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The Association of Platelet Decrease Following Continuous Renal Replacement Therapy Initiation and Increased Rates of Secondary Infections
Journal article   Open access   Peer reviewed

The Association of Platelet Decrease Following Continuous Renal Replacement Therapy Initiation and Increased Rates of Secondary Infections

Benjamin R Griffin, Chaorong Wu, John C O'Horo, Sarah Faubel, Diana Jalal and Kianoush Kashani
Critical care medicine, Vol.49(2), pp.e130-e139
02/01/2021
DOI: 10.1097/CCM.0000000000004763
PMCID: PMC8530244
PMID: 33372743
url
https://www.ncbi.nlm.nih.gov/pmc/articles/8530244View
Open Access

Abstract

Thrombocytopenia is common in critically ill patients treated with continuous renal replacement therapy and decreases in platelets following continuous renal replacement therapy initiation have been associated with increased mortality. Platelets play a role in innate and adaptive immunity, making it plausible that decreases in platelets following continuous renal replacement therapy initiation predispose patients to development of infection. Our objective was to determine if greater decreases in platelets following continuous renal replacement therapy correlate with increased rates of secondary infection. Retrospectivecohort analysis. This study uses a continuous renal replacement therapy database from Mayo Clinic (Rochester, MN), a tertiary academic center. Adult patients who survived until ICU discharge and were on continuous renal replacement therapy for less than 30 days were included. A subgroup analysis was also performed in patients with thrombocytopenia (platelets < 100 × 103/µL) at continuous renal replacement therapy initiation. The primary predictor variable was a decrease in platelets from precontinuous renal replacement therapy levels of greater than 40% or less than or equal to 40%, although multiple cut points were analyzed. The primary outcome was infection after ICU discharge, and secondary endpoints included post-ICU septic shock and post-ICU mortality. Univariable, multivariable, and propensity-adjusted analyses were used to determine associations between the predictor variable and the outcomes. Among 797 eligible patients, 253 had thrombocytopenia at continuous renal replacement therapy initiation. A greater than 40% decrease in platelets after continuous renal replacement therapy initiation was associated in the multivariable-adjusted models with increased odds of post-ICU infection in the full cohort (odds ratio, 1.49; CI, 1.02-2.16) and in the thrombocytopenia cohort (odds ratio, 2.63; CI, 1.35-5.15) cohorts. Platelet count drop by greater than 40% following continuous renal replacement therapy initiation is associated with an increased risk of secondary infection, particularly in patients with thrombocytopenia at the time of continuous renal replacement therapy initiation. Further research is needed to evaluate the impact of both continuous renal replacement therapy and platelet loss on subsequent infection risk.
 Acute Kidney Injury - physiopathology Acute Kidney Injury - therapy Adult Aged Biomarkers - blood Continuous Renal Replacement Therapy - adverse effects Critical Illness - therapy Humans Intensive Care Units Male Middle Aged Platelet Count Renal Replacement Therapy - adverse effects Retrospective Studies Risk Factors Thrombocytopenia - blood Thrombocytopenia - physiopathology

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