Critical Care: Incidence and Risk Factors of Thrombocytopenia in Critically Ill Trauma Patients

Abstract

Objective To determine the incidence of thrombocytopenia (<100 platelets × 103/mm3) and potential risk factors, including medications, associated with the development of thrombocytopenia in critically ill trauma patients. Design Prospective, observational study. Setting A 20-bed trauma intensive care unit (ICU) at a university hospital. Patients Sixty-three critically ill trauma patients without baseline thrombocytopenia admitted to the trauma ICU for at least 48 hours. Interventions Patients were followed for up to 14 days. Platelet counts were determined daily. The following data were collected and analyzed as potential risk factors for the development of thrombocytopenia: medications, age, sex, race, trauma score, mode and type of injury, alcohol history, units of packed red blood cells (PRBC) and platelets transfused, surgical procedures, duration of ICU stay, and the development of systemic inflammatory response syndrome or disseminated intravascular coagulation. Results Thrombocytopenia occurred in 26 (41%) of the patients. Among risk factors studied, nonhead injury, age, trauma score, duration of ICU stay, and the number of PRBC transfusions were significanüy associated with the development of thrombocytopenia (P < 0.05). However, nonhead injury, age, and trauma score were useful variables in predicting the development of thrombocytopenia by using multivariate analysis. Medications were not associated with the development of thrombocytopenia. Conclusions The type of injury sustained, the quantity of platelet-deficient transfusions, and age are the greatest risk factors associated with the development of thrombocytopenia in critically ill trauma patients. Drug-induced thrombocytopenia appears to play a minor role in the development of thrombocytopenia; therefore, medications should not be automatically discontinued or substituted when thrombocytopenia occurs.

La thrombopénie en réanimation chirurgicale: incidence, analyse des facteurs de risque et impact sur le pronostic

“…Cette étendue s'explique par la variabilité des critères d'inclusion et des populations étudiées. Ainsi, les incidences les plus élevées sont observées chez les polytraumatisés [13], les patients septiques [19] et les transplantés hépatiques [2]. La thrombopénie en réanimation est souvent multifactorielle.…”

“…Il s'agit soit de thrombopénies périphériques par destruction ou séquestra-tion des plaquettes, soit de thrombopénies centrales par insuffisance de production [10]. En réanimation, l'origine de la thrombopénie est souvent multifactorielle incluant le sepsis, le saignement, la transfusion, le syndrome de détresse respiratoire aigu, les néoplasies et la présence de cathéters invasifs tels les cathéters artériels pulmonaires [7,9,[11][12][13][14] ; liste à laquelle s'ajoutent les thrombopénies médicamenteuses dont celles induites par l'héparine. Ces étiologies sont souvent intriquées chez le patient de réanimation, d'où l'intérêt d'étudier les facteurs associés à la survenue de la thrombopénie, afin de cibler la surveillance sur certains patients à risque particulier.…”

Thrombocytopenia in the critically ill: prevalence, incidence, risk factors, and clinical outcomes

“…5,[7][8][9][10] Studies published to date have included selected patient populations, have been underpowered, and have evaluated and identified a limited number of risk factors. [2][3][4]9,[11][12][13][14][15] In addition, these studies have failed to evaluate the relative importance of thrombocytopenia among different diagnostic categories. 3,4,9,[11][12][13][14][15] The relation between thrombocytopenia and bleeding has also been reported inconsistently.…”

“…[2][3][4]9,[11][12][13][14][15] In addition, these studies have failed to evaluate the relative importance of thrombocytopenia among different diagnostic categories. 3,4,9,[11][12][13][14][15] The relation between thrombocytopenia and bleeding has also been reported inconsistently. 2 By using a very large and heterogeneous cohort of cardiac, medical, and surgical critically ill patients, this study aimed to evaluate the prevalence, incidence, and risk factors for thrombocytopenia and to evaluate its impact on bleeding, length of stay, and mortality in the critically ill, with further comparisons amongst major diagnostic categories.…”

“…Thrombocytopenia acquired in the ICU was defined as thrombocytopenia occurring in the days following ICU-admission and was considered ''incident thrombocytopenia''. We identified factors associated with thrombocytopenia to be evaluated after a literature review of published studies 3,9,11,[13][14][15]22,23 and overviews (Appendix 1). 24,25 Admission diagnoses were classified into 14 categories based on ICD-9 and ICD-10 codes (Table E1; available as electronic supplementary material).…”