Severe thrombocytopenia on admission to the intensive care unit in patients with multiple organ failure

Marco-Schulke, C.M.; Sánchez-Casado, M.; Hortigüela-Martín, V.A.; Quintana-Díaz, Manuel; Rodríguez-Villar, S.; Pérez-Pedrero, M.J.; Velasco-Ramos, A.; Canabal, Alfonso; Arrese-Cosculluela, M. Ángeles

doi:10.1016/j.medine.2012.04.004

Cited by 4 publications

(12 citation statements)

References 37 publications

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“…Identified studies eligible for inclusion were published in the period from 1983 to 2019. Six of the included studies were case‐control studies, 5,19‐23 one was an RCT, 24 five were post hoc analyses of RCTs, 7,25‐28 one study was a protocol for an RCT, 29 and 57 studies were cohort studies 3,6,8‐14,30‐77 …”

Section: Resultsmentioning

confidence: 99%

“…The definitions and categories of thrombocytopenia used in the included studies are presented in Table 1. In 50 (71%) of the included studies, thrombocytopenia was defined according to an absolute platelet count, 3,5‐14,19,21,23,27,28,30‐34,36‐44,46,47,49,51,52,55‐57,59‐62,64,65,68,69,71‐75 and in 7 (10%) studies thrombocytopenia was further or exclusively (one study) defined by a relative decrease in platelet count (range > 30% to > 50% decrease) 21,23,38,53,57,59,65 . Most studies graded thrombocytopenia as mild when the platelet count was <150 × 10 9 /L, moderate; <100 × 10 9 /L, severe; <50 × 10 9 /L and very severe; <20 × 10 9 /L (or <30 × 10 9 /L) 3,6,7,9‐14,19,22,28,30,34,37,42,46,47,49,51,54,55,60‐62,69,71,73,74 ; some studies used other grades of severity 8,23,36,40,75 …”

Section: Resultsmentioning

confidence: 99%

“…The reported prevalence of thrombocytopenia in the ICU ranged from 21% to 77% and the overall incidence from 8 to 56 per 100 ICU admissions 3,7,9,12,13,19,21,23,36,38,39,41,47,52,56,61,62,64‐68,71,72 . The incidence of severe thrombocytopenia ranged from 1 to 17 per 100 ICU admissions 7,9,12,13,41,55,71 . The incidence and prevalence of thrombocytopenia in different types of ICUs are presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies reported crude risk estimates (Table 4), 5,6,9,11,44 and 17 studies reported adjusted risk estimates (Table 5). 5,7,9‐13,23,27,30,36,41‐43,46,55,62 Some studies assessed risk factors for thrombocytopenia by univariate analysis without providing any risk estimate and are, therefore, not presented 3,8,14,19,27,28,34,38‐40,47,51‐53,59,61,64,66,68,71,72 …”

Section: Resultsmentioning

confidence: 99%

“…Acute conditions associated with increased risk of thrombocytopenia included sepsis, 6,9,23,30,41,44,55 disseminated intravascular coagulation, 12,43 bleeding 30 and trauma 36 …”

Section: Resultsmentioning

confidence: 99%

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Thrombocytopenia in intensive care unit patients: A scoping review

Jonsson

Rygård

Hildebrandt

et al. 2020

Acta Anaesthesiol Scand

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Background Thrombocytopenia is frequent in intensive care unit (ICU) patients and may be associated with adverse outcomes. We aimed to assess the incidence, risk factors, and outcomes associated with thrombocytopenia in adult ICU patients. Methods We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Review and Meta‐analyses extension for Scoping Reviews (PRISMA‐ScR) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included study reports on adult ICU patients with thrombocytopenia and assessed patient‐important outcomes, including mortality and health‐related quality‐of‐life. Results We included a total of 70 studies comprising a total of 215 098 patients; 57 were cohort studies. The incidence of thrombocytopenia varied from 8 to 56 per 100 admissions (very low quality of evidence). We identified several risk factors including age, sepsis, and higher disease severity (low quality of evidence). Thrombocytopenia was associated with bleeding, use of life support, length of stay in the ICU, and increased mortality (low/very low quality of evidence). Data on platelet transfusion before invasive procedures and transfusion thresholds were limited. No studies assessed the benefits and harms of thromboprophylaxis in ICU patients with thrombocytopenia. Conclusions Thrombocytopenia is common and associated with increased morbidity and mortality in adult ICU patients. Several risk factors for thrombocytopenia exists, but the evidence‐base on management strategies, including transfusion thresholds and thromboprophylaxis in ICU patients is very limited.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Acute conditions associated with increased risk of thrombocytopenia included sepsis, 6,9,23,30,41,44,55 disseminated intravascular coagulation, 12,43 bleeding 30 and trauma 36 …”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Thrombocytopenia in intensive care unit patients: A scoping review

Jonsson

Rygård

Hildebrandt

et al. 2020

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

Dynamics of platelet count in critically ill medical patients as a prognostic marker and its associated risk factors – Experience at a tertiary care center of North-West India

Mehta

Goyal

Joshi

et al. 2016

Indian Journal of Medical Specialities

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Incidence, Clinical Characteristics and Outcomes of Early Hyperbilirubinemia in Critically Ill Patients: Insights From the MARS Study

Juschten

Bos

Grooth

et al. 2021

Shock

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To investigate the incidence, clinical characteristics and outcomes of early hyperbilirubinemia in critically ill patients. Design and Setting: This is a post hoc analysis of a prospective multicenter cohort study. Patients: Patients with measured bilirubin levels within the first 2 days after ICU admission were eligible. Patients with liver cirrhosis were excluded. Endpoints: The primary endpoint was the incidence of early hyperbilirubinemia, defined as bilirubin !33 mmol/L within 2 days after ICU admission. Secondary endpoints included clinical characteristics of patients with versus patients without early hyperbilirubinemia, and outcomes up to day 30. Results: Of 4,836 patients, 559 (11.6%) patients had early hyperbilirubinemia. Compared to patients without early hyperbilirubinemia, patients with early hyperbilirubinemia presented with higher severity of illness scores, and higher incidences of sepsis and organ failure. After adjustment for confounding variables, early hyperbilirubinemia remained associated with mortality at day 30 (odds ratio, 1.31 [95%-confidence interval 1.06-1.60]; P ¼ 0.018). Patients with early hyperbilirubinemia and thrombocytopenia (interaction P-value ¼ 0.005) had a higher likelihood of death within 30 days (odds ratio, 2.61 [95%-confidence interval 2.08-3.27]; P < 0.001) than patients with early hyperbilirubinemia and a normal platelet count (odds ratio, 1.09 [95%-confidence interval 0.75-1.55]; P ¼ 0.655). Conclusions: Early hyperbilirubinemia occurs frequently in the critically ill, and these patients present with higher disease severity and more often with sepsis and organ failures. Early hyperbilirubinemia has an association with mortality, albeit this association was only found in patients with concomitant thrombocytopenia.

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Severe thrombocytopenia on admission to the intensive care unit in patients with multiple organ failure

Cited by 4 publications

References 37 publications

Thrombocytopenia in intensive care unit patients: A scoping review

Thrombocytopenia in intensive care unit patients: A scoping review

Dynamics of platelet count in critically ill medical patients as a prognostic marker and its associated risk factors – Experience at a tertiary care center of North-West India

Incidence, Clinical Characteristics and Outcomes of Early Hyperbilirubinemia in Critically Ill Patients: Insights From the MARS Study

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