Association of Thrombocytopenia and Mortality in Critically ill Children Admitted to PICU in Tertiary Hospital In Biratnagar

Abstract

Introduction: Thrombocytopenia is a clinical condition characterized by decrease in number of platelets below the normal range. It is associated with bleeding tendency, hemodynamic instability, impaired inflammatory process and thus affecting host defence mechanism. There has been only few studies published till date in pediatric intensive care units suggesting thrombocytopenia is associated with increased mortality.
 Objectives: To determine the prevalence of thrombocytopenia in the critically ill children and its relationship with mortality in Pediatric intensive care unit (PICU) admitted children.
 Methodology: A prospective observational study was performed over a period of 12 months on 102 critically ill children admitted in PICU who fulfilled the criteria. Two patients left the study due to financial problems and as outcome could not be assessed on them, they were excluded from the study. Platelet count was noted at the time of admission and consecutively for the initial four days at PICU. Thrombocytopenia was defined as platelet count less than 150/nL. Mortality in PICU was recorded as primary outcome.
 Results: The prevalence of thrombocytopenia during consecutive 4 days was 34% (n=34) and at the time of admission in PICU was 16% (n=16) among 100 children analysed in the study. The mortality in the PICU was 27% (n=27). Mortality among thrombocytopenic children was 61.7% (n=21) as compared to 7.6% (n=5) in non-thrombocytopenic children (p=<0.001). Mortality was 18 times more for those who were thrombocytopenic at the time of admission as compared to those who subsequently developed thrombocytopenia during course of stay in PICU.
 Conclusion: Thrombocytopenia has significant association with increased mortality. Thrombocytopenic children at the time of admission have more likelihood of mortality than nonthrombocytopenic children in intensive care units.

Admission platelet count and indices as predictors of outcome in children with severe Sepsis: a prospective hospital-based study

“…This was in accordance with Venkata et al, [22], who found that thrombocytopenia carries an independent risk for mortality in ICU patients and is a negative prognostic indicator for adverse clinical outcomes in ICU patients [22]. Also, a recent study stated that thrombocytopenic children at the time of admission have more likelihood of mortality than non-thrombocytopenic children in intensive care units [23]. Gao et al, [24] found that PCT was correlated to platelet count with similar clinical implication, and they found markedly decreased PCT in patients who expired.…”

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

“…In this study, the prevalence was 37.78%. This is similar to the results shown in the studies conducted by Sah et al [15] and Kaur et al [1] where the prevalence of thrombocytopaenia was 34% and 32.36%, respectively. Relatively higher prevalence was observed in the studies conducted by Divecha et al [8] (60.3%), Yilmaz et al [6] (59.57%) and Mussa et al [16] (44.61%), respectively, while relatively lower prevalence was observed in the studies conducted by Krishnan et al [17] (25.3%) and Agrawal et al [7] (25%).…”

“…In this study, maximum patients 24 out of total 68 thrombocytopaenic patients that is, 35.29% had mild thrombocytopaenia followed in decreasing order by moderate thrombocytopaenia (33.82%), severe thrombocytopaenia (19.12%) and very severe thrombocytopaenia (11.76%). 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.…”

“…Mortality was 22.22% in this study, which was comparable to Sah et al [15] (26%), Mittal et al [19] (20%) and Kaur et al [1] (19.64%), whereas it was 37.2% and 53.07% in Yilmaz et al [6] and Mussa et al [16] study. The difference may be attributed to the different diagnosis of the patients and admission criteria in different studies.…”

“…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.…”