Monday, September 12, 2016

Thrombocytopenia as a prognostic marker in septic shock

This paper was highlighted in ACP Hospitalist Weekly as an important study and although it is the first time thrombocytopenia has been looked at in this way in my view it is not fundamentally new or practice changing. From the paper:

Design: Prospective, multicenter, observational cohort study.

Setting: Fourteen ICUs from 10 French university teaching and nonacademic hospitals.

Patients: Consecutive adult patients with septic shock admitted between November 2009 and September 2011 were eligible.

Intervention: None.

Measurements and Main Results: Of the 1,495 eligible patients, 1,486 (99.4%) were included. Simplified Acute Physiology Score II score of greater than or equal to 56, immunosuppression, age of more than 65 years, cirrhosis, bacteremia (p less than or equal to 0.001 for each), and urinary sepsis (p = 0.005) were globally associated with an increased risk of thrombocytopenia within the first 24 hours following the onset of septic shock. Survival at day 28 estimated by the Kaplan-Meier method was lower in patients with thrombocytopenia and decreased with thrombocytopenia severity. By multivariate Cox regression, a platelet count of less than or equal to 100,000/mm3 was independently associated with a significantly increased risk of death within the 28 days following septic shock onset. The risk of death increased with the severity of thrombocytopenia (hazard ratio, 1.65; 95% CI, 1.31-2.08 for a platelet count below 50,000/mm3 vs greater than 150,000/mm3; p less than 0.0001).

Conclusions: This is the first study to investigate thrombocytopenia within the first 24 hours of septic shock onset as a prognostic marker of survival at day 28 in a large cohort of ICU patients. Measuring platelet count is inexpensive and easily feasible for the physician in routine practice, and thus, it could represent an easy "alert system" among patients in septic shock.

The last statement is not practice changing and almost sounds silly given that all patients with sepsis get at least an automated CBC which routinely includes a platelet count.

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