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  • Meeting abstract
  • Open Access

A prospective study of thrombocytopenia and prognosis in intensive care

  • 1,
  • 1,
  • 2,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care20003 (Suppl 1) :P236

https://doi.org/10.1186/cc609

  • Published:

Keywords

  • Intensive Care Unit
  • Platelet Count
  • Thrombocytopenia
  • Intensive Care Unit Patient
  • Intensive Care Unit Stay

Introduction

To study the incidence and prognosis of thrombocytopenia in an adult critically ill population. 329 patients consecutively admitted during a 5-month period to the medical intensive care unit (ICU) of a university hospital (212 patients) and a medical-surgical ICU of a regional hospital (117 patients), were prospectively surveyed. The primary outcome measure was ICU mortality.

Results

One hundred and thirty-six patients (41.3%) had at least one platelet count < 150 × 109/l. These patients displayed a higher APACHE (Acute Physiology and Chronic Health Evaluation) II, SAPS II (new Simplified Acute Physiology Score) and MODS (Multiple Organ Dysfunction Score) at admission, longer ICU stay (8 versus 5 days median (interquartile range)) and a higher mortality rate (crude odds ratio, OR = 5.0, 95% confidence interval, CI 2.7–9.1) than those who never developed thrombocytopenia (P < 0.0005 for all comparisons). Bleeding incidence rose from 4.1% in non-thrombocytopenic patients to 21.4% in patients with minimal platelet counts between 101 and 149 × 109/l (P = 0.0002), and to 51.9% in patients with minimal platelet counts < 100 × 109/l (P < 0.0001). 19.5% of the study population died in the ICU following the index admission. Eighteen of 193 patients (9.3%) who never became thrombocytopenic died, versus 31 of 89 patients who were thrombocytopenic at admission (OR = 5.2, 95% CI 2.7–9.8, P < 0.0001) and versus 15 of 47 patients (31.9%) who developed thrombocytopenia later on during ICU stay (OR = 4.6, 95% CI 2.1–10.0, P = 0.0002). In addition we found that a drop in platelet count to ≤ 50% of admission was associated with higher death rates (OR = 6.0, 95% CI 3.0–12.0. P < 0.0001). In a linear regression analysis, adjusting for admission APACHE II. SAPS II and MODS, admission thrombocytosis and the occurrence of bleeding, nadir thrombocytosis remained significantly related to ICU mortality.

Conclusion

Thrombocytopenia is a simple and readily available risk marker for ICU mortality, independent of and complementary to established severity of disease indices. Both a low nadir thrombocytosis and a significant fall of platelet count predict a poor vital outcome in adult ICU patients.

Authors’ Affiliations

(1)
Department of General Internal medicine, Medical Intensive Care Unit, University hospitals, Herestraat 49 3000 Leuven, Belgium
(2)
Department of Intensive Care, Ste-Anne St-Remi Hospital, Boulevard Jules Graindor 66, Brussels, 1070, Belgium

Copyright

© Current Science Ltd 1999

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