Clinical study of recombinant human thrombopoietin in patients with sepsis-associated thrombocytopenia

Abstract

Objective To evaluate the efficacy of recombinant human thrombopoietin (rhTPO) in patients with severe sepsis and thrombocytopenia. Methods Sixty-six patients with severe sepsis and hrombocytopenia between October 2013 and September 2015 were divided into the experiment group (35 cases) and control group (31 cases). All patients received primary treatment and infection control. And patients in the experiment group received rhTPO 300 U·kg-1·d-1 by hypodermic injection, and withdraw when platelet count (PLT) ≥ 50 × 109/L, and the course did not exceed 14 d. Levels of PLT, C-reactive protein and alanine aminotransferase (ALT) were detected before and after the treatment on 1, 2, 3, 5, 7, 9 ans 14 d. The platelet transfusion cases, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), the time of temperature dropped to normal, time of clinical symptom disappearance, pulmonary imaging recovery time, 28-day fatality rate and length of ICU stay were compared between the two groups. The adverse reactions were recorded, and the activated partial thromboplastin time, levels of ALT, C-reactive protein and total bilirubin were compared before and after treatment in the experiment group. Results The PLT only increased markedly on 3 and 5 d after treatment in the experiment group as compared with those in the control group [(56 ± 19) × 109/L vs. (42 ± 18) × 109/L, t = 3.112, P < 0.05; (67 ± 22) × 109/L vs. (54 ± 21) × 109/L, t = 2.520, P < 0.05]. The platelet transfusion rate in the experiment group was much lower than that in the control group (5/35 vs. 11/31, χ2 = 4.022, P = 0.045). However, the APACHEⅡ scores (t = 0.692, P < 0.05), the time of temperature dropped to normal (t = 0.510, P < 0.05), time of clinical symptom disappearance (t = 0.262, P < 0.05), pulmonary imaging recovery time (t = 0.685, P < 0.05), 28-day fatality rate (χ2 = 0.001, P < 0.05) and length of ICU stay (t = 0.637, P < 0.05) all showed no significant differences between the two groups after treatment. Meanwhile, there was no adverse reactions happened, and the activated partial thromboplastin time (t = 0.697, P < 0.05), levels of ALT (t = 0.478, P < 0.05), C-reactive protein (t = 0.110, P < 0.05) and total bilirubin (t = 1.634, P < 0.05) in the experiment group also showed no significant differences before and after the treatment. Conclusions The use of rhTPO combined with conventional treatment in patients with sepsis-associated thrombocytopenia is safe. It can significantly enhance the platelet count, reduce platelet transfusion and improve patient's prognosis. Key words: Recombinant human thrombopoietin; Sepsis; Thrombocytopenia