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Published on: January 31, 2018
Platelet Count Trajectory and Survival in Children With Sepsis: Single-Center Retrospective Study in China, 2015-2023
Xin Luo1, Huan Li1, Xiaofeng Feng2
1Department of Laboratory Medicine, Women and Children's Hospital, Southern University of Science and Technology, Guangzhou, China.
Insights
In children with sepsis, distinct platelet count patterns over time significantly impact survival. Identifying these dynamic platelet trajectories can help predict mortality risk and guide clinical management in pediatric sepsis.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Infectious diseases
Background:
- Thrombocytopenia in pediatric sepsis is associated with adverse outcomes, including increased mortality.
- Dynamic changes in platelet counts over time in pediatric sepsis are not well understood.
- Understanding these trends is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate dynamic platelet count patterns in children with sepsis.
- To examine the association between these platelet trajectories and 28-day mortality.
- To identify patient-illness factors associated with different platelet count patterns.
Main Methods:
- Single-center retrospective cohort study of 1010 children with sepsis.
- Group-based trajectory analysis to identify platelet count trends over the first 7 days of admission.
- Multivariable Cox proportional hazards model to assess the association between trajectories and mortality, adjusted for covariates.
Main Results:
- Three distinct platelet count trajectories were identified: persistently low, high-normal, and persistently high.
- Factors like age, fibrinogen, aPTT, and lactic acid were associated with these trajectories.
- 28-day mortality varied significantly: 12.6% (low), 2.2% (high-normal), and 1.2% (persistently high).
- Compared to the low platelet group, both high-normal and persistently high platelet groups showed significantly reduced 28-day mortality (HR 0.26 and 0.18, respectively).
Conclusions:
- Three clinically relevant platelet count trajectories exist in pediatric sepsis.
- These trajectories are independently associated with 28-day survival.
- Platelet count dynamics provide valuable prognostic information in pediatric sepsis.
Objectives:
In children with sepsis, thrombocytopenia is linked to poor outcomes, including longer hospital length of stay, increased bleeding risk, and higher mortality. However, the clinical significance of changes in platelet counts over time remain poorly characterized. We have examined dynamic platelet patterns and their association with mortality and patient-illness factors.
Design:
Single-center retrospective cohort study.
Setting:
Hospital pediatrics and PICU at Guangdong Women and Children Hospital, China.
Patients:
Children with sepsis between January 2015 and December 2023.
Interventions:
None.
Measurements And Main Results:
Group-based trajectory analysis was used to examine the trend in platelet count during the first 7 days of hospital admission. A regression model was developed to investigate possible associations between patient characteristics with platelet count trajectory. Additionally, a multivariable Cox proportional hazards model, adjusted for age, sex, comorbidities, and site/source of infection, was constructed to evaluate the association between platelet count trajectories and 28-day mortality. Among 1010 children with sepsis, we identified three platelet count trajectories with distinct characteristics. Age, fibrinogen level, activated partial thromboplastin time, and lactic acid were each associated with platelet count trajectories. The overall 28-day mortality for the cohort was 5.4%, varying across groups: 1.2% in group 3 with persistently high platelet count; 2.2% in group 2 with high-normal platelet count; and 12.6% in group 1 with low platelet count. In the multivariable Cox proportional hazards model, compared with group 1, both groups 2 and 3 were independently associated with reduced hazard of death at 28 days (hazard ratio, 0.26; p < 0.001 for group 2 and hazard ratio, 0.18; p = 0.021 for group 3).
Conclusions:
We have identified three distinct and clinically relevant platelet count trajectories in children with sepsis, which serve as robust associations with survival in this patient population.
