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Platelet counts of adults upon acute hospital admission to internal medicine units are a predictor of mortality

  • Guillaume MoulisEmail author
  • Christian Fynbo Christiansen
  • Bianka Darvalics
  • Ina Trolle Andersen
  • Henrik Toft Sørensen
  • Mette Nørgaard
Original Article
  • 13 Downloads

Abstract

The objective of this cohort study was to examine the association between platelet counts upon acute hospitalization and mortality. The study included all adults in North and Central Denmark Regions with a first acute admission to an internal medicine unit during 2006–2012, categorized by first platelet count within +/−24 hours of admission. We assessed the association between platelet count and in-hospital, 30-day, 90-day, and 365-day mortality using age- and sex-adjusted Cox models. We also stratified analyses by presence/absence of comorbidity and performed additional analyses restricted to patients with a primary discharge diagnosis of cardiovascular disease or infection. Among the 274,148 study patients, the 1-year mortality was 12.6%. The association between platelet count and mortality took the form of an asymmetric U-shaped curve. For 30-day mortality, hazard ratios (HRs) were 5.24 (95% CI: 4.60–5.97) for platelet count < 50 × 109/L and 2.50 (95% CI: 2.33–2.69) for platelet count ≥ 500 × 109/L, compared with a normal platelet count (150–400 × 109/L). A slightly increased risk of mortality was observed for platelet counts < 200 × 109/L and ≥ 250 × 109/L. A similar pattern was observed for 30-day, 90-day, and 365-day mortality and in all subgroups except patients with a primary discharge diagnosis of infection. In this case, patients with a platelet count between 150 × 109/L and 199 × 109/L had the lowest mortality. Platelet counts in adults upon acute hospital admission to internal medicine units, including counts within the normal range, are a predictor of mortality.

Keywords

Platelet count Mortality Acute hospitalization 

Notes

Acknowledgments

To conduct this study, GM received grants from the Foundation for the Development of Internal Medicine in Europe (FDIME, linked to the European Federation of Internal Medicine), from the Institut Servier, and from Toulouse University Hospital (CHU de Toulouse).

Authors’ contributions

GM, MN, CFC, and HTS designed the study; GM, BD, and ITA made the data management and the statistical analyses; GM, MN, CFC, and HTS wrote the manuscript. All the authors critically reviewed the manuscript and gave final approval for submission.

Compliance with ethical standards

In accordance with Danish law, we obtained permission from the Danish Data Protection Agency for this study (Record no. 2015-57-0002, Aarhus University record no. 2016-051-000001/396).

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

277_2019_3855_MOESM1_ESM.docx (3.9 mb)
ESM 1 (DOCX 3960 kb)

