| Part ? The Predictive Value of Platelet Count for Acute Kidney Injury in Patients with Hemorrhagic Shock?Objection? The aim of this study was to evaluate the predictive value of platelet counts for acute kidney injury(AKI)in patients with hemorrhagic shock.?Methods? A retrospective cohort study of clinical data.Clinical data of patients with hemorrhagic shock admitted to the Department of Intensive Care(ICU),the Second People's Hospital of Shenzhen from January 2010 to December 2015 was collected.For each patient,basic data(age,sex,etiology),biochemical indicators(blood routine,liver and kidney function,coagulation Functional,arterial blood gas analysis),treatment,Acute Physiology and Chronic Health Evaluation(APACHE II),Sequential Organ Failure Assessment(SOFA),ICU length of stay,outcomes was collected.Patients were divided into death group and survivor group according to whether the patients hospitalized 28-day outcomes.T-test,F-test,Chi-square test or Mann-Whitney U test was used to analyze the differences between the AKI group and the non-AKI group.Univariate and multivariate logistic regression analysis was used to analyze the independent predictive value of platelet count in AKI patients with hemorrhagic shock.Receiver operating characteristic curve(ROC)was used to predict platelet counts for the best clinical cut-off point for AKI in hemorrhagic shock patients.?Results? 1?Demographic characteristics and vital signs of the AKI group andnon-AKI group: there were 91 patients with hemorrhagic shock admitted to the ICU.According to the inclusion and exclusion criteria,84 patients were included in this study.The age of all patients ranged from 18 to 85 and the average age is 37.11±14.11.There were 77 young adults(<60 years old)(91.67%)and 7 elders(? 60 years old)(8.33%).There was no significant difference in age between the AKI group(40.77±13.59)and the non-AKI group(35.07±14.11)(P=0.076).There were 58 males(69.05%)(22 AKIs and 36 non-AKIs)and 26 females(30.95%)(8 AKIs and 18 non-AKIs).There was no significant difference between the two groups(P=0.527).There was no significant difference in mean arterial pressure and heart rate between the two groups(P>0.05).2?The causes of hemorrhagic shock were as follows: 32 patients(38.10%)of traffic injuries,20 patients(23.81%)of fall injuries,12 patients(14.29%)of sharp injuries,9 patients(10.71%)of gastrointestinal bleeding,and 11 patients(13.09%)of other causes.There was no significant difference in etiology between the two groups(P=0.812);There were 30 patients(35.71%)of AKI and 54 patients(64.29%)of non-AKI,of which 10 patients(33.33%)were in AKI stage 1,13 patients(43.33%)in AKI stage 2,and 7 patients(23.33%)in AKI stage 3.3?Surgical treatment was performed in 60 patients(71.43%)(22 with AKI,38 with non-AKI),non-surgical treatment 24 cases(28.57%)(8 with AKI,16 with non-AKI),no significant difference in surgical treatment between the two groups(P=0.773).There were 25 patients(29.76%)of vasopressor therapy(17 patients with AKI,8 patients with non-AKI),59 patients(70.24%)with non-vasopressor therapy(13 patients with AKI,46 patients with non-AKI).There were significant differences in the use rates of vasopressors between the two groups(56.67% vs.14.81%,P<0.001).There were 58 patients of mechanically ventilated(69.05%)(28 patients with AKI,30 patients with non-AKI),26 patients of non-mechanical ventilation(30.95%)(2 patients with AKI,24 patients with non-AKI).AKI group mechanical ventilation use rate was significantly higher than non-AKI Group(93.33% vs.55.56%,P<0.001).4?There were statistically significant differences in red blood cell transfusions,platelet count,white blood cell count,hemoglobin,alanine aminotransferase,aspartate aminotransferase,total bilirubin,p H,carbon dioxide,oxygenation index,actual bicarbonate,lactic acid,APTT,PT,SOFA scores and APACHE II scores between AKI and non-AKI(P < 0.05).There were no statistically significant difference in plasma transfusions,platelet transfusions,cryoprecipitate transfusions,mean platelet volume,lymphocyte count,albumin,and arterial oxygen partial pressure between AKI and non-AKI(P > 0.05).5?Univariate and multivariate logistic regression analysis showed lactate(?=1.33 P=0.0106),carbon dioxide partial pressure(?=1.12 P=0.0468),alanine aminotransferase(?=1.01 P=0.0471),mechanical ventilation(OR=28.29 P=0.0087),SOFA score(?=2.74 P=0.0052)and APACHE-II score(?= 1.25 P=0.0065)were independent risk factors for AKI in hemorrhagic shock patients.Nevertheless the platelet counts(?=0.71 P=0.0128)was the only protective factor for AKI.The area under the ROC curve(AUC)of the nadir platelet counts to predict hemorrhagic shock within 48 hours was 0.838(P<0.01,95% CI: 0.731-0.929),and the best cutoff point was 75×109/L,and the sensitivity and specificity were 81.5% and 76.7%,respectively.?Conclusion? The patients with hemorrhagic shock who happened acute kidney injury was not related to age,gender,surgery treatment,and component blood transfusion.It was closely related to platelet count,lactic acid,carbon dioxide pressure,alanine aminotransferase,APACHE-II score,SOFA score,and mechanical ventilation.Platelet count was theprotective factor for AKI in patients with hemorrhagic shock.The incidence of AKI was reduced by 29% for each increase by 10×109/L of platelet count.The area