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Original Research: Chest Infections |

Thrombocytosis Is a Marker of Poor Outcome in Community-Acquired PneumoniaThrombocytosis in Pneumonia

Elena Prina, MD; Miquel Ferrer, MD, PhD; Otavio T. Ranzani, MD; Eva Polverino, MD, PhD; Catia Cillóniz, PhD; Encarnación Moreno, RN; Josep Mensa, MD; Beatriz Montull, MD; Rosario Menéndez, MD, PhD; Roberto Cosentini, MD; Antoni Torres, MD, PhD
Author and Funding Information

From the Servei de Pneumologia (Drs Prina, Ferrer, Ranzani, Polverino, Cillóniz, and Torres, and Ms Moreno), Institut del Torax, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain; Emergency Medicine Department (Drs Prina and Cosentini), Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028) (Drs Ferrer, Polverino, Cillóniz, Menéndez, and Torres, and Ms Moreno), Barcelona, Spain; Respiratory Intensive Care Unit (Dr Ranzani), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brazil; Servicio de Enfermedades Infecciosas (Dr Mensa), Hospital Clínic, IDIBAPS, Barcelona, Spain; and Servicio de Neumologia (Drs Montull and Menéndez), Hospital Universitario La Fe, Valencia, Spain.

Correspondence to: Miquel Ferrer, MD, PhD, Unitat de Vigilancia Intensiva Respiratoria, Servei de Pneumologia, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain; e-mail: miferrer@clinic.ub.es


Funding/Support: This work was supported by the Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CibeRes CB06/06/0028)-Instituto de Salud Carlos III [Grant 2009 SGR 911], PII de infecciones respiratorias of SEPAR, and IDIBAPS.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):767-775. doi:10.1378/chest.12-1235
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Background:  Thrombocytosis, often considered a marker of normal inflammatory reaction of infections, has been recently associated with increased mortality in hospitalized patients with community-acquired pneumonia (CAP). We assessed the characteristics and outcomes of patients with CAP and thrombocytosis (platelet count ≥ 4 × 105/mm3) compared with thrombocytopenia (platelet count < 105/mm3) and normal platelet count.

Methods:  We prospectively analyzed 2,423 consecutive, hospitalized patients with CAP. We excluded patients with immunosuppression, neoplasm, active TB, or hematologic disease.

Results:  Fifty-three patients (2%) presented with thrombocytopenia, 204 (8%) with thrombocytosis, and 2,166 (90%) had normal platelet counts. Patients with thrombocytosis were younger (P < .001); those with thrombocytopenia more frequently had chronic heart and liver disease (P < .001 for both). Patients with thrombocytosis presented more frequently with respiratory complications, such as complicated pleural effusion and empyema (P < .001), whereas those with thrombocytopenia presented more often with severe sepsis (P < .001), septic shock (P = .009), need for invasive mechanical ventilation (P < .001), and ICU admission (P = .011). Patients with thrombocytosis and patients with thrombocytopenia had longer hospital stays (P = .004), and higher 30-day mortality (P = .001) and readmission rates (P = .011) than those with normal platelet counts. Multivariate analysis confirmed a significant association between thrombocytosis and 30-day mortality (OR, 2.720; 95% CI, 1.589-4.657; P < .001). Adding thrombocytosis to the confusion, respiratory rate, and BP plus age ≥65 years score slightly improved the accuracy to predict mortality (area under the receiver operating characteristic curve increased from 0.634 to 0.654, P = .049).

Conclusions:  Thrombocytosis in patients with CAP is associated with poor outcome, complicated pleural effusion, and empyema. The presence of thrombocytosis in CAP should encourage ruling out respiratory complication and could be considered for severity evaluation.

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