Thrombocytopenia and platelet course on hospital mortality in neurological intensive care unit: a retrospective observational study from large database

Risk factors for thrombocytopenia in patients receiving linezolid therapy: a systematic review and meta-analysis

PURPOSE

The incidence of linezolid-induced thrombocytopenia (LIT) has been reported to vary widely across studies. We performed a meta-analysis to identify the risk factors for thrombocytopenia among patients who received linezolid treatment.

METHODS

The PubMed, Embase and Cochrane Library databases were searched from inception to November 2022 to identify eligible studies. Data on the potential predictors of incidence in LIT were pooled using a random effects model. Sensitivity analyses were performed to determine the robustness of the results when significant heterogeneity was observed.

RESULTS

Forty observational studies involving 6454 patients treated with linezolid were included in the analysis. LIT was estimated to occur in 37% of patients. The following important factors were associated with the incidence of LIT: advanced age, body mass index, concurrent renal impairment or liver disease, abnormal laboratory parameters (including white blood cell count, serum creatinine, baseline platelet count, albumin, creatinine clearance rate, and estimated glomerular filtration rate), treatment duration and renal replacement therapy.

CONCLUSIONS

A variety of risk factors related to the occurrence of LIT were revealed in our analysis. Early identification of these factors could help patients improve clinical outcomes.

Relationship between the red cell distribution width-to-platelet ratio and in-hospital mortality among critically ill patients with acute myocardial infarction: a retrospective analysis of the MIMIC-IV database

OBJECTIVES

We aimed to investigate the association between red cell distribution width-to-platelet ratio (RPR), and in-hospital mortality in critically ill patients with acute myocardial infarction (AMI).

DESIGN

A retrospective cohort study.

SETTING

Data were collected from the Medical Information Mart for Intensive Care database (MIMIC-IV) consisting of critically ill participants between 2008 and 2019 at the Beth Israel Deaconess Medical Centre in Boston.

PARTICIPANTS

A total of 5067 patients with AMI were enrolled from the MIMIC-IV database.

PRIMARY AND SECONDARY OUTCOME

In-hospital mortality.

RESULTS

A total of 4034 patients survived, while 1033 died. In a multiple regression analysis adjusted for age, weight and ethnicity, RPR also showed a positive correlation with in-hospital mortality (HR 1.91, 95% CI 1.42 to 2.56, p<0.0001). Moreover, after adjusting for additional confounding factors, obvious changes were observed (HR 1.63, 95% CI 1.03 to 2.57, p=0.0357). In model 2, the high ratio quartile remained positively associated with hospital mortality compared with the low ratio quartile (HR 1.20, 95% CI 1.01 to 1. 43), with a p-value trend of 0.0177. Subgroup analyses showed no significant effect modifications on the association between RPR and in-hospital mortality in the different AMI groups (p>0.05).

CONCLUSION

RPR is an independent predictor of in-hospital mortality in critically ill patients with AMI.

Prognostic Value of Serum Albumin Level in Critically Ill Patients: Observational Data From Large Intensive Care Unit Databases

Background

Decreased serum albumin level (SAL) is associated with adverse clinical outcomes. We designed the present study to further assess the prognostic value of SAL in critically ill patients based on data from large intensive care unit (ICU) databases.

Methods

This retrospective cohort study recruited 18,353 patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Restricted cubic splines (RCS) were performed to visualize the association of SAL at admission with ICU and hospital mortalities. The prognostic value of SAL was analyzed using logistic regression models and receiver operating characteristic (ROC) curves in overall patients and subgroups.

