THROMBOCYTOPENIA IN CRITICALLY ILL SURGICAL PATIENTS

A STUDY EVALUATING ATTRIBUTABLE PATIENT’S MORTALITY AND TRANSFUSION REQUIREMENT

Abstract

Thrombocytopenia is a well known complication in the surgical intensive
care unit (ICU) patients. The influence of thrombocytopenia on patient’s mortality is difficult to assess.
Thrombocytopenia results in increased mortality and transfusion requirement of platelets and other blood products, has
not been confirmed by previous studies. We performed a case control study in surgical intensive care unit of Combined
Military Hospital Rawalpindi in which 119 critically ill surgical patients developed thrombocytopenia of less than 50x109
platelets/L. These patients were carefully matched with control patients for the severity of underlying disease and
important variables. Purpose of study was to evaluate attributable mortality and transfusion requirement in
thrombocytopenic patients at that unit.. Fifty-two (44%) cases died versus forty (33%) control patients. Eighty one (76%)
matched pairs had a concordant outcome and in 25% of those pairs, the cases died (exact binomial probabilities
0.036). The estimated attributable mortality rate was 18.4% (95% confidence interval 3.12-11.8) and the estimated odds
ratio was 2.6 (95% confidence interval 1.02-7.10). The estimated attributable transfusion requirement was 23% (95%
confidence interval 5.3-43.5) and the estimated odds ratio was 1.51.This study suggests that thrombocytopenia of less
than 50x10 /L seems to be a marker 9 of severity the illness and increases risk of death. Thrombocytopenia also leads
to more blood product consumption.