In daily haematological practice, predicting bleeding in thrombocytopenic patients is difficult, and clinicians adhere to transfusion triggers to guide patients through the aplastic phase of chemotherapy. Platelet count is not the only determinant of bleeding and additional mechanisms for impending haemostasis are likely. Beside clot formation, platelets are essential for the maintenance of integrity of vascular beds. We therefore prospectively investigated associations between biomarkers for endothelial damage (urine albumin excretion) and inflammation (C-reactive protein) and bleeding (WHO grading) in 88 patients with 116 on-protocol episodes. We found an increase in grade 2 bleeding with a higher urine albumin/creatinine ratio one day after the measurement [odds ratio (OR) 1·24 for every doubling of the ratio, 95% CI 1·05-1·46, P-value 0·01] and a 29% increase in the odds of grade 2 bleeding for every doubling of serum C-reactive protein (CRP) (95% CI 1·04-1·60, P-value 0·02) after correction for morning platelet count. The 24 h post-transfusion corrected count increment (CCI24 ) showed a significant association with these biomarkers: increasing urine albumin/creatinine ratio and CRP were associated with lower CCI24. We report two inexpensive and easy-to-apply biomarkers that could be useful in designing a prediction model for bleeding risk in thrombocytopenic patients.

中文翻译：

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增生性血小板减少症患者的出血与内皮功能不全和炎症标志物之间的关联：一项队列研究。

在日常血液学实践中，很难预测血小板减少症患者的出血，临床医生坚持使用输血触发器来指导患者经历再生障碍性化疗。血小板计数不是出血的唯一决定因素，并且可能存在止血的其他机制。除了形成血块外，血小板对于维持血管床的完整性至关重要。因此，我们前瞻性地调查了88例116例依从性发作的患者中，内皮细胞损伤（尿白蛋白排泄），炎症（C反应蛋白）和出血（WHO分级）的生物标志物之间的关联。测量后一天，我们发现2级出血增加，尿白蛋白/肌酐比值更高[比值每增加一倍，比值比（OR）1·24，95％CI 1·05-1·46，P值0·01]和每2倍血清C反应蛋白（CRP）的2级出血几率增加29％（95％CI 1·04-1·60，P值0·02）校正早晨血小板计数后。输血后24小时校正计数增加（CCI24）与这些生物标记物显着相关：尿白蛋白/肌酐比值的增加和CRP与较低的CCI24相关。我们报告了两种廉价且易于应用的生物标记物，它们可用于设计血小板减少症患者出血风险的预测模型。尿白蛋白/肌酐比值的增加和CRP与CCI24降低有关。我们报告了两种廉价且易于应用的生物标记物，它们可用于设计血小板减少症患者出血风险的预测模型。尿白蛋白/肌酐比值的增加和CRP与CCI24降低有关。我们报告了两种廉价且易于应用的生物标记物，它们可用于设计血小板减少症患者出血风险的预测模型。