Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcomeReportar como inadecuado




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Journal of Intensive Care

, 1:9

First Online: 30 December 2013Received: 19 July 2013Accepted: 24 October 2013

Abstract

BackgroundSepsis is a major risk factor for the development of thrombocytopenia, but few studies have specifically evaluated prognostic importance of thrombocytopenia in patients with sepsis. We investigated the incidence, risk factors, and prognostic importance of thrombocytopenia in adult patients admitted to the intensive care unit ICU with sepsis.

MethodsA retrospective analysis of patients admitted with severe sepsis-septic shock from December 2007 to January 2009 to a 24-bed medical ICU was done.

ResultsA total of 304 patients were included in the study. The patients- mean ±SD age was 68.8 ±15.8 years. The majority 93.7% had septic shock, and pneumonia was the most common infection 38.8%. Thrombocytopenia developed in 145 patients 47.6%: 77 25.3% at ICU admission and 68 22.3% during their hospital course. The median IQR duration of thrombocytopenia was 4.4 1.9–6.9 days. Patients who developed thrombocytopenia had more episodes of major bleeding 14.4% vs. 3.7%, P < 0.01 and received more transfusions. Patients with thrombocytopenia had a higher incidence of acute kidney injury 44.1% vs. 29.5%, P < 0.01, prolonged vasopressor support median IQR: 37 17–76 vs. 23 13–46 h, P < 0.01, and longer ICU stay median IQR: 3.1 1.6–7.8 vs. 2.1 1.2–4.4 days, P < 0.01. The 28-day mortality was similar between patients with and without thrombocytopenia 32.4% vs. 24.5%, P = 0.12. However, while 15 of 86 patients 17.4% who resolved their thrombocytopenia died, 32 of 59 patients 54.2% whose thrombocytopenia did not resolve died P < 0.01. The association between non-resolution of thrombocytopenia and mortality remained significant after adjusting for age, APACHE III score and compliance with a sepsis resuscitation bundle P < 0.01.

ConclusionsThrombocytopenia is common in patients who are admitted to the ICU with severe sepsis and septic shock. Patients with thrombocytopenia had more episodes of major bleeding, increased incidence of acute kidney injury, and prolonged ICU stay. Non-resolution of thrombocytopenia, but not thrombocytopenia itself, was associated with increased 28-day mortality.

KeywordsThrombocytopenia Sepsis Septic shock Intensive care unit Prognosis Mortality AbbreviationsALIAcute lung injury

APACHEAcute physiology, Age, and Chronic Health Evaluation

ARDSAcute respiratory distress syndrome

DICDisseminated intravascular coagulation

ELISAEnzyme-linked immunosorbent assay

FFPFresh frozen plasma

HITHeparin-induced thrombocytopenia

ICUIntensive care unit

IQRInterquartile range

PRBCPacked red blood cells

RIFLERisk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function and end-stage kidney disease

ROCReceiver operating characteristic

SDStandard deviation

SOFASequential organ failure assessment

TRALITransfusion-associated acute lung injury

TTPThrombotic thrombocytopenic purpura.

Electronic supplementary materialThe online version of this article doi:10.1186-2052-0492-1-9 contains supplementary material, which is available to authorized users.

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Autor: Chakradhar Venkata - Rahul Kashyap - J Christopher Farmer - Bekele Afessa

Fuente: https://link.springer.com/







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