Thrombocytopenia in critically ill patients: Clinical and laboratorial behavior and its correlation with short-term outcome during hospitalization

Khurana, Divya S.; Deoke, Shilpa

doi:10.4103/ijccm.ijccm_279_17

Cited by 49 publications

(51 citation statements)

References 7 publications

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“…Platelet count is a simple and readily available biomarker, which is independently associated with disease severity and risk of mortality in the intensive care unit (ICU) [4][5][6]. Moreover, a low platelet count correlates with higher disease severity scores such as Multiple Organ Dysfunction Score (MODS), Simplified Acute Physiology Score (SAPS) II, and Acute Physiology and Chronic Health Evaluation (APACHE) II [5].…”

Section: Introductionmentioning

confidence: 99%

Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis

Lippi

Plebani

Henry

2020

Clinica Chimica Acta

1,544

1,256

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Section: Introductionmentioning

confidence: 99%

Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis

Lippi

Plebani

Henry

2020

Clinica Chimica Acta

1,544

1,256

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“…The coagulopathy of sepsis is quite complex, composed of platelet dysfunction and abnormalities of the coagulation cascade. Thrombocytopenia, DIC, and decreased ADAMTS-13 activity have all been associated with poor outcomes in sepsis (31,33,34,44,45). We believe that coagulopathy is often present clinically, prior to laboratory derangements, so absolute values were not used to determine candidacy for treatment at our institution, or to monitor response to treatment.…”

Section: Discussionmentioning

confidence: 99%

The Therapeutic Efficacy of Adjunct Therapeutic Plasma Exchange for Septic Shock with Multiple Organ Failure: A Single Center Retrospective Review

Keith

Wells

Hodges

et al. 2020

Preprint

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Background: Sepsis remains a common condition with high mortality when multiple organ failure develops. The evidence for therapeutic plasma exchange (TPE) in this setting is promising but inconclusive. Our study aims to evaluate the efficacy of adjunct TPE for septic shock with multiple organ failure compared to standard therapy alone. Methods: A retrospective, observational chart review was performed, evaluating outcomes of patients with catecholamine resistant septic shock and multiple organ failure in Intensive Care Units at a tertiary care hospital in Winston Salem, North Carolina from August 2015- March 2019. Adult patients with catecholamine resistant septic shock (≥ 2 vasopressors) and evidence of multiple organ failure were included. Patients who received adjunct TPE were identified and compared to patients who received standard care alone. A propensity score using age, gender, chronic co-morbidities (HTN, DM, CKD, COPD), APACHE II score, SOFA score, lactate level, and number of vasopressors was used to match patients, resulting in 40 patients in each arm. Results: Mean baseline APACHE II and SOFA scores were 32.5 and 14.3 in TPE patients versus 32.7 and 13.8 in control patients. The 28-day mortality rate was 40% in the TPE group versus 65% in the standard care group (p=0.043). Improvements in baseline SOFA scores at 48 hours were greater in the TPE group compared to standard care alone (p=0.001), and patients receiving adjunct TPE had a more favorable fluid balance at 48 hours (p=0.01). Patients receiving adjunct TPE had longer ICU and hospital lengths of stay (p=0.003 and p=0.006). Conclusions: Our retrospective, observational study in adult patients with septic shock and multiple organ failure demonstrated improved 28-day survival with adjunct TPE compared to standard care alone. Hemodynamics, organ dysfunction, and fluid balance all improved with adjunct TPE, while lengths of stay were increased in survivors. The study design does not allow for a generalized statement of support for TPE in all cases of sepsis with multiple organ failure but offers valuable information for a prospective, randomized clinical trial.

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“…Lower plasma platelet level and high levels of PT, APTT, and D-dimer at admission are ominous for ROSC patients. Khurana et al [36] found that low platelet count and its progressive decline at admission indicated the severity of critically ill patients and were directly related to prognosis and mortality in ICU patients. Akca et al [37] studied 1,440 patients admitted to the ICU and showed that 30% of patients had a reduced platelet count at admission (PLT<150×10 9 /L), and the survivors had higher platelet counts.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest survival post-resuscitation in-hospital (CASPRI)—a tool to predict neurological outcome after ROSC

Liu¹,

Jiang²,

Sun³

et al. 2020

Preprint

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Objectives: To develop a cardiac arrest survival post-resuscitation in-hospital (CASPRI) scoring system evaluating the prognosis of neurological function in ROSC patients.Methods: This single-center, retrospective study reviewed the eligible patients admitted to the emergency department of West China Hospital of Sichuan University who received cardiopulmonary resuscitation and restored spontaneous circulation from January 1, 2014 00:00 to December 31, 2017 23:59. Clinical histories, blood test, biochemistry proﬁle, coagulation indexes and other laboratory tests during emergency department visit were collected. The MEWS, sOHCA, APACHE II, and the highest SOFA scores were calculated during the period between emergency room admission and ROSC. The clinical data of ROSC patients in the test group were analyzed by univariate and multivariate logistic analysis. The possible risk factors related to the unfavorable prognosis of 90-day neurological function were screened and CASPRI score was constructed. The eﬃcacy of CASPRI score on evaluating the neurological function of ROSC patients was analyzed by ROC curve and proved in the validation group.Main results: 503 patients were included in the test group. After correcting potential confounding factors, multivariate logistic regression analysis showed that TBIL, ALB at admission of emergency department, Lac at ROSC, resuscitation time, non-shockable rhythms were independent risk factors for poor neurological prognosis of ROSC patients (p<0.05). ROC curve showed that the CASPRI score was superior to the APACHE II score, SOFA score, MEWS score and sOHCA score, and the diﬀerence was statistically signiﬁcant (p<0.05). In the validation group with 256 patients included, the incidence of poor neurological prognosis in high-risk, intermediate-risk, and low-risk groups based on CASPRI score were 97.89%, 85.59%, and 58.33%, respectively, and the diﬀerence was statistically signiﬁcant (p<0.001). CASPRI score was superior to the SOFA score and MEWS score, the diﬀerence was statistically signiﬁcant (p<0.05).Conclusions: CASPRI score is an eﬀective tool for the early evaluation of the neurological prognosis of ROSC patients. Its eﬃcacy exceeds the MEWS and SOFA scoring systems currently used in clinical practice.

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Thrombocytopenia in critically ill patients: Clinical and laboratorial behavior and its correlation with short-term outcome during hospitalization

Cited by 49 publications

References 7 publications

Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis

Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis

The Therapeutic Efficacy of Adjunct Therapeutic Plasma Exchange for Septic Shock with Multiple Organ Failure: A Single Center Retrospective Review

Cardiac arrest survival post-resuscitation in-hospital (CASPRI)—a tool to predict neurological outcome after ROSC

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