title: Thrombocytopenia is associated with acute respiratory distress syndrome mortality: an international study.
abstract: BACKGROUND
  Early detection of the Acute Respiratory Distress Syndrome (ARDS) has the potential to improve the prognosis of critically ill patients admitted to the intensive care unit (ICU). However, no reliable biomarkers are currently available for accurate early detection of ARDS in patients with predisposing conditions.
  
  
  OBJECTIVE
  This study examined risk factors and biomarkers for ARDS development and mortality in two prospective cohort studies.
  
  
  METHODS
  We examined clinical risk factors for ARDS in a cohort of 178 patients in Beijing, China who were admitted to the ICU and were at high risk for ARDS. Identified biomarkers were then replicated in a second cohort of1,878 patients in Boston, USA.
  
  
  RESULTS
  Of 178 patients recruited from participating hospitals in Beijing, 75 developed ARDS. After multivariate adjustment, sepsis (odds ratio [OR]:5.58, 95% CI: 1.70-18.3), pulmonary injury (OR: 3.22; 95% CI: 1.60-6.47), and thrombocytopenia, defined as platelet count <80×10(3)/µL, (OR: 2.67; 95% CI: 1.27-5.62)were significantly associated with increased risk of developing ARDS. Thrombocytopenia was also associated with increased mortality in patients who developed ARDS (adjusted hazard ratio [AHR]: 1.38, 95% CI: 1.07-1.57) but not in those who did not develop ARDS(AHR: 1.25, 95% CI: 0.96-1.62). The presence of both thrombocytopenia and ARDS substantially increased 60-day mortality. Sensitivity analyses showed that a platelet count of <100×10(3)/µL in combination with ARDS provide the highest prognostic value for mortality. These associations were replicated in the cohort of US patients.
  
  
  CONCLUSIONS
  This study of ICU patients in both China and US showed that thrombocytopenia is associated with an increased risk of ARDS and platelet count in combination with ARDS had a high predictive value for patient mortality.
authors.affiliation: Peking University Third Hospital, Beijing, China.
authors.forename: Tiehua
authors.initials: T
authors.lastname: Wang
authors.affiliation: Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China.
authors.forename: Zhuang
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Zhaoxi
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China.
authors.forename: Meili
authors.initials: M
authors.lastname: Duan
authors.affiliation: China-Japan Friendship Hospital, Beijing, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.affiliation: China-Japan Friendship Hospital, Beijing, China.
authors.forename: Shupeng
authors.initials: S
authors.lastname: Wang
authors.affiliation: Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, China.
authors.forename: Wenxiong
authors.initials: W
authors.lastname: Li
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Zhaozhong
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Yongyue
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
authors.affiliation: Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China.
authors.forename: Ang
authors.initials: A
authors.lastname: Li
authors.affiliation: Peking University Third Hospital, Beijing, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D002681:China; D015331:Cohort Studies; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000150:complications*; D055815:Young Adult
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