Results

Restricted cubic splines revealed rapid increasing risks in ICU and hospital mortalities when SAL declined to below 30 g/l. Patients with SAL <30 g/l (n = 6,069) had higher ICU (13.7% vs. 6.4%, p < 0.001) and hospital (23.9% vs. 10.7%, p < 0.001) mortalities than those with SAL ≥30 g/l. Multivariable logistic regression model revealed that SAL <30 g/l independently correlated with higher risks of both ICU (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.07–1.36) and hospital (OR: 1.51, 95% CI: 1.37–1.66) mortalities. However, the association diminished in patients with cirrhosis (OR: 1.16, 95% CI: 0.91–1.49 for ICU mortality; OR: 1.21, 95% CI: 1.00–1.48 for hospital mortality). ROC curves revealed a poor performance of SAL in predicting mortalities, both in overall patients and in those with cirrhosis.

Conclusions

Decreased SAL is associated with increased risk of mortality. However, it possesses low sensitivity and specificity for outcome prediction in critically ill patients, especially in those with cirrhosis.

Linezolid induced thrombocytopenia in critically ill patients: Risk factors and development of a machine learning-based prediction model

INTRODUCTION

Linezolid is an antimicrobial with broad activity against Gram-positive bacteria. Thrombocytopenia is one of its most common side effects often leading to severe complications. The aim of this study is to identify factors related with development of this condition in critically ill patients and to develop and evaluate a predictive machine learning-based model considering easy-to-obtain clinical variables.

METHODS

Data was obtained from the Medical Information Mart for Intensive Care III. Patients who received linezolid for over three days were considered, excluding those under 18 years and/or lacking laboratory data. Thrombocytopenia was considered as a platelet decrease of at least 50% from baseline.

RESULTS

Three hundred and twenty patients met inclusion criteria of which 63 developed thrombocytopenia and presented significant greater duration of treatment, aspartate-aminotransferase, bilirubin and international normalized ratio; and lower renal clearance and platelet count at baseline. Thrombocytopenia development was associated with a worse outcome (30 days mortality [OR: 2.77; CI95%: 1.87-5.89; P < .001], 60 days mortality [OR: 3.56; CI95%: 2.18-7.26; P < .001]). Thrombocytopenia was also correlated with higher length of hospital stays (35.56 [20.40-52.99] vs 22.69 [10.05-38.61]; P < .001). Median time until this anomaly was of 23 days (CI95%:19.0-NE). Two multivariate models were performed. Accuracy, sensitivity, specificity and AUROC obtained in the best of them were of 0.75, 0.78, 0.62 and 0.80, respectively.

CONCLUSION

Linezolid associated thrombocytopenia entails greater mortality rates and hospital stays. Although the proposed predictive model has to be subsequently validated in a real clinical setting, its application could identify patients at risk and establish screening and surveillance strategies.

Association between platelets and in-hospital mortality in critically ill patients with tumours: a retrospective cohort study

OBJECTIVES

Platelet count is an independent predictor of mortality in patients with cancer. It remains unknown whether the platelet count is related to in-hospital mortality in severely ill patients with tumours.

DESIGN

A retrospective study based on a dataset from a multicentre cohort.

SETTING

This was a secondary analysis of data from one Electronic Intensive Care Unit Collaborative Research Database survey cycle (2014-2015).

PARTICIPANTS

The data pertaining to severely ill patients with tumours were collected from 208 hospitals located across the USA. This study initially a total of 200 859 participants. After the population was limited to patients with combined tumours and platelet deficiencies, the remaining 2628 people were included in the final data analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main measure was the platelet count, and the main outcome was in-hospital mortality.

RESULTS

After adjustment for the covariates, the platelet count had a curvilinear relationship with in-hospital mortality (p<0.001). The first inflection point was 18.4 (per 10 change). On the left side of the first inflection point (platelet count ≤184 'x10ˆ9/L), an increase of 10 in the platelet count was negatively associated with in-hospital mortality (OR 0.92, 95% CI 0.89 to 0.95, p<0.001). The second inflection point was 44.5 (per 10 change). Additional increases of 10 in the platelet count thereafter were positively associated with hospital mortality (OR 1.13, 95% CI 1.00 to 1.28, p=0.0454). The baseline platelet count was in the range of 184 'x10ˆ9/L-445 'x10ˆ9/L(p=0.0525), and the hospital mortality was lower than the baseline platelet count in other ranges.

