Thrombocytopenia and Bloodstream Infection: Incidence and Implication on Length of Stay in the Pediatric Intensive Care Unit

Abstract

The incidence and prognosis of thrombocytopenia in critically ill patients with bloodstream infection (BSI) is not well delineated in the pediatric intensive care unit (PICU) setting. We assessed these variables in our PICU and sought to determine whether thrombocytopenia could serve as a prognostic marker for length of stay (LOS). The study was conducted at the medical PICU of a university hospital, on all critically ill pediatric patients consecutively admitted during a 3-year period. Patient surveillance and data collection have been used to identify the risk factors during the study period. The main outcomes were BSI incidence and implication on morbidity and LOS. Data from 2,349 PICU patients was analyzed. The overall incidence of BSI was 3.9% (93/2,349). Overall, 85 of 93 patients (91.4%) with BSI survived and 8 patients died (8.6% mortality rate). The overall incidence of thrombocytopenia among these 93 patients was 54.8% (51/93) and 100% (8/8) for the nonsurvivors. Out of the 85 survivors, 27 thrombocytopenic patients were hospitalized for >14 days versus 14 of nonthrombocytopenic patients (p = 0.007). Thrombocytopenia was associated with borderline significance with an increased LOS (adjusted odds ratio = 3.00, 95% confidence interval: 0.93–9.71, p = 0.066). Thrombocytopenia is common in critically ill pediatric patients with BSI and constitutes a simple and readily available risk marker for PICU LOS.

Keywords

thrombocytopenia - platelets - critical care - pediatric intensive care unit - sepsis - bloodstream infection

^* These authors contributed equally to this work.

Publication History

Received: 24 October 2020

Accepted: 26 November 2020

Article published online:
20 January 2021

• References

• 1 Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6 (01) 2-8
• 2 Hanna W, Wong HR. Pediatric sepsis: challenges and adjunctive therapies. Crit Care Clin 2013; 29 (02) 203-222
• 3 Viscoli C. Bloodstream Infections: the peak of the iceberg. Virulence 2016; 7 (03) 248-251
• 4 Carcillo JA, Halstead ES, Hall MW. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigators. Three hypothetical inflammation pathobiology phenotypes and pediatric sepsis-induced multiple organ failure outcome. Pediatr Crit Care Med 2017; 18 (06) 513-523
• 5 Saini A, Spinella PC, Ignell SP, Lin JC. Thromboelastography variables, immune markers, and endothelial factors associated with shock and NPMODS in children with severe sepsis. Front Pediatr 2019; 7: 422
• 6 Levi M, Poll Tv. Coagulation in patients with severe sepsis. Semin Thromb Hemost 2015; 41 (01) 9-15
• 7 Iba T, Nisio MD, Levy JH, Kitamura N, Thachil J. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: a retrospective analysis of a nationwide survey. BMJ Open 2017; 7 (09) e017046
• 8 Greinacher A, Selleng K. Thrombocytopenia in the intensive care unit patient. Hematology Am Soc Hematol Educ Program 2010;
• 9 Kappstein I, Schulgen G, Beyer U, Geiger K, Schumacher M, Daschner FD. Prolongation of hospital stay and extra costs due to ventilator-associated pneumonia in an intensive care unit. Eur J Clin Microbiol Infect Dis 1992; 11 (06) 504-508
• 10 Ree IMC, Fustolo-Gunnink SF, Bekker V, Fijnvandraat KJ, Steggerda SJ, Lopriore E. Thrombocytopenia in neonatal sepsis: incidence, severity and risk factors. PLoS One 2017; 12 (10) e0185581
• 11 Parker RI. Etiology and significance of thrombocytopenia in critically ill patients. Crit Care Clin 2012; 28 (03) 399-411 , vi
• 12 Moitra VK, Guerra C, Linde-Zwirble WT, Wunsch H. Relationship between ICU length of stay and long-term mortality for elderly ICU survivors. Crit Care Med 2016; 44 (04) 655-662
• 13 Williams TA, Ho KM, Dobb GJ, Finn JC, Knuiman M, Webb SA. Royal Perth Hospital ICU Data Linkage Group. Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients. Br J Anaesth 2010; 104 (04) 459-464
• 14 Krishnan J, Morrison W, Simone S, Ackerman A. Implications of thrombocytopenia and platelet course on pediatric intensive care unit outcomes. Pediatr Crit Care Med 2008; 9 (05) 502-505
• 15 Agrawal S, Sachdev A, Gupta D, Chugh K. Platelet counts and outcome in the pediatric intensive care unit. Indian J Crit Care Med 2008; 12 (03) 102-108
• 16 Yilmaz S, Yildizdas D, Acipayam C. et al. The effect of thrombocytopenia on outcome in critically ill children. Crit Care Shock 2013; 16: 48-57
• 17 Kaur A, Sethi GK, Goyal RK. et al. Thrombocytopenia in paediatric ICU: incidence, transfusion requirement and role as prognostic indicator. J Clin Diagn Res 2015; 9 (12) SC05-SC07
• 18 Kaier K, Heister T, Motschall E, Hehn P, Bluhmki T, Wolkewitz M. Impact of mechanical ventilation on the daily costs of ICU care: a systematic review and meta regression. Epidemiol Infect 2019; 147: e314
• 19 Evans J, Kobewka D, Thavorn K, D'Egidio G, Rosenberg E, Kyeremanteng K. The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada. Can J Anaesth 2018; 65 (06) 627-635
• 20 Carcillo JA, Berg RA, Wessel D. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. A multicenter network assessment of three inflammation phenotypes in pediatric sepsis-induced multiple organ failure. Pediatr Crit Care Med 2019; 20 (12) 1137-1146
• 21 Nguyen TC, Liu A, Liu L. et al. Acquired ADAMTS-13 deficiency in pediatric patients with severe sepsis. Haematologica 2007; 92 (01) 121-124
• 22 Vincent JL, Yagushi A, Pradier O. Platelet function in sepsis. Crit Care Med 2002; 30 (5, Suppl): S313-S317
• 23 Paterson R, MacLeod DC, Thetford D. et al. Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit. Clin Med (Lond) 2006; 6 (03) 281-284
• 24 Dewitte A, Lepreux S, Villeneuve J. et al. Blood platelets and sepsis pathophysiology: a new therapeutic prospect in critically [corrected] ill patients?. Ann Intensive Care 2017; 7 (01) 115