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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Platelet counts and outcome in the pediatric intensive care unit
Shruti Agrawal1, Anil Sachdev, Dhiren Gupta
1Pediatric Intensive Care, Sir Ganga Ram Hospital, New Delhi, India.
Insights
Thrombocytopenia is common in pediatric intensive care units (PICUs). A significant drop in platelet counts, even without full thrombocytopenia, is linked to higher mortality risk and bleeding in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Clinical Research
Background:
- Thrombocytopenia is a frequent complication in critically ill pediatric patients.
- Understanding its risk factors and impact on outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate platelet count variations and identify risk factors for thrombocytopenia in pediatric intensive care unit (PICU) patients.
- To assess the prognostic value of platelet counts for mortality in this population.
Main Methods:
- Prospective observational cohort study of 138 consecutively admitted patients to an 8-bedded PICU.
- Data collected included platelet counts, Pediatric Risk of Mortality Score (PRISM), and clinical outcomes over a 7-month period.
Main Results:
- Twenty-five percent of patients experienced thrombocytopenia, with 80% developing it during their PICU stay.
- PICU-acquired thrombocytopenia was associated with lower platelet counts and a higher risk of bleeding.
- Factors like PRISM score, prolonged PICU stay, sepsis, and coagulopathy were linked to thrombocytopenia and mortality.
Conclusions:
- Thrombocytopenia is prevalent in PICU settings and associated with increased bleeding risk.
- A platelet count drop greater than 27% and thrombocytopenia are independent predictors of mortality.
- Serial platelet count monitoring offers better prognostic value than single measurements for predicting pediatric intensive care outcomes.
Objectives:
Thrombocytopenia is commonly observed in critically ill patients. This study was undertaken to evaluate the variation in platelet counts and the risk factors associated with thrombocytopenia and mortality in pediatric intensive care patients. In addition, prognostic value of platelet counts for outcome in pediatric intensive care unit was studied.
Study Design:
Prospective, observational cohort analysis.
Setting:
8- bedded pediatric intensive care unit of a tertiary care teaching hospital.
Patients:
All consecutively admitted patients (n=138) staying in the pediatric intensive care unit (PICU) for at least 48h over a 7 months period were studied.
Measurements And Main Results:
Thrombocytopenia was defined as platelet counts <150.0/nL. Median 1(st) day Pediatric Risk of Mortality Score (PRISM) was 5 (range 0-30) and median ICU stay was 4 days (range 2-98 days). Twenty five percent patients had at least one episode of thrombocytopenia during the stay. Twenty percent of these patients had thrombocytopenia on admission and rest (80%) developed it during the PICU stay. Seventy one percent (19) of the patients developed thrombocytopenia by fourth day of admission. Patients with PICU acquired thrombocytopenia had statistically significant lower baseline, nadir and 4th day platelet counts and a significantly higher drop in platelet counts (56% vs. 6% P<0.001) as compared to non thrombocytopenic patients. PRISM score, long PICU stay, sepsis, coagulopathy, and creatinine levels were significantly associated with occurrence of thrombocytopenia. Patients with thrombocytopenia had higher probability of bleeding (34% vs. 15%, P=0.01). Higher platelet counts on admission were associated with significantly reduced risk of thrombocytopenia (P=0.00) Baseline, nadir and day-4 platelet counts, presence of thrombocytopenia on admission, sepsis, coagulopathy and a higher mean PRISM score on univariate analysis were significantly associated with mortality. Leucopenia or leucocytosis, thrombocytopenia and coagulopathy were found to significantly affect outcome. Drop in platelet counts was found to have slightly higher discriminative value for mortality prediction than PRISM on the ROC curve. The survivors had higher platelet counts throughout the PICU stay and after an initial fall in platelet counts in the PICU showed a significantly higher rise in the platelet counts in the following days than the non-survivors.
Conclusions:
Thrombocytopenia is common in PICU. Patients requiring cardiopulmonary resuscitation or with circulatory shock, coagulopathy, sepsis and with more severe disease have higher risk of developing thrombocytopenia. Thrombocytopenic patients have a higher risk of bleeding. Drop in platelet counts >27% and thrombocytopenia were independently related to mortality. Serial measurements of platelet counts are better predictors of pediatric intensive care outcome than one-time values. Any drop in platelet counts even without thrombocytopenia needs an urgent and extensive evaluation.
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