Thrombocytopenia: A Risk Factor of Mortality for Patients with Sepsis in the Intensive Care Unit

Burunsuzoglu, Bunyamin; Saltürk, Cüneyt; Karakurt, Zühal; Öngel, Esra Akkütük; Takır, Hurıye Berk; Kargın, Feyza; Horzum, Gülbanu; Balcı, Merih Kalamanoğlu; Moçin, Özlem Yazıcıoğlu; Adıgüzel, Nalan; Güngör, Gökay; Yılmaz, Adnan

doi:10.5578/ttj.17.1.002

Cited by 14 publications

(14 citation statements)

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“…The search strategy identified 2820 studies, and the data were from 7 studies comprising 4243 patients (Table 2) [18][19][20][21][22][23][24]. The characteristics of the included studies are shown in Table 2.…”

Section: Results 31 Study Characteristicsmentioning

confidence: 99%

“…Among these studies, 2 studies were conducted in France, 1 study was conducted in Isreal, 1 study was conducted in USA, 1 study was conducted in Turkey, 1 study was conducted in Greece, 1 study was conducted in The Netherlands. Of these studies, two of the studies were multi-center studies [20,23], and five were single-center studies [18,19,21,22,24]. Table 2 The basic characteristics of studies included in meta-analysis The short-term mortality of thrombocytopenia group was higher than that of the no thrombocytopenia group (odds ratio [OR] = 2.01;95% CI, 1.73-2.33; P < 0.00001;Chi 2 = 26.86; I 2 = 78%) (Fig.…”

Section: Results 31 Study Characteristicsmentioning

confidence: 99%

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Thrombocytopenia in critically ill patients with sepsis or septic shock: a systematic review and meta-analysis

Li¹,

Guo²,

Zhang³

2019

Preprint

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Background Thrombocytopenia is a common feature of sepsis or septic shock, but few meta-analyses have specifically evaluated prognostic importance of thrombocytopenia in patients with sepsis or septic shock. The objective of this meta-analysis was to evaluate the prognosis of thrombocytopenia in critically ill patients with sepsis or septic shock.Methods We searched the PubMed, Cochrane, and Embase databases for studies from inception to the 30th of November 2019. Prospective or retrospective cohort studies comparing thrombocytopenia to no thrombocytopenia in critically ill patients with sepsis or septic shock were included. All authors reported our primary outcome of short-term mortality(defined as ICU or 48-hour mortality) with clinically relevant secondary outcomes(ICU length of stay, rate of AKI, rate of mechanical ventilation). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results Seven studies including 4243 patients were included. The results of this meta-analysis showed that the short-term mortality of thrombocytopenia group was higher than that of the no thrombocytopenia group (odds ratio [OR]=2.01;95% CI, 1.73-2.33; P<0.00001; I2=78%).In addition, compared with no thrombocytopenia group, thrombocytopenia group showed higher rate of AKI(odds ratio [OR]=1.31;95% CI, 1.03-1.66; P=0.03 I2=65%) and longer ICU length of stay(Mean difference=1.31;95% CI, 0.66-1.96; P<0.0001; I2=50%). There was no statistically significant difference in the rate of mechanical ventilation between 2 groups (odds ratio [OR]=1.24;95% CI, 0.82-1.88; P=0.30; I2=0%).Conclusions Thrombocytopenia was associated with increased short-term mortality, ICU length of stay and rate of AKI in critically ill patients with sepsis or septic shock. The analysis of secondary outcomes showed no significant difference in the rate of mechanical ventilation between the two groups. Further randomized controlled studies of thrombocytopenia are still required.

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Section: Results 31 Study Characteristicsmentioning

confidence: 99%

Section: Results 31 Study Characteristicsmentioning

confidence: 99%

Thrombocytopenia in critically ill patients with sepsis or septic shock: a systematic review and meta-analysis

Li¹,

Guo²,

Zhang³

2019

Preprint

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“…Several other studies evaluated septic shock in cancer patients, but they included patients with sepsis and septic shock, with the proportion of septic shock patients ranging between 25 and 60% of the study population [ 4 , 7 , 13 – 19 , 21 , 23 , 24 ]. Lemiale et al [ 23 ] recently published the characteristics and outcomes of a large cohort of cancer patients treated with sepsis and septic shock at 7 European ICUs over two decades (1994–2015).…”

