先天性心脏病重症监护病房出现的血小板减少症：发病率、风险因素和结果。

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2025-01-01 Epub Date: 2024-06-21 DOI:10.1016/j.jtha.2024.05.036

Huayan Shen, Qiyu He, Wenke Li, Guoyan Zhu, Xu Wang, Jinping Liu, Yang Zhang, Shoujun Li, Zhou Zhou

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引用次数: 0

摘要

背景：血小板减少症是重症监护病房（ICU）患者的常见病，与不良预后有关。对接受心肺旁路（CPB）心脏手术的儿科患者在重症监护室血小板减少症的研究尚不充分：目的：我们旨在研究使用 CPB 进行先天性心脏手术后 ICU 血小板减少症的发生率、风险因素和预后作用：方法：我们对 11761 名患者进行了回顾性研究。根据重症监护室期间检测的血小板计数，将患者分为四组血小板减少症：无（> 150×109/L）、轻度（100-150×109/L）、中度（50-100×109/L）和重度（< 50×109/L）。利用 Logistic 和 Cox 回归分析探讨血小板减少的风险因素以及 ICU 血小板减少与 30 天死亡率的关系：4007名患者（34.1%）观察到了ICU血小板减少，其中轻度、中度和重度血小板减少分别发生在2773名（23.6%）、987名（8.4%）和247名（2.1%）患者中。年龄较小、发绀性心脏病、CPB 持续时间和术前实验室检查结果（红细胞、血小板减少、红细胞分布宽度、血细胞比容、凝血功能障碍）被认为是 ICU 血小板减少的独立风险因素。中度患者[HR：11.38 (3.02-42.87)，p 结论：ICU 血小板减少症发生率为 1%：三分之一的先天性心脏病手术后使用 CPB 的患儿发生了 ICU 血小板减少症，且与多种不良预后相关。

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Thrombocytopenia developed in intensive care unit for congenital heart disease: incidence, risk factors, and outcomes.

Background: Thrombocytopenia is common for patients in the intensive care unit (ICU) and is associated with adverse outcomes. ICU thrombocytopenia in pediatric patients who underwent cardiac surgeries with cardiopulmonary bypass (CPB) is inadequately studied.

Objectives: We aimed to investigate the incidence, risk factors, and prognostic role of ICU thrombocytopenia after congenital cardiac surgeries with CPB.

Methods: A retrospective study involving 11 761 patients was conducted. Patients were categorized into 4 groups of thrombocytopenia based on platelet counts tested during ICU: non (>150 × 10⁹/L), mild (100-150 × 10⁹/L), moderate (50-100 × 10⁹/L), and severe (<50 × 10⁹/L). Logistic and Cox regression analyses were utilized to explore the risk factors of thrombocytopenia and the association of ICU thrombocytopenia with 30-day mortality.

Results: ICU thrombocytopenia was observed in 4007 patients (34.1%), with mild, moderate, and severe thrombocytopenia occurring in 2773 (23.6%), 987 (8.4%), and 247 (2.1%) patients, respectively. Younger age, cyanotic congenital heart disease, CPB duration, and preoperative laboratory findings (red blood cell, thrombocytopenia, red cell distribution width, hematocrit, and coagulation disorder) were identified as independent risk factors of ICU thrombocytopenia. Patients with moderate (hazard ratio [95% CI]: 11.38 [3.02-42.87]; P < .001) and severe thrombocytopenia (hazard ratio [95% CI]: 49.54 [13.11-187.14]; P < .001) had a significantly higher risk of 30-day mortality. Furthermore, with the increase in the severity of ICU thrombocytopenia, there was an incremental increase in the incidence of postoperative critical bleeding and thrombosis, perioperative blood transfusions, length of ICU stays, and duration of mechanical ventilation.

Conclusion: ICU thrombocytopenia occurred in one-third of children after congenital cardiac surgery with CPB, and it was associated with multiple adverse outcomes.

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.