Effect of platelet dynamic changes on disseminated intravascular coagulation and prognosis in severe heatstroke patients.

Postgraduate medicine Pub Date : 2024-09-01 Epub Date: 2024-08-27 DOI:10.1080/00325481.2024.2394017
Lingling Zhang, Jinhai Wang, Tijun Gu, He Zhang, Haitao Xiao, Fujing Liu
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Abstract

Objective: This study aimed to investigate the dynamic changes in the platelets of patients with severe heatstroke and the impact of these changes on the occurrence of disseminated intravascular coagulation (DIC) and prognosis in them.

Methods: This retrospective cohort study conducted at two tertiary hospitals recruited 264 patients with severe heatstroke. Logistic regression was used to analyze the association between platelet counts and DIC. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of platelets count for DIC occurrence. We used mediation effect to analysis the role of DIC as a mediating variable to mediate the relationship between platelet count decrease after 24 hours and death.

Results: There were 214 patients with lower platelet counts compared to admission (107 × 109/L[69,168] vs.171 × 109/L[126,215], p < 0.001). The DIC patients had lower platelet counts than the non-DIC patients when measured in the emergency department and after 24 hours. The platelet count decrease after 24 hours was a risk factor for DIC (odds ratio [OR] = 2.710, 95% confidence interval [CI] = 1.069-6.869). The results of the ROC curve revealed that the predictive performance of the platelet count after 24 hours (area under the curve [AUC] = 0.8685, 95% CI = 0.8173-0.9197) was significantly better than that of the platelet count measured in the emergency department (AUC = 0.7080, 95% CI = 0.6345-0.7815). Mediation analyses showed that PLT decrease after 24 hours did not directly lead to death, but can indirectly cause death by inducing the development of DIC.

Conclusions: Decreased platelet count is an independent risk factor for DIC in patients with severe heatstroke. Although the platelet counts measured in the emergency department and after 24 hours show a good predictive performance for DIC occurrence, the prediction performance of the latter is better.

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血小板动态变化对重症中暑患者弥散性血管内凝血和预后的影响。
研究目的本研究旨在探讨重症中暑患者血小板的动态变化及其对弥散性血管内凝血(DIC)发生和预后的影响:这项回顾性队列研究在两家三甲医院进行,共招募了264名重症中暑患者。采用逻辑回归分析血小板计数与 DIC 之间的关系。使用接收者操作特征曲线(ROC)评估血小板计数对 DIC 发生的预测性能。我们使用中介效应分析了 DIC 作为中介变量在 24 小时后血小板计数下降与死亡之间的中介作用:结果:与入院时相比,有 214 名患者的血小板计数降低(107 × 109/L[69,168] vs.171 × 109/L[126,215], p 结论:血小板计数降低是导致 DIC 发生的重要因素:血小板计数降低是重症中暑患者发生 DIC 的独立危险因素。虽然在急诊室和 24 小时后测量的血小板计数对 DIC 的发生有良好的预测作用,但后者的预测作用更好。
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