Thrombocytopenia Is Associated with Acute Respiratory Distress Syndrome Mortality: An International Study

Abstract

BackgroundEarly detection of the Acute Respiratory Distress Syndrome (ARDS) has the potential to improvethe prognosis of critically ill patients admitted to the intensive care unit (ICU). However, no reliable biomarkers are currently available for accurate early detection of ARDS in patients with predisposing conditions.ObjectivesThis study examined risk factors and biomarkers for ARDS development and mortality in two prospective cohort studies.MethodsWe examined clinical risk factors for ARDS in a cohort of 178 patients in Beijing, China who were admitted to the ICU and were at high risk for ARDS. Identified biomarkers were then replicated in a second cohort of1,878 patients in Boston, USA.ResultsOf 178 patients recruited from participating hospitals in Beijing, 75 developed ARDS. After multivariate adjustment, sepsis (odds ratio [OR]:5.58, 95% CI: 1.70–18.3), pulmonary injury (OR: 3.22; 95% CI: 1.60–6.47), and thrombocytopenia, defined as platelet count <80×103/µL, (OR: 2.67; 95% CI: 1.27–5.62)were significantly associated with increased risk of developing ARDS. Thrombocytopenia was also associated with increased mortality in patients who developed ARDS (adjusted hazard ratio [AHR]: 1.38, 95% CI: 1.07–1.57) but not in those who did not develop ARDS(AHR: 1.25, 95% CI: 0.96–1.62). The presence of both thrombocytopenia and ARDS substantially increased 60-daymortality. Sensitivity analyses showed that a platelet count of <100×103/µLin combination with ARDS provide the highest prognostic value for mortality. These associations were replicated in the cohort of US patients.ConclusionsThis study of ICU patients in both China and US showed that thrombocytopenia is associated with an increased risk of ARDS and platelet count in combination with ARDS had a high predictive value for patient mortality.

Association of the Plasma Platelet-Derived Microparticles to Platelet Count Ratio with Hospital Mortality and Disseminated Intravascular Coagulopathy in Critically Ill Patients

“…The meaning of the PDMP/Plts ratio should be considered. A higher PDMP/Plts ratio might be a consequence of the association between thrombopenia and mortality, as previously reported [35][36][37] . The PDMP/Plts ratio is elevated as a result of a decreased platelet count.…”

Incidence and risk factors for thrombocytopenia in the intensive care units of a tertiary hospital in northern India

“…[20,[23][24][25][26][27] There have been reports indicating that the rate of platelet decline or recovery from thrombocytopenia may have important prognostic value in diseases such as sepsis and acute respiratory distress syndrome (ARDS). [21,22,24,26] Our study had several limitations. Firstly, this study was conducted at a single tertiary care centre in a northern part of India.…”

A Missense Genetic Variant in LRRC16A/CARMIL1 Improves Acute Respiratory Distress Syndrome Survival by Attenuating Platelet Count Decline

“…Thrombocytopenia is the most common coagulation problem in the ICU, and is generally caused by the following mechanisms: increased destruction or consumption of platelets, decreased production, dilution, and sequestration of platelets (30,31). Clinical events related to these mechanisms, such as disseminated intravascular coagulation, trauma, or massive transfusions, are considered risk factors that affect ARDS outcomes (7,32,33). Thus, treatments for thrombocytopenia might have benefits for patients with ARDS, whereas the treatments should be given in respect to the etiology (34).…”

“…For example, worsening oxygenation, multiple organ dysfunction, and progressive underlying diseases are common risk factors for ARDS mortality (4). Recently, platelets have been increasingly recognized for their roles in ARDS outcomes, which are likely mediated by their involvement in inflammatory responses and disseminated intravascular coagulation (5)(6)(7). Genetic risk factors may also determine ARDS outcomes (8); studies have identified a few potential prognostic biomarkers (9)(10)(11)(12)(13).…”