Thrombocytopenia upon Admission in Pediatric Septic Patients is Associated with a Higher Vasopressors Requirement | Insight Medical Publishing

Background: Thrombocytopenia has been identified as a reliable predictor of increased morbidity and mortality in critically ill patients admitted to the pediatric intensive care unit (PICU). In this study, we assessed the clinical outcomes of patients admitted to the PICU with sepsis and concomitant thrombocytopenia. Methods: A retrospective chart review was performed focusing on patients admitted to the PICU at a tertiary care institution with a documented diagnosis of sepsis, severe sepsis or septic shock between January 1st, 2011 and June 30th, 2015. Patients were divided into two groups: those with a normal platelet count on admission (platelet count ≥ 150,000/ μL) and those with thrombocytopenia (<150,000/ μL). Results: 138 charts were reviewed and a total of 71 sepsis admissions were analyzed. Of these, 28 (39.5%) had thrombocytopenia. We determined that patients with thrombocytopenia had a higher need for vasopressors as compared to those with normal platelet counts. (22.5% vs 15.5% respectively; p<0.01) This association was especially significant in patients with gram-negative sepsis. The overall mortality in our study population was 6.9% (n=5). The mortality for septic patients with thrombocytopenia was 10.7% (n=3) versus 4.7% (n=2) for septic patients with a normal platelet counts. This difference was not statistically significant. Conclusions: Thrombocytopenia on admission in septic pediatric patients is associated with a higher vasopressor requirement. This association is even stronger in patients with gram-negative sepsis and concomitant thrombocytopenia.