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Kidney Week

Abstract: SA-PO553

Platelet Decrease Following Continuous Renal Replacement Therapy (CRRT) Initiation Predicts Mortality in Patients with Severe AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Griffin, Benjamin, University of Colorado, Aurora, Colorado, United States
  • Arruda, Nigel, University of Colorado, Aurora, Colorado, United States
  • Jovanovich, Anna Jeanette, Denver VA / University of Colorado, Denver, Colorado, United States
  • Gist, Katja M., University of Colorado, Children''s Hospital Colorado, Aurora, Colorado, United States
  • Aftab, Muhammad, University of Colorado, Anschutz Medical Center, Aurora, Colorado, United States
  • Jalal, Diana I., University of Iowa, Iowa City, Iowa, United States
  • Faubel, Sarah, University of Colorado Denver, Denver, Colorado, United States
Background

Thrombocytopenia is common in critically ill patients and is associated with increased mortality. Recent data suggest that CRRT is associated with decreased circulating platelet levels, possibly due to consumptive platelet-filter interactions. The impact of this platelet decrease on mortality is unclear. The purpose of this study was to examine the impact of platelet decrease following CRRT initiation on in-hospital mortality.

Methods

We conducted a retrospective analysis of adult patients initiated on CRRT at the University of Colorado Hospital between July 2015 and September 2016. Patients who died < 24 hours after CRRT initiation were excluded. Patients were categorized based on the percentage decrease from pre-CRRT levels to nadir following CRRT initiation: (1) no decrease (platelet increase from baseline), (2) mild decrease (0-50% decrease), and (3) severe decrease (>50% decrease). The primary outcome was in-hospital mortality. Logistic regression was used to adjust for SOFA score (excluding platelet component), body mass index (BMI), gender, and baseline platelets.

Results

A total of 154 cases met inclusion criteria. Platelet counts decreased in 101 (65.6%) patients and 38 (24.7%) had a decrease of >50%. In-hospital mortality occurred in 72 (46.7%) patients. Patients with a severe decrease in platelets were 3.16 times more likely to die in the hospital compared to patients with an increase in platelets after adjusting for confounders (Table 1). In this study, <50% platelet decrease was not associated with mortality.

Conclusion

Platelet consumption following CRRT initiation is common, and a severe decrease is independently associated with mortality after adjusting for confounders. The mechanism of platelet decrease and its impact on mortality in patients requiring CRRT merits further study.

Table 1. Effect of platelet decrease in final multivariate model for in-hospital mortality
VariableOR (95% CI)p value
Platelet Decrease > 50%*3.16 (1.11 - 8.99)0.003
Platelet Decrease 0-50%*1.59 (0.64 - 3.95)0.3

*Platelet decreases are in comparison to patients with an increase in platelets following CRRT initiation. The model was also adjusted for SOFA score (minus platelet component), Gender, BMI, and baseline platelets.

Funding

  • Other NIH Support