CONCLUSIONS

The relationship between platelet count and in-hospital mortality in critically ill patients with tumours was curvilinear. The lowest in-hospital mortality was associated with platelet count between 184 'x10ˆ9/Land 445 'x10ˆ9/L. This indicates that both high and low platelet count should receive attention in clinical practice.

Association between basal platelet count and all-cause mortality in critically ill patients with acute respiratory failure: a secondary analysis from the eICU collaborative research database

BACKGROUND

Evidence regarding the correlation between platelet count and all-cause mortality in critically ill patients with acute respiratory failure (ARF) is limited. Therefore, the aim of the study was to evaluate whether platelet count was associated with all-cause mortality in critical patients with ARF by using the electronic intensive care unit (eICU) Collaborative Research Database (eICU-CRD).

METHODS

In this retrospective multicenter cohort study, the data of 26961 patients with ARF hospitalized in ICUs between 2014 and 2015 were collected. The independent variable was log2 basal platelet count, and the dependent variables were all-cause in-hospital and ICU mortality. Covariates including demographic data, Acute Physiology and Chronic Health Evaluation (APACHE) IV score, supportive treatment, and comorbidities were collected.

RESULTS

In the fully adjusted model, log2 basal platelet count was negatively associated with all-cause mortality both in hospital [RR: 0.87, 95% CI: 0.84-0.91] and in ICU [RR: 0.87, 95% CI: 0.83-0.92]. A non-linear relationship between log2 basal platelet count and all-cause in-hospital and ICU mortality was identified by the nonlinearity test. The inflection points we got were 6.83 and 6.86 respectively (after inverse log2 logarithmic conversion, the platelet counts were 114×10⁹/L and 116×10⁹/L, respectively). On the right side of the inflection point, however, no association was observed between blood platelets and all-cause in-hospital (RR: 0.96, 95% CI: 0.88-1.03) and ICU mortality (RR: 0.97, 95% CI: 0.91-1.04).

CONCLUSIONS

For patients with ARF in ICU, platelet count was negatively associated with all-cause in-hospital and ICU mortality when the platelet count was less than 114×10⁹/L and 116×10⁹/L respectively, but when the platelet count was higher, we failed to observe a correlation between them. The safe ranges of platelet count for hospital stay and ICU stay were 78×10⁹/L-145×10⁹/L and 89×10⁹/L-147×10⁹/L respectively.

Association of early severe thrombocytopenia and platelet course with in-hospital mortality in critically ill children

This study aimed to assess the association of early severe thrombocytopenia and platelet course with in-hospital mortality in critically ill children. Data of critically ill children in this study were obtained from the Pediatric Intensive Care Database. Patients with and without severe thrombocytopenia were adjusted for covariates using propensity score matching (PSM) to ensure the robustness of the results. Univariate and multivariate logistic regression analyses were performed on the original and PSM cohorts, respectively. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CI). In studies of the platelet course, logistic regression analysis was used to assess the effect of different degrees of recovery on in-hospital mortality in critically ill children with early severe thrombocytopenia. The study included 4,848 critically ill children, of whom 450 with early severe thrombocytopenia were matched to 450 without early severe thrombocytopenia. Univariate and multivariate logistic regression results showed that early severe thrombocytopenia was an independent risk factor for in-hospital mortality in critically ill children in both the original and PSM groups. In addition, the study results of platelet course showed that the recovery of platelet count to ≥150 × 10⁹/L in the short term was a protective factor for the prognosis of patients (OR, 0.301; 95% CI, 0.139-0.648, P = 0.002). Our study revealed that early severe thrombocytopenia is an independent risk factor for in-hospital mortality in critically ill children. In addition, in-hospital mortality was significantly reduced in children with early severe thrombocytopenia, whose platelet count returned to normal levels in the short term.