Frequency of Thombocytopenıa in Intensıve Care Patıents and Related Factors

Year 2021, , 33 - 43, 30.04.2021

Cem Ece

https://doi.org/10.34084/bshr.843462

Abstract

Aim:
Thrombocytopenia is a common hematological disorder in intensive care patients with serious consequences. Determining the etiology as well as detecting thrombocytopenia is important in terms of patient management and treatment planning. In our study, it was aimed to examine the incidence of thrombocytopenia and related factors in patients hospitalized in our general intensive care unit.
Materials and Methods:
In our retrospective study, the information of patients hospitalized in the Intensive Care clinic was retrospectively and randomly scanned. Deep thrombocytopenia was considered to be less than 50,000 / μL of the patients, and the development of thrombocytopenia in the first five days of hospitalization in the intensive care unit was accepted as early stage thrombocytopenia. Statistical analyzes were performed using SPSS version 17.0 software. Mann-Whitney U test, Pearson's Chi Square or Fisher's Exact Chi Square test were used for comparisons. Logistic regression analysis was performed to determine the risk factor. The cases where the p-value was less than 0.05 were considered statistically significant.
Results:
83 female (53.2%), 73 male (46.8%) 156 patients were included in our study. While the number of patients with thrombocytopenia was found in 26 (16.7%) during the first admission to intensive care, it was observed that thrombocytopenia developed in 23 (14.7%) of the patients during the days of hospitalization in the intensive care unit. Deep thrombocytopenia was detected in 9 (5.8%) patients.
The mean time to onset of thrombocytopenia was 5.8 ± 5.1 days and the median was 4 (IQR = 6) (min-max 1-20) days. The number of patients who developed early thrombocytopenia was 7 (4.48%). It was observed that 30.4% of the patients who developed thrombocytopenia during the days of intensive care hospitalization were thrombocytopenic in the early period. The incidence of thrombocytopenia in patients with sepsis was 48.1% (n = 26), and the rate of thrombocytopenia in those who did not develop was found to be 22.5% (n = 23). The rate of development of thrombocytopenia (n = 1) in patients using linezolid was found to be 4.3%.
Discussion:
In our study, the incidence of thrombocytopenia developed during admission to intensive care and during hospitalization is consistent with other studies. The rate of deep thrombocytopenia found during hospitalization in intensive care is higher than in other studies. This rate may be due to the fact that our study was conducted in tertiary care patients, the proportion of patients diagnosed with sepsis and the use of multiple drugs.
In our study, the mortality rate in patients with early thrombocytopenia (n = 7) was not found to be statistically significant compared to those with late thrombocytopenia; It was observed that the presence of sepsis significantly increased the incidence of thrombocytopenia.
Result:
Thrombocytopenia is a parameter that should be followed in terms of etiology and prognosis in intensive care patients.

Keywords

intensive care, thrombocytopenia, sepsis, deep thrombocytopenia, early thrombocytopenia

Yoğun Bakım Hastalarında Trombositopeni Sıklığı ve İlişkili Faktörler

Abstract

Amaç: Trombositopeni yoğun bakım hastalarında sık görülen ve ciddi sonuçlara yol açabilen bir hematolojik bozukluktur. Trombositopeniyi tespit etmek kadar etiyolojisini saptamak hasta yönetimi ve tedavinin planlaması açısından önemlidir. Çalışmamızda genel yoğun bakım ünitemizde yatan hastalarda trombositopeni insidansının ve ilişkili faktörlerin incelenmesi amaçlandı.
Gereç-Yöntem: Retrospektif yapılan çalışmamızda Yoğun Bakım kliniğinde yatan hastaların bilgileri retrospektif, randomize olaracak tarandı. Hastaların 50.000/μL altı trombosit değeri derin trombositopeni, yoğun bakıma yatışın ilk beş gününde trombositopeni gelişmesi ise erken dönem dönem trombositopeni kabul edildi. İstatistiksel analizler SPSS versiyon 17.0 yazılımı kullanılarak yapıldı. Karşılaştırmalar için Mann-Whitney U testi , Pearson's Chi Square veya Fisher's Exact Chi Square testi kullanıldı. Risk faktörü belirlemek için logistic regression analizi yapıldı. p-değerinin 0.05’in altında olduğu durumlar istatistiksel olarak anlamlı kabul edildi.
Bulgular: Çalışmamıza 83'ü kadın (%53.2), 73 ’ü erkek (%46.8 ) 156 hasta dahil edildi. Yoğun bakıma ilk yatış anında trombositopenisi olan hasta sayısı 26 (%16,7) bulunurken, Hastaların 23'ünde (%14,7) yoğun bakımda yattığı günler içerisinde trombositopeni geliştiği görüldü. Dokuz (%5,8) hastada ise derin trombositopeni saptandı.
Trombositopeninin ortaya çıkış süresi ortalama 5,8±5,1 gün ve medyan 4 (IQR=6) (min-maks 1-20) gün bulundu. Erken dönem trombositopeni gelişen hasta sayısı 7 (% 4,48) bulundu. Yoğun Bakıma yattığı günler içerisinde trombositopeni gelişen hastaların % 30.4’ünün erken dönemde trombositopenik olduğu görüldü. Sepsis gelişen hastalarda trombositopeni görülme oranı %48,1 (n=26), gelişmeyenlerde trombositopeni görülme oranı %22,5 (n=23) olarak bulumdu. Linezolid kullanan hastalarda trombositopeni gelişme oranı (n=1) %4,3 olarak bulundu.
Tartışma:
Çalışmamızda yoğun bakıma başvuruda ve yatış süresince gelişen trombositopeni insidansı diğer çalışmalarla uyumludur. Yoğun bakımda yatış süresince saptanan derin trombositopeni oranı diğer çalışmalara göre daha yüksektir. Bu oran çalışmamızın üçüncü basamak yoğun bakım hastalarında yapılmış olması, sepsis tanılı hasta oranına ve çoklu ilaç kullanımına bağlı olabilir. Çalışmamızda erken dönem trombositopeni gelişen hastalardaki mortalite oranı geç dönem trombositopeni gelişenlere göre istatistiksel olarak anlamlı bulunmazken; sepsis varlığının trombositopeni görülme oranını istatistiksel olarak anlamlı arttırdığı görüldü
Sonuç:
Yoğun bakımda hastalarında trombositopeni etiyoloji ve prognoz açısından takip edilmesi gereken bir parametredir.

Keywords

yoğun bakım, trombositopeni, sepsis, derin trombositopeni, erken trombositopeni

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