Download PDF
J Pediatr Intensive Care 2022; 11(03): 209-214
DOI: 10.1055/s-0040-1722338
Original Article

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

Reut Kassif Lerner    *
1   Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
4   Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Dana Levinkopf   *
2   Neonatal Intensive Care Unit, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
,
Inna Zaslavsky Paltiel
3   Women and Children's Health Research Unit, The Gertner Institute for Epidemiology and Health Policy Research, The Chain Sheba Medical Center, Tel Hashomer, Israel
,
Tal Sadeh
1   Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
,
Marina Rubinstein
1   Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
,
Itai M. Pessach
1   Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
4   Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
,
Nathan Keller
5   Tel Aviv University, Sheba Medical Center, Tel Hashomer, Israel
6   Ariel University, Israel
,
Liat Lerner-Geva
3   Women and Children's Health Research Unit, The Gertner Institute for Epidemiology and Health Policy Research, The Chain Sheba Medical Center, Tel Hashomer, Israel
7   School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
,
Gideon Paret
1   Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
4   Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

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

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • 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
    CrossrefPubMedGoogle Scholar
  • 2 Hanna W, Wong HR. Pediatric sepsis: challenges and adjunctive therapies. Crit Care Clin 2013; 29 (02) 203-222
    CrossrefPubMedGoogle Scholar
  • 3 Viscoli C. Bloodstream Infections: the peak of the iceberg. Virulence 2016; 7 (03) 248-251
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 Levi M, Poll Tv. Coagulation in patients with severe sepsis. Semin Thromb Hemost 2015; 41 (01) 9-15
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 8 Greinacher A, Selleng K. Thrombocytopenia in the intensive care unit patient. Hematology Am Soc Hematol Educ Program 2010; DOI: 10.1182/asheducation-2010.1.135.
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 Parker RI. Etiology and significance of thrombocytopenia in critically ill patients. Crit Care Clin 2012; 28 (03) 399-411 , vi
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 22 Vincent JL, Yagushi A, Pradier O. Platelet function in sepsis. Crit Care Med 2002; 30 (5, Suppl): S313-S317
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar