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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Clinical Score for Risk Stratification in Febrile Thrombocytopenia
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Clinical Score for Risk Stratification in Febrile Thrombocytopenia

机译：发热性血小板减少症风险分层的临床评分

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The monsoon and peri-monsoon season often entail, a high patient influx with fever and thrombocytopenia. In severe cases, blood transfusion is necessary, but as there are no guidelines or a precise laboratory cut-off for platelets at which transfusion is requisite, unwarranted blood transfusions adversely affect the patients and overwhelm blood banks. Kshirsagar P et al., developed a risk assessment score system for febrile thrombocytopenia to aid in determining therapeutic intervention. Validation of this scoring system on a larger sample size is imperative, taking into consideration both aetiology and comorbidities.Aim: To validate clinical scoring system developed by Kshirshagar P et al., and to correlate etiology, comorbidities and platelet count with clinical score and outcome in patients with febrile thrombocytopenia.Materials and Methods: The prospective observational study was conducted in a tertiary centre in Kolar. Patients >18 years with temperature >99°F and platelet count <1,50,000/cumm, were scored according to Kshirshagar P et al., scoring system and then categorised into low (=7), moderate (8-15) and high-risk (16-26) groups. Based on pulse, temperature, respiratory rate, blood pressure, platelet count, central nervous system, respiratory, haematological, hepatic and renal complications, the outcome was assessed for each group. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20 software. Non parametric Chi-square, unpaired Student?s t-test and one-way ANOVA were applied in comparative analysis results between different groups. The p-value <0.05 was considered as statistically significant.Results: Between June-December 2017 (monsoon period) 465 patients were admitted with febrile thrombocytopenia. Based on the clinical score, 199 patients (43%) were in low risk group, 240 (52%) in moderate and 26 (5%) in high risk group. All the patients in high risk group had extended hospital stay and required ICU support. In our study, nine high-risk patients died, highlighting the significant association between high risk group and outcome (p-value <0.001). Elderly (p-value <0.024) and patients diagnosed with dengue or undetermined cause (p-value <0.003 and p-value <0.016) also had high risk score and poor outcome thereby validating the clinical scoring system. No significant relationship (p-value=0.35) between the initial platelet presentation and outcome of the patient was observed. During the course of the study, 135 patients had platelets transfusion and at least 16% of these platelet transfusion could have been avoided if the risk score were calculated in the early phase of treatment development.Conclusion: Total risk score can predict the severity of illness, the need for transfusion and the probable outcome. The scoring system is easily reproducible and can be used at bedside to evaluate patients with febrile thrombocytopenia and help plan its management, including the need for platelet transfusion. This score also helps to prognosticate patients?outcomes to optimise care and survival rate of the patients.
机译：季风季节和季风季节经常导致高潮患者涌入发烧和血小板减少症。在严重的情况下，必须进行输血，但是由于没有指南或需要精确输血的血小板的严格实验室标准，无故输血会对患者产生不利影响，并使血库不堪重负。 Kshirsagar P等人开发了针对高热性血小板减少症的风险评估评分系统，以帮助确定治疗干预措施。必须在考虑到病因和合并症的情况下，在更大样本量上验证该评分系统。目标：验证Kshirshagar P等人开发的临床评分系统，并将病因，合并症和血小板计数与临床相关联材料和方法：前瞻性观察性研究是在Kolar的一家三级中心进行的。根据Kshirshagar P等人的评分系统对18岁以上，体温> 99°F，血小板计数<150,000 / cum的患者进行评分，然后将其分为低（= 7），中（8-15）和高（ -风险（16-26）组。根据脉搏，温度，呼吸频率，血压，血小板计数，中枢神经系统，呼吸，血液，肝和肾并发症，评估每组的结局。使用“社会科学统计软件包（SPSS）20版”对数据进行了分析。非参数卡方，未配对的学生t检验和单因素方差分析用于不同组之间的比较分析结果。 p值<0.05被认为具有统计学意义。根据临床评分，低危组199例（43％），中危组240例（52％），高危组26例（5％）。高危组的所有患者均需延长住院时间并需要ICU支持。在我们的研究中，有9名高危患者死亡，突显了高危人群与预后之间的显着相关性（p值<0.001）。老年人（p值<0.024）和被诊断为登革热或原因不明的患者（p值<0.003和p值<0.016）也具有较高的风险评分和较差的结果，从而验证了临床评分系统。初始血小板呈递与患者预后之间无显着相关性（p值= 0.35）。在研究过程中，有135名患者进行了血小板输注，如果在治疗发展的早期就计算了风险评分，则可以避免至少16％的血小板输注。结论：总风险评分可以预测疾病的严重程度，是否需要输血以及可能的结果。该评分系统易于复制，可在床边用于评估发热性血小板减少症患者并帮助计划其管理，包括需要输血。该分数还有助于预后患者的结果，以优化患者的护理和存活率。

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