输注血小板治疗对成人脓毒症患者预后的影响

王巧红; 陈星星; 朱为民; 甘慧玲; 许仙仙; 卞兵兵; 李萍; 杨鹏; 单仁飞; 蒋永泼

doi:10.16766/j.cnki.issn.1674-4152.003875

输注血小板治疗对成人脓毒症患者预后的影响

doi: 10.16766/j.cnki.issn.1674-4152.003875

浙江省台州医院急诊科，浙江台州 318050

基金项目:

浙江省医药卫生研究基金项目 2022KY435

台州市科技计划项目 23ywa47

详细信息

通讯作者:
蒋永泼，E-mail：jyongpo8@163.com

中图分类号: R631 R457.1
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出版历程
- 收稿日期: 2024-01-25
- 网络出版日期: 2025-03-27

Impact of platelet transfusion on the prognosis of patients with sepsis: a propensity score matching analysis

Department of Emergency, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang 318050, China

摘要

摘要: 目的血小板减少是脓毒症患者常见并发症之一。输注血小板常用于增加血小板计数, 但对脓毒症诱导的血小板减少症患者的临床影响尚不清楚。本研究旨在探讨输注血小板治疗对脓毒症患者预后的影响。方法选择2019年1月-2021年12月入住台州医院ICU的脓毒症患者为研究对象。根据有无输注血小板治疗, 将患者分为输注血小板组(PT组)和未输注血小板组(NPT组)。采用1:1倾向性评分匹配法以减少组间不平衡。利用Cox回归模型及Kaplan-Meier生存分析法, 分析输注血小板治疗对脓毒症患者预后的影响。结果共纳入274例脓毒症患者, 其中57例患者接受输注血小板治疗, 成功匹配了38对患者纳入分析。PT组与NPT组28 d死亡率[31.6%(12/38)vs.36.8%(14/38), P>0.05]和90 d死亡率[36.8%(14/38)vs.39.5%(15/38)]比较差异均无统计学意义(P>0.05)。Kaplan-Meier生存分析发现PT组与NPT组患者的28 d和90 d累积生存率比较差异也无统计学意义(P>0.05)。多因素Cox回归分析显示, APACHE Ⅱ评分是脓毒症患者28 d预后的影响因素(HR=1.138, 95%CI: 1.066~1.215, P < 0.05), 输注血小板治疗不是脓毒症患者28 d预后的影响因素(HR=0.457, 95%CI: 0.182~1.146, P>0.05)。结论本研究结果显示APACHE Ⅱ评分是脓毒症患者28 d死亡的独立影响因子, 而输注血小板治疗不能改善脓毒症患者的预后。
- 脓毒症 /
- 血小板减少症 /
- 输注血小板治疗 /
- 预后
Abstract: Objective Thrombocytopenia is one of the common complications in patients with sepsis.Platelet transfusions are frequently administered to increase platelet counts, however, their clinical impacts in sepsis-induced thrombocytopenia remains unclear.This article discusses the impact of platelet transfusion on the prognosis of patients with sepsis. Methods Patients with sepsis admitted to the ICU of Taizhou Hospital from January 2019 to December 2021 were selected as the study subjects.According to the platelet transfusion at ICU admission, septic patients were divided into two groups: a platelet transfusion group (PT group) and a non-platelet transfusion group (NPT group).Propensity score matching (PSM 1:1) was used to balance the groups.Cox logistic regression model and Kaplan-Meier survival analysis were used to analyze the impact of platelet transfusion on the prognosis in patients with sepsis. Results A total of 274 patients with sepsis were included in the study, with 57 patients in the platelet transfusion group.After PSM, 38 patients were matched in each group.The primary outcomes were 28-day and 90-day mortalities, which were 31.6%(12/38) and 36.8%(14/38) in the PT group, respectively, compared to 36.8%(14/38) and 39.5%(15/38) in the NPT group, with no significant difference (P>0.05).Kaplan-Meier survival analysis showed no significant difference in the 28-day and 90-day cumulative survival rates of patients between the platelet transfusion group and the NPT group (P>0.05).The Cox logistic regression model showed the APACHE Ⅱ score (HR=1.138, 95%CI: 1.066-1.215, P < 0.05) as an independent factor influencing prognosis in sepsis patients, while platelet transfusion (HR=0.457, 95%CI: 0.182-1.146, P>0.05) was not a significant factor. Conclusion This study found that the APACHE Ⅱ score is an independent factor for 28-day mortality in septic patients, while platelet transfusion does not improve the prognosis of patients with sepsis.
- Sepsis /
- Thrombocytopenia /
- Platelet transfusion /
- Prognosis

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图 1 匹配后PT组和NPT组患者的Kaplan-Meier生存曲线

注：A为28 d生存率；B为90 d生存率。

Figure 1. Kaplan-Meier survival curves of PT group and NPT group after matching

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表 1 匹配前后2组患者的临床基线特征和临床结局

Table 1. Baseline characteristics and clinical outcomes of the two groups before and after PSM

