Clinical value of monitoring platelet aggregation function in children with sepsis
10.3760/cma.j.cn101070-20200528-00902
- VernacularTitle:血小板聚集功能监测在儿童脓毒症中的临床价值
- Author:
Yi HUI
1
;
Shuang LIU
;
Dong QU
Author Information
1. 首都儿科研究所附属儿童医院重症医学科，北京 100020
- Keywords:
Sepsis;
Platelet aggregation function;
Coagulation function;
Child
- From:
Chinese Journal of Applied Clinical Pediatrics
2021;36(18):1377-1382
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the relationship between platelet aggregation function changes in children with sepsis and its prognosis.Methods:This was a prospective observational study involving 53 children with sepsis and platelet count of > 100×10 9/L who were admitted in the Pediatric Intensive Care Unit (PICU) of Children′s Hospital Affiliated to the Capital Institute of Pediatrics from January 2017 to December 2018.During the same period, 53 age-matched healthy children were selected as the healthy control group.Platelet aggregation function was detected in each participant, and the differences between the two groups were compared.In addition, 53 children with sepsis were sub-divided into risk group (≤80 grades) and non-risk group (>80 grades) according to pediatric critical illness scores (PCIS). They were further divided into sepsis survival group and sepsis death group according to the prognosis within 24 hours of admission.Platelet aggregation function test was performed on the 1 st and 3 rd day of admission, conventional coagulation function and clinical data were detected as well.Their differences between risk group and non-risk group, and sepsis survival group and sepsis death group were compared, so as to analyze the correlation between platelet aggregation function and clinical prognosis of children with sepsis. Results:No significant differences in the gender and age were found between sepsis group and the healthy control group (all P>0.05). In sepsis group, no significant differences in the gender and age were found between risk group and non-risk group (all P>0.05). There were 44 cases (83%) in sepsis survival group and 9 cases (17%) in sepsis death group.Platelet aggregation function was significantly worse in sepsis death group than in the healthy control group (47.4% vs.79.9%, P<0.001). Compared with non-risk group, platelet aggregation function in risk group significantly decreased (32.5% vs.53.4%, P<0.05). Fibrinogen (FIB) and platelet count in risk group were significantly lower than those of non-risk group (3.28 g/L vs.4.53 g/L and 215×10 9/L vs.346×10 9/L, respectively, all P<0.05). Fibrin degradation products (FDP) in risk group was higher than non-risk group(12.1 mg/L vs.6.0 mg/L, P<0.05). There were no significant differences in the prothrombin time, activated partial thromboplastin time and D-Dimer between risk group and non-risk group (all P>0.05). Platelet aggregation function in the death group was significantly lower than that of survival group (11.1% vs.59.7%, P<0.001). On the 1 st and 3 rd day of admission, platelet aggregation function of died children in risk group continued to be low (11.1%, 10.9%), while platelet aggregation function of survival children was relatively high (59.7%, 65.7%). Platelet aggregation function was positively correlated with FIB, Ca 2+ levels and PCIS ( P<0.05, P<0.05 and P<0.001, respectively). Logistic regression analysis showed that platelet aggregation function was a contributing factor to the mortality of children with sepsis.According to receiver operating characteristic curve of platelet aggregation function in predicting the mortality of children with sepsis, area under curve was 0.889, cut-off value was 18.3%, sensitivity was 88.6%, and specificity was 77.8% ( P<0.001), suggesting that a lower than 18.3% of platelet aggregation function predicted an increased risk of death in children with sepsis. Conclusions:In children with sepsis, there is a decrease in platelet aggregation function, while the platelet count has not decreased.Platelet aggregation function in children with sepsis is correlated with the severity of the disease.In detail, reduced platelet aggregation in early sepsis is an alarm of a poor prognosis in children with sepsis.
