The influence of serum platelet level on prognosis in critically ill patients

Gao Fei; Dong Liang; Yang Ting; Yan Jie; Guo Yun

doi:10.3969/j.issn.1002-1949.2017.11.007

Abstract：Objective To investigate the prevalence of serum platelet abnormalities in critically ill patients in the intensive care unit (ICU) and the effects of serum platelet levels on the prognosis.Methods A prospective selection of critically ill patients treated at ICU from March 2015 to March 2017 was screened.All the enrolled patients received venous blood within ICU 24 hours of stay,and the specimens were detected serum platelet level,and recorded as PLT.Grouped by PLT level:PLT ＜ 100 × 109/L for the low PLT group;100 × 109/L≤PLT≤300 × 109/L for the normal PLT group;PLT ＞ 300 × 109/L for the high PLT group.Statistics of all patients' age and gender,past history,diagnosis,duration of mechanical ventilation and ICU stay,28 day mortality,sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score.Logistic regression analysis was used to screen the risk factors of death in patients with severe Kaplan-Meier;using survival analysis,stratified by PLT level,rendering the 28 day survival curve,using Log-rank test the cumulative survival rate of low PLT group and high PLT group and normal PLT group.Results ①A total of 330 patients with severe diseases,including low PLT group 136 cases,high PLT group 35 cases and normal PLT group 159 cases.②The patients with low PLT group were more frequent with sepsis (37.50％).The patients with cerebral infarction were more frequent in the high PLT group (48.57％),and the lung infection was more common in the normal group (19.50％).③Compared with low PLT group and normal PLT group in gender,age,chronic disease,APACHE Ⅱ score,the difference was not statistically significant (P ＞ 0.05);patients with low PLT showed higher SOFA score (P =0.039) and 28-day mortality (P =0.033),and longer duration of mechanical ventilation (P =0.035) and ICU stay (P =0.019) were significantly longer.④According to the multi-factor Logistic regression analysis showed that serum level of PLT (OR =1.327,95％ CI =1.113 ～ 1.627,P =0.010) and APACHE Ⅱ score (OR =1.545,95％ CI =1.322 ～ 1.806,P =0.000) were independent risk factors of severe ICU patients died within 28 days.The Kaplan-Meier survival curve was drawn according to the serum PLT levels,and the cumulative survival rate in the low PLT group was significantly lower than that in the normal PLT group in 28 days,and the difference between the two groups was statistically significant (P =0.029).Conclusion Serum platelet level is closely related to the mortality of patients with severe ICU,and we should pay attention to the occurrence of thrombocytopenia in clinical work.