Abstract Number: PB0311
Meeting: ISTH 2020 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: The incidence of thrombocytopenia in critically ill patients varies considerably in different studies, likely depending on setting and definitions.1,2Previous studies suggest that ICU patients with thrombocytopenia are sicker, have longer ICU stays and worse outcome.3,4Patients with sepsis are at particular risk,3,5but there are few studies on thrombocytopenia in these patients.3,5
Aims: To describe prevalence of thrombocytopenia in critically ill patients with sepsis during the first 5 ICU days, and assess association with mortality.
Methods: Post-hoc analysis of a randomised trial in patients with sepsis needing fluid (6S trial, ClinicalTrials.gov number NCT00962156) allocating participants to hydroxyethyl starch (HES) 130/0.42 vs. Ringers acetate in 26 general ICUs in 13 university and 13 non-university hospitals in 4 countries.6 Patients with life-threatening bleeding were excluded.
Platelet counts were collected within 24-hours prior to randomisation and during the following 5 days in ICU. The association between thrombocytopenia and mortality was analysed by Cox regression adjusting for age, haematological malignancy, shock at admission and allocation (HES vs. Ringers) with a follow-up time of 28 days. Log-rank test was used to compare the Kaplan-Meier curves.
Results: The 6S trial included 798 patients; median time in ICU before randomisation was 3.8 (1.3-12.3) hours. At baseline, 37% of the patients had thrombocytopenia, and by day 3 half of the patients had developed thrombocytopenia (platelet count < 150 x 109/litre), which was severe (< 50 x 109/litre) in 101/633 patients (16%) (Table 1). Patients with thrombocytopenia had higher 28-day mortality; adjusted hazard ratio 1.40 (95% CI 1.097-1.787) (Fig. 1)
Conclusions: These results are in line with previous studies showing that thrombocytopenia is common among ICU patients with sepsis and is associated with higher mortality.
| Age | 66 (56-75) | |||||
| mSOFA score (baseline) | 7 (5-9) | |||||
| Haematological malignancy | 72 (9) | |||||
| Baseline (N = 771) | Day 1 (N=705) | Day 2 (N=732) | Day 3 (N=633) | Day 4 (N=538) | Day 5 (N=465) | |
| Platelet count (x 109/L | 194 (110-275) | 164 (91-247) | 161 (84-239) | 144 (82-230) | 143 (78-220) | 154 (78-224) |
| Patients with thrombocytopenia | 283(37) | 315(45) | 349(48) | 326(52) | 284(53) | 221(48) |
| Mild (100-149) | 118 (15) | 122(17) | 134(18) | 132(21) | 104(19) | 79 (17) |
| Moderate (50-99) | 88 (11) | 107(15) | 108(15) | 93 (15) | 90(17) | 65(14) |
| Severe (20-49) | 40 (5) | 55 (8) | 70 (10) | 57 (9) | 56 (10) | 47 (10) |
| Very severe (<20) | 37 (5) | 31 (4) | 37 (5) | 44 (7) | 34 (6) | 30 (6) |
[Table 1. Thrombocytopenia in patients with severe sepsis.Data are in median (IQR) or no. (%).]
[Figure 1. 28-day mortality in patients with severe sepsis with and without thrombocytopenia within the first 3 days.]
References
1. Vanderschueren CCM 2000
2. Venkata J Intensive Care. 2013
3. Sharma Annals Intensive Care2007
4. Williamson Can J Anaesth2013
5. Thiolliere ICM 2013
6. Perner NEJM 2012
To cite this abstract in AMA style:
Russell L, Haase N, Perner A. Thrombocytopenia in adult ICU patients with sepsis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/thrombocytopenia-in-adult-icu-patients-with-sepsis/. Accessed October 1, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/thrombocytopenia-in-adult-icu-patients-with-sepsis/