Epidemiology and outcome of thrombocytopenic patients in the intensive care unit: results of a prospective multicenter study

Thiollière, Fabrice; Serre-Sapin, Anne; Reignier, Jean; Benedit, Marcel; Constantin, Jean Michel; Lebert, Christine; Guélon, D.; Timsit, Jean François; Souweine, Bertrand

doi:10.1007/s00134-013-2963-3

Cited by 66 publications

(89 citation statements)

References 40 publications

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“…Yoğun bakımlarda trombositopeni daha kötü sonuçlarla ilişkili olmasına rağmen, trombosit sayımının zamanla seyri ve mortalite oranı arasındaki ilişki kesin ve net bir şekilde daha önce tanımlanmamıştır (3,6,8,(16)(17)(18). Kritik hastalarda trombosit sayısının zamanla seyri ve mortalite oranı arasındaki ilişkiyi tanımlamak amaçlı Akca ve ark.…”

Section: Discussionunclassified

Incidence of Thrombocytopenia in Patients Hospitalized in the Intensive Care Unit and Factors Affecting the Development of Thrombocytopenia

Coşkun¹,

Mendil²,

Kaya³

et al. 2016

Yoğun Bakim Derg

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GirişTrombositopeni için farklı tanımlamalar olmakla beraber tam kan sayımındaki trombosit sayısının 150.000/μL altında olması trombositopeni olarak kabul edilir (1). Ancak bazı yazarlar tarafından trombositopeni sınırı 100.000/μL olarak kabul edilmektedir (2, 3). Trombositopenisi olan hastalarda beklenen en önemli problem kanamadır. Kanama riski trombosit değerleri ile ters orantılıdır (1).Objective: Thrombocytopenia is common in intensive care units (ICUs) and is associated with high mortality. The aim of this study was to determine the incidence of thrombocytopenia and to evaluate the factors affecting the development of thrombocytopenia in patients who stayed at a medical intensive care unit (MICU). Material and Methods:This study was conducted retrospectively in a MICU. The data were obtained from patients' folders and the hospital's electronic records system. Patients who stayed for more than 24 h in the ICU were included in the study. The demographic data, the worst laboratory values in the first 24 h, the lowest platelet counts, and medications that can cause thrombocytopenia were recorded.Results: A total of 237 patients were included in this study; 106 of them (45%) were female and 131 (55%) were male. Their average age was 62±18 years. The most common reasons for hospitalization in the ICU were respiratory failure (33%) and neurological diseases (13%). During follow-up, 45% of the patients developed thrombocytopenia. The mean APACHE-II score was 24±10 and SOFA score was 9±4. The mean MODS score was 6±3, and it was higher in the patients who developed thrombocytopenia than those who did not (p<0.0001). Upon analyzing the factors affecting the development of thrombocytopenia, prophylactic or therapeutic heparin use was determined in 61% of the patients. It was determined that 106 patients (45%) were using one or more drugs that can trigger thrombocytopenia. The patients who developed thrombocytopenia stayed longer in the ICU (p=0.042), and their overall mortality rate was higher than those who did not develop thrombocytopenia (91% vs. 55%; p<0.0001). Bulgular: Çalışmaya 237 hasta dâhil edildi. Hastaların 106'sı kadın (%45), 131'i ise erkekti (%55). Yaş ortalaması 62±18 yıl idi. En sık yoğun bakıma yatış nedenleri; solunum yetmezliği (%33) ve nörolojik hastalıklar (%13) idi. Takiplerinde hastaların %45'inde trombositopeni gelişti. Hastaların ortalama APACHE II skoru 24±10, SOFA skoru 9±4 ve MODS skoru 6±3 idi ve trombositopeni gelişen hastalarda gelişmeyenlere göre daha yüksek bulundu (p<0,0001). Trombositopeni gelişimini etkileyen faktörler incelendiğinde hastaların %61'inin profilaktik veya tedavi dozunda heparin aldığı tespit edildi. Hastaların 106'sında (%45) ise bir veya daha fazla trombositopeni yapan ilaç kullanıldığı görüldü. Trombositopeni gelişen hastalarda yoğun bakımda kalma süresi daha uzun idi (p=0,042). Hastaların genel mortalitesi trombositopeni gelişenlerde gelişmeyenlere göre daha yüksek idi (%91 ve %55; p<0,0001).

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Section: Discussionunclassified

Incidence of Thrombocytopenia in Patients Hospitalized in the Intensive Care Unit and Factors Affecting the Development of Thrombocytopenia

Coşkun¹,

Mendil²,

Kaya³

et al. 2016

Yoğun Bakim Derg

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“…Most of our knowledge in this field is based on studies performed in oncohematological patients in stable conditions, in whom central thrombocytopenia, due to reduced bone marrow thrombopoiesis, has been shown the main mechanism responsible for low PLT count [11 -14] . On the contrary, in critically ill patients admitted in the ICU, thrombocytopenia is more often caused by increased PLT consumption, mainly consequent to the development of sepsis and/or DIC [10,15] . Interestingly, in critically ill patients, the relationship between thrombocytopenia and bleeding risk is less stringent than in onco-hematologic patients [6,7] , (14) 4.3% (12) 7.1% (7) 8.3% (4) probably related to the preserved production of functional PLTs [10,16] .…”

Section: Discussionmentioning

confidence: 99%

Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department

Turvani¹,

Pigozzi²,

Barutta

et al. 2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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Background: Thrombocytopenia is the most common coagulation disorder in critically ill patients. No studies have investigated the epidemiology and clinical impact of this condition in emergency department (ED) patients. We aimed to investigate epidemiological features, incidence of bleeding, and diagnostic and therapeutic requirements of patients with thrombocytopenia admitted to the ED. Methods: We performed a retrospective observational study enrolling all patients admitted to the medical-surgical ED of the " Citt à della Salute e della Scienza di Torino " Hospital with a platelet count < 150 × 10 9 PLTs/L, during four non-consecutive months. There were no exclusion criteria. Results: The study included 1218 patients. The percentage of patients with severe ( < 50 × 10 9 PLTs/L) or very severe ( < 20 × 10 9 PLTs/L) thrombocytopenia was about 12%. Thrombocytopenia associated with liver cirrhosis was the most represented etiology. On the contrary, the most frequent cause in patients with newly recognized low platelet count was disseminated intravascular coagulation/sepsis. The incidence of bleeding and hypovolemia, as well as the need of transfusional support and mechanical, surgical or endoscopic hemostasis progressively increased with the severity of thrombocytopenia.

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“…Three studies provided new insights on this topic with potential implications for patient management. In a very interesting prospective multicenter study, Thiolliere et al [80] evaluated 301 patients with either absolute (platelet count \100 9 10 9 /l) or relative (decrease in the platelet count [30 %) thrombocytopenia. The frequencies of absolute and relative thrombocytopenia were 8.9 and 6.7 %, respectively.…”

Section: Hematological Issues In the Critically Illmentioning

confidence: 99%

Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients

et al. 2014

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Epidemiology and outcome of thrombocytopenic patients in the intensive care unit: results of a prospective multicenter study

Abstract: In thrombocytopenic patients, sepsis is the leading cause of TP. Bone marrow aspirates may yield significant information on TP mechanisms and contribute to the subsequent management of patients, especially those with absolute TP.

Cited by 66 publications

References 40 publications

Incidence of Thrombocytopenia in Patients Hospitalized in the Intensive Care Unit and Factors Affecting the Development of Thrombocytopenia

Incidence of Thrombocytopenia in Patients Hospitalized in the Intensive Care Unit and Factors Affecting the Development of Thrombocytopenia

Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department

Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients

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