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Published on: May 25, 2017
The Importance of Abnormal Platelet Count in Patients with Clostridioides difficile Infection
Shira Buchrits1,2, Anat Gafter-Gvili1,2, Jihad Bishara2,3
1Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 49100, Israel.
Insights
Abnormal platelet counts, including thrombocytopenia and thrombocytosis, are linked to increased mortality in patients with Clostridium difficile infection (CDI). Thrombocytosis may indicate CDI severity, while thrombocytopenia might reflect underlying patient conditions.
Area of Science:
- Infectious Diseases
- Hematology
- Immunology
Background:
- Clostridium difficile infection (CDI) is a significant cause of hospital-acquired morbidity and mortality.
- Platelets play a crucial role in both innate and adaptive immunity.
- The impact of abnormal platelet counts on CDI outcomes requires further investigation.
Purpose of the Study:
- To determine the incidence of thrombocytopenia and thrombocytosis in hospitalized patients with CDI.
- To evaluate the association between abnormal platelet counts and clinical outcomes, specifically 30-day all-cause mortality.
Main Methods:
- A retrospective cohort study of 527 adult patients with laboratory-confirmed CDI was conducted.
- Data were collected from January 2013 to December 2018 at a single center.
- Logistic regression analysis was used to identify risk factors for 30-day all-cause mortality.
Main Results:
- 34% of CDI patients had an abnormal platelet count (22% thrombocytopenia, 11.5% thrombocytosis).
- Both thrombocytosis (OR 1.89) and thrombocytopenia (OR 1.70) were independently associated with increased 30-day mortality.
- Thrombocytosis was linked to higher white blood cell count, while thrombocytopenia was associated with malignancies and immunosuppression.
Conclusions:
- Thrombocytosis in CDI patients may serve as a marker for disease severity.
- Increased mortality in CDI patients with thrombocytopenia might be attributed to underlying conditions rather than infection severity.
- Further research should explore thrombocytosis as a severity marker in CDI, potentially alongside white blood cell count.
Background:
Clostridium difficile infection (CDI) causes morbidity and mortality. Platelets have been increasingly recognized as an important component of innate and adaptive immunity. We aimed to assess the incidence of thrombocytopenia and thrombocytosis in CDI and the effect of an abnormal platelet count on clinical outcomes.
Methods:
This single-center, retrospective cohort study consisted of all adult patients hospitalized in Rabin Medical Center between 1 January 2013 and 31 December 2018 with laboratory confirmed CDI. The primary outcome was 30-day all-cause mortality. Risk factors for 30-day all-cause mortality were identified by univariable and multivariable analyses, using logistic regression.
Results:
A total of 527 patients with CDI were included. Among them 179 (34%) had an abnormal platelet count: 118 (22%) had thrombocytopenia and 61 (11.5%) had thrombocytosis. Patients with thrombocytosis were similar to control patients other than having a significantly higher white blood cell count at admission. Patients with thrombocytopenia were younger than control patients and were more likely to suffer from malignancies, immunosuppression, and hematological conditions. In a multivariable analysis, both thrombocytosis (OR 1.89, 95% CI 1.01-3.52) and thrombocytopenia (OR 1.70, 95% CI 1.01-2.89) were associated with 30-days mortality, as well as age, hypoalbuminemia, acute kidney injury, and dependency on activities of daily living. A sensitivity analysis restricted for patients without hematological malignancy or receiving chemotherapy revealed increased mortality with thrombocytosis but not with thrombocytopenia.
Conclusions:
In this retrospective study of hospitalized patients with CDI, we observed an association between thrombocytosis on admission and all-cause mortality, which might represent a marker for disease severity. Patients with CDI and thrombocytopenia also exhibited increased mortality, which might reflect their background conditions and not the severity of the CDI. Future studies should assess thrombocytosis as a severity marker with or without the inclusion of the WBC count.
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