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Hugues Georges, MD; Nicolas Brogly, MD; Serge Alfandari, MD; Olivier Leroy, MD
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From the Intensive Care Unit (Drs Georges, Brogly, and Alfandari) and Infectious Diseases Department (Dr Leroy), Hôpital Chatilliez.

Correspondence to: Hugues Georges, MD, Intensive Care Unit, Hopital Chatilliez, Rue du President Coty, Tourcoing 59200, France; e-mail: hgeorges@ch-tourcoing.fr


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(5):1256-1257. doi:10.1378/chest.11-0010
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To the Editor:

We thank Drs Cunha and Hage for their interest in our recent letter published in CHEST (November 2010).1 We reported that thrombocytopenia was an important predictor of outcome in patients with severe community-acquired pneumonia (CAP). Cunha and Hage suggest that because platelets are not an acute-phase reactant, they have no prognostic significance in patients with sepsis. Moreover, they assume platelet count to be essentially a diagnostic tool, suggestive of mostly nonbacterial pneumonia diagnosis. However, we disagree with these two suggestions.

Incidence of thrombocytopenia (platelet count <150 ×109/L) in critically ill medical patients nears 40%.2 Main factors contributing to thrombocytopenia in patients with sepsis are impaired platelet production, increased consumption or destruction, or spleen platelets sequestration. Platelet consumption probably plays an important role in patients with sepsis. Thrombin is the most potent activator of platelets in vivo, and intravascular thrombin generation is a ubiquitous event in sepsis, with or without evidence of overt disseminated intravascular coagulation. Disseminated intravascular platelet activation may occur, which will contribute to microvascular failure and, thereby, play a role in the development of organ dysfunction. In the recent Infectious Diseases Society of America guidelines on the management of CAP in adults, a platelet count <100 ×103/μL was a criterion for severe CAP.3 More generally, severity of thrombocytopenia has been included in different scores that evaluate critically ill patients, such as the Sequential-Related Organ Failure Assessment (SOFA) score.4

In a previous study, we reported the prevalence and prognostic value of thrombocytopenia in 822 patients admitted to the ICU.5 Causative pathogens were isolated in 490 (59.6%) patients. We assessed the relation between bacterial documentation and platelet count in 365 patients with a single isolated causative pathogen and 332 patients with no identified pathogen (Table 1) and found no association. Bacterial documentation of our population was representative of pathogens isolated in patients with severe CAP. A part of unidentified pathogens might have been viral pneumonia, which is not usually searched in clinical practice.4 These results showing thrombocytopenia for a high percentage of common bacterial pathogens suggest that thrombocytopenia in critically ill patients with CAP is a severity criteria and not a diagnostic tool.

Table Graphic Jump Location
Table 1 —Relationship Between Platelet Count and Etiological Diagnosis

Data are presented as No. (%).

Georges H, Brogly N, Olive D, Leroy O. Thrombocytosis in patients with severe community-acquired pneumonia. Chest. 2010;1385:1279. [CrossRef] [PubMed]
 
Vanderschueren S, De Weerdt A, Malbrain M, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med. 2000;286:1871-1876. [CrossRef] [PubMed]
 
Mandell LA, Wunderink RG, Anzueto A, et al; Infectious Diseases Society of America Infectious Diseases Society of America American Thoracic Society American Thoracic Society Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44suppl 2:S27-S72. [CrossRef] [PubMed]
 
Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;227:707-710. [CrossRef] [PubMed]
 
Brogly N, Devos P, Boussekey N, Georges H, Chiche A, Leroy O. Impact of thrombocytopenia on outcome of patients admitted to ICU for severe community-acquired pneumonia. J Infect. 2007;552:136-140. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Relationship Between Platelet Count and Etiological Diagnosis

Data are presented as No. (%).

References

Georges H, Brogly N, Olive D, Leroy O. Thrombocytosis in patients with severe community-acquired pneumonia. Chest. 2010;1385:1279. [CrossRef] [PubMed]
 
Vanderschueren S, De Weerdt A, Malbrain M, et al. Thrombocytopenia and prognosis in intensive care. Crit Care Med. 2000;286:1871-1876. [CrossRef] [PubMed]
 
Mandell LA, Wunderink RG, Anzueto A, et al; Infectious Diseases Society of America Infectious Diseases Society of America American Thoracic Society American Thoracic Society Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44suppl 2:S27-S72. [CrossRef] [PubMed]
 
Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;227:707-710. [CrossRef] [PubMed]
 
Brogly N, Devos P, Boussekey N, Georges H, Chiche A, Leroy O. Impact of thrombocytopenia on outcome of patients admitted to ICU for severe community-acquired pneumonia. J Infect. 2007;552:136-140. [CrossRef] [PubMed]
 
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