背景:尽管有新的证据表明血细胞指数(BCI)与败血症死亡率有关,观察性研究的不一致掩盖了这些关联的清晰性.本研究旨在阐明BCI对脓毒症患者28天死亡率的因果影响。
方法:利用单变量和多变量孟德尔随机化(MR)分析,我们通过分析来自广泛的全基因组关联研究的数据,研究了BCI对脓毒症死亡率的影响.逆方差加权(IVW)方法是我们的主要分析工具,辅以几种鲁棒性检查,以减轻多效性,包括加权中位数,基于模式的估计,MR-Egger回归,MR-PRESSO随后,我们进行了一项回顾性研究,利用真实世界数据进一步探讨血小板指数与脓毒症28日死亡率之间的相关性.
结果:我们的发现强调了血小板分布宽度(PDW)与脓毒症患者28天死亡率之间的显著因果关系,单变量孟德尔随机化方法的比值比为1.12(95%CI,1.06-1.26;P<0.05)。多变量分析进一步证实了PDW与死亡风险的强相关性(OR1.23;95%CI,1.03-1.48;P<0.05)。相反,我们的分析没有发现遗传易感性与其他BCI(包括红细胞计数)之间的显着相关性,红细胞分布宽度,血小板计数,平均血小板体积,白细胞计数,中性粒细胞计数,中性粒细胞百分比,淋巴细胞计数,以及脓毒症患者淋巴细胞百分比和28天死亡率。此外,反向MR分析未确定脓毒症患者28日死亡率对PDW的因果影响(OR1.00;95%CI,1.00~1.07;P=0.29).此外,在回顾性研究中也观察到了类似的结果.
结论:该研究强调了PDW在预测脓毒症患者28天死亡率方面的独立因果作用,表明其在早期患者评估中的潜在效用,风险分层,和定制治疗干预措施。
BACKGROUND: Despite emerging evidence linking blood cell indices (BCIs) to
sepsis mortality, the inconsistency of observational studies obscures the clarity of these associations. This study aims to clarify the causal influence of BCIs on 28-day mortality rates in
sepsis patients.
METHODS: Utilizing univariable and multivariable Mendelian randomization (MR) analyses, we examined the impact of BCIs on
sepsis mortality by analyzing data from extensive genome-wide association studies. The inverse-variance weighted (IVW) method was our primary analytic tool, complemented by several robustness checks to mitigate pleiotropy, including weighted median, mode-based estimates, MR-Egger regression, and MR-PRESSO. Subsequently, we conducted a retrospective study to further explore the correlation between platelet indices and 28-day mortality of sepsis using real-world data.
RESULTS: Our findings highlight a significant causal relationship between platelet distribution width (PDW) and 28-day mortality in
sepsis, with the univariable Mendelian randomization approach yielding an odds ratio of 1.12 (95% CI, 1.06-1.26; P < 0.05). Multivariable analysis further substantiated PDW\'s robust association with mortality risk (OR 1.23; 95% CI, 1.03-1.48; P < 0.05). Conversely, our analysis did not uncover significant correlations between the genetic predispositions to other BCIs-including red blood cell count, erythrocyte distribution width, platelet count, mean platelet volume, white blood cell count, neutrophil count, neutrophil percentage, lymphocyte count, and lymphocyte percentage-and 28-day mortality in sepsis. Additionally, an inverse MR analysis did not establish a causal impact of 28-day mortality in
sepsis on PDW (OR 1.00; 95% CI, 1.00-1.07; P = 0.29). Moreover, a similar result was observed in the retrospective study.
CONCLUSIONS: The study underscores the independent causal role of PDW in predicting 28-day mortality in sepsis, suggesting its potential utility in early patient assessment, risk stratification, and tailoring of therapeutic interventions.