Elena Prina1, Miquel Ferrer2, Otavio T Ranzani3, Eva Polverino4, Catia Cillóniz4, Encarnación Moreno4, Josep Mensa5, Beatriz Montull6, Rosario Menéndez7, Roberto Cosentini8, Antoni Torres4. 1. Servei de Pneumologia, Institut del Torax, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain; Emergency Medicine Department, Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 2. Servei de Pneumologia, Institut del Torax, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain. Electronic address: Spainmiferrer@clinic.ub.es. 3. Servei de Pneumologia, Institut del Torax, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain; Respiratory Intensive Care Unit, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brazil. 4. Servei de Pneumologia, Institut del Torax, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain. 5. Servicio de Enfermedades Infecciosas, Hospital Clínic, IDIBAPS, Barcelona, Spain. 6. Servicio de Neumologia, Hospital Universitario La Fe, Valencia, Spain. 7. Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain; Servicio de Neumologia, Hospital Universitario La Fe, Valencia, Spain. 8. Emergency Medicine Department, Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
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 ≥ 4 × 105/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 TB, or hematologic disease. RESULTS: Fifty-three patients (2%) presented with thrombocytopenia, 204 (8%) with thrombocytosis, and 2,166 (90%) had normal platelet counts. Patients with thrombocytosis were younger (P < .001); those with thrombocytopenia more frequently had chronic heart and liver disease (P < .001 for both). Patients with thrombocytosis presented more frequently with respiratory complications, such as complicated pleural effusion and empyema (P < .001), whereas those with thrombocytopenia presented more often with severe sepsis (P < .001), septic shock (P = .009), need for invasive mechanical ventilation (P < .001), and ICU admission (P = .011). Patients with thrombocytosis and patients with thrombocytopenia had longer hospital stays (P = .004), and higher 30-day mortality (P = .001) and readmission rates (P = .011) than those with normal platelet counts. Multivariate analysis confirmed a significant association between thrombocytosis and 30-day mortality (OR, 2.720; 95% CI, 1.589-4.657; P < .001). Adding thrombocytosis to the confusion, respiratory rate, and BP plus age ≥65 years score slightly improved the accuracy to predict mortality (area under the receiver operating characteristic curve increased from 0.634 to 0.654, P = .049). CONCLUSIONS: 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.
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 ≥ 4 × 105/mm3) compared with thrombocytopenia (platelet count &lt; 105/mm3) and normal platelet count. METHODS: We prospectively analyzed 2,423 consecutive, hospitalized patients with CAP. We excluded patients with immunosuppression, neoplasm, active TB, or hematologic disease. RESULTS: Fifty-three patients (2%) presented with thrombocytopenia, 204 (8%) with thrombocytosis, and 2,166 (90%) had normal platelet counts. Patients with thrombocytosis were younger (P &lt; .001); those with thrombocytopenia more frequently had chronic heart and liver disease (P &lt; .001 for both). Patients with thrombocytosis presented more frequently with respiratory complications, such as complicated pleural effusion and empyema (P &lt; .001), whereas those with thrombocytopenia presented more often with severe sepsis (P &lt; .001), septic shock (P = .009), need for invasive mechanical ventilation (P &lt; .001), and ICU admission (P = .011). Patients with thrombocytosis and patients with thrombocytopenia had longer hospital stays (P = .004), and higher 30-day mortality (P = .001) and readmission rates (P = .011) than those with normal platelet counts. Multivariate analysis confirmed a significant association between thrombocytosis and 30-day mortality (OR, 2.720; 95% CI, 1.589-4.657; P &lt; .001). Adding thrombocytosis to the confusion, respiratory rate, and BP plus age ≥65 years score slightly improved the accuracy to predict mortality (area under the receiver operating characteristic curve increased from 0.634 to 0.654, P = .049). CONCLUSIONS: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.
Authors: Lauren R Wottlin; Gordon E Carstens; William C Kayser; William E Pinchak; Jennifer M Thomson; Valerie Copié; Galen P O'Shea-Stone Journal: J Anim Sci Date: 2020-12-22 Impact factor: 3.159
Authors: Lauren R Wottlin; Gordon E Carstens; William C Kayser; William E Pinchak; Jennifer M Thomson; Valerie Copié; Galen P O'Shea-Stone Journal: J Anim Sci Date: 2021-01-01 Impact factor: 3.159
Authors: Leo Nicolai; Alexander Leunig; Kami Pekayvaz; Konstantin Stark; Sophia Brambs; Rainer Kaiser; Tobias Weinberger; Michael Weigand; Maximilian Muenchhoff; Johannes C Hellmuth; Stephan Ledderose; Heiko Schulz; Clemens Scherer; Martina Rudelius; Michael Zoller; Dominik Höchter; Oliver Keppler; Daniel Teupser; Bernhard Zwißler; Michael von Bergwelt-Baildon; Stefan Kääb; Steffen Massberg Journal: Circulation Date: 2020-07-28 Impact factor: 29.690