者工作特征(ROC)曲线,评估血小板变化率(△PLT)对院内死亡的预测价值.根据△PLT的最佳截断值进行分组,对各组患者进行Kaplan-Meier生存曲线分析,比较患者机械通气时间、ICU住院时间、总住院时间及28 d累积生存率的差异.结果①58例患者住院期间死亡,病死率为44.6%.死亡组患者急性生理学及慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、接受有创机械通气、使用升压药及输血的比例高于存活组.②69例患者(53.0%)存在基线血小板减少症(TP).CRRT后新发TP 36例(27.7%).死亡组患者CRRT后血小板最低值低于存活组(24.00×109/L vs.58.50×109/L,P<0.001).③△PLT预测患者住院期间死亡的曲线下面积(AUC)为0.711(95%CI0.621~0.802,P<0.001),最佳截断值为51.28%.④多因素Logistic回归分析显示,△PLT≥51.28%是接受CRRT的AKI患者院内死亡的独立危险因素(OR=3.349,95%CI1.500~7.474,P=0.003).⑤Kaplan-Meier曲线分析显示,CRRT后PLT下降51.28%以上的患者机械通气时间、ICU住院时间及总住院时间延长,28 d累积生存率降低.结论血小板减少在接受CRRT的AKI患者中常见,且与患者短期不良预后相关.

Association between platelet decrease and short-term prognosis of the patients with acute kidney injury receiving continuous renal replacement therapy

Objective To investigate the association between platelet decrease and short-temi prognosis of patients with acute kidney injury(AK I)receiving continuous renal replacement therapy(CRRT).Methods This retrospective study included 130 patients with AKI receiving CRRT from January 2016 to February 2019 in intensive care unit(ICU)of the Affiliated Hospital of Nantong University.Patients were divided into survival group(n=12)and non-survival group(n=58)according to in-hospital outcome.The clinical and demographic characteristics of patients were analyzed by univariate analysis.Independent risk factors of in-hospital death were analyzed by multivariable Logistic regression.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value for in-hospital prognosis of APLT.Kaplan-Meier survival analysis was used to assess the effects of different degrees of platelet decreases on the duration of mechanical ventilation,the length of stay in ICU and in hospital and 28-day cumulative survival rates.Results①58 patients died in hospital with mortality rate of 44.6%.The acute physiology and chronic health evaluation scoring system II(APACHE II)score,sequential organ failure assessment(SOFA)score,proportion of invasive mechanical ventilation,vasopressors and transfusion requirements in non-survival group were significantly higher than those in survival group.②The prevalence of thrombocytopenia before or after the initiation of CRRT was 53.0%and 27.7%,respectively.In non—survivors,the nadir platelet count after the initiation of CRRT was significantly lower than in survivors(24.00 x 10^9/L vs.58.50 x 10^9/L,P<0.001).(3)The area under ROC curve of APLT for predicting the death of patients was 0.711(95%C/0.621-0.802,P<0.001),the optimal cut-off value was 51.28%.④Multivariable Logistic regression analysis identified△ APLT≧51.28%was an independent risk factor for in-hospital death(0R3.349,95%CI1.500-7.474,P=0.003).⑤Kaplan-Meier survival analysis showed a drop of A P △ APLT≧51.28%was associated with prolonged duration of invasive mechanical ventilation,increased ICU and hospital length of stay and decreased 28-day cumulative survival rate.Conclusion In the patients with AKI who are on CRRT,platelet decrease is common and is associated with poor short-term prognosis of patients.