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Medline ® Abstract for Reference 95

of 'Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis'

95
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Is Thrombocytopenia an Early Prognostic Marker in Septic Shock?
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Thiery-Antier N, Binquet C, Vinault S, Meziani F, Boisramé-Helms J, Quenot JP, EPIdemiology of Septic Shock Group
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Crit Care Med. 2016 Apr;44(4):764-72.
 
OBJECTIVES: To assess whether early thrombocytopenia during septic shock is associated with an increased risk of death at day 28 and to identify risk factors associated with a low platelet count.
DESIGN: Prospective, multicenter, observational cohort study.
SETTING: Fourteen ICUs from 10 French university teaching and nonacademic hospitals.
PATIENTS: Consecutive adult patients with septic shock admitted between November 2009 and September 2011 were eligible.
INTERVENTION: None.
MEASUREMENTS AND MAIN RESULTS: Of the 1,495 eligible patients, 1,486 (99.4%) were included. Simplified Acute Physiology Score II score of greater than or equal to 56, immunosuppression, age of more than 65 years, cirrhosis, bacteremia (p≤0.001 for each), and urinary sepsis (p = 0.005) were globally associated with an increased risk of thrombocytopenia within the first 24 hours following the onset of septic shock. Survival at day 28 estimated by the Kaplan-Meier method was lower in patients with thrombocytopenia and decreased with thrombocytopenia severity. By multivariate Cox regression, a platelet count of less than or equal to 100,000/mm was independently associated with a significantly increased risk of death within the 28 days following septic shock onset. The risk of death increased with the severity of thrombocytopenia (hazard ratio, 1.65; 95% CI, 1.31-2.08 for a platelet count below 50,000/mm vs>150,000/mm; p<0.0001).
CONCLUSIONS: This is the first study to investigate thrombocytopenia within the first 24 hours of septic shock onset as a prognostic marker of survival at day 28 in a large cohort of ICU patients. Measuring platelet count is inexpensive and easily feasible for the physician in routine practice, and thus, it could represent an easy "alert system" among patients in septic shock.
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1Centre Hospitalier William Morey, Service de Réanimation Polyvalente, Chalon sur Saône, France. 2INSERM, CIC1432, moduleépidémiologie clinique, Dijon, France. CHU de Dijon, Centre d'Investigation Clinique, module Epidémiologie Clinique/Essais Cliniques, Dijon, France. 3Service de Réanimation Médicale, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 4EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Facultéde médecine, Universitéde Strasbourg, Strasbourg, France. 5INSERM, EA 3072, Strasbourg, France. 6CHU Dijon, Service de réanimation médicale, Dijon, France. 7Lipness Team, INSERM, Research Center UMR866, Universitéde Bourgogne-Franche-Comté, Dijon, France.
PMID