under the ROC curve(AUC)of platelet counts for predicting AKI in hemorrhagic shock is 0.838 and the best cutoff point is 75 × 109/L.Part ? Relationship between Platelet Count and 28-day Mortality in Patients with Hemorrhagic Shock?Objection? The aim of the study was to evaluate the effect of the nadir platelet counts on the 28-day mortality in patients with hemorrhagic shock in the ICU within 48 hours of admission.?Methods? A retrospective cohort study of clinical data.Clinical data of patients with hemorrhagic shock admitted to the Department of Intensive Care(ICU),the Second People's Hospital of Shenzhen from January 2010 to December 2015 was collected.For each patient,basic data(age,sex,etiology),biochemical indicators(blood routine,liver and kidney function,coagulation Functional,arterial blood gas analysis),treatment,Acute Physiology and Chronic Health Evaluation(APACHE II),Sequential Organ Failure Assessment(SOFA),ICU length of stay,outcomes were collected.Patients were divided into death group and survivor group according to the hospitalized 28-day outcomes of patients.Ttest,Chi-square test or Mann-Whitney U test was used to analyze the differences between the death group and the survival group.KaplanMeier survival analysis and Log Rank method were used to examine the 28-day mortality rate of AKI and non-AKI patients.Finally,the Cox regression model was used to analyze the risk factors associated with 28-day mortality in patients with hemorrhagic shock.?Results? 1?Demographic characteristics and vital signs of the death group and survival group:there were 58 males(69.05%)(19 deaths,39 survivals)and 26 females(30.95%)(9 deaths and 17 survivals).There was nosignificant difference in gender between the two groups(P=0.867).There were 28 patients died(33.33%),56 patients survived(66.67%),and the age of the death group age(42.75 ± 16.92)was significantly greater than the survival group(34.29 ± 11.65)(P=0.009).There was no significant difference in mean arterial pressure and heart rate between the two groups(P>0.05).2?Surgical treatment was performed in 60 patients(71.43%)(21 deaths,39 survivals),non-surgical treatment in 24 patients(28.57%)(7 deaths,17 survivals),and there was no significant difference in surgical treatment between the two groups(P =0.608).There were 25 patients(29.76%)of vasopressor therapy(18 deaths,7 survivals),and 59 patients(70.24%)of non-vasopressors therapy(10 deaths,49 survivals).There was a significant difference between the two groups in vasopressor use(64.29% vs.12.50%,P<0.001).58 patients(69.05%)were mechanically ventilated(25 deaths,33 survivals),26 patients(30.95%)were non-mechanical ventilated(3 deaths,23 survivals).The rate of mechanical ventilation was significantly higher in the death group than in the survival group(89.29% vs.58.93%,P<0.001).There were 19 patients(67.86%)with AKI,and 9 patients(32.14%)without AKI in the death group.In the survival group,11 patients(19.64%)of AKI occurred and 45 patients(80.36%)did not occur AKI,and the incidence of AKI in death group was significantly higher than survival group(67.86% vs.19.64%,P<0.001).3?There were statistically significant differences in platelet counts,hemoglobin,white blood cell count,neutrophil count,platelet lymphocyte ratio,alanine aminotransferase,aspartate aminotransferase,total bilirubin,urine volume,urea nitrogen,creatinine,glomerular filtration,PH,carbon dioxide partial pressure,oxygenation index,lactic acid,actual bicarbonate,APTT,PT,APACHE II score,and SOFAscore between death group and survival group(P < 0.05).There was no statistically significant difference in etiology,red blood cell transfusions,plasma transfusions,platelet transfusions,cryoprecipitate transfusions,mean platelet volume,lymphocyte count,platelet neutrophil ratio,albumin,arterial oxygen partial pressure between death group and survival group(P > 0.05).4?The 28-day mortality of patients with AKI is associated with CRRT.The 28-day mortality of the non-CRRT group was significantly higher than the CRRT group in 30 AKI patients(87.50% vs.35.71%,P<0.001).5?Cox regression model showed that lactic acid(HR=1.140 P<0.001),AKI(HR=0.130 P < 0.001),vasopressor therapy(HR=2.45 P=0.027),mechanical ventilation(HR=0.33 P= 0.039),SOFA score(HR=1.32 P=0.001)and APACHE-II score(HR=1.11 P=0.001)were independent risk factors for 28-day mortality of patients with hemorrhagic shock.Nevertheless platelet counts(HR=0.886 P=0.031)was the only protective factor.The platelet counts increased by 10×109/L,the 28-day all-cause mortality was reduced by 11.4%.Kaplan-Meier and Log Rank tests were used to compare the 28-day mortality rate between AKI and non-AKI patients.The results showed that there was a statistically significant difference in 28-day mortality between the two groups(P<0.0001).?Conclusion? The 28-day mortality of patients with hemorrhagic shock was not related to age,gender,surgery treatment,and component blood transfusion.It was closely related to platelet count,lactic acid,AKI,vasopressors therapy,mechanical ventilation,SOFA score and APACHE-II score.The platelet counts was the protective factor for 28-day all-cause mortality in patients with hemorrhagic shock.The platelet counts increased by 10×109/L,and the 28-day mortality was reduced by 11.4%. |
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