The frequency of thrombocytopenia in ICU, causes of mortality and morbidity and to investigate the correlation

Purpose: Thrombocytopenia is a highly common clinical problem encountered in Intensive Care Units. The purpose of the present study is to determine the thrombocytopenia frequency in Ç.Ü.T.F. Internal Medicine Intensive Care Unit, the underlying causes of thrombocytopenia, clinical results, and the coefficient to the mortality and morbidity as well as to review the management of the intensive care patients with thrombocytopenia in the light of such results. Material and Method: 548 patients monitored by Ç.Ü.T.F. Internal Medicine Intensive Care Unit are examined between July 2011 and August 2012. Within these patients, 165 of them are included in the study with thrombocyte count below 150.000/uL. The causes of thrombocytopenia are investigated. Patients with thrombocytopenia are divided into 4 groups (0-19.000/uL, 20-49.000/uL, 50-99.000/uLand 100-149.000/uL) based on their thrombocyte count, three groups (10-24, 25-34, 35 and above) based on their APACHE II scores and then their mortality, hospitalization duration in the Intensive Care, coagulation parameters, hemoglobin, White Blood Cell values and thrombocytopenia development days are examined. Mortality and Intensive Care hospitalization durations of the patients with thrombocytopenia and without thrombocytopenia are compared. Findings: A total of 548 patients were monitored in the Internal Medicine Intensive Care Unit during the study period and 165 of them were noted with thrombocytopenia (30,1%). 61 of the patients were female (37%), and 104 of the patients were male (63%). The mean age was 57,2±16,4 (min: 18, max: 91). While 143 of the patients monitored (81,2%) had existing thrombocytopenia during their admittance to the intensive care; 31 of them (18,8%) developed thrombocytopenia during their intensive care monitoring. Sepsis was the cause of thrombocytopenia in 30 of the patients (18%), and DIC was the cause of thrombocytopenia in 18 of the patients (10,9%). The mean APACHE II score calculated on the first day of admittance to the Intensive Care was 22 (min: 10, max: 42). 288 of the 548 patients (52,5%) monitored in the Internal Medicine Intensive Care Unit manifested exitus during the study period. 260 patients (47,5%) were referred to services or discharged. 115 of 165 thrombocytopenic patients (69,7%) and 173 of 383 non- thrombocytopenic patients (45,1%) included in our study manifested exitus. Accordingly, mortality is significantly higher in patients with thrombocytopenia (p=0,020). 37 of 44 patients (84,1%) with lowest thrombocytopenia level achieved below 20.000/uL, 46 of 62 patients (74,2%) with lowest thrombocytopenia level achieved between 20 and 50.000/uL, and 32 of 59 patients (54,2%) with lowest thrombocytopenia level achieved above 50.000/uLdeveloped exitus; it is observed that the mortality statistically significantly increased as the lowest thrombocytopenia level achieved decreased (thrombocytopenia deepened) (p=0,003). Furthermore, it is seen that the mortality statistically significantly increased as the thrombocytopenia count decreased in the patient groups with same APACHE II score (p=0,002). XIConclusion: The most common causes of Thrombocytopenia in Ç.Ü.T.F. Internal Medicine Intensive Care Unit are Sepsis and DIC, and Thrombocytopenia is a factor increasing the mortality. Keywords: Thrombocytopenia, thrombocytopenia in Intensive Care, APACHE II, Thrombocytopenia and mortality, Sepsis, DIC, Immune thrombocytopenia, Medicine linked thrombocytopenia, Heparin linked thrombocytopenia