Abstract
BACKGROUND: That thrombocytopenia results in increased mortality or transfusion requirements has not been confirmed by previous studies. We performed a case-control study in which 36 patients who developed severe thrombocytopenia of less than 50x109 platelets/l were carefully matched for the severity of underlying disease and other important variables. RESULTS: Seventeen (47%) thrombocytopenic patients died, versus 10 (28%) matched control patients who were not thrombocytopenic.Nine pairs had a discordant outcome, and in eight of these pairs the thrombocytopenic patient died (exact binomial probability 0.037). The estimated attributable mortality was 19.5% (95% confidence interval 3.2-35.8), and the estimated odds ratio was 2.7 (95% confidence interval 1.02-7.10). Thrombocytopenic patients had comparable values for severity of illness scores between day of admission and day of thrombocytopenia, in contrast with control patients who had a statistically significant decrease in severity of illness scores during the same period. Thirty (83%) of the thrombocytopenic patients required transfusion of blood products, versus 21 (58%) control patients (paired chi2 test 4.92, P < 0.04). The estimated attributable transfusion requirement was 25% (95% confidence interval 5.4-44.6), and the estimated odds ratio was 1.52 (95 confidence interval 1.05-2.20). CONCLUSION: The present study suggests that thrombocytopenia of less than 50 x 109 platelets/l may be a marker for more severe illness and increased risk of death, rather than causative, because a true causal relationship is not established. Thrombocytopenia also leads to an excess of blood product consumption.
Highlights
Thrombocytopenia is a well known complication in intensive care unit (ICU) patients
The original version of this paper is the electronic version which can be seen on the Internet
Thrombocytopenia was related to sepsis in eight patients; sepsis and disseminated intravascular coagulation (DIC) in 11 patients; bleeding in nine patients; bleeding and DIC in six patients; undetermined shock and DIC in one patient; and haemolysis–elevated liver enzymes– low platelets syndrome with DIC in one patient
Summary
Thrombocytopenia is a well known complication in intensive care unit (ICU) patients. It has been associated with various risk factors, but mainly with sepsis [1,2,3]. Previous studies have not clearly demonstrated that thrombocytopenia results in increased mortality or increased transfusion requirements, . That thrombocytopenia results in increased mortality or transfusion requirements has not been confirmed by previous studies. We performed a case–control study in which 36 patients who developed severe thrombocytopenia of less than 50 × 109 platelets/l were carefully matched for the severity of underlying disease and other important variables
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