Thrombocytopenia and platelet count recovery in patients with sepsis-3: a retrospective observational study

Abstract

Thrombocytopenia is common in critical illness. But there are no studies that focus on thrombocytopenia and platelet recovery in Sepsis-3 patients. We employed a large database to identify sepsis based on Sepsis-3 criteria. Patients were grouped by nadir platelet count during ICU, propensity score matching was used to eliminate covariates imbalance, multivariable cox proportional hazard model was used for evaluating mortality. A total of 9709 patients were enrolled based on Sepsis-3, 1794 (18%) patients developed thrombocytopenia, with 858 (8.8%) exhibiting thrombocytopenia at ICU admission (prevalent), 891 (9.2%) developed thrombocytopenia during ICU stay (incident). In the incident thrombocytopenia group, survivors exhibited higher nadir platelet count, higher rate in platelet count recovery and shorter time to platelet recovery compared to non-survivors. Platelet recovery was not observed until 1 days (IQR, 1–2) after weaning of mechanical ventilation and 1 days (IQR, 1–3) after discontinuation of vasopressor in survivors of incident thrombocytopenia. Furthermore, thrombocytopenia was associated with longer duration of ICU length of stay, longer duration of mechanical ventilation and vasopressor use compared to no thrombocytopenia. Moderate (20–50 × 10⁹/L) and severe (<20 × 10⁹/L) thrombocytopenia group showed increased 28 days mortality compared to no thrombocytopenia, while the mortality rate between mild (51–100 × 10⁹/L) and no thrombocytopenia group (≥100 × 10⁹/L) showed no significant difference. Taken together these data revealed that thrombocytopenia occurred in 18% Sepsis-3 patients; platelet recovery occurred more frequent and earlier in survivors; platelet recovery was not observed until clinical improvement. Thrombocytopenia in Sepsis-3 demonstrated increased disease severity, and patients with platelet count <50 × 10⁹/L showed increased 28 days mortality.

Keywords:

• Mortality
• multiple organ dysfunction syndrome
• platelet recovery
• sepsis-3
• thrombocytopenia

Acknowledgements

This study was financially supported by the National Natural Science Foundation of China (82002088 to Zhengzheng Yan); The president fund of Nanfang Hospital (No. 2019Z021 to Zhengzheng Yan). We would like to thank Editage (www.editage.cn) for English language editing.

Authorship contributions

Hui. Zhou extracted data from the MIMIC-III database, Hui. Zhou, Zhengzheng. Yan designed the research and guided the literature review. Zhifeng Li and Hui Liang participated in the processing and analysing the data. Hui. Zhou, Zhengzheng. Yan wrote the manuscript.

Disclosure statement

The authors declare no competing financial interest.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [82002088]; President Foundation of Nanfang Hospital, Southern Medical University [No. 2019Z021].