Is Thrombocytopenia an Early Prognostic Marker in Septic Shock?

Thiery-Antier, Nadiejda; Binquet, Christine; Vinault, Sandrine; Meziani, Ferhat; Boisramé-Helms, Julie; Quenot, Jean‐Pierre

doi:10.1097/ccm.0000000000001520

Cited by 117 publications

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“…In addition, our results also highlighted that only significant reductions in platelet counts (>50% reduction) were associated with increased mortality. Finally, although sepsis is a known risk factor for thrombocytopaenia in critically ill patients, our study did not show a significant association between thrombocytopaenia and mortality in septic patients in the ICU setting, which is consistent with current literature …”

Section: Discussionsupporting

confidence: 93%

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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

et al. 2019

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Section: Discussionsupporting

confidence: 93%

“…Finally, although sepsis is a known risk factor for thrombocytopaenia in critically ill patients, 9 our study did not show a significant association between thrombocytopaenia and mortality in septic patients in the ICU setting, which is consistent with current literature. 25,26 Implications of study findings…”

Section: Comparison With Previous Studiesmentioning

confidence: 97%

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

et al. 2019

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“…The 28-day all-cause mortality of sepsis patients varies in different patient populations. According to the previous studies, the 28-day mortality of sepsis patients with severe thrombocytopenia was more than 50% [19,20,31]. Furthermore, in our single-center, retrospective, cohort study, the 28-day mortality of these patients treated with rhTPO was 29.2%.…”

Section: Sample Sizementioning

confidence: 48%

“…Moreover, a multicenter prospective trial in France pointed out that thrombocytopenia was an early prognostic indicator for sepsis patients, and the occurrence and duration of thrombocytopenia were closely related to length of ICU stay, hospitalization stay and 28-day mortality. Furthermore, the greater the extent of thrombocytopenia was, the higher the mortality was [19]. Another study found that severe thrombocytopenia released more inflammatory factors, stimulated endothelial cells, inhibited leukocyte adhesion/activation related signaling pathways, activated complement related signaling pathways, and caused dysregulated host defense responses.…”

Section: Introductionmentioning

confidence: 99%

The effect of recombinant human thrombopoietin (rhTPO) on sepsis patients with acute severe thrombocytopenia: a study protocol for a multicentre randomised controlled trial (RESCUE trial)

et al. 2019

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Background: Sepsis is still a common critical disease with high morbidity and mortality in intensive care unit. Despite published guidelines for sepsis, development of antibiotic therapy and advanced organ support technologies, the mortality of sepsis patients is still 25% or more. It is necessary to distinguish the subtypes of sepsis, and the targeted therapy for the patients need to be explored. Platelets have various biological functions in hemostasis and thrombosis, host defense, inflammatory/immune responses and tissue repair/regeneration. Moreover, severe thrombocytopenia or sustained thrombocytopenia was closely associated with multiply organ dysfunction and higher mortality in sepsis patients. The clinical therapies for thrombocytopenia are platelet transfusion and platelet-elevating drugs. However, platelet transfusion has many defects in clinical practice in sepsis patients, and the impact of platelet-elevating drugs for sepsis patients is still unclear. RESCUE trial is aim to explore the effect of a platelet-elevating drug, recombinant human thrombopoietin (rhTPO), as an effective rescue therapy on sepsis patients with acute severe thrombocytopenia. Methods: It is a randomized, open-label, multi-center, controlled trial in 5 tertiary academic hospitals including medical, surgical or general ICUs. In this study, a total of 200 sepsis patients with severe thrombocytopenia will be randomly assigned in a 1:1 ratio to the control and rhTPO group. The patients will be followed up to 28 days after randomization. All patients in two groups receive the same treatment based on the guideline of Surviving Sepsis Campaign. Primary outcome is 28-day mortality. Secondary outcomes are the changes of PCs, blood transfusion, biomarkers of infection and organ function, days free from advanced organ support, drug-related adverse events, the length of ICU and hospital stay. Discussion: RESCUE trial is the first randomized controlled trial to explore the impact of rhTPO for severe thrombocytopenia in sepsis patients diagnosed by sepsis-3.0 standard. Furthermore, RESCUE trial results will be of significant clinical value on the targeted therapy and add clinical evidence that rhTPO is an effective rescue therapy for these sepsis patients.

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“…In a multicenter prospective evaluation of 1238 patients with severe sepsis, thrombocytopenia was present in 14.5% of patients [61]. In patients with septic shock, the incidence of thrombocytopenia approaches 50% [62,63]. Thrombocytopenia has consistently been associated with increased mortality in septic patients [10,61,62].…”

Section: Step 5: Evaluation For Sepsismentioning

confidence: 99%

Thrombocytopenia in the Intensive Care Unit

Walter

2020

Evidence-Based Critical Care

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A 68-year-old male is admitted to the medical ICU with acute hypoxemic respiratory failure from community acquired pneumonia. He was recently hospitalized for acute cholecystitis during which he received prophylactic subcutaneous heparin. He is placed on invasive mechanical ventilation and given ceftriaxone and azithromycin. A lower extremity duplex ultrasound is performed for unilateral leg swelling which demonstrates an acute right femoral deep vein thrombosis. He is subsequently started on an infusion of unfractionated heparin. The following morning, his platelet count is noted to have dropped from 250 × 10 9 cells/L to 110 × 10 9 cells/L.

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Is Thrombocytopenia an Early Prognostic Marker in Septic Shock?

Cited by 117 publications

References 0 publications

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

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

The effect of recombinant human thrombopoietin (rhTPO) on sepsis patients with acute severe thrombocytopenia: a study protocol for a multicentre randomised controlled trial (RESCUE trial)

Thrombocytopenia in the Intensive Care Unit

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