Reliability of Thrombocytopenia in Sepsis as a Predicting Tool for ICU Mortality

Abstract

Introduction: There are many easy reproducible scores used in Intensive Care Unit (ICU) to predict mortality. But these need to be reassessed on a regular basis. There are many variables used to calculate these scores. But there can be some loss of data as the scores are repeated 24-48 hours apart and have many parameters which may make the process less user friendly. Aim: To study the predictive value of new onset thrombocytopenia as an effective tool in predicting mortality in septic patients. Materials and Methods: In this prospective observational study, 200 patients with thrombocytopenia at admission or at any time during ICU hospitalisation between 1st February 2015 to 1st November 2016 were selected; patients hospitalised for less than 24 hours were excluded. Thrombocytopenia is defined as a platelet count lower than 150,000/mm3, and recovery is defined as returning to levels above 150,000/mm3 after showing thrombocytopenia. Admission prognosis variables Acute Physiology, Age and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) Score and platelet counts during the hospitalisation and outcomes were assessed using descriptive statistics, Chi-square test and One-way Analysis of Variance (ANOVA). Results: Out of 200 patients included, overall incidence of thrombocytopenia was 29.83%. The mean age was 49 (SD 18.24) years and mean duration of stay was 8.85 (SD 6.58) days. Maximum patients belonged to the age group of 18-30 years and 51-60 years. Total 89 (44.5%) of the 200 had sepsis and out of them 24 patients died, therefore, mortality rate among those in sepsis with thrombocytopenia was 27%. Mean SOFA score and APACHE II scores were 6.32 (SD 3.44) and 14 (SD 7.89), respectively. In the patients with thrombocytopenia and poor outcomes in the form of death or Discharge Against Medical Advice (DAMA), the SOFA scores were 9.04 and 6.96, respectively (p=0.0438). Similarly, patients with sepsis and thrombocytopenia who had either died or given DAMA the mean APACHE II scores were 18.66 and 17.96, respectively (p-value 0.0492). Conclusion: There was a significant association between, APACHE II and SOFA scores with new onset thrombocytopenia. Therefore, it can be used as an independent individual variable to predict mortality in patients of sepsis with thrombocytopenia.