References

  1. 1.
    Xu XR, Zhang D, Oswald BE, Carrim N, Wang X, Hou Y, Zhang Q, Lavalle C, McKeown T, Marshall AH, Ni H (2016) Platelets are versatile cells: new discoveries in hemostasis, thrombosis, immune responses, tumor metastasis and beyond. Crit Rev Clin Lab Sci 53:409–430CrossRefGoogle Scholar
  2. 2.
    Bonaccio M, Di Castelnuovo A, Costanzo S, De Curtis A, Donati MB, Cerletti C, de Gaetano G, Iacoviello L, MOLI-SANI Investigators (2016) Age-sex-specific ranges of platelet count and all-cause mortality: prospective findings from the MOLI-SANI study. Blood 127:1614–1616CrossRefGoogle Scholar
  3. 3.
    Vinholt PJ, Hvas AM, Frederiksen H, Bathum L, Jørgensen MK, Nybo M (2016) Platelet count is associated with cardiovascular disease, cancer and mortality: A population-based cohort study. Thromb Res 148:136–142CrossRefGoogle Scholar
  4. 4.
    Tsai M-T, Chen Y-T, Lin C-H, Huang T-P, Tarng D-C, Taiwan Geriatric Kidney Disease Research Group (2015) U-shaped mortality curve associated with platelet count among older people: a community-based cohort study. Blood 126:1633–1635CrossRefGoogle Scholar
  5. 5.
    Msaouel P, Lam AP, Gundabolu K, Chrysofakis G, Yu Y, Mantzaris I, Friedman E, Verma A (2014) Abnormal platelet count is an independent predictor of mortality in the elderly and is influenced by ethnicity. Haematologica 99:930–936CrossRefGoogle Scholar
  6. 6.
    Moulis G, Christiansen CF, Darvalics B, Nørgaard M (2018) Prevalence of thrombocytopenia and thrombocytosis upon acute hospital admission to internal medicine units. A cross-sectional study in Denmark. Eur J Intern Med 57:e34–e37CrossRefGoogle Scholar
  7. 7.
    Morrell CN, Aggrey AA, Chapman LM, Modjeski KL (2014) Emerging roles for platelets as immune and inflammatory cells. Blood 123:2759–2767CrossRefGoogle Scholar
  8. 8.
    Parikh F (2016) Infections and thrombocytopenia. J Assoc Physicians India 64:11–12PubMedGoogle Scholar
  9. 9.
    Lampah DA, Yeo TW, Malloy M, Kenangalem E, Douglas NM, Ronaldo D, Sugiarto P, Simpson JA, Poespoprodjo JR, Anstey NM, Price RN (2015) Severe malarial thrombocytopenia: a risk factor for mortality in Papua, Indonesia. J Infect Dis 211:623–634CrossRefGoogle Scholar
  10. 10.
    Pinto RC, de Castro DB, de Albuquerque BC, de S Sampaio V, Passos RAD, da Costa CF, Sadahiro M, Braga JU (2016) Mortality predictors in patients with severe dengue in the state of Amazonas, Brazil. PLoS One 11:e0161884CrossRefGoogle Scholar
  11. 11.
    Gorelik O, Izhakian S, Barchel D, Almoznino-Sarafian D, Tzur I, Swarka M, Beberashvili I, Feldman L, Cohen N, Shteinshnaider M (2017) Prognostic significance of platelet count changes during hospitalization for community-acquired pneumonia. Platelets 28:380–386CrossRefGoogle Scholar
  12. 12.
    Mirsaeidi M, Peyrani P, Aliberti S, Filardo G, Bordon J, Blasi F, Ramirez JA (2010) Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest 137:416–420CrossRefGoogle Scholar
  13. 13.
    Lee DY, Chung EL, Guend H, Whelan RL, Wedderburn RV, Rose KM (2014) Predictors of mortality after emergency colectomy for Clostridium difficile colitis: an analysis of ACS-NSQIP. Ann Surg 259:148–156CrossRefGoogle Scholar
  14. 14.
    Sohn SH, Kim KH, Park JH, Kim TN (2016) Predictors of mortality in Korean patients with pyogenic liver abscess: a single center, retrospective study. Korean J Gastroenterol 67:238–244CrossRefGoogle Scholar
  15. 15.
    Dettmer MR, Damuth E, Zarbiv S, Mitchell JA, Bartock JL, Trzeciak S (2017) Prognostic factors for long-term mortality in critically ill patients treated with prolonged mechanical ventilation: a systematic review. Crit Care Med 45:69–74CrossRefGoogle Scholar
  16. 16.
    Guru PK, Singh TD, Akhoundi A, Kashani KB (2016) Association of thrombocytopenia and mortality in critically ill patients on continuous renal replacement therapy. Nephron 133:175–182CrossRefGoogle Scholar
  17. 17.
    Delsart P, Beregi J-P, Devos P, Haulon S, Midulla M, Mounier-Vehier C (2014) Thrombocytopenia: an early marker of late mortality in type B aortic dissection. Heart Vessel 29:220–230CrossRefGoogle Scholar
  18. 18.
    Lo P-H, Huang Y-F, Chang C-C, Yeh C-C, Chang C-Y, Cherng Y-G, Chen T-L, Liao C-C (2016) Risk and mortality of gastrointestinal hemorrhage in patients with thrombocytopenia: Two nationwide retrospective cohort studies. Eur J Intern Med 27:86–90CrossRefGoogle Scholar
  19. 19.
    Prina E, Ferrer M, Ranzani OT, Polverino E, Cillóniz C, Moreno E, Mensa J, Montull B, Menéndez R, Cosentini R, Torres A (2013) Thrombocytosis is a marker of poor outcome in community-acquired pneumonia. Chest 143:767–775CrossRefGoogle Scholar
  20. 20.
    Harrison MT, Short P, Williamson PA, Singanayagam A, Chalmers JD, Schembri S (2014) Thrombocytosis is associated with increased short and long term mortality after exacerbation of chronic obstructive pulmonary disease: a role for antiplatelet therapy? Thorax 69:609–615CrossRefGoogle Scholar
  21. 21.
    Salim A, Hadjizacharia P, DuBose J, Kobayashi L, Inaba K, Chan LS, Margulies DR (2009) What is the significance of thrombocytosis in patients with trauma? J Trauma 66:1349–1354CrossRefGoogle Scholar
  22. 22.
    Gurung AM, Carr B, Smith I (2001) Thrombocytosis in intensive care. Br J Anaesth 87:926–928CrossRefGoogle Scholar
  23. 23.
    Schmidt M, Pedersen L, Sørensen HT (2014) The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 29:541–549CrossRefGoogle Scholar
  24. 24.
    Grann AF, Erichsen R, Nielsen AG, Frøslev T, Thomsen RW (2011) Existing data sources for clinical epidemiology: the clinical laboratory information system (LABKA) research database at Aarhus University, Denmark. Clin Epidemiol 3:133–138CrossRefGoogle Scholar
  25. 25.
    Lynge E, Sandegaard JL, Rebolj M (2011) The Danish National Patient Register. Scand J Public Health 39:30–33CrossRefGoogle Scholar
  26. 26.
    Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT (2015) The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490CrossRefGoogle Scholar
  27. 27.
    Vest-Hansen B, Riis AH, Christiansen CF (2013) Registration of acute medical hospital admissions in the Danish National Patient Registry: a validation study. Clin Epidemiol 5:129–133CrossRefGoogle Scholar
  28. 28.
    Royston P (2000) A strategy for modelling the effect of a continuous covariate in medicine and epidemiology. Stat Med 19:1831–1847CrossRefGoogle Scholar
  29. 29.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  30. 30.
    Thygesen SK, Christiansen CF, Christensen S, Lash TL, Sørensen HT (2011) The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients. BMC Med Res Methodol 11:83CrossRefGoogle Scholar
  31. 31.
    Ludvigsson JF, Håberg SE, Knudsen GP, Lafolie P, Zoega H, Sarkkola C, von Kraemer S, Weiderpass E, Nørgaard M (2015) Ethical aspects of registry-based research in the Nordic countries. Clin Epidemiol 7:491–508CrossRefGoogle Scholar
  32. 32.
    Bedet A, Razazi K, Boissier F, Surenaud M, Hue S, Giraudier S, Brun-Buisson C, Dessap AM (2018) Mechanisms of thrombocytopenia during septic shock: a multiplex cluster analysis of endogenous sepsis mediators. Shock 49:641–648CrossRefGoogle Scholar
  33. 33.
    Greinacher A, Selleng S (2016) How I evaluate and treat thrombocytopenia in the intensive care unit patient. Blood 128:3032–3042CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Clinical Epidemiology, Institute of Clinical MedicineAarhus University HospitalAarhusDenmark

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