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A prospective observational study of risk indicators associated with the development of thrombocytopenia in a community based ICU/CCU Verma, Arun Kumar
Abstract
INTRODUCTION: Thrombocytopenia is a common complication in .critically ill patients and can present a challenging clinical problem. Its incidence has been reported to range between 13% to 41% and is associated with an increased length of hospital stay and mortality. Information is needed to clarify risk indicators associated with the development of thrombocytopenia in critically ill patients and to improve clinical decision-making when addressing this common problem. OBJECTIVES: 1. To estimate the incidence of thrombocytopenia in a community based intensive and coronary care unit (ICU/CCU). 2. To compare the incidence of thrombocytopenia in ICU and CCU patients 3. To identify risk indicators associated with the development of thrombocytopenia in ICU/CCU patients using logistic regression modelling. 4. To compare clinical outcomes among patients who did and did not develop thrombocytopenia during their ICU/CCU stay. DESIGN: A prospective, observational, study. SETTING: The Intensive/Coronary Care Unit (ICU/CCU) at Lions Gate Hospital (LGH), which is a 350 bed community-based hospital in North Vancouver, British Columbia, Canada. PATIENTS: The target population for this study included all patients over the age of 18 years who had 2 or more platelet counts recorded, at least 12 hours apart, during an ICU/CCU admission. All patients were included unless they met any of the exclusion criteria, which included an admission platelet count < 150 x 109/L, repeat admission to the unit, concurrent involvement in another study, indication of hypersplenism, and particular disease states associated with the development of thrombocytopenia. METHODS: Data were obtained prospectively during each patient's ICU/CCU stay through daily review of the medical record, patient interviews, and discussion with the medical team. Most responsible diagnoses, clinical outcomes, and any missing data were obtained retrospectively from the patients' medical charts approximately six weeks after discharge from hospital. Thrombocytopenia was defined as two consecutive platelet counts < 150 x 10⁹/L at least 12 hours apart. Descriptive analysis was used to summarize baseline demographic characteristics of the study sample, as well as to select potential variables for logistic regression analysis. Univariate analyses identified variables (p < 0.25) potentially associated with thrombocytopenia, which were then subjected to multivariate backward stepwise logistic regression using (p[sub out] > 0.10 and p[sub in] < 0.05) to generate two different models. The first model was an admission or baseline model that identified risk indicators independently associated with thrombocytopenia upon admission to the ICU/CCU. The second was a model that included indicators present on admission and those that patients were exposed to in the ICU/CCU. RESULTS: Of the 362 patients who met the inclusion criteria, 68 (18.8%; 95% CI: 14.8% - 22.8%) developed thrombocytopenia during their ICU/CCU stay. Thrombocytopenia developed more often in patients with an ICU (29.7%; 95% CI: 22.9% - 36.5%) than CCU (8.9%; 95% CI: 4.9% - 12.9%) most responsible diagnosis. Baseline multivariate logistic regression analysis identified eight risk indicators independently associated with the development of thrombocytopenia: sepsis, gastrointestinal diagnosis, GI bleed diagnosis, respiratory non-surgery diagnosis, musculoskeletal/connective tissue diagnosis, age1, APACHE II Score, and admission platelet count1. The ICU/CCU model identified nine risk indicators independently associated with thrombocytopenia: sepsis, gastrointestinal diagnosis, respiratory non-surgery diagnosis, musculoskeletal/connective tissue diagnosis, packed red blood cell (PRBC) transfusion, fresh frozen plasma (FFP) transfusion, Swan-Ganz catheter insertion, acetylsalicylic acid (ASA)¹, and admission platelet count1. Exploratory analysis identified bleeding episodes as a possible risk indicator for thrombocytopenia. No medications, including heparin, were found to be associated with increased risk of developing thrombocytopenia following multivariate logistic regression analysis. Clinicians discontinued heparin in 18% of the patients who developed thrombocytopenia, apparently due to concern regarding HIT. Mean length of ICU/CCU and hospital stays, and mortality were greater among patients who developed thrombocytopenia. CONCLUSIONS: Thrombocytopenia developed in approximately 19% of patients admitted to a community based ICU/CCU. Indicators associated with an increased risk for thrombocytopenia included markers for severity of illness (e.g. sepsis, APACHE II score, or respiratory non-surgery diagnosis), foreign surfaces (e.g. Swan-Ganz catheters), and, based on an exploratory finding, episodes of bleeding. The identified risk indicators should be considered when treatment decisions are made in critically ill thrombocytopenic patients.
Item Metadata
Title |
A prospective observational study of risk indicators associated with the development of thrombocytopenia in a community based ICU/CCU
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Creator | |
Publisher |
University of British Columbia
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Date Issued |
2000
|
Description |
INTRODUCTION: Thrombocytopenia is a common complication in .critically ill patients and can
present a challenging clinical problem. Its incidence has been reported to range between
13% to 41% and is associated with an increased length of hospital stay and mortality.
