Association of longitudinal platelet count trajectory with ICU mortality: A multi-cohort study

作者：Jiajin Chen, Xi Gao, Sipeng Shen, Jingyuan Xu, Zhe Sun, Ruilang Lin, Zhixiang Dai, Li Su, David C. Christiani, Feng Chen, Ruyang Zhang, Yongyue Wei · 发表于：Frontiers in Immunology · 年份：2022 · DOI：10.3389/fimmu.2022.936662 · 被引用次数：36 · 研究领域：Inflammatory Biomarkers in Disease Prognosis、Platelet Disorders and Treatments、Heparin-Induced Thrombocytopenia and Thrombosis

Objective Platelet (PLT) engages in immune and inflammatory responses, all of which are related to the prognosis of critically ill patients. Although thrombocytopenia at ICU admission contributes to in-hospital mortality, PLT is repeatedly measured during ICU hospitalization and the role of longitudinal PLT trajectory remains unclear. We aimed to identify dynamic PLT trajectory patterns and evaluate their relationships with mortality risk and thrombocytopenia. Methods We adopted a three-phase, multi-cohort study strategy. Firstly, longitudinal PLT trajectory patterns within the first four ICU days and their associations with 28-day survival were tested in the eICU Collaborative Research Database (eICU-CRD) and independently validated in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Secondly, the relationships among PLT trajectory patterns, thrombocytopenia, and 28-day mortality were explored and validated. Finally, a Mortality GRade system for ICU dynamically monitoring patients (Mortality-GRID) was developed to quantify the mortality risk based on longitudinal PLT, which was further validated in the Molecular Epidemiology of Acute Respiratory Distress Syndrome (MEARDS) cohort. Results A total of 35,332 ICU patients were included from three cohorts. Trajectory analysis clustered patients into ascending (AS), stable (ST), or descending (DS) PLT patterns. DS patients with high baseline PLT decline quickly, resulting in poor prognosis. AS patients have ...