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Etiology and complications of thrombocytopenia in hospitalized medical patients

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Abstract

To determine incidence, risk factors, hematologic complications, and prognostic significance of thrombocytopenia in the general medicine population, we performed a single-institutional, retrospective study of all adult patients admitted to a general medical ward from January 1st, 2014 to December 31st, 2014 with hospital-acquired thrombocytopenia. Those with moderate thrombocytopenia, defined as a platelet count nadir of <100 × 10^9/L and/or a >50% relative decline, were compared to those with less severe thrombocytopenia. Of the 7420 patients admitted, 465 (6.3%) developed hospital-acquired thrombocytopenia. Infection and moderate thrombocytopenia were present in 56 and 23%, respectively. Severe sepsis and antibiotic use were both associated with moderate thrombocytopenia, and proton pump inhibitor use was statistically significant in both univariate and multivariate analysis. Hematologic complications were more frequent with moderate thrombocytopenia, including frequency of HIT testing and red blood cell transfusions. Outcome metrics including transfer to an intensive care unit (OR 6.78), death during admission (OR 6.85), and length of stay (10.6 vs. 5.1 days) were all associated with moderate thrombocytopenia. Thrombocytopenia is associated with poor prognosis, and the association between moderate thrombocytopenia and proton pump inhibitor use is relatively novel and should be validated in prospective studies.

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Funding

This study was funded by a Duke Internal Medicine Research Award.

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Authors and Affiliations

  1. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Eric M. Fountain & Gowthami M. Arepally

  2. Division of Hematology, Duke University Medical Center, Durham, NC, USA

    Gowthami M. Arepally

  3. Division of Hematology, DUMC, Rm 301 Alex H. Sands Bldg. Research Drive, Box 3486, Durham, NC, 27710, USA

    Eric M. Fountain

Authors
  1. Eric M. Fountain
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Correspondence to Eric M. Fountain.

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Conflict of interest

Dr. Fountain and Dr. Arepally have no conflict of interests to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

As a retrospective study, informed consent was waived with permission of the Duke Institutional Review Board.

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Fountain, E.M., Arepally, G.M. Etiology and complications of thrombocytopenia in hospitalized medical patients. J Thromb Thrombolysis 43, 429–436 (2017). https://doi.org/10.1007/s11239-016-1467-8

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  • DOI: https://doi.org/10.1007/s11239-016-1467-8

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