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This Article Full Text (PDF) Free All Versions of this Article: chest.06-2233v1 131/6/1735    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Delphine, M. Articles by Elie, A. Search for Related Content PubMed PubMed Citation Articles by Delphine, M. Articles by Elie, A.

Platelet Count Decline: An Early Prognostic Marker in Critically Ill Patients with Prolonged ICU Stays

(1) Medical ICU, Saint Louis Teaching Hospital, Paris; (2) Medical ICU, Michallon Teaching Hospital, Grenoble and Department of Epidemiology Inserm U578; (3) Medical-Surgical ICU, Saint Joseph Teaching Hospital, 75014 Paris; (4) Medical-Surgical ICU, Louis Mourier Teaching Hospital, 92700 Colombes; 5) Microbiology Unit, Necker Hospital; 6) Medical ICU, Hôpital de La Fontaine, Saint Denis; 7) Medical-Surgical ICU, Avicenne Teaching Hospital, 93009 Bobigny. The members of the OUTCOMEREA study group are listed in the appendix

elie.azoulay{at}outcomerea.org

Abstract

BACKGROUNDThrombocytopenia is common in intensive-care-unit (ICU) patients. The objective of this study was to evaluate possible links between declining platelet counts early in the ICU stay and survival. METHODS: All patients who were admitted for at least 5 days and had no thrombocytopenia at admission were included. A multivariable logistic regression model with hospital mortality as the outcome variable was built. RESULTS: We included 1077 patients. At admission, median platelet count was not significantly different in survivors (256 [interquartile range, 206-330]·10⁹/L) and nonsurvivors (262 [211-351] ·10⁹/L). Median SAPSII score at admission was worse in nonsurvivors (50 [37-63] versus 37 [27-48] in survivors, P<0.0001), as was the mean SOFA score on day 3 (6.3±3.24 versus 4±2.8, P<0.0001). Absolute platelet counts were lowest on day 4, but differed significantly between survivors and nonsurvivors only on day 7. Conversely, any percentage decline in platelet counts from 10% to 60% on day 4 was significantly associated with mortality. By multivariable analysis, a 30% decline in platelet count independently predicted death (OR 1.54, 95% CI [1.12-2.14], P=0.008), in addition to increasing or stable SOFA from admission to day 4, older age, male gender, admission for coma, worse SAPSII score at admission, transfer from another ward and co-morbidity. CONCLUSION: In patients who spend more than 5 days in the ICU and have normal platelet counts at admission, a decline in platelet counts provides prognostic information. This parameter deserves to be included in new scoring systems.

Key Words: Platelet count • Severity Score • Intensive care • Mortality • Outcome

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				D. R. Williamson and D. Pilon Risk Factors for Thrombocytopenia in Patients Treated With Prolonged Heparin Therapy Arch Intern Med, October 27, 2008; 168(19): 2170 - 2171. [Full Text] [PDF]