项目	匹配前				匹配后
项目	NPT组(n=217)	PT组(n=57)	统计量	P值	NPT组(n=38)	PT组(n=38)	统计量	P值
年龄(x±s，岁)	66.5±16.1	62.3±16.6	1.794^a	0.074	62.3±18.4	64.2±16.6	-0.484^a	0.629
男性[例(%)]	121(55.8)	32(56.1)	0.003^b	0.959	22(57.9)	24(63.2)	0.220^b	0.639
SOFA评分[M(P₂₅, P₇₅), 分]	6.0(4.0, 8.0)	9.0(7.0, 14.0)	-5.145^c	＜0.001	9.0(1.0, 11.0)	8.0(6.0, 14.0)	-0.021^c	0.983
APACHE Ⅱ评分[M(P₂₅, P₇₅), 分]	14.0(10.0, 19.0)	18.0(13.0, 22.0)	-2.857^c	0.004	16.0(10.0, 21.0)	18.0(13.0, 22.5)	-0.229^c	0.819
感染部位来源[例(%)]			2.434^b	0.692			3.874^b	0.423
呼吸系统	69(31.8)	14(24.6)			12(31.6)	7(18.4)
腹部感染	60(27.6)	16(28.1)			13(34.2)	11(28.9)
泌尿系统	27(12.4)	6(10.5)			1(2.6)	4(10.5)
血流感染	8(3.7)	4(7.0)			2(5.3)	3(7.9)
其他	24(11.1)	9(15.8)			12(31.6)	7(18.4)
实验室检查[M(P₂₅, P₇₅)]
WBC(×10⁹)	13.9(8.5, 21.5)	14.4(6.8, 21.8)	-0.337^c	0.736	14.4(9.0, 19.8)	11.0(7.6, 14.6)	-0.083^c	0.388
N(%)	89.8(84.8, 93.6)	90.9(82.9, 94.4)	-0.661^c	0.508	90.5(83.5, 93.7)	88.3(78.6, 92.8)	-1.382^c	0.831
L(%)	5.8(3.4, 10.0)	6.1(3.0, 11.2)	-0.027c	0.978	5.4(3.7, 9.2)	7.4(5.0, 13.2)	-0.883^c	0.369
CRP(mg/L)	148.3(90.7, 236.9)	172.0(111.5, 222.9)	-0.650^c	0.516	136.0(66.1, 194.2)	172.0(101.5, 238.4)	-1.679^c	0.093
PCT(ng/mL)	10.0(1.9, 47.5)	27.0(10.0, 100.0)	-3.396^c	0.001	27.0(4.1, 51.0)	20.0(7.3, 100.0)	-1.223^c	0.613
PLT(×10⁹)	164(100.7, 239.2)	32.0(11.0, 59.5)	-8.878^c	＜0.001	54.0(36.5, 69.0)	43.0(35.0, 56.5)	-3.506^c	0.090
HGB(×g/L)	114(98.7, 130.2)	99.0(87.0, 123.5)	-2.853^c	0.004	109.0(92.5, 124.0)	93.0(84.0, 107.5)	-0.951^c	0.149
PT(s)	15.3(14.3, 16.8)	17.2(14.7, 22.5)	-2.695^c	＜0.001	15.8(14.9, 19.3)	16.2(14.6, 21.8)	-0.317^c	0.751
INR	1.2(1.1, 1.4)	1.5(1.2, 2.0)	-4.032^c	＜0.001	1.3(1.2, 1.7)	1.3(1.2, 2.0)	-0.088^c	0.930
APTT(s)	35.5(5.8, 46.0)	41.0(6.8, 52.2)	-1.896^c	0.058	42.7(6.0, 60.0)	41.0(6.8, 58.3)	-0.135^c	0.893
并发症[例(%)]
急性肾损伤	84(38.7)	43(75.4)	24.490^b	＜0.001	18(47.4)	26(68.4)	3.455^b	0.063
呼吸衰竭	93(42.9)	34(59.6)	5.119^b	0.024	21(55.3)	21(55.3)	< 0.001^b	0.999
出血事件	14(6.5)	10(17.5)	6.950^b	0.008	4(10.5)	7(18.4)	0.957^b	0.328
住院接受的治疗[例(%)]
使用血管活性药物	129(59.4)	47(82.5)	8.837^b	0.003	22(57.9)	30(78.9)	3.897^b	0.050
机械通气	116(53.5)	38(66.7)	3.201^b	0.074	22(57.9)	27(71.1)	1.436^b	0.234
肾脏替代治疗	31(14.3)	24(42.1)	21.776^b	＜0.001	11(28.9)	12(31.6)	0.062^b	0.803
主要临床结局[例(%)]
28 d内病死率	40(18.4)	23(40.4)	12.248^b	0.001	14(36.8)	12(31.6)	0.234^b	0.629
90 d内病死率	47(21.7)	26(45.6)	13.254^b	＜0.001	15(39.5)	14(36.8)	0.056^b	0.813
次要临床结局[M(P₂₅, P₇₅), d]
ICU住院时间	5.0(3.0, 10.0)	8.0(4.0, 14.5)	-2.105^c	0.165	5.5(3.0, 9.0)	9.0(4.0, 17.0)	-2.253^c	0.070
住院总时间	15.0(8.0, 25.0)	14.0(5.0, 22.0)	-1.007^c	0.740	15.0(7.0, 24.3)	16.0(5.0, 22.3)	-0.031^c	0.500
注: ^a为t值，^b为χ²值，^c为Z值。

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参考文献(17)

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