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Is Thrombocytopenia an Early Prognostic Marker in Septic Shock?

Thiery-Antier, Nadiejda MD; Binquet, Christine MD, PhD; Vinault, Sandrine MSc; Meziani, Ferhat MD, PhD; Boisramé-Helms, Julie MD, PhD; Quenot, Jean-Pierre MD, PhD; on behalf of the EPIdemiology of Septic Shock Group

doi: 10.1097/CCM.0000000000001520
Clinical Investigations

Objectives: To assess whether early thrombocytopenia during septic shock is associated with an increased risk of death at day 28 and to identify risk factors associated with a low platelet count.

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 ≤ 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 > 150,000/mm3; p < 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.

1Centre Hospitalier William Morey, Service de Réanimation Polyvalente, Chalon sur Saône, France.

2INSERM, CIC1432, module épidémiologie clinique, Dijon, France. CHU de Dijon, Centre d’Investigation Clinique, module Epidémiologie Clinique/Essais Cliniques, Dijon, France.

3Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

4EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France.

5INSERM, EA 3072, Strasbourg, France.

6CHU Dijon, Service de réanimation médicale, Dijon, France.

7Lipness Team, INSERM, Research Center UMR866, Université de Bourgogne-Franche-Comté, Dijon, France.

A list of EPIdemiology of Septic Shock study group members is provided in the Appendix.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Drs. Binquet and Vinault’s institutions received grant support from Direction Interrégionale de la Recherche Clinique Est/Ministry of Health, the Ministry of Health, Burgundy region, Lyon University Hospital, and Dijon and Besancon University Hospitals. Their institutions received other support from Biogen Idec, Gambro/Baxter, and Biomerieux. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: jean-pierre.quenot@chu-dijon.fr

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