Thrombocytopenia in the critically ill: prevalence, incidence, risk factors, and clinical outcomes

Abstract

Purpose The aim of this cohort study was to describe the prevalence, incidence, and risk factors for thrombocytopenia in the intensive care unit (ICU) and to evaluate the impact of thrombocytopenia on mortality with further comparisons amongst major diagnostic categories. Methods Patients admitted to the ICU from 1997-2011 for cardiac, medical, surgical, and trauma conditions were included. The presence of a platelet count\ 100 9 10 9 ÁL -1 on admission day or its appearance during ICU stay were considered as prevalent and incident thrombocytopenia, respectively. Risk factors for thrombocytopenia and the influence of thrombocytopenia on mortality were also analyzed. Results This study included 20,696 patients. Prevalent and incident thrombocytopenia occurred in 13.3% and 7.8% of patients, respectively, with associated mortality rates of 14.3% and 24.7%, respectively, compared with 10.2% in the group with normal platelet count (P \ 0.001). After adjustments, thrombocytopenia remained associated with an increased risk of mortality (odds ratio 1.25; 95% confidence interval 1.20 to 1.31; P \ 0.001). The greatest impact of thrombocytopenia on mortality was observed in the cancer, respiratory, digestive, genitourinary, and infectious diagnostic categories. Independent risk factors included age, female sex, admission platelet counts and hemoglobin, mechanical ventilation, days of hospitalization prior to ICU admission, liver cirrhosis, hypersplenism, coronary bypass grafting, intra-aortic balloon pump placement, acute hepatitis, septic shock, and pulmonary embolism or deep vein thrombosis. Conclusions Thrombocytopenia in the ICU is associated with an independent risk of mortality that varies greatly depending on diagnostic admission category.Electronic supplementary material The online version of this article

Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery: Erratum

“…We have recently demonstrated that low postoperative platelet counts are associated with an increased risk for AKI and death after CABG surgery,(13) which is similar to observations in critically ill patients (28) Our finding that moderate to severe thrombocytopenia was associated with delayed but not early stroke, is intriguing, and supports the hypothesis that a postoperative prothrombotic state with associated platelet activation is an important factor in delayed stroke. Defining the mechanisms that drive these events will be crucial to the development of improved strategies to prevent postoperative stroke.…”

“…(11) We recently reported that, similar to observations in critically ill patients (12), postoperative thrombocytopenia, defined as the lowest inhospital values, is associated with acute kidney injury (AKI) and increased risk for…”

Thrombocytopenia in the critically ill

“…Les auteurs ont examiné les facteurs de risque de thrombocytopénie ainsi que les associations possibles entre la thrombocytopénie et la durée de séjour à l'hôpital, les saignements, et la mortalité. 7 Les maladies fortement associées à la thrombocytopénie étaient exclues (par ex. la coagulation intravasculaire disséminée, les microangiopathies, la thrombocytopénie induite par l'héparine, l'anémie aplasique, les autres syndromes d'aplasie médullaire et la thrombocytopénie secondaire).…”

“…The authors investigated the risk factors for thrombocytopenia as well as possible associations between thrombocytopenia and length of hospital stay, bleeding, and mortality. 7 Diseases highly associated with thrombocytopenia were excluded (e.g., disseminated intravascular coagulation, microangiopathies, heparin-induced thrombocytopenia, aplastic anemia, other bone marrow failure syndromes, and secondary thrombocytopenia).…”

Clinical characteristics and prognostic significance of changes in platelet count in an internal medicine ward

“…Therefore, platelet count (PC) may change significantly within several days as a result of altered production and increased destruction and sequestration of thrombocytes [4][5][6]. These pathogenic mechanisms may be encountered in acute conditions such as severe infection, inflammation, trauma, major surgery, mechanical ventilation, bleeding and transfusions [4][5][6][7][8][9]. Changes in PC may also be caused by a variety of chronic disorders, including malignant diseases, nutritional deficiencies or liver failure and certain drugs [4,8,9].…”