A study to evaluate the prognostic significance of thrombocytopenia among critically ill children

Abstract

Background: Pediatric critical care differs from Adult critical care not only in age but also in the outcomes. There are no studies regarding thrombocytopenia in the pediatric population. Therefore, in the current study, our objective was to study the prevalence and, the severity of thrombocytopenia, clinical features, and prognostic significance of low platelet count as an independent predictor of mortality and prolonged hospital and ICU stay.Methods: This was a prospective observational study conducted at tertiary care paediatric intensive care unit in India. Children between 1 month to 18 years admitted to the Pediatrics intensive care unit with thrombocytopenia due to any cause at admission were involved in the study. Detailed history was documented. Haemoglobin levels, total leucocyte counts, platelet counts, and platelet indices were recorded on the first and fourth day of admission. Outcomes were analysed in term of survivors and non-survivors and duration of ICU and hospital stay.Results: The study group consisted of 150 children with mean age of 8.458(± 5.604) years. Majority of children in the study group had severe thrombocytopenia 77 (51.3%). Moderate and mild thrombocytopenia was seen in 35(23.3%) and 38(25.4%) children respectively. Infection (50.66%) was the most common cause of thrombocytopenia, followed by sepsis (10.66%). Sepsis (27.5%) was observed to be the most common cause of mortality. Rise in platelet count on the fourth day among survivors, and no survivors were observed in 79.1% and 15.9% respectively. Failure of the rise in platelet count on the fourth day of admission was significantly associated with mortality (p value=0.001). The severity of thrombocytopenia does not correlate with duration of hospital and ICU stay.Conclusions: Platelet counts and indices at the time of admission to a critical care unit have limited use as a prognostic marker for predicting mortality in children.

To estimate the prevalence of thrombocytopaenia and its role as prognostic marker in patients of paediatric intensive care unit

“…Similar results were observed in the study conducted by Sah et al [15] where maximum (41.7%) patients had mild thrombocytopaenia (platelet count <150 × 10 9 /L) followed by 32.3% of patients with moderate thrombocytopaenia (platelet count <100 × 10 9 /L) and 26.4% of patients with severe thrombocytopaenia (platelet count <50 × 10 9 /L). Studies conducted by Mundkur et al [18] and Kaur et al [1] who showed higher prevalence of severe thrombocytopaenia 51% (platelet count <50 × 10 9 /L) whereas the study by Yilmaz et al [6] showed lower prevalence (7.45%) of severe thrombocytopaenia as compared to our study. Thus, there is varying prevalence of severity of thrombocytopaenia.…”

“…Maximum age range was 1 month-18 years in the study of Mundkur et al [18] The mean age of the patients in the present study was 5.4 years which is similar to the studies conducted by Mittal et al [19] and Mussa et al [16] The range of age groups of the study population in this study was 1 month-17 years, which is similar to that of the study by Mundkur et al [18] who had included patients from 1 month to 18 years of age. The median age observed in our study was 36 months (3 years), which is similar to the study by Agrawal et al [7] (2008), where a median age was 32 months.…”

“…The majority of patients (60.56%) had PICU stay duration of <5 days whereas 5.55% had PICU stay duration of 5 days and 33.89% had more than 5 days of PICU stay. The study conducted by Mundkur et al [18] who showed that the median duration of PICU stay in mild and moderate thrombocytopaenia was 4 days and in severe thrombocytopaenia was 3 days. The median duration of PICU stay was 8 days (3-120 days) in the study by Yilmaz et al [6] In the study by Mussa et al, [16] PICU stay duration was divided into <7 days, 7-14 days and >14 days with 56.2%, 25.4% and 18.5% of study population, respectively.…”

“…Kaur et al [1] and Mittal et al [19] observed that mortality among thrombocytopaenic and nonthrombocytopaenic patients was similar to this study. Higher mortality was observed among thrombocytopaenic patients in the studies by Sah et al, [15] Yilmaz et al, [6] Mussa et al [16] and Agrawal et al [7] while lower mortality was seen among thrombocytopaenic patients in studies by Mundkur et al [18] and Krishnan et al [17] Sah et al [15] observed that there were 18 times more risk of mortality among thrombocytopaenic patient compared to non-thrombocytopaenic patients with odds ratio 18 at 95% CI. Mortality including this study was statistically significant in thrombocytopaenic group as compared to non-thrombocytopaenic group in all studies.…”