The Value Of Platelet As An Early Predictor In Patients With Sepsis

Objective:To investigate the changes of early platelet counts in patients with sepsis and their impact on prognosis,and to determine the risk factors related to the occurrence of platelet reduction in patients with sepsis.The aim is to explore the predictive value of platelets on the prognosis of patients with sepsis and to guide the treatment of patients with sepsis.Methods:This study retrospectively collected 202 patients with sepsis who were admitted to the ICU of the Second Affiliated Hospital of Da Lian Medical University from June 2018 to June 2019.Based on the patient's platelet count within 24 hours of the first diagnosis of sepsis in the ICU,the study subjects were divided into three groups:group A:platelet count?100?10~9/L;group B:100?10~9/L<platelet count?150?10~9/L;group C:platelet count>150?10~9/L.The general information,basic disease,primary infection site,and pathogenic bacteria of all patients were recorded,and multiple logistic regression was used to analyze the risk factors of thrombocytopenia.The impact of platelet count on the prognosis of patients with sepsis was assessed based on length of ICU and hospital stay(among survivors and nonsurvivors).Log-rank method was used to compare the differences in survival time between the three groups of patients.Further analysis of independent risk factors affecting the prognosis of sepsis patients was performed by multivariate Cox regression.A line chart of platelet counts during the hospitalization period was used to analyze the platelet changes.Results:A total of 95 patients had thrombocytopenia with an incidence of 47%.Among them,22%(57/202)patients had a platelet count?100?10~9/L,18%(38/202)patients had a platelet count of 100-150?10~9/L.The distribution of the three groups of patients was significantly different among the three basic diseases of age,whether they have hypertension,diabetes,and chronic lung disease(P<0.05).Gram-negative bacilli were the main pathogens in the patients,and the distribution was statistically different between the three groups(P=0.018<0.05).The maximum APACHE?score within24 hours of diagnosis of sepsis was significantly higher in the thrombocytopenia group than in the normal platelet group,which was statistically significant(P=0.034<0.05).The incidence of septic shock in the thrombocytopenia group was higher than that in the normal platelet group,which was statistically significant(P=0.005<0.05).Primary gram-negative bacilli infection increases the risk of platelet counts below 100 109/L(OR=3.061,P=0.019<0.05).The differences in overall survival rates between the three groups were statistically significant(?2=22.232,P<0.001).The mortality of the thrombocytopenia group was significantly higher than that of the normal platelet group(P<0.05),and the mortality increased significantly with the decrease of the platelet count.Early thrombocytopenia is an independent predictor of death in patients with sepsis.The risk of hospitalized death in the platelet count?100?10~9/L group was3.153(95%CI:1.673-5.943)times that of the normal platelet group.Conclusions:(1)Combining hypertension,chronic lung disease,and Gram-negative bacilli in the underlying disease will increase the risk of thrombocytopenia in patients with sepsis;(2)Patients>65 years of age with previous hypertension,chronic cardiac insufficiency,and early platelet counts in patients with sepsis are independent risk factors for death in patients with sepsis;(3)Thrombocytopenia can occur early in patients with sepsis.The platelet count is negatively correlated with the severity of sepsis patients.The lower the platelet count,the more severe the sepsis patients,the higher the mortality,and the shorter the survival time.