@article{Ye2024, 
author = {Qian Ye and Xuan Wang and Xiaoshuang Xu and Jiajin Chen and David C. Christiani and Feng Chen and Ruyang Zhang and Yongyue Wei},
title = {Serial platelet count as a dynamic prediction marker of hospital mortality among septic patients},
year = {2024},
journal = {Burns & Trauma},
volume = {12},
pages = {tkae016},
keywords = {Sepsis, Platelet count trajectory, Joint latent class model, Dynamic prediction, Intensive care medicine},
url = {https://www.sciopen.com/article/10.1093/burnst/tkae016},
doi = {10.1093/burnst/tkae016},
abstract = {BackgroundPlatelets play a critical role in hemostasis and inflammatory diseases. Low platelet count and activity have been reported to be associated with unfavorable prognosis. This study aims to explore the relationship between dynamics in platelet count and in-hospital morality among septic patients and to provide real-time updates on mortality risk to achieve dynamic prediction.MethodsWe conducted a multi-cohort, retrospective, observational study that encompasses data on septic patients in the eICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The joint latent class model (JLCM) was utilized to identify heterogenous platelet count trajectories over time among septic patients. We assessed the association between different trajectory patterns and 28-day in-hospital mortality using a piecewise Cox hazard model within each trajectory. We evaluated the performance of our dynamic prediction model through area under the receiver operating characteristic curve, concordance index (C-index), accuracy, sensitivity, and specificity calculated at predefined time points.ResultsFour subgroups of platelet count trajectories were identified that correspond to distinct in-hospital mortality risk. Including platelet count did not significantly enhance prediction accuracy at early stages (day 1 C-indexDynamic vs C-indexWeibull: 0.713 vs 0.714). However, our model showed superior performance to the static survival model over time (day 14 C-indexDynamic vs C-indexWeibull: 0.644 vs 0.617).ConclusionsFor septic patients in an intensive care unit, the rapid decline in platelet counts is a critical prognostic factor, and serial platelet measures are associated with prognosis.}
}