Value of early platelet parameters combined with serum granulocyte colony-stimulating factor in predicting withdrawal failure within 72 hours after first extubation in extremely preterm infants with broncho-pulmonary dysplasia

doi:10.3877/cma.j.issn.1673-5250.2025.06.011

Objective

To explore the value of early (within 24 hours after birth) platelet parameters combined with serum granulocyte colony-stimulating factor (G-CSF) level in predicting 72 hours withdrawal failure in extremely preterm infants with broncho-pulmonary dysplasia (BPD).

Methods

A total of 106 cases of extremely preterm infants with BPD who received invasive mechanical ventilation treatment at Changzhou Maternal and Child Health Care Hospital from July 2020 to July 2023 were selected as research subjects. Based on the weaning outcome within 72 hours after the first extubation, the infants were divided into failure group (n=32, those who needed reintubation within 72 hours after the first extubation due to respiratory failure or other reasons) and success group (n=74, those who did not need reintubation within 72 hours after the first extubation). The platelet parameters [platelet count (PLT), platelet distribution width (PDW), and mean platelet volume (MPV)] and serum G-CSF level within 24 hours after birth, as well as perinatal and general information of infants in two groups were collected by prospective study method and were compared using independent-samples t tests and chi-square test. Multivariate unconditional logistic regression analysis was used to analyze the influencing factors of weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD. Receiver operating characteristic (ROC) curve was used to assess the predictive value of early platelet parameters and serum G-CSF level for weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD. The procedures followed in this study complied with the standards of the Medical Ethics Committee of Changzhou Maternal and Child Health Care Hospital and were approved by the committee (Approval No. 202070).

Results

①Among 106 extremely premature infants with BPD who underwent invasive mechanical ventilation, 32 cases required reintubation within 72 hours after after first extubation, and the failure rate was 30.2%. ②The intrauterine infection rate was higher in failure group than that in success group, and the duration of invasive mechanical ventilation before the first extubation was longer than that in success group, and the early MPV and serum G-CSF were higher than those in success group, and all the differences were statistically significant (χ²=4.66, P=0.031; t=3.66, P=0.001; t=4.43, P=0.001; t=2.07, P=0.041). ③Multivariate unconditional logistic regression analysis showed that the duration of invasive mechanical ventilation before the first extubation (OR=4.495, 95%CI: 2.588-7.806), early MPV (OR=3.086, 95%CI: 1.777-5.359), and early serum G-CSF level (OR=3.747, 95%CI: 2.158-6.507) were all independent factors influencing weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD (P<0.05). ④ROC curve analysis showed that the sensitivities of early MPV and serum G-CSF level alone and in combination for predicting weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD were 73.9% (95%CI: 64.2%-85.2%), 75.1% (95%CI: 67.1%-89.4%), and 84.2% (95%CI: 75.6%-93.5%), respectively; the specificities were 77.4% (95%CI: 69.1%-86.3%), 68.2% (95%CI: 60.2%-76.5%), and 83.9% (95%CI: 74.2%-91.3%), respectively; and the area under the curve (AUC) were 0.737, 0.712, and 0.879, respectively.

Conclusions

Early MPV and serum G-CSF level are associated with weaning failure within 72 hours after the first extubation in extremely preterm infants with BPD, and can be used to assist in predicting the risk of weaning failure within 72 hours after the first extubation in these infants.

Key words: Bronchopulmonary dysplasia, Respiration, artificial, Platelet parameters, Mean platelet volume, Granulocyte colony-stimulating factor, Mechanical ventilation, Weaning failed, Infant, extremely premature

表1 2组BPD超早产儿围产期资料比较[例数(%)]

组别	例数	娩出方式		孕母妊娠期糖尿病	孕母妊娠期高血压疾病	产前使用地塞米松	宫内感染
组别	例数	顺产	剖宫产	孕母妊娠期糖尿病	孕母妊娠期高血压疾病	产前使用地塞米松	宫内感染
失败组	32	19(59.4)	13(40.6)	5(15.6)	9(28.1)	15(46.9)	6(18.8)
成功组	74	52(70.3)	22(29.7)	9(12.2)	18(24.3)	44(59.5)	4(5.4)
χ²值		1.20		0.23	0.17	1.43	4.66
P值		0.274		0.629	0.680	0.231	0.031

表1 2组BPD超早产儿围产期资料比较[例数(%)]

组别	例数	娩出方式		孕母妊娠期糖尿病	孕母妊娠期高血压疾病	产前使用地塞米松	宫内感染
组别	例数	顺产	剖宫产	孕母妊娠期糖尿病	孕母妊娠期高血压疾病	产前使用地塞米松	宫内感染
失败组	32	19(59.4)	13(40.6)	5(15.6)	9(28.1)	15(46.9)	6(18.8)
成功组	74	52(70.3)	22(29.7)	9(12.2)	18(24.3)	44(59.5)	4(5.4)
χ²值		1.20		0.23	0.17	1.43	4.66
P值		0.274		0.629	0.680	0.231	0.031

