The evaluation of sequential platelet counts has prognostic value for acute kidney injury patients requiring dialysis in the intensive care setting

Abstract

OBJECTIVE:To evaluate the prognostic value of platelet counts in acute kidney injury patients requiring renal replacement therapy.METHODS:This prospective cohort study was performed in three tertiary-care hospitals. Platelet counts were obtained upon admission to the intensive care unit and during the first week of renal replacement therapy on days 1, 3, 5 and 7. The outcome of interest was the hospital mortality rate. With the aim of minimizing individual variation, we analyzed the relative platelet counts on days 3, 5, 7 and at the point of the largest variation during the first week of renal replacement therapy. Logistic regression analysis was used to test the prognostic value of the platelet counts.RESULTS:The study included 274 patients. The hospital mortality rate was 62%. The survivors had significantly higher platelet counts upon admission to the intensive care unit compared to the non-survivors [175.5×103/mm3 (108.5–259×103/mm3) vs. 148×103/mm3 (80−141×103/mm3)] and during the first week of renal replacement therapy. The relative platelet count reductions were significantly associated with a higher hospital mortality rate compared with the platelet count increases (70% vs. 44% at the nadir, respectively). A relative platelet count reduction >60% was significantly associated with a worse outcome (mortality rate = 82.6%). Relative platelet count variations and the percentage of reduction were independent risk factors of hospital mortality during the first week of renal replacement therapy.CONCLUSION:Platelet counts upon admission to the intensive care unit and at the beginning of renal replacement therapy as well as sequential platelet count evaluation have prognostic value in acute kidney injury patients requiring renal replacement therapy.

Association of Thrombocytopenia and Mortality in Critically Ill Patients on Continuous Renal Replacement Therapy

“…The higher prevalence of thrombocytopenia is most likely related to the severity of underlying conditions as evidenced by higher SOFA and CCI scores. Although thrombocytopenia is common in dialysis-requiring AKI, community-acquired pneumonia, and general ICU patients, severe thrombocytopenia is less common (seen only in 5-8%) [10,13]. In contrast, we found that a higher percentage (17%) of patients already had severe thrombocytopenia prior to the CRRT initiation, and this was associated with poor survival.…”

“…From a management standpoint, identification of factors that could predict the outcome prior to or after the initiation of invasive therapies like CRRT in critically ill patients would be beneficial. In 2013, Valente et al reported their experience with a group of 274 patients with kidney dysfunction who were predominantly (80%) managed by CRRT [13]. While severe thrombocytopenia was reported in only 9% of patients at the start of CRRT, these patients had worse outcomes (mortality 88 vs. 62%).…”

“…Little is known about the incidence, prevalence, and outcome of thrombocytopenia in the CRRT subgroup. In a small study of AKI patients receiving both intermittent and CRRT, platelet counts of 100,000-149,000/μl, 50,000-99,000/μl, and <50,000/µl on the first day of dialysis were associated with an increase in hospital mortality with ORs (95% CI) of 1.5 (0.7-3.3), 2.39 (0.97-5.5), and 13.3 (2.6-65.8), respectively [13]. Because CRRT potentially alters the patients' overall short- and long-term management strategy and prognosis, we sought to determine the impact of thrombocytopenia on the ICU patients who received CRRT.…”

Thrombocytopenia as a Marker of Outcome in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…In another study involving patients with community-acquired pneumonia, those with TP more often presented with severe sepsis, septic shock, ICU admission, and the need for invasive mechanical ventilation [17]. TP was associated with higher mortality in acute kidney injury patients requiring dialysis [18].…”

SOFA coagulation score and changes in platelet counts in severe acute kidney injury: Analysis from the randomized evaluation of normal versus augmented level (RENAL) study

“…Thrombocytopaenia is a common complication in patients with AKI, in particular in those requiring RRT, with its incidence ranging from 50 to 65% . Low platelet counts are associated with an increased risk of bleeding, which further contributes to microvascular failure, multiple organ dysfunction as well as high mortality .…”