Thrombocytopenia in Septic Shock: Key Factors Linked to High Mortality
Abstract:
Introduction: Thrombocytopenia is a common complication among patients in intensive care units (ICUs), particularly those suffering from septic shock. It is strongly associated with poor outcomes, including increased mortality. This study aims to examine the epidemiological, clinical, biological, therapeutic, and prognostic characteristics of these patients to identify predictive factors for mortality
Methods: We conducted a retrospective study of 148 patients with septic shock and thrombocytopenia admitted to the Surgical Emergency Intensive Care Unit at IBN ROCHD University Hospital, Casablanca, from January 1, 2020, to December 31, 2023. Patients with platelet counts below 150,000/µL were included. Data on demographics, clinical and biological parameters, treatments, and outcomes were analyzed. Multivariate logistic regression was used to identify factors associated with mortality.
Results: Of the 199 patients with septic shock, 148 (74.4%) developed thrombocytopenia. The average age of these patients was 55 years, with a predominance of male patients (sex ratio of 1.4). Key findings included an average ICU stay of 4.9 days and septic shock onset averaging 2.8 days after admission. Fever, mucosal purpura, and cutaneous purpura were common clinical signs. Most patients exhibited anemia (82%), leukocytosis (84%), and coagulation abnormalities, including low prothrombin rate (89%) and prolonged aPTT (75%). The mortality rate was high at 89%. Multivariate analysis revealed that factors significantly associated with increased mortality included fever or mucosal purpura, anemia, low prothrombin rate, prolonged aPTT, elevated CRP levels (≥ 250 mg/L), and transfusions of red blood cells or fresh frozen plasma. Conversely, a lower CRP level and the use of heparin were associated with better outcomes.
Conclusion: Thrombocytopenia in septic shock patients is a critical marker for identifying those at high risk of mortality. While transfusion of platelet concentrates was not associated with improved outcomes in this study, further research is needed to clarify its role. Identifying and addressing predictive factors can improve patient management and reduce mortality.
