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Implications of thrombocytopenia and platelet course on pediatric intensive care unit outcomes

Jambunathan Krishnan1, Wynne Morrison, Shari Simone

  • 1Division of Pediatric Critical Care (JK), Cardinal Glennon Childrens Medical Center, St. Louis University, St. Louis, MO, USA. jkrishnanpeds.umaryland.edu

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|August 6, 2008
PubMed

Insights

Thrombocytopenia in critically ill children significantly increases mortality and length of stay in the pediatric intensive care unit (PICU). Falling platelet counts also indicate a higher risk of adverse outcomes.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Clinical Outcomes Research

Background:

  • Thrombocytopenia is a known predictor of mortality and prolonged hospital stay in critically ill adults.
  • Limited data exist on the impact of thrombocytopenia in pediatric intensive care unit (PICU) populations.
  • This study investigates the relationship between platelet counts and outcomes in PICU patients.

Purpose of the Study:

  • To determine if admission thrombocytopenia is a risk factor for mortality and prolonged length of stay in the PICU.
  • To assess the association between thrombocytopenia at any point during PICU stay and patient outcomes.
  • To evaluate if falling platelet counts during PICU stay correlate with increased mortality and length of stay.

Main Methods:

  • Prospective observational study conducted in a multidisciplinary tertiary care PICU.
  • Inclusion of all patients admitted to the PICU over a one-year period.
  • Analysis of data using logistic and linear regression models.

Main Results:

  • 17.3% of PICU patients had admission thrombocytopenia, with significantly higher mortality (17.6% vs. 2.47%) and longer length of stay (4 days vs. 1.6 days).
  • 25.3% of patients developed thrombocytopenia during their PICU stay, experiencing substantially higher mortality (17.1% vs. 0.9%) and longer stays (6.6 days vs. 1.5 days).
  • A 10% fall in platelet count from admission was associated with increased mortality (OR 1.4) and longer length of stay. New-onset thrombocytopenia during PICU stay dramatically increased mortality risk (OR 18.6).

Conclusions:

  • Thrombocytopenia at admission or during a PICU stay is significantly associated with increased mortality.
  • A declining trend in platelet counts during PICU admission is linked to a greater risk of mortality and prolonged hospital stay.
  • These findings highlight the importance of monitoring platelet counts in critically ill pediatric patients.
Abstract

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