Prognostic Study Of Patients With Acute Respiratory Distress Syndrome Combined With Thrombocytopenia

ObjectivePeripheral platelet count less than 100×10~9/L is usually defined as thrombocytopenia clinically.Thrombocytopenia is common in hospitalized patients,with many patients having thrombocytopenia during hospitalization,and numerous studies have shown that thrombocytopenia is associated with mortality in critically ill patients.Studies have shown that the mortality of septic shock patients with thrombocytopenia in ICU is higher than that of patients with non-thrombocytopenia septic shock.Acute respiratory distress syndrome is a common syndrome in ICU with high morbidity and mortality.However,there are few studies on the relationship between thrombocytopenia and mortality in patients with ARDS.This project aims to explore whether thrombocytopenia is associated with a high risk of death in early ARDS patients and the risk factors for thrombocytopenia.MethodsThis study was a single-center,retrospective study.The subjects of this study were all patients diagnosed with ARDS in the ICU of Zhongnan hospital of Wuhan university from January 2016 to April 2018.We collect patients basic information including age,sex,source,etc.,the first time in the ICU check indexes including liver function(ALT,AST,total bilirubin),kidney(creatinine and urea nitrogen),blood coagulation function(prothrombin time,activated partial thromboplastin time,and blood gas analysis index,and into the ICU vital signs(respiration,heart rate,blood pressure)and acute physiology and chronic health evaluation II.Platelet-related indicators(platelet count,mean platelet volume)were collected within 24 hours of ARDS diagnosis.Indicators related to mechanical ventilation include positive end-expiratory pressure(PEEP),partial pressure of oxygen(PaO2),and oxygenation index.Outcome indicators collected included ICU hospitalization time,total hospitalization time,mechanical ventilation time,ICU mortality,hospitalization mortality,liver function change,renal function change and coagulation function change during hospitalization.ARDS patients were then divided intodeathgroupandsurvivalgroup,thrombocytopeniagroupand non-thrombocytopenia group.Advanced univariate analysis was performed,and multiple logistic regression analysis was performed to obtain the relevant risk factors of mortality and thrombocytopenia.Then the severity of thrombocytopenia was graded and the K-M survival curve was used for analysis.Independent sample t test was performed for platelet count in patients with intrapulmonary and extrapulmonary ARDS.Variance analysis was used to analyze the difference of platelet count among patients with ARDS of different severity grading.All analyses were performed using statistical software SPSS.ResultsA total of 404 patients met the inclusion criteria,104 patients were excluded according to the exclusion criteria,and finally 300 patients were included in the study.The incidence of thrombocytopenia in ARDS patients was 41.3%.The incidence of thrombocytopenia in patients with ARDS caused by extrapulmonary causes is higher than that in patients with ARDS caused by intrapulmonary causes.There was no statistically significant difference in the incidence of thrombocytopenia in ARDS patients with different severity grades.The mortality of patients with thrombocytopenia(ICU mortality(P=0.002)and hospitalization mortality(P=0.007)was higher in the thrombocytopenia group than in the non-thrombocytopenia group,with statistically significant differences.Subgroup analysis of patients with thrombocytopenia showed that the lower the platelet count,the higher the mortality.Platelet count?100×10~9/L compared with platelet count?20×10~9/L(P<0.001),platelet count?100×10~9/L compared with platelet count 20–50×10~9/L(P=0.034),platelet count?100×10~9/L compared with platelet count 50–100×10~9/L(P=0.072).Multivariate regression analysis showed that lactic acid level,APACHE II and thrombocytopenia are risk factors for ARDS patients.Procalcitonin(PCT),hemoglobin,activation of partial thrombin time,and lactic acid are the risk factors for thrombocytopenia.Conclusion The incidence of thrombocytopenia in ARDS patients is relatively high,which is 41.3%.The higher the degree of thrombocytopenia,the higher the mortality.The incidence of thrombocytopenia in patients with ARDS caused by extrapulmonary causes is higher than that in patients with ARDS caused by intrapulmonary causes.Lactate,APACHEII score are associated with high mortality in ARDS patients.