Sepsis is the most common critical disease with high mortality in intensive care unit. Platelet count (PC) frequently altered in sepsis patients and implicated in the pathogenesis of multi-organ failure. It is also worth mentioning that thrombocytopenia was closely associated with poor outcomes in sepsis patients. However, whether drug intervention aimed at correcting thrombocytopenia would improve the prognosis of sepsis patients and which kind of sepsis patients could benefit from this therapy is still unclear. This study aims to explore the effect of severe thrombocytopenia on the prognosis of sepsis and the impact of a platelet-elevating drug (recombinant human thrombopoietin, rhTPO) for these sepsis patients. In this study, we included 249 sepsis patients diagnosed by sepsis 3.0, and these patients were classified into the three groups based on PC: normal (PC ≥ 100 × 109/L), mild-moderate thrombocytopenia (50 × 109/L ≤ PC < 100 × 109/L), and severe thrombocytopenia (PC < 50 × 109/L). We found that patients with severe thrombocytopenia had more blood transfusion, shorter days free from organ support, and worse outcomes as compared with the normal group. However, there was no significant difference between normal and mild-moderate thrombocytopenia groups. Furthermore, a subgroup analysis showed that rescue therapy with rhTPO could rapidly lead to a recovery of the PC, prolong days free from organ support, increase survival days, and reduce the 28-day mortality in sepsis patients with severe thrombocytopenia. These results suggested that sepsis patients with severe thrombocytopenia, not mild-moderate thrombocytopenia, had a poorer prognosis. RhTPO, probably as effective rescue therapy, could quickly recover PC and improve the prognosis in these sepsis patients.

中文翻译：

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危重患者脓毒症相关严重血小板减少症的预后和抢救治疗

脓毒症是重症监护病房中死亡率最高的危重病。脓毒症患者的血小板计数 (PC) 经常改变，并与多器官衰竭的发病机制有关。还值得一提的是，血小板减少症与败血症患者的不良预后密切相关。然而，旨在纠正血小板减少症的药物干预是否会改善脓毒症患者的预后以及哪种脓毒症患者可以从这种治疗中受益尚不清楚。本研究旨在探讨严重血小板减少症对脓毒症预后的影响以及血小板升高药物（重组人血小板生成素，rhTPO）对这些脓毒症患者的影响。在这项研究中，我们纳入了 249 名通过脓毒症 3.0 诊断的脓毒症患者，根据PC将这些患者分为三组：正常（PC≥100×109/L）、轻中度血小板减少症（50×109/L≤PC<100×109/L）和重度血小板减少症（PC<100×109/L） 50 × 109/L）。我们发现与正常组相比，患有严重血小板减少症的患者输血更多，无器官支持的天数更短，结果更差。然而，正常组和轻度-中度血小板减少症组之间没有显着差异。此外，亚组分析表明，使用 rhTPO 进行抢救治疗可以迅速恢复 PC，延长无器官支持的天数，增加存活天数，并降低严重血小板减少的脓毒症患者的 28 天死亡率。这些结果表明脓毒症患者有严重的血小板减少症，而不是轻中度的血小板减少症，预后较差。RhTPO 可能作为一种有效的抢救疗法，可以快速恢复 PC 并改善这些脓毒症患者的预后。