Study On The Dynamic Changes Of Platelet Parameters And Assess The Correlation Of Prognosis In Patients With Septic Shock

Objective: To explore the dynamic changes of platelets-related parameters and their predictive value in clinical prognosis among patients with septic shock in the intensive care unit.Methods: This retrospective study was conducted in the intensive care unit at the first affiliated hospital of Wannan Medical College from January 2018 to December 2019.We selected 89 hospitalized patients with a definite diagnosis of septic shock as test subjects.The demographic and clinical data were recorded and analyzed,including general clinical data、vital signs、infection lesions、arterial blood gas analysis、creatinine、white blood cell count、hematokrit、Platelet parameters on day1、3、5 and 7 after admission(platelet count;mean platelet volume;platelet distribution width;platelet accumulation)、28-day survival rate、hospital stays、GCS scores and APACHE-II scores.The Patients with septic shock were divided into the death group(N=47)and the survival group(N=42)by 28-day outcome,and were divided into the APACHE-II >20 group(N=50)and APACHE-II≤20group(N=39)by APACHE-II scores.The differences in general clinical data and laboratory indicators between the above groups were compared,and the receiver operating characteristic curve(ROC curve)of platelets related parameters on 1d,3d,5d and 7d after admission to ICU the area under the ROC curve(AUC)of each parameter was used to evaluate.In addition,dynamic changes of platelet-related parameters at different time points among groups were compared and analyzing the correlation withplatelet-related parameters and the severity of patients’ disease.Results: A total of 89 patients with septic shock were included in this study,including 47 in the death group and 42 in the survival group,with a mortality rate of 52.8%.1.Comparison of general data among groups with different prognosis and outcomes: age,APACHE-II scores and blood lactic acid in the death group were higher than those in the survival group(P<0.05).The mean arterial pressure,PH,hematocrit and GCS scores of the former were lower than those of the latter(P<0.05).2.Comparison of general data among groups with different severity of disease: age and creatinine values in APACHE-II >20 group were higher than those in APACHE-II≤20group(P<0.05).The mean arterial pressure and PH of the former was lower than those of the latter,and the difference was statistically significant(P<0.05).3.Dynamic monitoring changes of platelet-related parameters: the PLT of patients in the death group and APACHE-II >20 group showed a progressive decline,while the PLT of patients in the survival group and APACHE-II≤20 group first decreased,then increased,and finally tended to normal.MPV in all patients showed a gradually increasing trend,but the baseline of MPV value in the death group and APACHE-II >20 group was significantly higher than that in the survival group and APACHE-II ≤ 20 group.The change trend of PDW value in each group was not significant,but the baseline level in the death group and APACHE-II >20 group was higher than survival group and APACHE-II≤20 group.The PCT values of patients in the death group and APACHE-II >20 group gradually decreased,while those in the survival group and APACHE-II≤20 group first decreased and then increased.4.Spearman correlation analysis of disease severity and platelet parameter: there was a negative correlation between PLT and PCT with severity of septic shock(P<0.05).MPV and PDW was positively correlated with the severity of septic shock(P<0.05).5.Analysis of the receiver operating characteristic curve for predicting the clinical outcome of septic shock with platelet-related parameters: PLT,MPV,PDW and PCT allhad a predictive value for prognosis of septic shock patients.PLT and PCT have a best predictive value at day 7.MPV and PDW have a best predictive value at day 3.Conclusion:1.There are significant differences on different clinical prognosis and severity on patients with septic shock among platelet-related parameter.2.With the dynamic changes of platelet parameters,disease progression and clinical outcome also changed.3.There was a significant correlation between platelet parameters and severity of sepsis shock patients,and monitor dynamically platelet parameters can reflect the change trend of patients’ condition to some certain extent.4.The predictive value of platelet-related parameters to the mortality risk of septic shock in different time periods was different.Platelet parameters with dynamic monitoring can positively predict the clinical prognosis of patients.