表2 2组BPD超早产儿一般资料比较

组别	例数	性别[例数(%)]		出生胎龄(周，±s)	出生体重(g，±s)	生后5 min Apgar评分(分，±s)	首次拔管前机械通气时间(h，±s)	使用PS[例数(%)]
组别	例数	男	女	出生胎龄(周，±s)	出生体重(g，±s)	生后5 min Apgar评分(分，±s)	首次拔管前机械通气时间(h，±s)	使用PS[例数(%)]
失败组	32	15(46.9)	17(53.1)	27.6±2.0	1 056.3±170.3	4.2±1.3	79.0±10.1	32(100.0)
成功组	74	34(45.9)	40(54.1)	27.3±1.3	1 007.9±152.1	4.8±1.4	72.2±8.3	74(100.0)
统计量		χ²＝0.01		t＝0.85	t＝1.45	t＝1.77	t＝3.66	—^a
P值		0.930		0.397	0.150	0.080	0.001	1.000

表2 2组BPD超早产儿一般资料比较

组别	例数	性别[例数(%)]		出生胎龄(周，±s)	出生体重(g，±s)	生后5 min Apgar评分(分，±s)	首次拔管前机械通气时间(h，±s)	使用PS[例数(%)]
组别	例数	男	女	出生胎龄(周，±s)	出生体重(g，±s)	生后5 min Apgar评分(分，±s)	首次拔管前机械通气时间(h，±s)	使用PS[例数(%)]
失败组	32	15(46.9)	17(53.1)	27.6±2.0	1 056.3±170.3	4.2±1.3	79.0±10.1	32(100.0)
成功组	74	34(45.9)	40(54.1)	27.3±1.3	1 007.9±152.1	4.8±1.4	72.2±8.3	74(100.0)
统计量		χ²＝0.01		t＝0.85	t＝1.45	t＝1.77	t＝3.66	—^a
P值		0.930		0.397	0.150	0.080	0.001	1.000

表3 2组BPD超早产儿生后早期血小板参数及血清G-CSF水平比较(

±s)

组别	例数	PLT(×10⁹/L)	PDW(%)	MPV(fL)	血清G-CSF水平(pg/mL)
失败组	32	209.5±31.3	16.3±1.3	10.7±0.9	112.3±36.1
成功组	74	217.6±26.8	16.7±1.0	10.0±0.7	98.2±30.4
t值		1.35	1.48	4.43	2.07
P值		0.180	0.142	0.001	0.041

表3 2组BPD超早产儿生后早期血小板参数及血清G-CSF水平比较(

±s)

组别	例数	PLT(×10⁹/L)	PDW(%)	MPV(fL)	血清G-CSF水平(pg/mL)
失败组	32	209.5±31.3	16.3±1.3	10.7±0.9	112.3±36.1
成功组	74	217.6±26.8	16.7±1.0	10.0±0.7	98.2±30.4
t值		1.35	1.48	4.43	2.07
P值		0.180	0.142	0.001	0.041

表4 影响BPD超早产儿首次拔管后72 h内撤机失败独立危险因素的多因素非条件逐步logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
首次拔管前机械通气时间(连续变量)	1.503	0.724	4.310	0.013	4.495	2.588~7.806
生后早期MPV(连续变量)	1.127	0.526	4.591	0.012	3.086	1.777~5.359
生后早期血清G-CSF水平(连续变量)	1.321	0.658	4.030	0.014	3.747	2.158~6.507

表4 影响BPD超早产儿首次拔管后72 h内撤机失败独立危险因素的多因素非条件逐步logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
首次拔管前机械通气时间(连续变量)	1.503	0.724	4.310	0.013	4.495	2.588~7.806
生后早期MPV(连续变量)	1.127	0.526	4.591	0.012	3.086	1.777~5.359
生后早期血清G-CSF水平(连续变量)	1.321	0.658	4.030	0.014	3.747	2.158~6.507

图1 生后早期MPV及血清G-CSF水平预测BPD超早产儿首次拔管后72 h内撤机失败的ROC曲线图注：MPV为平均血小板体积，G-CSF为粒细胞集落刺激因子，BPD为支气管肺发育不良，ROC曲线为受试者工作特征曲线

表5 生后早期MPV与血清G-CSF水平预测BPD超早产儿首次拔管后72 h内撤机失败的效能分析

指标	ROC曲线		最佳临界值	敏感度及其95%CI(%)	特异度及其95%CI(%)
指标	AUC(95%CI)	P值	最佳临界值	敏感度及其95%CI(%)	特异度及其95%CI(%)
生后早期MPV	0.737(0.609~0.861)	<0.001	10.39 fL	73.9(64.2~85.2)	77.4(69.1~86.3)
生后早期血清G-CSF水平	0.712(0.591~0.843)	<0.001	105.32 pg/mL	75.1(67.1~89.4)	68.2(60.2~76.5)
二者联合	0.879(0.785~0.972)	<0.001	－	84.2(75.6~93.5)	83.9(74.2~91.3)

表5 生后早期MPV与血清G-CSF水平预测BPD超早产儿首次拔管后72 h内撤机失败的效能分析

指标	ROC曲线		最佳临界值	敏感度及其95%CI(%)	特异度及其95%CI(%)
指标	AUC(95%CI)	P值	最佳临界值	敏感度及其95%CI(%)	特异度及其95%CI(%)
生后早期MPV	0.737(0.609~0.861)	<0.001	10.39 fL	73.9(64.2~85.2)	77.4(69.1~86.3)
生后早期血清G-CSF水平	0.712(0.591~0.843)	<0.001	105.32 pg/mL	75.1(67.1~89.4)	68.2(60.2~76.5)
二者联合	0.879(0.785~0.972)	<0.001	－	84.2(75.6~93.5)	83.9(74.2~91.3)

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