Thrombocytopenia in the critically ill: prevalence, incidence, risk factors, and clinical outcomes La thrombocytopénie chez les personnes gravement malades: prévalence, incidence, facteurs de risque et pronostics cliniques

Purpose The aim of this cohort study was to describe the prevalence, incidence, and risk factors for thrombocytopenia in the intensive care unit (ICU) and to evaluate the impact of thrombocytopenia on mortality with further comparisons amongst major diagnostic categories. Methods Patients admitted to the ICU from 1997-2011 for cardiac, medical, surgical, and trauma conditions were included. The presence of a platelet count\ 100 9 10 L on admission day or its appearance during ICU stay were considered as prevalent and incident thrombocytopenia, respectively. Risk factors for thrombocytopenia and the influence of thrombocytopenia on mortality were also analyzed. Results This study included 20,696 patients. Prevalent and incident thrombocytopenia occurred in 13.3% and 7.8% of patients, respectively, with associated mortality rates of 14.3% and 24.7%, respectively, compared with 10.2% in the group with normal platelet count (P \ 0.001). After adjustments, thrombocytopenia remained associated with an increased risk of mortality (odds ratio 1.25; 95% confidence interval 1.20 to 1.31; P \ 0.001). The greatest impact of thrombocytopenia on mortality was observed in the cancer, respiratory, digestive, genitourinary, and infectious diagnostic categories. Independent risk factors included age, female sex, admission platelet counts and hemoglobin, mechanical ventilation, days of hospitalization prior to ICU admission, liver cirrhosis, hypersplenism, coronary bypass grafting, intra-aortic balloon pump placement, acute hepatitis, septic shock, and pulmonary embolism or deep vein thrombosis. Conclusions Thrombocytopenia in the ICU is associated with an independent risk of mortality that varies greatly depending on diagnostic admission category. Electronic supplementary material The online version of this article (doi:10.1007/s12630-013-9933-7) contains supplementary material, which is available to authorized users. Author contributions M. David Williamson designed the study and wrote the manuscript. M. David Williamson and M. Vincent Nault participated in the acquisition and analysis of data. M. David Williamson, Olivier Lesur, Jean-Pierre Tétrault, and Danielle Pilon participated in the interpretation of data. Olivier Lesur, Jean-Pierre Tétrault, Danielle Pilon, and M. Vincent Nault critically revised the manuscript. This article is accompanied by an editorial. Please see Can J Anesth 2013; 60: this issue. D. R. Williamson, MSc O. Lesur, MD, PhD J.-P. Tétrault, MD V. Nault, BSc D. Pilon, MD Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada D. R. Williamson, MSc (&) Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin West, Montréal, QC H4J 1C5, Canada e-mail: [email protected] D. R. Williamson, MSc Faculté de pharmacie, Université de Montréal, Montréal, QC, Canada O. Lesur, MD, PhD Medical and Surgical Intensive Care Units, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada O. Lesur, MD, PhD D. Pilon, MD Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada J.-P. Tétrault, MD Department of Anesthesiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada 123 Can J Anesth/J Can Anesth (2013) 60:641–651 DOI 10.1007/s12630-013-9933-7