脓毒症和脓毒性休克患者血小板减少对血流感染的预测价值

Xia Li, Sheng Wang, Junjie Ma, Su-Ge Bai, Su-Zhen Fu
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摘要

背景 败血症和脓毒性休克患者常见血小板减少。目的 分析重症监护病房脓毒症和脓毒性休克患者血小板数量的减少情况,以预测血流感染。方法 对邢台市人民医院收治的败血症和脓毒性休克患者进行回顾性分析。收集患者特征和实验室数据进行分析。结果 研究组包括 85 名(39%)血流感染住院患者,对照组包括 133 名(61%)结果为阴性或污染的患者。病原体阳性患者的血小板计数下降百分比(PPCs)[57.1(41.3-74.6)]明显高于对照组[18.2(5.1-43.1)](P < 0.001),而革兰氏阳性菌血症、革兰氏阴性菌血症和真菌感染患者的血小板计数下降百分比无明显差异。利用接收器操作特征曲线,血小板下降率的曲线下面积为 0.839(95%CI:0.783-0.895)。结论 在预测脓毒症和脓毒性休克患者的血流感染时,血小板计数下降百分比很敏感。但是,它不能识别革兰氏阳性菌血症、革兰氏阴性菌血症和真菌感染。
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Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock
BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock. AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit. METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited. Patient population characteristics and laboratory data were collected for analysis. RESULTS The study group consisted of 85 (39%) inpatients with bloodstream infection, and the control group consisted of 133 (61%) with negative results or contamination. The percentage decline in platelet counts (PPCs) in patients positive for pathogens [57.1 (41.3-74.6)] was distinctly higher than that in the control group [18.2 (5.1–43.1)] (P < 0.001), whereas the PPCs were not significantly different among those with gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection. Using receiver operating characteristic curves, the area under the curve of the platelet drop rate was 0.839 (95%CI: 0.783-0.895). CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock. However, it cannot identify gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection.
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