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

Abstract

Background: Both acute kidney injury (AKI) requiring dialysis and thrombocytopenia are very common and have been independently associated with mortality and morbidity in critically ill patients. Thrombocytopenia is an independent risk factor for AKI and also a marker of disease severity. There is a paucity of literature on the prevalence, incidence, and outcome of thrombocytopenia in patients receiving continuous renal replacement therapy (CRRT). We aimed at identifying the impact of thrombocytopenia on patients in the intensive care unit (ICU) with AKI requiring CRRT. Methods: We retrospectively studied consecutive adult patients admitted to the ICU from December 9, 2006 through December 31, 2009, with follow-up for 12 months who received CRRT. Thrombocytopenia was defined as platelet counts of <150,000/µl and severe thrombocytopenia as platelet counts of <50,000/µl. Outcomes were mortality and length of stay, both in ICU and hospital. Descriptive summary and multivariable regression model were used for data analyses. Results: Out of the 541 patients studied, thrombocytopenia was observed in 350 (65%) prior to the initiation of CRRT, and 107 (20%) developed it after CRRT was started. The average age of patients was 61 ± 15; 328 (61%) were men. Sepsis was present in more than half of the patients requiring CRRT. We found a graded increase (p = 0.01) in ICU mortality with worsening platelet counts; 33, 40, and 51% of patients died in ICU with platelet counts ≥150,000/μl, 50,000-149,000/μl, and ≤50,000/µl, respectively. Thrombocytopenia prior to the initiation of CRRT and severe thrombocytopenia prior to and following the initiation of CRRT were associated with increased ICU mortality (p = 0.01). Conclusions: Thrombocytopenia is very common in ICU patients who are on CRRT, and both thrombocytopenia prior to the start of CRRT and severe thrombocytopenia developing after the initiation of CRRT significantly impact patient survival. Future large-scale prospective studies will help to explore the role of platelet in prognostication of outcome among CRRT patients.

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

“…fluid overload and SIRS), the incidence of thrombocytopaenia prior to CRRT was only 26.4% . On the other hand, in a study including patients with more severe form of AKI (KDIGO criteria stage III), up to 65% of the patients had thrombocytopaenia prior to commencement of CRRT . Our study demonstrated that 48.7% of AKI patients had abnormal SOFA‐CS/thrombocytopaenia prior to RRT.…”

“…The association of thrombocytopaenia with increased mortality in severe AKI patients has only been described in a small prospective study and in a retrospective single centre study . None of them, however, assessed the relationship with RRT treatment modification and RRT outcomes.…”

“…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 .…”

Prognostic Factors and Efficacy for Continuous Renal Replacement Therapy in Critically Ill Patients: A Chinese Single-Center Retrospective Study

“…To our knowledge, this is the first study showing a relationship between PCO 2 and the outcomes of patients treated with CRRT. Previous studies related to the predictive factors for survival renal recovery of the critically ill patients receiving CRRT focused on status of fluid, serum creatinine, glomerular filtration rate [10, 14, 15], coagulation functions [7, 16], inflammatory related mediators [5], and electrolyte and mineral disturbances [6]. However, there were few studies investigating parameters from respiratory system predicting survival with CRRT therapy.…”

Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19

“…Anticoagulant drugs that prevent coagulation in the circuit may also affect the patient's coagulation state, increasing the risk of bleeding-induced thrombocytopenia or inducing HIT [58]. Guru et al [59] reported that thrombocytopenia occurred in 65% of critically ill patients who planned to receive CRRT, and thrombocytopenia occurred in another 20% of patients during CRRT. Patients with CRRT using heparin anticoagulation have more significant platelet decline than patients without CRRT using heparin anticoagulation.…”