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Relationship between thrombocytopenia and prognosis in children with septic shock: a retrospective cohort study
Ruichen Zhang1, Haixin Huang1, Siwei Lu1
1Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Insights
Early thrombocytopenia (low platelet count) in children with septic shock significantly increases the risk of death within 28 days. This condition also leads to longer hospital stays and more complications.
Area of Science:
- Pediatrics
- Critical Care Medicine
- Hematology
Background:
- Septic shock is a global health threat often accompanied by thrombocytopenia (low platelet count).
- Platelets are vital in immunity, coagulation, and endothelial function, impacting disease progression.
- Limited research exists on thrombocytopenia's prognostic impact in pediatric septic shock.
Purpose of the Study:
- To investigate the effect of early thrombocytopenia on the prognosis of pediatric patients diagnosed with septic shock.
- To identify risk factors associated with the development of thrombocytopenia in pediatric septic shock.
Main Methods:
- A monocentric study included pediatric septic shock patients from 2015 to 2022.
- Thrombocytopenia was defined as a platelet count <100 × 109/L within 24 hours of shock onset.
- Propensity score matching was employed to control for disease severity, comparing patients with and without thrombocytopenia.
Main Results:
- Patients with thrombocytopenia exhibited higher 28-day mortality (55.5% vs. 38.7%, p=.005).
- Thrombocytopenia was linked to reduced 28-day Pediatric Intensive Care Unit (PICU) free days (0 vs. 13) and ventilator-free days (0 vs. 19).
- Elevated lactate and white blood cell (WBC) count were independent risk factors for developing thrombocytopenia.
Conclusions:
- Early-onset thrombocytopenia in pediatric septic shock is a significant predictor of increased 28-day mortality.
- Thrombocytopenia is associated with greater bleeding events, blood product transfusions, and organ failure.
- No significant differences were found in microbial pathogens or infection sites between groups.
Abstract:
Septic shock is a life-threatening disease worldwide often associated with thrombocytopenia. Platelets play a crucial role in bridging the gap between immunity, coagulation, and endothelial cell activation, potentially influencing the course of the disease. However, there are few studies specifically evaluating the impact of thrombocytopenia on the prognosis of pediatric patients. Therefore, the study investigates effects of early thrombocytopenia in the prognosis of children with septic shock. Pediatric patients with septic shock from 2015 to 2022 were included monocentrically. Thrombocytopenia was defined as a platelet count of <100 × 109/L during the first 24 hours of septic shock onset. The primary outcome was the 28-day mortality. Propensity score matching was used to pair patients with different platelet counts on admission but comparable disease severity. A total of 419 pediatric patients were included in the analysis. Patients with thrombocytopenia had higher 28-day mortality (55.5% vs. 38.7%, p = .005) compared to patients with no thrombocytopenia. Thrombocytopenia was associated with reduced 28-PICU free days (median value, 0 vs. 13 days, p = .003) and 28-ventilator-free (median value, 0 vs. 19 days, p = .001) days. Among thrombocytopenia patients, those with platelet count ≤50 × 109/L had a higher 28-day mortality rate (63.6% vs. 45%, p = .02). Multiple logistic regression showed that elevated lactate (adjusted odds ratio (OR) = 1.11; 95% confidence interval (CI): 1.04-1.17; P <0.001) and white blood cell (WBC) count (OR = 0.97; 95% CI: 0.95-0.99; p = .003) were independent risk factors for the development of thrombocytopenia. Thrombocytopenia group had increased bleeding events, blood product transfusions, and development of organ failure. In Kaplan-Meier survival estimates, survival probabilities at 28 days were greater in patients without thrombocytopenia (p value from the log-rank test, p = .004). There were no significant differences in the type of pathogenic microorganisms and the site of infection between patients with and without thrombocytopenia. In conclusion, thrombocytopenia within 24 hours of shock onset is associated with an increased risk of 28-day mortality in pediatric patients with septic shock.
