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Original Research: CRITICAL CARE MEDICINE |

Platelet Count Decline*: An Early Prognostic Marker in Critically Ill Patients With Prolonged ICU Stays

Delphine Moreau, MD; Jean-François Timsit, MD, PhD; Aurélien Vesin, MS; Maité Garrouste-Orgeas, MD; Arnaud de Lassence, MD; Jean-Ralph Zahar, MD; Christophe Adrie, MD, PhD; François Vincent, MD; Yves Cohen, MD, PhD; Benoît Schlemmer, MD; Elie Azoulay, MD, PhD
Author and Funding Information

Affiliations: *From the Medical ICU (Drs. Moreau, Schlemmer, and Azoulay), Saint Louis Teaching Hospital, Paris, France; the Medical ICU (Drs. Timsit and Vesin), Michallon Teaching Hospital, Grenoble, France; the Medical-Surgical ICU (Dr. Garrouste-Orgeas), Saint Joseph Teaching Hospital, Paris, France; the Medical-Surgical ICU (Dr. de Lassence), Louis Mourier Teaching Hospital, Colombes, France; the Microbiology Unit (Dr. Zahar), Necker Hospital, Paris, France; the Medical ICU (Dr. Adrie), Hôpital de La Fontaine, Saint Denis, France; and the Medical-Surgical ICU (Dr. Vincent) and Service de Réanimation (Dr. Cohen), Avicenne Teaching Hospital, Bobigny, France.,  Deceased.,  A complete list of members of the Outcomerea Study Group is located in the Appendix.

Correspondence to: Elie Azoulay, MD, PhD, Medical ICU, Saint Louis Teaching Hospital, 1 Ave Claude Vellefaux, 75010 Paris, France; e-mail: elie.azoulay@outcomerea.org



Chest. 2007;131(6):1735-1741. doi:10.1378/chest.06-2233
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Background: Thrombocytopenia is common in ICU patients. The objective of this study was to evaluate possible links between declining platelet counts early in the ICU stay and survival.

Methods: All patients who were admitted to the ICU for at least 5 days and had no thrombocytopenia at the time of admission were included in the study. A multivariable logistic regression model, with hospital mortality as the outcome variable, was built.

Results: We included 1,077 patients in the study. At ICU admission, the median platelet count was not significantly different in survivors (256 × 109 cells/L; interquartile range [IQR], 206 to 330 × 109 cells/L) and nonsurvivors (262 × 109 cells/L; 211 to 351 × 109 cells/L). Median simplified acute physiology scores II (SAPS II) at ICU admission was worse in nonsurvivors than in survivors (50 [IQR, 37 to 63] vs 37 [IQR, 27 to 48], respectively; p < 0.0001), as was the mean (± SD) sequential organ failure assessment (SOFA) score on day 3 (6.3 ± 3.24 vs 4 ± 2.8, respectively; p < 0.0001). Absolute platelet counts were lowest on day 4, but differed significantly between survivors and nonsurvivors only on day 7. Conversely, any percentage decline in platelet counts from 10 to 60% on day 4 was significantly associated with mortality. By multivariable analysis, a 30% decline in platelet count independently predicted death (odds ratio, 1.54; 95% confidence interval, 1.12 to 2.14; p = 0.008), in addition to increasing or stable SOFA scores from ICU admission to day 4, older age, male gender, ICU admission for coma, worse SAPS II score at ICU admission, transfer from another ward, and comorbidity.

Conclusion: In patients who spend > 5 days in the ICU and have normal platelet counts at ICU admission, a decline in platelet counts provides prognostic information. This parameter deserves to be included in new scoring systems.

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