The Research On Predicting The Severity Of Patients By Peripheral Blood Platelet Count Combined With Apache Ⅱ System

Systemic Inflammatory Response Syndrome(SIRS), it is a kind of sustained self-amplification and self-destruction under organism respond to different damages(which induced by body in response to different damages), characterized by disseminated activation of inflammatory cell, inflammatory mediator spillover and systemic inflammation in distant parts. Foreign researches showed that the incidence of SIRS in adult patients under intensive care was about 87%, and about 80%~90% in children under the same condition. According to domestic retrospective data, the incidence of SIRS in children under intensive care was about 92%. Multiple Organ Dysfunction Syndrome(MODS) was further developed from SIRS. Patients with SIRS and MODS in ICU were critically ill and their disease progressed rapidly, but there was a lack of specific criteria for symptoms evaluation. Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) is the most widely and authoritative system for evaluating the critically ill at home and abroad currently. The severity of SIRS could be evaluated by a low platelet count, and its degree was related to the decrease of platelet. The systemic micro-vascular endothelial system was activated when patients were suffering from SIRS, and then the consumption of platelets was accelerated and its count decreased significantly, and SIRS got worse.Objective: Retrospective cohort study was performed on severe patients in ICU during January to December 2013 in Hefei First People’s Hospital. The study was to explore whether peripheral blood platelet count and Acute Physiology and Chronic Health EvaluationⅡ were correlated to prognosis of severe patients, and investigate whether peripheral blood platelet count combined with APACHEⅡ could forecast the prognosis. So far, there were lots of researches on the application of APACHE II in the intensive care unit, and the effect of APACHE II in prognosis has also got certain affirmation. Whether peripheral blood platelet count combined with APACHEⅡcould forecast the prognosis of patients with SIRS and MODS in ICU was investigated by retrospectively analysis. It provided the references for the clinical treatment of critically ill patients in ICU.Methods:108 cases in ICU were analyzed retrospectively. According to the severity, they were divided into three groups as follows.A group: patients with SIRS caused by various factors and MODS, but without DIC(n=33); B group: patients with SIRS only, and without DIC(n=38); C group: non-SIRS patients without DIC(n=37). Under the prognosis of patients, the cases were divided into two groups, and they were the survival group(n=90) and the death group(n=18). Platelet counts of group A, B, and C were recorded on the first, third, sixth and ninth day. Platelet levels were analyzed. APACHE Ⅱ score of group A, B, and C were calculated after 24 hours, respectively, and compared each other. The similar treatments were done on the survival and death group.Results:The difference in platelet counts was statistically significant between patients with SIRS and MODS and ones with SIRS only(p<0.05), and again so did APACHE II score(p < 0.05). The difference in platelet counts was significant between patients with SIRS only and non-SIRS patients(p < 0.05), and so did APACHE II score(p < 0.05). The difference in platelet counts was significant between patients with SIRS and MODS and non-SIRS patients(p<0.05), and so did APACHE II score(p < 0.05). After treatment, platelet counts in survival group increased gradual, but it reduced progressively in death group, and the difference was significant(p<0.05). The difference in APACHE II score was statistically significant between survival and death group(p<0.05).Conclusion:With the increase of APACHE II score, the disease got worse. APACHE II score in the death group was significantly higher than that in the survival group, and it also proved that the APACHE II score could reveal the severity and prognosis.The higher APACHE II scores of patients in ICU, the lower platelet counts, and the more serious the illness. Platelet count in death group was obviously lower than that in survival group, and this is consistent with related literatures. Research has suggested that platelet counts of critically ill patients in ICU could be regarded as index to evaluate the severity of their disease.It was better for getting patient’s condition to perform APACH II immediately after admission, meantime overall condition of patients and disease progression could be further evaluated by dynamic monitoring platelet counts in the course, thus increasing survival and decreasing mortality. The work offered references and experiences for evaluating the condition of patients with SIRS and MODS in ICU by peripheral blood platelet count combined with APACHEⅡ.