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Abstract: PO0209

Admission Platelet Count Is an Independent Predictor of AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Griffin, Benjamin R., The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Miell, Kelly, Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Perencevich, Eli, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Reisinger, Heather, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Sarrazin, Mary Vaughan, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Schweitzer, Marin R., Iowa City VA Medical Center, Iowa City, Iowa, United States
  • Jalal, Diana I., The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Background

Thrombocytopenia is a recognized marker of disease severity that is associated with higher mortality in patients with sepsis-associated acute kidney injury (SA-AKI). It is plausible that thrombocytopenia is also a predictor of SA-AKI development due to the characterisitic microvascular dysfunction seen in this disease state, but human studies are lacking. In this analysis, we evaluated admission platelet counts and SA-AKI rates in a large VA database of patients with methacillin-resistant staph aureus (MRSA) bacteremia.

Methods

We evaluated patients admitted to 124 VA Hospitals who developed MRSA bloodstream infections during a hospitalization from 2007-2014. Patients were excluded if platelet counts or creatinine values were not available on 2 or more days. Predictor variables were platelet counts <150 and <100 at admission. Primary outcome was the development of in-hospital AKI, defined as a platelet increase of 0.3 mg/dL over 48 hours, or an increase of 1.5x baseline within 7 days. Cox proportional hazard modeling was used to determine the association between predictors and primary outcome, and covariates were chosen using forward stepwise regression. Potential covariates evaluated for inclusion were age, race, admission laboratory values, comorbidities, antibiotic agents, infection location, healthcare utilization prior to admission, and surgical intervention, among others.

Results

A total of 6,765 patients were included, of which 2,656 (39.3%) developed AKI during admission. At admission, 1,633 (24.1%) and 757 (11.2%) had platelet counts <150 and <100, respectively. AKI rates in these pateints were 44.1% and 46.2%, respecitvely. Hazard ratios for AKI were 1.17 (CI 1.07-1.28) in patients with platelets <150, and 1.24 (CI 1.10-1.39) in patients <100.

Conclusion

Platelet counts of <150 and <100 at admission were found to be independent predictors of subsequent SA-AKI development in a large database of patients with MRSA bacteremia. These findings may inform future studies in the prevention and prediction of AKI development.