Dynamic Change Of Platelet Counts In The Early Stage Post-burn And Its Clinical Significance For Severely Burned Patients

Objective:To investigate the dynamic change of platelet counts and MPV/PLT in the early stage post-burn for severely burned patients and explore the factors influencing the changes,to evaluate the prognostic value of platelet counts recovery and MPV/PLT in the early stage post-burn as an warning of the severity of illness.Methods:1.Platelet count recovery as an indicator to evaluate the severity of illness for severely burned patientsA total number of 244 severely burned?total area burned?50%TBSA?adult patients,admitted to the Burn Center of Rui Jin Hospital from January 1st,2006 to December 31st,2015,were included in the first study.The dynamic changes in platelet counts of the initial 10 days post-burn were analyzed and compared between the survival group and the non-survival group.Cox regression analysis and ROC curve were employed to determine whether platelet counts that did not return to normal within 1 week post-burn could be used as indicator to evaluate the severity of illness for severely burned patients.Logistic regression analysis was used to explore the factors influencing the recovery of platelet counts.2.MPV/PLT as an indicator to predict the prognosis for severely burned patientsA total number of 225 severely burned?total area burned?50%TBSA?adult patients,admitted to the Burn Center of Rui Jin Hospital from January 1st,2006 to December 31st,2015,were included in the second study.The dynamic changes in MPV/PLT of the initial 14 days post-burn were analyzed and compared between the survival group and the non-survival group.Cox regression analysis and Kaplan-Meier survival curve were employed to determine whether MPV/PLT?PBD9?could be used as a prognostic indicator for severely burned patients.Results:1.Platelet count recovery as an indicator to evaluate the severity of illness for severely burned patients212 cases were involved in the survival group with a mean length of stay of50±32 days,while the non-survival group included 32 adult patients with a mean length of stay of 20±10 days.The platelet count kept declining from 1st to 4th day post-burn and rebound from 4th to 10th day post-burn in both the survival and non-survival groups.However,in the survival group the platelet counts returned to normal within 1 week post-burn while the non-survival group did not.The mortality was significantly higher in the group with platelet counts did not return to normal within 1 week compared to those with platelet counts returned to normal?27.2%vs.6.1%,P<0.01?.Multivariate Cox regression analysis showed that platelet counts that did not return to normal within 1 week post-burn was an independent risk factor for mortality in severely burned patients?HR:1.522,P<0.01?.The ROC curve generated an area under the curve of 0.745?95%CI:0.645-0.845,P<0.01?,with a sensitivity and specificity of 0.714 and 0.710 respectively,when the cut-off value was 150 x 10⁹/L.Cause of burn,full-thickness burn area and time from burn to admission were independent factors influencing recovery of platelet counts post-burn.2.MPV/PLT as an indicator to predict the prognosis for severely burned patients195 cases were involved in the survival group with a mean length of stay of50±32 days,while the non-survival group included 30 adult patients with a mean length of stay of 20±10 days.The MPV/PLT value kept rising from 1st to 4th day post-burn and declining from 4th to 14th day post-burn in both the survival and non-survival groups.The mortality was significantly higher in the group with MPV/PLT?PBD9?>4.4×10-11fL·L compared to those with MPV/PLT?PBD9??4.4×10^-11fL·L?23.7%vs.2.7%,P<0.01?.Multivariate Cox regression analysis and Kaplan-Meier survival curve showed that MPV/PLT?PBD9?>4.4×10-11fL·L was an independent risk factor for mortality in severely burned patients?HR:1.328,P<0.05?.The ROC curve generated an area under the curve of 0.773?95%CI:0.683-0.863,P<0.01?,with a sensitivity and specificity of 0.900 and 0.554 respectively.Conclusions:1.Platelet count recovery as an indicator to evaluate the severity of illness for severely burned patientsPlatelet counts recovery in the early stage post-burn could be used as an important indicator to evaluate the severity of illness for severely burned patients.Platelet counts recovery was closely correlated to cause of burn,full-thickness burn area and time from burn to admission.2.MPV/PLT as an indicator to predict the prognosis for severely burned patientsMPV/PLT?PBD9?was closely related to the prognosis of severely burned patients.MPV/PLT?PBD9?>4.4×10^-11fL·L was an independent risk factor for mortality in severely burned patients.