Abstract: FR-PO052

Thrombocytopenia Predicts Mortality in Patients with AKI Requiring Renal Replacement Therapy (RRT)

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Griffin, Benjamin, University of Colorado, Aurora, Colorado, United States
  • You, Zhiying, UC Denver, Aurora, Colorado, United States
  • Palevsky, Paul M., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Faubel, Sarah, University of Colorado Denver, Denver, Colorado, United States
  • Jalal, Diana I., University of Colorado Denver Health Science Center, Aurora, Colorado, United States
Background

Thrombocytopenia is common in critically ill patients and is associated with increased mortality. The impact of thrombocytopenia in patients requiring RRT for AKI is unknown. In this study we assessed the prognostic value of thrombocytopenia at RRT initiation in a large database of critically patients with AKI requiring RRT.

Methods

We conducted a secondary analysis of the Acute Renal Failure Trial Network (ATN) database. The ATN study compared intensive to less-intensive RRT dosing strategies in patients with AKI. In this analysis, patients were categorized based on pre-RRT platelet levels, which were classified as normal (> 100 x 103/µL), moderate (50-100 x 103/µL) and severe (<50 x 103/µL) thrombocytopenia. 60-day mortality was compared using chi-squared test. Logistic regression was used to adjust for age, race, and gender in the initial model, and body mass index (BMI) and SOFA score in the final model.

Results

62% of patients had at least moderate thrombocytopenia prior to initiation, and 14% had severe thrombocytopenia. Thrombocytopenia was highly associated with 60-day mortality even after adjustments for demographics and illness severity (Table 1). In patients who survived >72 hours, the platelet decrease at day 3 as a continuous variable did not have a clinically relevant association with 60-day mortality, with an OR of 0.996 (0.993 - 0 .999, p = 0.02).

Conclusion

Thrombocytopenia is present > 60% of patients with at the initiation of RRT and is independently and significantly associated with increased mortality even after adjusting for illness severity. The role of thrombocytopenia in outcomes of patients with AKI requiring RRT merits future study.

Table 1. Final multivariate model for 60-day ICU mortality. Platelet levels are compared to <50 x10^3/µL
VariableOR (95% CI)P value
Platelet Level 50-100 x10^3/µL0.46 (0.27 -0 .79).0047
Platelet Level >100 x10^3/µL0.34 (0.20 – 0.55)<0.0001
SOFA Score1.30 (1.18 – 1.42)<0.0001
Female Gender0.91 (0.64 – 1.28)0.57
African-American Race1.21 (0.78 – 1.86)0.38
Age (years)1.03 (1.02 – 1.04)<0.0001
BMI (kg/m^2)0.98 (.095 – 1.00)0,06