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Analysis of significant decrease in platelet count and thrombocytopenia, graded according to NCI-CTC, as prognostic
Inan Olmez1, Muhammad Zafar, Muhammad Shahid
1University of Texas MD Anderson Cancer Center, Holcombe Boulevard, Houston, TX, USA. iolmez@mdanderson.org
Journal of Pediatric Hematology/Oncology
|November 2, 2011
Summary
Thrombocytopenia (TP) and significant platelet count decrease in pediatric patients are linked to higher mortality and longer hospital stays. The National Cancer Institute criteria can standardize TP grading, and a platelet drop alone signals risk.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Oncology
Background:
- Thrombocytopenia (TP) and a ≥30% platelet count decrease are linked to adverse outcomes in adults.
- These associations are less understood in the pediatric intensive care unit (PICU) population.
- The National Cancer Institute (NCI) Common Terminology Criteria (CTC) is not routinely used for TP grading.
Purpose of the Study:
- To evaluate the association of TP and significant platelet count decrease with mortality, length of stay (LOS), and morbidity in pediatric patients.
- To assess the utility of NCI-CTC for grading TP in this population.
Main Methods:
- Retrospective review of medical records for 204 pediatric patients.
- TP was graded using NCI-CTC criteria.
- Analysis of associations between TP grades, ≥30% platelet decrease, and clinical outcomes (mortality, LOS, infection).
Main Results:
- Both TP (25%) and a ≥30% platelet decrease (58.3%) were significantly associated with increased mortality and LOS (P<0.0001).
- Both conditions correlated with increased infection rates.
- Higher TP grades showed a trend towards increased mortality, with Grade 4 TP significantly linked to longer LOS (P=0.0001).
- Patients with a significant platelet decrease, even without TP, had higher mortality and LOS compared to those with neither condition.
Conclusions:
- The NCI-CTC is a viable tool for standardizing TP classification in pediatric patients.
- A ≥30% decrease in platelet count, irrespective of TP diagnosis, serves as a significant prognostic marker for adverse outcomes including mortality, morbidity, and prolonged LOS.
