Abstract：
Septic shock is a life-threatening disease worldwide often associated with thrombocytopenia. Platelets play a crucial role in bridging the gap between immunity, coagulation, and endothelial cell activation, potentially influencing the course of the disease. However, there are few studies specifically evaluating the impact of thrombocytopenia on the prognosis of pediatric patients. Therefore, the study investigates effects of early thrombocytopenia in the prognosis of children with septic shock. Pediatric patients with septic shock from 2015 to 2022 were included monocentrically. Thrombocytopenia was defined as a platelet count of <100 × 109/L during the first 24 hours of septic shock onset. The primary outcome was the 28-day mortality. Propensity score matching was used to pair patients with different platelet counts on admission but comparable disease severity. A total of 419 pediatric patients were included in the analysis. Patients with thrombocytopenia had higher 28-day mortality (55.5% vs. 38.7%, p = .005) compared to patients with no thrombocytopenia. Thrombocytopenia was associated with reduced 28-PICU free days (median value, 0 vs. 13 days, p = .003) and 28-ventilator-free (median value, 0 vs. 19 days, p = .001) days. Among thrombocytopenia patients, those with platelet count ≤50 × 109/L had a higher 28-day mortality rate (63.6% vs. 45%, p = .02). Multiple logistic regression showed that elevated lactate (adjusted odds ratio (OR) = 1.11; 95% confidence interval (CI): 1.04-1.17; P <0.001) and white blood cell (WBC) count (OR = 0.97; 95% CI: 0.95-0.99; p = .003) were independent risk factors for the development of thrombocytopenia. Thrombocytopenia group had increased bleeding events, blood product transfusions, and development of organ failure. In Kaplan-Meier survival estimates, survival probabilities at 28 days were greater in patients without thrombocytopenia (p value from the log-rank test, p = .004). There were no significant differences in the type of pathogenic microorganisms and the site of infection between patients with and without thrombocytopenia. In conclusion, thrombocytopenia within 24 hours of shock onset is associated with an increased risk of 28-day mortality in pediatric patients with septic shock.
What is the context? Septic shock is a life-threatening disease worldwide, leading to higher mortality.Platelets play a crucial role in bridging the gap between immunity, coagulation, and endothelial cell activation.Although it is known that platelets are associated with prognosis, most studies have focused on adult populations. Limited data are available on the incidence of thrombocytopenia and its correlation with clinical outcomes , specifically, in pediatric patients with sepsis and septic shock. What is new? The present study suggests that thrombocytopenia within 24 hours of septic shock onset reflects a reliable tool for predicting the prognosis of septic shock in pediatric patients.Furthermore, elevated lactate and reduced white-blood-cell count were independent risk factors for the development of thrombocytopenia in pediatric patients with septic shock. What is the impact? This study suggests that thrombocytopenia within 24 hours of septic shock onset is associated with an increased risk of 28-day mortality and decreased ventilation-free, PICU-free days in pediatric patients with septic shock. In septic shock, thrombocytopenia is also associated with increased bleeding events, blood product transfusions, and organ dysfunction.
What is the context? Septic shock is a life-threatening disease worldwide, leading to higher mortality.Platelets play a crucial role in bridging the gap between immunity, coagulation, and endothelial cell activation.Although it is known that platelets are associated with prognosis, most studies have focused on adult populations. Limited data are available on the incidence of thrombocytopenia and its correlation with clinical outcomes , specifically, in pediatric patients with sepsis and septic shock. What is new? The present study suggests that thrombocytopenia within 24 hours of septic shock onset reflects a reliable tool for predicting the prognosis of septic shock in pediatric patients.Furthermore, elevated lactate and reduced white-blood-cell count were independent risk factors for the development of thrombocytopenia in pediatric patients with septic shock. What is the impact? This study suggests that thrombocytopenia within 24 hours of septic shock onset is associated with an increased risk of 28-day mortality and decreased ventilation-free, PICU-free days in pediatric patients with septic shock. In septic shock, thrombocytopenia is also associated with increased bleeding events, blood product transfusions, and organ dysfunction.
摘要：
感染性休克是一种威胁生命的疾病，通常与血小板减少症相关。血小板在弥合免疫力之间的差距中起着至关重要的作用，凝血,和内皮细胞活化，可能影响疾病的进程。然而,很少有专门评估血小板减少对儿科患者预后影响的研究.因此,本研究调查了早期血小板减少对感染性休克患儿预后的影响。2015年至2022年发生感染性休克的儿科患者被纳入单中心。血小板减少症定义为在脓毒性休克发作的前24小时内血小板计数<100×109/L。主要结果是28天死亡率。使用倾向评分匹配对入院时血小板计数不同但疾病严重程度相当的患者进行配对。共有419名儿科患者被纳入分析。血小板减少症患者28天死亡率较高（55.5%vs.38.7%,p=0.005）与无血小板减少症的患者相比。血小板减少与减少28-PICU免费天数相关(中位值，0vs.13天,p=.003)和28-无呼吸机(中值，0vs.19天,p=.001）天。在血小板减少症患者中，血小板计数≤50×109/L的患者28天死亡率较高(63.6%vs.45%,p=.02）。多因素logistic回归分析显示，乳酸升高（校正比值比（OR）=1.11；95％置信区间（CI）：1.04-1.17；P<0.001）和白细胞（WBC）计数（OR=0.97；95％CI：0.95-0.99；p=.003）是血小板减少症发生的独立危险因素。血小板减少组出血事件增加，输血,和器官衰竭的发展。在Kaplan-Meier生存估计中,在没有血小板减少症的患者中，28天的生存概率更大（来自对数秩检验的p值，p=.004）。有和没有血小板减少症的患者之间的病原微生物类型和感染部位没有显着差异。总之,休克发病24小时内的血小板减少与感染性休克儿科患者28日死亡风险增加相关.
背景是什么？感染性休克是一种威胁生命的疾病，导致更高的死亡率。血小板在弥合免疫力之间的差距中起着至关重要的作用，凝血,和内皮细胞活化。尽管已知血小板与预后相关,大多数研究都集中在成年人群。关于血小板减少症的发生率及其与临床结果的相关性的数据有限。具体来说,在小儿脓毒症和脓毒性休克患者中。有什么新的？本研究表明，脓毒性休克发作24小时内的血小板减少症反映了预测儿科患者脓毒性休克预后的可靠工具。此外，乳酸升高和白细胞计数减少是感染性休克患儿发生血小板减少的独立危险因素.有什么影响？这项研究表明，感染性休克发病24小时内的血小板减少与28天死亡率和无通气减少的风险增加有关。小儿感染性休克患者无PICU天数。在感染性休克中,血小板减少症也与出血事件增加相关,输血,和器官功能障碍。
背景是什么？感染性休克是一种威胁生命的疾病，导致更高的死亡率。血小板在弥合免疫力之间的差距中起着至关重要的作用，凝血,和内皮细胞活化。尽管已知血小板与预后相关,大多数研究都集中在成年人群。关于血小板减少症的发生率及其与临床结果的相关性的数据有限。具体来说,在小儿脓毒症和脓毒性休克患者中。有什么新的？本研究表明，脓毒性休克发作24小时内的血小板减少症反映了预测儿科患者脓毒性休克预后的可靠工具。此外，乳酸升高和白细胞计数减少是感染性休克患儿发生血小板减少的独立危险因素.有什么影响？这项研究表明，感染性休克发病24小时内的血小板减少与28天死亡率和无通气减少的风险增加有关。小儿感染性休克患者无PICU天数。在感染性休克中,血小板减少症也与出血事件增加相关,输血,和器官功能障碍。
