Thrombocytosis is a marker of poor outcome in community-acquired pneumonia.
Chest. 2012 Sep 10;
Authors: Prina E, Ferrer M, Ranzani OT, Polverino E, Cillóniz C, Moreno E, Mensa J, Montull B, Menéndez R, Cosentini R, Torres A
Abstract
ABSTRACT BACKGROUND: Thrombocytosis, often considered a marker of normal inflammatory reaction of infections, has been recently associated with increased mortality in hospitalized patients with community-acquired pneumonia (CAP). We assessed the characteristics and outcomes of patients with CAP and thrombocytosis (platelet count ?4x105/mm3), compared with thrombocytopenia (platelet count <105/mm3) and normal platelet count. METHODS: We prospectively analyzed 2,423 consecutive hospitalized patients with CAP. We excluded patients with immunosuppression, neoplasm, active tuberculosis or hematological disease. RESULTS: Fifty-three patients (2%) presented thrombocytopenia, 204 (8%) thrombocytosis and 2,166 (90%) had normal platelet count. Patients with thrombocytosis were younger (p<0.001) while those with thrombocytopenia had more frequently chronic heart and liver disease (p<0.001 both). Patients with thrombocytosis presented more frequently respiratory complications such as complicated pleural effusion and empyema (p<0.001), whereas those with thrombocytopenia presented more often severe sepsis (p<0.001), septic shock (p=0.009), need for invasive mechanical ventilation (p<0.001) and intensive care unit admission (p=0.011). Patients with thrombocytosis and thrombocytopenia had longer hospital stay (p=0.004), higher 30-day mortality (p=0.001) and readmission rate (p=0.011) than those with normal platelet count. Multivariate analysis confirmed a significant association between thrombocytosis and 30-day mortality (OR 2.720, 95% CI 1.589-4.657; p<0.001). Adding thrombocytosis to the CRB-65 score slightly improved the accuracy to predict mortality (area under the ROC curve increased from 0.634 to 0.654 p=0.049). CONCLUSION: Thrombocytosis in patients with CAP is associated with poor outcome, complicated pleural effusion and empyema. The presence of thrombocytosis in CAP should encourage ruling out respiratory complication and could be considered for severity evaluation.1Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain.2Emergency Medicine Department, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.3Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain.4Respiratory Intensive Care Unit, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brazil.5Servicio de Enfermedades Infecciosas, Hospital Clínic, IDIBAPS, Barcelona, Spain.6Servicio de Neumologia, Hospital Universitario La Fe,Valencia, Spain.Correspondence: Dr. Miquel Ferrer. UVIR, Servei de Pneumologia, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain. E-mail: miferrer@clinic.ub.esFunded By: This work was supported by Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CibeRes CB06/06/0028)-Instituto de Salud Carlos III (ISCiii), 2009 SGR 911, PII de infecciones respiratorias of SEPAR, and IDIBAPS.
PMID: 23187959 [PubMed - as supplied by publisher]