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目的:探讨血小板计数（PLT）短期动态变化在重症监护病房（ICU）脓毒症患者预后预测中的临床意义。方法:采用回顾性队列研究方法，选择2015年11月至2018年10月上海市第一人民医院南院重症医学科收治的符合脓毒症3.0诊断标准、年龄18～80岁的脓毒症患者作为研究对象。根据患者入ICU 28 d预后分为死亡组和存活组，比较两组患者的一般资料及临床基线数据（包括疾病严重程度、感染生物标志物、PLT及心脏、肝脏、肾脏、凝血等器官和系统功能指标与炎性指标）；对差异有统计学意义的指标绘制其预测28 d预后的受试者工作特征曲线（ROC）。采用单因素和多因素Logistic回归分析筛选ICU脓毒症患者28 d死亡的危险因素；基于多因素Logistic回归分析结果构建多参数模型，绘制其预测28 d死亡的ROC曲线，评估其预测价值。结果:共220例ICU脓毒症患者纳入最终分析，28 d死亡61例，存活159例，28 d病死率为27.7%。与存活组比较，死亡组患者年龄更大，更容易合并心血管、肾脏、免疫系统等慢性疾病，急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、序贯器官衰竭评分（SOFA）、弥散性血管内凝血（DIC）评分更高，1 d和7 d PLT更低，持续性血小板减少（入ICU 1周内PLT均<100×10n 9/L）或获得性血小板减少（入ICU当天PLT≥100×10n 9/L，入ICU 1周内PLT下降超过初始值的50%或以上）发生率以及降钙素原（PCT）、白细胞介素-6（IL-6）的水平更高，心脏、肾脏、凝血功能更差，差异均有统计学意义；但两组在性别、疾病类型、感染部位、感染病原菌和肝功能方面差异均无统计学意义。ROC曲线分析显示，3种疾病严重程度评分均能够预测ICU脓毒症患者28 d预后，以SOFA评分的ROC曲线下面积（AUC）最大（AUC＝0.878）；7 d PLT的AUC大于1 d PLT（AUC：0.862比0.674）；其他主要临床指标的AUC均<0.8。单因素和多因素Logistic回归分析结果显示，SOFA评分〔优势比（n OR）＝1.423，95%可信区间（95%n CI）为1.089～1.859，n P＝0.010〕、肌钙蛋白I（TnI；n OR＝2.056，95%n CI为1.057～3.999，n P＝0.034）、持续性或获得性血小板减少（n OR＝13.028，95%n CI为4.033～42.090，n P<0.001）是导致ICU脓毒症患者28 d死亡的独立危险因素。基于多因素Logistic回归分析结果，以SOFA评分、TnI和持续性或获得性血小板减少构建多参数模型，该模型预测ICU脓毒症患者28 d死亡的AUC为0.926，当最佳临界值为0.398时，敏感度为76.8%，特异度为92.8%。n 结论:入院1周内出现持续性或获得性血小板减少对ICU脓毒症患者预后具有较高的临床预测价值，针对血小板减少的临床干预可能成为此类患者治疗的新靶点。“,”Objective:To explore clinical predictive value of short-term dynamic changes in platelet counts (PLT) for prognosis of sepsis patients in intensive care unit (ICU).Methods:A retrospective cohort study was conducted. The patients aging 18 to 80 years old who were diagnosed by Sepsis-3 admitted to ICU of South Branch of Shanghai General Hospital from November 2015 to October 2018 were enrolled. According to whether the patients died within 28 days, they were divided into death and survival groups. General information and clinical baseline data [including disease severity score, infection biomarkers, PLT and organ function parameters (cardiac, liver, kidney, coagulation) and inflammatory cytokines] between the two groups were compared. Based on clinical indicators which had statistically significance, receiver operating characteristic (ROC) curve was drawn to predict the prognosis of the patients within 28 days. Then, risk factors of 28-day mortality of sepsis patients in ICU were screened by univariate and multivariate Logistic regression analysis. On the basis of multivariate Logistic regression analysis results, a multiparameter model was built, and the ROC curve was drawn to predict its prognosis within 28 days.Results:A total of 220 sepsis patients were enrolled. Among them, 61 patients died and 159 patients survived within 28 days with a 28-day mortality of 27.7%. Compared with the survival group, the patients in the death group were senior in age, more likely to suffer from chronic cardiovascular, chronic kidney and immune system disease, had higher scores in acute physiologic and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, disseminated intravascular coagulation (DIC) score and less PLT on the 1st and 7th day, sustained a higher incidence of persistent thrombocytopenia (PLT were all < 100×10 n 9/L in the first week after ICU admission) or acquired thrombocytopenia (PLT ≥ 100×10n 9/L on the day of ICU admission, but dropped over 50% during the first week after ICU admission), were subjected to higher procalcitonin (PCT) and interleukin-6 (IL-6) levels and endured worse organ function (cardiac, kidney, coagulation) with statistically significant differences. However, there was no significant difference in gender, disease type, infection sites, pathogens or liver function. The ROC curve analysis for the 28-day prognosis of sepsis illustrated that the three disease severity scores could predict the 28-day prognosis of sepsis in ICU, and the area under ROC curve (AUC) of SOFA score was the highest (AUC = 0.878). The AUC of PLT on the 7th day was higher than that on the 1st day (AUC: 0.862 vs. 0.674), and the AUC of other clinical indicators were all < 0.8. Univariate and multivariate Logistic regression analysis showed that SOFA score [odds ratio ( n OR) = 1.423, 95% confidence interval (95%n CI) was 1.089-1.859, n P = 0.010], troponin I (TnI; n OR = 2.056, 95%n CI was 1.057-3.999, n P = 0.034), and persistent or acquired thrombocytopenia (n OR = 13.028, 95%n CI was 4.033-42.090, n P < 0.001) were three independent risk factors for 28-day mortality of the sepsis patients in ICU. Based on the multivariate Logistic regression analysis results, a multiparameter model was built with SOFA score, TnI and persistent or acquired thrombocytopenia, which showed a AUC of 0.926 to predict the 28-day mortality of sepsis patients in ICU. When the optimum cut-off value was 0.398 in the model, the sensitivity was 76.8%, and the specificity was 92.8%.n Conclusions:Persistent or acquired thrombocytopenia within the first week of hospitalization proves to have a relatively momentous clinical predictive value for prognosis of sepsis patients in ICU. Clinical intervention focusing on thrombocytopenia may become a new potential therapy for these sepsis patients.