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Thrombocytopenia Kinetics Is Related To Mortality In ICU Patients

机译：ICU患者的血小板减少动力学与死亡率相关

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BACKGROUND: Thrombocytopenia is a common event in ICU patients, with controversial effects over their outcome. We aimed to assess the importance of thrombocytopenia kinetics on mortality of ICU patients. METHODS: We conducted a retrospective cohort study analyzing patients admitted to the adult ICU from a teaching University Hospital which had at least one platelet count <100,000 cells/mm3. Patients with thrombocytopenia prior to ICU admission were excluded. RESULTS: We analyzed 27 consecutive thrombocytopenic patients admitted to the adult ICU (22.5% of all ICU patients) in a 5-month period. Trauma (40%) and medical illness (26%) were the most common causes of admission. Those who died during ICU stay were significantly older than those who were discharged, and tended to be more severely ill, but there was no difference in bleeding events. The proportion of time with low platelets count in ICU and, specially, thrombocytopenia kinetics (evolution to rising or fall until discharge or death) were related to mortality. CONCLUSION: Thrombocytopenia kinetics, with tendency of declining during length of stay, predicts mortality better than sheer platelet count in ICU patients. INTRODUCTION Thrombocytopenia is a common event in ICU patients, with prevalence ranging from 13% to 41% (1-4), and it has meaningful morbidity and economic impact(3).It may be a multifactorial phenomenon, involving drugs, high consumption and low production of platelets (consumptive coagulopathy and acute illness) and also hemodilution secondary to infusion of fluids and blood products(2). However, the real impact of thrombocytopenia on mortality is debatable, once literature does not clearly show this association(2, 5-8).Thus, we aimed to determine the relationship between severity of thrombocytopenia andin-hospital/ICU length of stay, as well as assess the relation between the kynetics of thrombocytopenia and morbimortality and describe the clinical and epidemiological profile of patients admitted to the adult ICU of a University Hospital. METHODS We conducted a retrospective cohort study through analysis of medical records from patients admitted to the Adult ICU of Western Paraná State University Hospital (a public teaching hospital with 173 beds), in Cascavel (Southern Brazil), for a five-month period who presented with thrombocytopenia. The 14-beds Adult ICU attends post-surgical (emergency and elective procedures), medical, trauma and obstetric patients. Inclusion criteria were: patients admitted to the Adult ICU in the period between August 1stand December 31st, 2011 that presented with thrombocytopenia (detected on one daily exam, at least). Exclusion criteria were: patients with thrombocytopenia prior to ICU admission, even if recorded during-hospital setting.The data obtained from medical records were tabulated so that differences could be observed in the prognostic role of thrombocytopenia (relation to death in the ICU or hospital). That was done by comparing clinical and epidemiologic factors, such as: gender, age, causes of ICU admission, possible etiologies of thrombocytopenia, and severity of disease at ICU admission (APACHE II score).Definitions of variables assessed in this paper:Thrombocytopenia: at least one Platelet count <100,000 cells/mm3.Major hemorrhage: Bleeding associated with one of the following: a decrease of hemoglobin over 2g/dl or drop of hematocrit over 6%; or need for blood products transfusion; or clinical instability (due to the hemorrhage); or intracranial or gastrointestinal bleeding.Minor bleeding: Mild clinical events and other causes (eg, epistaxis, skin and mucosal bleeding, and small hematomas).Trauma: Injuries caused by external source; traffic accidents or violence (insults by physical and chemical agents, injury by firearms and bladed weapons, which are common events in Brazilian routine).Sepsis: it was used definition established by Bone and cols (9).Leukopenia: at least one blood total leukocyte count <4,000 cel
机译：背景：血小板减少症是ICU患者的常见事件，其结果存在争议。我们旨在评估血小板减少动力学对ICU患者死亡率的重要性。方法：我们进行了一项回顾性队列研究，分析了一家教学大学医院的成人ICU入院患者的血小板计数至少为100,000个/ mm3。排除ICU入院前血小板减少症患者。结果：我们分析了在5个月内连续27例成人ICU入院的血小板减少症患者（占所有ICU患者的22.5％）。创伤（40％）和内科疾病（26％）是最常见的入院原因。在ICU住院期间死亡的患者比出院的患者年龄要大得多，而且病情更重，但出血事件没有差异。 ICU中血小板计数低的时间比例，特别是血小板减少动力学（演变为上升或下降直至出院或死亡）与死亡率有关。结论：血小板减少症的动力学，在住院期间会下降，预示着ICU患者的死亡率要好于纯粹的血小板计数。简介血小板减少症是ICU患者的常见事件，患病率在13％至41％之间（1-4），具有有意义的发病率和经济影响（3），可能是一种多因素现象，涉及药物，高消耗量和血小板产量低（消耗性凝血病和急性疾病），以及因输注液体和血液制品而导致的血液稀释（2）。然而，一旦文献没有清楚地表明血小板减少对死亡率的真正影响尚有争议（2，5-8）。因此，我们旨在确定血小板减少的严重程度与住院/ ICU住院时间之间的关系。以及评估血小板减少症的动力学与病死率之间的关系，并描述入读大学医院成人ICU的患者的临床和流行病学特征。方法我们通过对巴西南部卡斯卡韦尔市西巴拉那州立大学医院（有173张病床的公共教学医院）成人ICU入院患者的病历进行分析，进行了一项回顾性队列研究，历时5个月。与血小板减少症。成人ICU有14张床，可接受外科手术（紧急和选修程序），内科，创伤和产科患者。入选标准为：2011年8月1日至2011年12月31日之间入住成人ICU的患者出现血小板减少症（至少每天进行一次检查）。排除标准为：即使在医院就诊期间也记录了ICU入院前的血小板减少症患者从医疗记录中获得的数据经过列表处理，因此可以观察到血小板减少症的预后作用存在差异（与ICU或医院的死亡相关） 。通过比较临床和流行病学因素（例如性别，年龄，ICU入院的原因，血小板减少的可能病因和ICU入院时疾病的严重程度（APACHE II评分））来完成这项工作。严重出血：伴有以下情况之一的出血：血红蛋白降低超过2g / dl或血细胞比容降低超过6％;或需要输血;或临床不稳定（由于出血）;轻微出血：轻度的临床事件和其他原因（例如鼻出血，皮肤和粘膜出血以及小血肿）。交通事故或暴力（物理和化学试剂造成的伤害，枪支和剑刃武器的伤害，这是巴西例行的常见事件）脓毒症：它是由Bone和cols建立的定义（9）。白细胞减少症：至少一种血液总数白细胞计数<4,000 cel

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