Thrombocytopenia in the ICU before and during the pandemic of the new coronavirus infection COVID-19: a comparative retrospective cohort study

Abstract

INTRODUCTION: Thrombocytopenia is common in critically ill patients. Its development is associated with a high risk of bleeding and other complications, including adverse outcomes. ОBJECTIVE: To analyze the incidence, severity, predictive significance of thrombocytopenia in critically ill patients before and during coronavirus infection. MATERIALS AND METHODS: The observational study included patients from intensive care units of a multidisciplinary hospital at different periods: before the COVID-19 and during the period when the hospital was operating as a COVID hospital. Patients from all intensive care units, excluding the hematology unit, were analyzed. RESULTS: Non-infectious period. Among 314 patients, 91 cases of thrombocytopenia were identified, representing 29 %. Severe thrombocytopenia among them was noted in 35 % (n = 32). The main etiological causes: performing extracorporeal procedures, liver disease, ischemic stroke, acute coronary syndrome. The infectious period. Thrombocytopenia occurred more frequently than in non-COVID patients (in 209 of 396 patients - 52.8 %) and was more uniform in severity. The most frequent cause of thrombocytopenia was a combination of sepsis, acute liver injury, performance of extracorporeal procedures and specific drug therapy of COVID-19 infection. CONCLUSIONS: According to our data, thrombocytopenia in the intensive care units of a multidisciplinary hospital (non-infectious period) occurred in one-third of critically ill patients. COVID 19 infection demonstrated an i ncreased incidence of thrombocytopenia in critical patients (in the presented study up to half of the patients). Severe thrombocytopenia is more common in patients of non-infectious period (35 % vs 20 %). In patients with coronavirus infection, thrombocytopenia was more frequently associated with a bleeding clinic (6.2 % vs 2.2 %), with less prognostic value as a criterion for adverse outcome: the presence of thrombocytopenia increased the risk of death by 5.5 times (95 % CI 2.97910.031) in noninfectious and by 1.54 times (95 % CI 1.3-1.82) in COVID-19 infection.