Association of platelet counts decline and mortality in severely burnt patients

• Published in: Journal of critical care Vol. 27; no. 5; pp. 529.e1 - 529.e7
• Main Authors: Guo, Feng, MD, Wang, Xiaojin, PhD, Huan, Jingning, MD, Liang, Xun, MD, Chen, Bin, MD, Tang, Jiajun, MD, PhD, Gao, Chengjin, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2012; Elsevier Limited
• Subjects: Adult; APACHE; Biomarkers; Burn; Burn Units - statistics & numerical data; Burns; Burns - blood; Burns - mortality; Critical Care; Female; Hospitalization; Hospitals; Humans; Male; Middle Aged; Mortality; Outcome; Patients; Platelet; Platelet Count; Prognosis; Retrospective Studies; ROC Curve; Sex Factors; Thrombocytopenia; PPC; platelet counts; full-thickness burns; PT; prothrombin time; interquartile range; odds ratio; FT; FDP; total body surface area; the percentage decline of PCs; APACHE-II score; fibrin degradation product; TBSA; receiver operating characteristic; Thrombocytopenia; PCs; OR; CI; Mortality; ROC; overtDIC; IQR; Burn; APTT; Platelet; activated partial thromboplastin time; Acute Physiology And Chronic Health Evaluation II score; Outcome; overt disseminated intravascular coagulation; confidence interval
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2011.12.006

Abstract Although the dramatic fluctuation of platelet counts (PCs) has always been observed in severely burnt patients, the underlying relationship between the decline of PCs and mortality has never been well defined. In this study, we evaluated the prognostic implications of PC decline in severely burnt patients. We performed a 3-year retrospective chart of adult patients with a burn index of 50 or greater admitted to 2 burn centers. A total of 97 survivors and 51 nonsurvivors were included in this study. The trends of PCs in 2 groups within first 10 days after admission are seen to constitute 2 stages, with a slump to a nadir during the first 3 days and then a variable recovery. With respect to 30-day mortality, the areas under the receiver operating characteristic curve for the percentage decline of PCs (PPC) during the first 3 days and Acute Physiology And Chronic Health Evaluation II score were 0.784 and 0.871, respectively ( P = .0549). Furthermore, an optimal cutoff of PPC during the first 3 days, which discriminated survivors with nonsurvivors, was 65.53% using the maximum Youden index (0.4853). Although the sensitivity and specificity of PPC during the first 3 days were not as high as the Acute Physiology And Chronic Health Evaluation II score in the present study, Kaplan-Meier estimation and multiple logistic regression models both indicated that a PPC of 65% or greater during the first 3 days was significantly associated with 30-day death (odds ratio, 1.054; 95% confidence interval, 1.006-1.104; P = .028). In summary, an initial slump of PCs, especially a PPC of 65% or greater during the first 3 days, provides prognostic significance for 30-day mortality in severely burnt patients.