Section: Discussionmentioning

confidence: 99%

A 12-year study evaluating the outcomes and predictors of mortality in critically ill cancer patients admitted with septic shock

et al. 2021

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Background Though sepsis is common in patients with cancer, there are limited studies that evaluated sepsis and septic shock in this patient population. The objective of this study was to evaluate the outcomes and to identify predictors of mortality in cancer patients admitted to the intensive care unit (ICU) with septic shock. Methods This was a retrospective study conducted at a medical-surgical oncologic ICU of a comprehensive cancer center. Adult cancer patients admitted with septic shock between January 1, 2008 and December 31, 2019 were enrolled. Septic shock was defined as an ICU admission diagnosis of sepsis that required initiating vasopressors within 24 h of admission. Patient baseline characteristics, ICU length of stay and ICU and hospital mortality were recorded. Univariate analysis and logistic regression were performed to identify predictors associated with ICU and hospital mortality. Results During the study period, 1408 patients met the inclusion criteria. The mean age was 56.8 ± 16.1 (SD) years and mean Acute Physiology and Chronic Health Evaluation (APACHE) II was 23.0 ± 7.91 (SD). Among the enrolled patients, 67.8% had solid tumors while the remaining had hematological malignancies. Neutropenia and thrombocytopenia were reported in 19.3 and 39.5% of the patients, respectively, and mechanical ventilation was required for 42% of the patients. Positive cultures were reported in 836 (59.4%) patients, most commonly blood (33%) and respiratory (26.6%). Upon admission, about half the patients had acute kidney injury, while elevated total bilirubin and lactic acid levels were reported in 13.8 and 65.2% of the patients, respectively. The median ICU length of stay was 4 days (IQR 3–8), and ICU and hospital mortality were reported in 688 (48.9%) and 914 (64.9%) patients, respectively. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significantly associated with both ICU and hospital mortality. Conclusions In a relatively large cohort of patients with solid and hematological malignancies admitted to the ICU with septic shock, hospital mortality was reported in about two-third of the patients. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significant predictors of mortality.

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“…Similarly, the importance of low platelet in prognostication is well described in multiple studies in critically ill patients. Various patterns such as low nadir platelet count, or rapid decline in platelet count have proven significance based on several studies [ 42 , 43 ]. The evidence so far has confirmed a low platelet count as an important prognostic indicator of severity and mortality in COVID-19 patients [ 44 ].…”

Section: Platelet Abnormalities and Covid-19mentioning

confidence: 99%

A review on how to do hematology consults during COVID-19 pandemic

Sahu

Černý

2021

Blood Reviews

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The ongoing COVID-19 pandemic is the most trending and talked topic across the World. From its point of origin in Wuhan, China to clinical laboratory at NIH, a mere six-month-old SARS-CoV-2 virus is keeping the clinicians, and scientists busy at various fronts. However, COVID-19 is an emerging and evolving disease and each day brings in more data, new figures, and findings from the field of clinical practice. The role of hematologists has been increasingly recognized during the current pandemic because of several reasons. Most important of them are the characteristic hematological findings of COVID-19 patients that also have prognostic implications and that were not seen in other viral infections. The treatment of hematological complications in COVID-19 patients is very challenging given the critical care setting. There are interim and limited guidelines thus far due to the novelty of the disease. As this remains to be a quite fluid situation, all the appropriate medical societies including the major hematology bodies are proposing initial and interim guidelines (e.g. ASH guideline). This puts a hematologist on consult service in a dubious position where, he/she must tailor the recommendations on case to case basis. The purpose of this review is to provide the background context about the impact of COVID-19 on the blood system and to summarize the current interim guidelines to manage the associated hematological issues in COVID-19 infection.

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Thrombocytopenia: A Risk Factor of Mortality for Patients with Sepsis in the Intensive Care Unit

Cited by 14 publications

References 35 publications

Thrombocytopenia in critically ill patients with sepsis or septic shock: a systematic review and meta-analysis

Thrombocytopenia in critically ill patients with sepsis or septic shock: a systematic review and meta-analysis

A 12-year study evaluating the outcomes and predictors of mortality in critically ill cancer patients admitted with septic shock

A review on how to do hematology consults during COVID-19 pandemic

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