Analysis Of Prognostic Value Of Early Changes Of BPC,MPV/PLT And PRL In Patients With Extremely Severe Burn

Object:In this study,the changes of platelet count（Blood platelets count,BPC）,platelet volume/platelet count（MPV/PLT）and platelet count/lymphoid count（Platelet to lymphocyte ratio,PLR）in patients with severe burn were retrospectively analyzed to explore the factors affecting these changes and the relationship between these changes and the prognosis of burn patients,so as to provide theoretical basis for clinical diagnosis and treatment.Methods:1.Analysis of prognostic value of early BPC changes in patients with extremely severe burn.From August 1,2018 to December 31,2022,95 adult patients with extra severe burn were treated in the Department of Burn plastic Surgery（Trauma Repair Department）of the First Hospital of Hebei Medical University.A total of 95 eligible subjects were selected according to the inclusion and exclusion criteria.The data of general condition（sex,age）、injury（injury factors,third degree burn area,total burn area,time from injury to hospitalization,respiratory tract injury or not）,treatment（mechanical ventilation,days of hospitalization,times of blood transfusion,times of TPO injection,number of operations）,laboratory examination（WBC,LY,RBC,BPC,MPV）were collected and sorted out,and the data were studied retrospectively.According to the prognosis,the patients were divided into survival group and death group,and the dynamic changes of BPC in the two groups within 14 days after injury were analyzed and compared.And according to whether BPC returned to normal within one week after injury（BPC≥125×10⁹/L）,it was divided into recovery group and non-recovery group,and the research results were statistically analyzed.2.Analysis of prognostic value of early changes of MPV/PLT and PLR in patients with extremely severe burn.From August 1,2018 to December 31,2022,87 adult patients with extra severe burn were treated in the Department of Burn and Plastic Surgery（Trauma Repair Department）of the First Hospital of Hebei Medical University.The data of general condition（sex,age）,injury（third degree burn area,total burn area,time from injury to hospitalization,whether complicated with respiratory tract injury）,treatment（mechanical ventilation,hospitalization days,times of blood transfusion,times of TPO injection,number of operations）,laboratory examination（BPC,MPV,LY）were collected and analyzed retrospectively.According to the prognosis,the patients were divided into survival group and death group.The MPV/PLT and PLR of the two groups were counted continuously within 14 days after injury.The data were divided into groups according to the ROC curve and the corresponding cutoff value of AUC.The research results were statistically analyzed.Results:1.Analysis of prognostic value of early BPC changes in patients with extremely severe burn.There were significant differences in average age,TBSA,inhalation injury,proportion of mechanical ventilation,times of operation and hospitalization days between 76 patients in survival group and 19 patients in death group.BPC in both groups decreased rapidly on the 1^st to 4^th day after injury,reached the bottom on the 3^rd or 4^th day,and gradually recovered on the 5^th to 14^th day after injury.The mean value of BPC in the survival group returned to normal within a week,while that in the death group did not return to normal.One week after injury,there were 63 patients with BPC recovery and 32 patients with no BPC recovery.the in-hospital survival rates were 93.7%（59 cases）and 53.1%（17cases）,respectively.Multivariate Cox regression analysis showed that the failure of BPC to return to normal within one week after injury was an independent risk factor for mortality in patients with extra severe burns（HR:4.114,95.0%CI:1.055-16.049,P<0.05）.The area under the curve measured by ROC curve was 0.801（95%CI:0.691-0.911,P<0.01）,and the cutoff value was 127×10⁹.Its sensitivity and specificity for predicting death were 78.9%and 77.6%respectively.2.Analysis of prognostic value of early changes of MPV/PLT and PLR in patients with extremely severe burn.There were 74 patients in the survival group and 13 patients in the death group.The results of Mann-Whitney U test showed that the levels of MPV/PLT and PLR in the death group were significantly higher than those in the survival group from 6^th to 14^th days after injury.The results of Kaplan-Meier curve and Log-rank test analysis showed that both MPV₁₃/PLT₁₃ and PLR₁₄ were shadow factors in the prognosis of shadow response.The survival rate of patients with MPV₁₃/PLT₁₃≥4.4×10^-11f L·L was significantly lower than that of MPV₁₃/PLT₁₃<4.4×10^-11f L·L（26.7%vs.97.3%,P<0.01）.The survival rate in the PLR₁₄≥65.63 group was significantly lower than that in the PLR₁₄<65.63 group（62.5%vs.98.2%,P<0.01）.Multivariate Cox analysis showed that MPV₁₃/PLT₁₃≥4.4×10^-11f L·L was an independent risk factor for death in patients with extra severe burns（HR=49.398,P<0.0l）.The product under the curve measured by ROC curve was 0.899（95%CI:0.788-1.000,P<0.0l）.The sensitivity and specificity were 84.60%and 94.60%respectively.Conclusions:1.Analysis of prognostic value of early BPC changes in patients with extremely severe burn.The recovery of BPC on the 7^th day after injury can be used as an important index to reflect the severity of extra severe burn patients,and BPC does not return to normal within one week after injury,gender（female has a higher risk of death than male）and larger TBSA are independent risk factors for death in patients with extra severe burn.2.Analysis of prognostic value of early changes of MPV/PLT and PLR in patients with extremely severe burn.The levels of serum MPV/PLT and PLR in patients with extra severe burn have certain predictive value and clinical significance for their poor prognosis.MPV₁₃/PLT₁₃and PLR₁₄are the factors affecting the prognosis.MPV₁₃/PLT₁₃≥4.4×10^-11f L·L is an independent risk factor for death in patients with extremely severe burns.