title: Is Thrombocytopenia an Early Prognostic Marker in Septic Shock?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective, multicenter, observational cohort study.
  
  
  METHODS
  Fourteen ICUs from 10 French university teaching and nonacademic hospitals.
  
  
  METHODS
  Consecutive adult patients with septic shock admitted between November 2009 and September 2011 were eligible.
  
  
  METHODS
  None.
  
  
  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/mm3 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/mm3 vs > 150,000/mm3; 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.
authors.affiliation: 1Centre Hospitalier William Morey, Service de Réanimation Polyvalente, Chalon sur Saône, France. 2INSERM, CIC1432, module épidémiologie 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), Faculté de médecine, Université de Strasbourg, Strasbourg, France. 5INSERM, EA 3072, Strasbourg, France. 6CHU Dijon, Service de réanimation médicale, Dijon, France. 7Lipness Team, INSERM, Research Center UMR866, Université de Bourgogne-Franche-Comté, Dijon, France.
authors.forename: Nadiejda
authors.initials: N
authors.lastname: Thiery-Antier
authors.forename: Christine
authors.initials: C
authors.lastname: Binquet
authors.forename: Sandrine
authors.initials: S
authors.lastname: Vinault
authors.forename: Ferhat
authors.initials: F
authors.lastname: Meziani
authors.forename: Julie
authors.initials: J
authors.lastname: Boisramé-Helms
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000150:complications / Q000401:mortality; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology*