Prevalence and Outcomes of Thrombocytopenia at ICU Admission Among Critically Ill Patients in a Resource-Limited...

Thrombocytopenia is a common hematologic abnormality among critically ill patients and may reflect underlying sepsis or multi-organ dysfunction. In low- and middle-income countries (LMICs), constrained transfusion capacity and delayed presentation may amplify its prognostic significance. This study evaluated the association between thrombocytopenia and ICU mortality at a tertiary hospital in Malawi.

We performed a retrospective analysis of patients admitted to the Kamuzu Central Hospital (KCH) Intensive Care Unit (ICU) in Lilongwe, Malawi, from 2016 to 2018. Platelet count was categorized as ≤ 50,000/μL (severe thrombocytopenia), 50,000-150,000/μL (thrombocytopenia), and ≥ 150,000/μL (normal). Bivariate and multivariable logistic regression analyses were performed to identify predictors of mortality. Bivariate analyses and multivariable logistic regression were used to identify factors associated with mortality.

Among 498 patients, 95 (19.1%), 70 (14.1%), and 37 (7.4%) have mild, moderate, and severe thrombocytopenia, respectively. The overall incidence of critical illness thrombocytopenia is 40%. Overall ICU mortality was 51.2% (n = 255), with higher mortality among those with severe thrombocytopenia compared to normal platelet counts (70.3% vs. 50.7%). After adjustment for confounders, severe thrombocytopenia remained independently associated with mortality (OR 2.57, 95% CI 1.18-5.58, p = 0.02).

Thrombocytopenia, particularly platelet counts ≤ 50,000/μL, is independently associated with increased mortality among critically ill patients in resource-limited ICUs. In contexts with limited transfusion and diagnostic capacity, platelet count may serve as a practical and accessible prognostic marker to identify high-risk patients and guide early intervention.