感染症: 予防と制御

An Observational Analytical Study of Causes, Severity, Risk Factors and Outcome of Thrombocytopenia in a Pediatric Intensive Care Unit

Dr. Chhaya Akshay Divecha*, Dr. Milind S. Tullu#, Dr Tanmayee S Thombare#

Background and Aims: Thrombocytopenia, commonly encountered in intensive care units, has been shown to be an independent predictor of mortality and prolonged hospital stay in critically ill. We conducted a study in the Pediatric Intensive Care Unit(PICU) to determine the causes and severity of thrombocytopenia as well as patient outcomes (bleeding and mortality).

Methods: Observational study was conducted in PICU of tertiary care hospital, India after ethics committee approval. Data were derived from routine examinations and investigations. Detailed information about demographic data, clinical data, length of stay (LOS), periodic platelet counts, primary diagnosis, complications, sites of bleeding (if any), use of mechanical ventilation, and outcome in PICU were noted.

Results: The occurrence of thrombocytopenia in the study population (N= 491) was 60.3%. Mild, moderate, severe, and very severe thrombocytopenia was seen in 27%, 32.1%, 34.1%, and 6.8% of patients respectively. Causes of thrombocytopenia were sepsis (27%), part of primary illness (25.7%), undetermined cause (24.7%), nosocomial sepsis (21.2%), and drugs (1.4%). 237 (48.3%) patients had bleeding during PICU stay. Maximum patients (26.1%) had respiratory system involvement. Risk factors associated with thrombocytopenia were sepsis, shock, and mechanical ventilation. Patients with thrombocytopenia had longer PICU and hospital stay. Patients with infectious disease and hematological disorders had statistically significant chances of thrombocytopenia. The shock was significantly associated with increasing severity of thrombocytopenia. The presence of thrombocytopenia and increasing severity were associated with higher mortality.

Conclusions: Thrombocytopenia is a readily available risk marker of mortality and increased PICU stay. Patients having sepsis, shock, and mechanical ventilation are at higher risk of developing thrombocytopenia.