Value Of Platelet Parameter In The Assessment And Prognosis Of Spontaneous Intracranial Hemorrhage

Background and Objective:Platelets are the main cellular components in circulating blood,which can be used as primary hemostasis during vascular injury.More and more studies have found that platelets play an important role in the occurrence and development of sepsis,cardiovascular disease and stroke disorders.Studies have shown that thrombocytopenia is an independent predictor of death in patients in intensive care units(ICU).Foreign studies have shown that increased MPV is an independent risk factor for myocardial infarction and recurrence rates,and some scholars have believed that it is an independent risk factor for stroke.In this study,platelet parameters of 100 cases with spontaneous intracranial hemorrhage(ICH)were monitored,the mortality of Patients and GOS score 3 months after discharged were recorded and analyzed to study the value of platelet parameter in the assessment and prognosis of spontaneous ICH,in order to determine the critical degree of the disease in the early period.Methods:A total of 100 Patients with spontaneous ICH who were admitted to Jiangsu Jiangyin Hospital from June 2015 to December 2016 were enrolled in this study,including 75 males and 25 females with an average age of 60.5 ± 13.3 years old.Inclusion criteria: 1.Diagnosis was in accordance with the Fourth National Cerebrovascular Disease Conference revised diagnostic criteria,confirmed by head CT or MRI.2.Onset to admission time ? 6h;Exclusion criteria: 1.Anticoagulant or drugs that affect platelet function,such as antiplatelet drugs were taken within 1 month before the onset.2.Ischemic stroke.3.Spontaneous subarachnoid hemorrhage.4.Patients with obvious liver and kidney dysfunction or cardiac insufficiency.5.Patients with recent history of surgery and trauma.6.Patients who recently treated with hormones or immunosuppression drugs.7.Any cause that patients could not take care of their own in daily life.8.Patients with hematological diseases.Methods: General characteristics of all patients were collected after admission,the APACHE-? score,bleeding sites,bleeding volume,removal of hematoma by surgery or not were calculated.Systolic blood pressure at the time of admission and 1 h after treatment,admission GCS score,admission NIHSS score,the first time measured platelet parameters(PLT,PDW,MPV)when admitted were recorded,follow-up GOS score were recorded 3 months after discharge.Patients were grouped by outcome(survival vs death),and their clinical characteristics were counted.The clinical characteristics of the patients were analyzed according to the GOS score(good and poor prognosis)3 months after discharge.Finally,logistic multivariate regression analysis was used to screen out the independent risk factors of poor prognosis,and the ROC curve was drawn to obtain the correlation between platelet parameters and prognosis.Results:(1)APACHE-? score in the poor prognosis group was significantly higher than that in the good prognosis group [(14.66±5.449)vs(6.26±3.018,? < 0.001];APACHE-II score was negatively correlated with platelet count(PLT)(r =-0.442);APACHE-? was positively correlated with platelet mean volume(MPV)(r = 0.553);APACHE-? was positively correlated with platelet distribution width(PDW)(r = 0.574).(2)The PLT count in the poor prognosis group was significantly lower than in the good prognosis group [(143.21±66.400)vs(205.94±66.498),P < 0.001],while MPV [(14.88±4.508)vs(10.82±1.525),P < 0.001] and PDW [(16.77±4.215)vs(12.95±2.654),P < 0.001] were higher than those of the good prognosis group.(3)The PLT count in the death group was significantly lower than that in the survival group [(100.41±14.298)vs(206.71±64.470),? < 0.001],while MPV [(18.02±2.944)vs(10.59±1.250),P < 0.001] and PDW [(19.07±3.395)vs(13.04±2.633),P < 0.01] were higher than those of the survival group.(4)Multivariate logistic regression analysis showed that age,NIHSS score,and MPV were independent risk factors for poor prognosis of patients 3 months after discharge.(5)Compared with the area under the ROC curve,the area under the curve of MPV(AUC=0.777)was close to APACHE-?(AUC=0.918),and MPV had a high specificity in judging the prognosis of spontaneous ICH.Conclusion:(1)Platelet parameters,especially MPV was the independent risk factor for poor prognosis of ICH patients,higher MPV suggested severer disease and worse prognosis;(2)MPV predicts the prognosis of ICH patients with high accuracy and differentiation,the actual performance is close to APACHE-?;(3)Age,NIHSS score,and MPV count were independent risk factors for poor prognosis 3 months after discharge.Therefore,early emphasis on changes in patients with platelets can predict the evolution of disease and improve clinical treatment.