Thrombocytopenia: A Risk Factor of Mortality for Patients with Sepsis in the Intensive Care Unit.

OBJECTIVES: The objective of this study was to evaluate the intensive care unit (ICU) and long-term mortality in sepsis patients with/without thrombocytopenia on the fifth day of ICU admission. MATERIALS AND METHODS: The retrospective observational cohort study was performed in a teaching hospital, and patients with sepsis who stayed more than 4 days in the ICU between January 2012 and December 2012 were included. Patients were divided into two groups according to thier platelet count at fifth day of ICU stay: Group 1, < 150.000/µL; Group 2, >150.000/µL. Patients having thrombocytopenia on admission were excluded. The patients' characteristics, comorbid diseases, body mass index, arterial blood gas analysis and blood biochemistry results, SIRS criteria, Acute Physiological and Chronic Health Evaluation Score II (APACHE II), implication of invasive and non-invasive mechanical ventilation, use of sedation, nutrition information, and culture results of microbiological samples were recorded. The groups were compared according to the recorded data. Logistic regression analysis was performed for ICU mortality; the Kaplan-Meier test was used to evaluate 12-month survival after ICU discharge. RESULTS: During the period, 1003 patients were admitted to the ICU; 307 sepsis patients were included in the study. Group 1 (n= 67) and Group 2 (n=240) had similar patient characteristics and sepsis findings. The groups had similar ICU and hospital stays; mortality was higher in Group 1 than in Group 2 (40.3% vs. 17.5%, respectively, p< 0.001). Fifth day thrombocytopenia, septic shock, male gender, and low albumin levels were found to be risk factors of ICU mortality; the respective odds ratios, 95% confidence intervals, and p values for these factors were 3.03, [1.15-7.45], p= 0.025; 4.97, [1.79-13.86], p= 0.002; 3.61, [1.27-10.23], p= 0.001; and 0.19, [0.07-0.52], p= 0.001. Follow-up after a year indicated that 124 out of 238 (52.1%) patients died, and 50% of the deaths occurred in the first 2 months. Kaplan-Meier analysis revealed no statistically significant effects of thrombocytopenia at ICU day 5 on 12-month mortality after ICU discharge. CONCLUSION: Higher rates of septic shock and mortality were seen in sepsis patients with thrombocytopenia in the ICU. The measurement of thrombocytopenia in the ICU, which is easy and low-cost, may help to predict mortality. Thus, precautions can be taken early in patient treatment and follow-up. As we know, early intervention is crucial in the approach to sepsis.

Pneumonia caused by diesel fuel aspiration.

An 18 years old Turkish boy was admitted to hospital due to cough, chest pain and shortness of breath for 4 days. Twentyfour hours before the onset of symptoms, the patient had accidentally aspirated diesel while siphoning from the fuel tank of a car. On admission, he was febrile and tachypnoeic. There were fine crackles on auscultation of the lungs. Chest X-ray revealed bilateral infiltration in the lower lung zones. Arterial blood gas analysis showed pH of 7.42, PaO2 of 45.6 mmHg, PaCO2 of 41.3 mmHg and oxygen saturation of 85.2%. He was treated with course of corticosteroid, antibiotic and oxygen supplementation. Chest X-ray showed near-complete resolution 2 weeks after discharge.

How do COPD comorbidities affect ICU outcomes?

BACKGROUND AND AIM: Chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) frequently require admission to the intensive care unit (ICU) for application of mechanical ventilation (MV). We aimed to determine whether comorbidities and clinical variables present at ICU admission are predictive of ICU mortality. METHODS: A retrospective, observational cohort study was performed in a tertiary teaching hospital's respiratory ICU using data collected between January 2008 and December 2012. Previously diagnosed COPD patients who were admitted to the ICU with ARF were included. Patients' demographics, comorbidities, body mass index (BMI), ICU admission data, application of noninvasive and invasive MV (NIV and IMV, respectively), cause of ARF, length of ICU and hospital stay, and mortality were recorded from their files. Patients were grouped according to mortality (survival versus non-survival), and all the variables were compared between the two groups. RESULTS: During the study period, a total of 1,013 COPD patients (749 male) with a mean age (standard deviation) of 70 ± 10 years met the inclusion criteria. Comorbidities of the non-survival group (female/male, 40/131) were significantly higher compared with the survival group (female/male, 224/618): arrhythmia (24% vs 11%), hypertension (42% vs 34%), coronary artery disease (28% vs 11%), and depression (7% vs 3%) (P<0.001, P<0.035, P<0.001, and P<0.007, respectively). Logistic regression revealed the following mortality risk factors: need of IMV, BMI <20 kg/m(2), pneumonia, coronary artery disease, arrhythmia, hypertension, chronic hypoxia, and higher acute physiology and chronic health evaluation II (APACHE II) scores. The respective odds ratios, confidence intervals, and P-values for each of these were as follows: 27.7, 15.7-49.0, P<0.001; 6.6, 3.5-412.7, P<0.001; 5.1, 2.9-8.8, P<0.001; 2.9, 1.5-5.6, P<0.001; 2.7, 1.4-5.2, P<0.003; 2.6, 1.5-4.4, P<0.001; 2.2, 1.2-3.9, P<0.008; and 1.1, 1.03-1.11, P<0.001. CONCLUSION: Patients with severe COPD and cardiac comorbidities and cachexia should be closely monitored in ICU due to their high risk of ICU mortality.

Reasons for ICU demand and long-term follow-up of a chronic obstructive pulmonary disease cohort.

Acute respiratory failure (ARF) can necessitate mechanical ventilation and intensive care unit (ICU) admission in patients with COPD. We evaluated the reasons COPD patients are admitted to the ICU and assessed long-term outcomes in a retrospective cohort study in a respiratory level-III ICU of a teaching government hospital between November 2007 and April 2012. All COPD patients admitted to ICU for the first time were enrolled and followed for 12 months. Patient characteristics, body mass index (BMI), long-term oxygen therapy (LTOT), non-invasive ventilation (LT-NIV) at home, COPD co-morbidities, reasons for ICU admission, ICU data, length of stay, prescription of new LTOT and LT-NIV, and ICU mortality were recorded. Patient survival after ICU discharge was evaluated by Kaplan-Meier survival analysis. A total of 962 (710 male) patients were included. The mean age was 70 (SD 10). The major reasons for ICU admission were COPD exacerbation (66.7%) and pneumonia (19.7%). ICU and hospital mortality were 11.4%, 12.5% respectively, and 842 patients were followed-up. The new LT-NIV prescription rate was 15.8%. The 6-month 1, 2, 3, and 5-year mortality rates were 24.5%, 33.7%, 46.9%, 58.9% and 72.5%, respectively. Long-term survival was negatively affected by arrhythmia (p < 0.013) and pneumonia (p < 0.025). LT-NIV use (p < 0.016) with LTOT (p < 0.038) increase survival. Pulmonary infection can be a major reason for ICU admission and determining outcome after ICU discharge. Unlike arrhythmia and pneumonia, LT-NIV can improve long-term survival in eligible COPD patients.