Thrombocytopenia in sepsis: a predictor of mortality in the intensive care unit

Disseminated intravascular coagulation (DIC) and thrombocytopenia are well-known complications of sepsis, but the relationship between these coagulation abnormalities and outcome have not been well documented. We studied the incidence of thrombocytopenia and DIC in our Medical Intensive Care Unit, and evaluated their usefulness as prognostic risk factors for mortality. Platelet count was not found to be an independent risk factor associated with overall mortality in the 107 patients studied. In the sub-group of 53 patients with sepsis, 22 (42%) developed DIC, 31 (58%) developed thrombocytopenia (< 150,000 x 10(9)/L) and 27 (51%) died. Thrombocytopenia was associated with presence of DIC (p = 0.003), but not with the type of infecting organism. The platelet count in non-survivors (mean +/- sem, 97 +/- 18 x 10(9)/L) was significantly lower than survivors (194 +/- 27 x 10(9)/L, p < 0.005). Multiple regression analysis showed that thrombocytopenia was a risk factor for mortality, independent of the APACHE II score. The presence of DIC surprisingly was not an independent risk factor. We conclude that DIC and thrombocytopenia are common in our adult Medical Intensive Care patients with sepsis, but only the latter is a prognostic factor in addition to the APACHE II score. The incidence of DIC in our patients (mainly Chinese) seems to be more than that of 10 to 20% reported in other series of Caucasian patients. We would, therefore, like to emphasise the importance of platelet count as an prognostic risk factor in sepsis.