Information is needed to clarify risk indicators associated with the development of
thrombocytopenia in critically ill patients and to improve clinical decision-making when
addressing this common problem.
OBJECTIVES:
1. To estimate the incidence of thrombocytopenia in a community based intensive and
coronary care unit (ICU/CCU).
2. To compare the incidence of thrombocytopenia in ICU and CCU patients
3. To identify risk indicators associated with the development of thrombocytopenia in
ICU/CCU patients using logistic regression modelling.
4. To compare clinical outcomes among patients who did and did not develop
thrombocytopenia during their ICU/CCU stay.
DESIGN: A prospective, observational, study.
SETTING: The Intensive/Coronary Care Unit (ICU/CCU) at Lions Gate Hospital (LGH), which is a
350 bed community-based hospital in North Vancouver, British Columbia, Canada.
PATIENTS: The target population for this study included all patients over the age of 18 years who had
2 or more platelet counts recorded, at least 12 hours apart, during an ICU/CCU
admission. All patients were included unless they met any of the exclusion criteria,
which included an admission platelet count < 150 x 109/L, repeat admission to the unit,
concurrent involvement in another study, indication of hypersplenism, and particular
disease states associated with the development of thrombocytopenia.
METHODS: Data were obtained prospectively during each patient's ICU/CCU stay through daily
review of the medical record, patient interviews, and discussion with the medical team.
Most responsible diagnoses, clinical outcomes, and any missing data were obtained
retrospectively from the patients' medical charts approximately six weeks after discharge
from hospital. Thrombocytopenia was defined as two consecutive platelet counts < 150 x
10⁹/L at least 12 hours apart. Descriptive analysis was used to summarize baseline
demographic characteristics of the study sample, as well as to select potential variables
for logistic regression analysis. Univariate analyses identified variables (p < 0.25)
potentially associated with thrombocytopenia, which were then subjected to multivariate
backward stepwise logistic regression using (p[sub out] > 0.10 and p[sub in] < 0.05) to generate two
different models. The first model was an admission or baseline model that identified risk
indicators independently associated with thrombocytopenia upon admission to the
ICU/CCU. The second was a model that included indicators present on admission and
those that patients were exposed to in the ICU/CCU.
RESULTS: Of the 362 patients who met the inclusion criteria, 68 (18.8%; 95% CI: 14.8% - 22.8%)
developed thrombocytopenia during their ICU/CCU stay. Thrombocytopenia developed
more often in patients with an ICU (29.7%; 95% CI: 22.9% - 36.5%) than CCU (8.9%;
95% CI: 4.9% - 12.9%) most responsible diagnosis. Baseline multivariate logistic
regression analysis identified eight risk indicators independently associated with the
development of thrombocytopenia: sepsis, gastrointestinal diagnosis, GI bleed diagnosis,
respiratory non-surgery diagnosis, musculoskeletal/connective tissue diagnosis, age1,
APACHE II Score, and admission platelet count1. The ICU/CCU model identified nine
risk indicators independently associated with thrombocytopenia: sepsis, gastrointestinal
diagnosis, respiratory non-surgery diagnosis, musculoskeletal/connective tissue
diagnosis, packed red blood cell (PRBC) transfusion, fresh frozen plasma (FFP)
transfusion, Swan-Ganz catheter insertion, acetylsalicylic acid (ASA)¹, and admission
platelet count1. Exploratory analysis identified bleeding episodes as a possible risk
indicator for thrombocytopenia. No medications, including heparin, were found to be
associated with increased risk of developing thrombocytopenia following multivariate
logistic regression analysis. Clinicians discontinued heparin in 18% of the patients who
developed thrombocytopenia, apparently due to concern regarding HIT. Mean length of
ICU/CCU and hospital stays, and mortality were greater among patients who developed
thrombocytopenia.
CONCLUSIONS: Thrombocytopenia developed in approximately 19% of patients admitted to a
community based ICU/CCU. Indicators associated with an increased risk for
thrombocytopenia included markers for severity of illness (e.g. sepsis, APACHE II score,
or respiratory non-surgery diagnosis), foreign surfaces (e.g. Swan-Ganz catheters), and,
based on an exploratory finding, episodes of bleeding. The identified risk indicators
should be considered when treatment decisions are made in critically ill
thrombocytopenic patients.
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Extent |
8765779 bytes
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Genre | |
Type | |
File Format |
application/pdf
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Language |
eng
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Date Available |
2009-07-20
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Provider |
Vancouver : University of British Columbia Library
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Rights |
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.
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DOI |
10.14288/1.0099573
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URI | |
Degree | |
Program | |
Affiliation | |
Degree Grantor |
University of British Columbia
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Graduation Date |
2000-11
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Campus | |
Scholarly Level |
Graduate
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Aggregated Source Repository |
DSpace
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Item Media
Item Citations and Data
Rights
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.