Association between dynamic platelet count trajectories and adverse outcomes in patients with sepsis-induced coagulopathy

Zhang Zhijiao; Liu Jian; Xu Fang; Tang Hong

doi:10.13406/j.cnki.cyxb.004099

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Association between dynamic platelet count trajectories and adverse outcomes in patients with sepsis-induced coagulopathy

Excellence in medical insights\：pathogenesis and clinical treatment of sepsis | 更新时间：2026-06-11

- Association between dynamic platelet count trajectories and adverse outcomes in patients with sepsis-induced coagulopathy
- Journal of Chongqing Medical University Vol. 51, Issue 6, Pages: 811-820(2026)
- 作者机构：
  
  1.重庆医科大学附属第一医院重症医学科，重庆 400016
  2.重庆医科大学附属第一医院酉阳医院重症医学科，重庆 400016
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.004099
  CLC： R459.7
- Received：19 January 2026，
  
  Revised：2026-03-27，
  
  Accepted：08 April 2026，
  
  Published：28 June 2026
- 稿件说明：
移动端阅览
张志娇，刘建，徐昉，等.脓毒症性凝血病患者血小板计数动态轨迹与不良预后的关联研究[J].重庆医科大学学报，2026，51（6）：811-820.

Zhang Zhijiao,Liu Jian,Xu Fang,et al.Association between dynamic platelet count trajectories and adverse outcomes in patients with sepsis-induced coagulopathy[J].Journal of Chongqing Medical University,2026,51(6):811-820.
张志娇，刘建，徐昉，等.脓毒症性凝血病患者血小板计数动态轨迹与不良预后的关联研究[J].重庆医科大学学报，2026，51（6）：811-820. DOI： 10.13406/j.cnki.cyxb.004099.

Zhang Zhijiao,Liu Jian,Xu Fang,et al.Association between dynamic platelet count trajectories and adverse outcomes in patients with sepsis-induced coagulopathy[J].Journal of Chongqing Medical University,2026,51(6):811-820. DOI： 10.13406/j.cnki.cyxb.004099.

摘要

目的

探究脓毒症性凝血病（sepsis-induced coagulopathy，SIC）患者血小板计数（platelet count，PLT）的动态轨迹，并分析各轨迹与患者28 d及90 d死亡率的关系。

方法

基于重症医学信息数据库-Ⅳ（Medical Information Mart for Intensive Care-Ⅳ，MIMIC-Ⅳ），采用潜类别混合模型（latent class mixed model，LCMM）识别SIC患者入重症监护病房（intensive care unit，ICU）后7 d内PLT变化轨迹。采用卡普兰-迈耶（Kaplan-Meier，K-M）生存曲线、多因素Cox比例风险模型分析不同PLT轨迹与28 d和90 d死亡率的关系。同时进行亚组分析和交互作用分析。

结果

共纳入1 500例患者，基于LCMM模型拟合度、分类可靠性、类别样本量分布以及临床可解释性，识别出3种不同的PLT轨迹，分为以下3组。组1：先降后升，持续低水平；组2：先升后降，始终处于正常偏高水平；组3：陡降陡升，但始终在正常范围。以组3作为参考组，K-M曲线显示，相较于组3患者，组1、组2患者在28 d和90 d的累积生存率显著降低。多因素Co

x风险模型表明，与组3相比，组2患者的28 d［风险比（hazard ratio，

）=1.79，95%置信区间（95% confidence interval，95%CI）=1.20~2.68］和90 d（

=1.56，95%CI=1.10~2.22）死亡风险更高。这种关联在多数亚组中保持一致。

结论

在ICU住院的前7天内，SIC患者的PLT呈现3种不同的变化轨迹，其中PLT先升后降，始终处于正常偏高水平的轨迹，与更高的死亡风险相关。

Abstract

Objective

To explore the dynamic trajectory of platelet count（PLT） in patients with sepsis-induced coagulopathy（SIC） and to analyze the relationship between each trajectory and the 28-day and 90-day mortality of patients.

Methods

Based on the Medical Information Mart for Intensive Care-Ⅳ，a latent class mixed model（LCMM） was used to identify the trajectory of PLT changes in SIC patients within 7 days after admission to the intensive care unit（ICU）. Kaplan-Meier（K-M） curves and multivariate Cox proportional hazards models were used to analyze the relationship between these trajectories and the 28-day and 90-day mortality，with additional subgroup and interaction analyses conducted.

Results

A total of 1 500 patients were enrolled. Based on the model fit，classification clarity，class sample size distribution，and clinical interpretability of the LCMM，three distinct trajectories of PLT were identified，i.e.，group 1： initial decrease and then increase，remaining at a low level；group 2： initial increase and then decrease，remaining at a high-normal level； group 3： a sharp decline followed by a rapid increase，but always remaining within the normal range. Group 3 was used as the reference. K-M curves showed that groups 1 and 2 had significantly lower cumulative survival rates than group 3 at 28 and 90 days. The multivariate Cox proportional hazards model revealed that group 2 had a higher mortality risk than group 3 at both 28 days （hazard ratio［

］=1.79，95%CI=1.20-2.68） and 90 days（

=1.56，95%CI=1.10-2.22）. This association remained consistent in most

subgroups.

Conclusion

During the first 7 days of ICU stay，three distinct trajectories of PLT changes were identified in patients with SIC. Among these trajectories，the trajectory of PLT that initially increased and then decreased while remaining at the high-normal level was associated with a higher risk of mortality.

关键词

Keywords

references

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