open access

Vol 48, No 5 (2016)
Original and clinical articles
Published online: 2016-11-11
Submitted: 2016-09-28
Accepted: 2016-10-31
Get Citation

Clinical outcome of critically ill patients with thrombocytopenia and hypophosphatemia in the early stage of sepsis

Evgeni Brotfain, Andrei Schwartz, Avi Boniel, Leonid Koyfman, Matthew Boyko, Ruslan Kutz, Moti Klein
DOI: 10.5603/AIT.a2016.0053
·
Pubmed: 27834985
·
Anaesthesiol Intensive Ther 2016;48(5):294-299.

open access

Vol 48, No 5 (2016)
Original and clinical articles
Published online: 2016-11-11
Submitted: 2016-09-28
Accepted: 2016-10-31

Abstract

BACKGROUND: Hypophosphatemia and thrombocytopenia may both be independent risk factors for the development of multiple organ failure and correlate well with the severity of sepsis. In the present study we wanted to analyze the potential clinical role and prognostic significance of both early hypophosphatemia and thrombocytopenia on clinical outcomes of critically ill ICU patients with severe sepsis.

METHODS: We analyzed the clinical data, including the outcome of critically ill ICU patients with severe sepsis who presented during a 5 year period with early hypophosphatemia and thrombocytopenia.This study was retrospective and single centre. All clinical and laboratory data was collected from the patients’ ICU and hospital electronic records. All laboratory measurements were done on admission and during the ICU stay.

RESULTS: The included patients were distributed into one of three study groups based on the presence of hypophosphatemia and/or thrombocytopenia during the first 24 hours of admission to the ICU: group 1 — early hypophosphatemia; group 2 — early hypophosphatemia and thrombocytopenia and group 3 — early thrombocytopenia. The ICU mortality rate was significantly higher in groups 2 and 3 (25.9% and 22% vs. 9.3%, respectively, P = 0.034). An APACHE II > 27, a TISS > 25 following the first 24 hours of ICU stay , an age higher than 70, male gender and total parenteral nutrition were independent predictors of ICU and hospital mortality in this study population.

CONCLUSION: It may be considered that hypophosphatemia and thrombocytopenia in the early stage of sepsis, even when severe and coexisting, reflect the degree of initial illness severity of sepsis. However, further investigations need to be done for a better understanding of the potential clinical role of these features in the septic critically ill population.

Abstract

BACKGROUND: Hypophosphatemia and thrombocytopenia may both be independent risk factors for the development of multiple organ failure and correlate well with the severity of sepsis. In the present study we wanted to analyze the potential clinical role and prognostic significance of both early hypophosphatemia and thrombocytopenia on clinical outcomes of critically ill ICU patients with severe sepsis.

METHODS: We analyzed the clinical data, including the outcome of critically ill ICU patients with severe sepsis who presented during a 5 year period with early hypophosphatemia and thrombocytopenia.This study was retrospective and single centre. All clinical and laboratory data was collected from the patients’ ICU and hospital electronic records. All laboratory measurements were done on admission and during the ICU stay.

RESULTS: The included patients were distributed into one of three study groups based on the presence of hypophosphatemia and/or thrombocytopenia during the first 24 hours of admission to the ICU: group 1 — early hypophosphatemia; group 2 — early hypophosphatemia and thrombocytopenia and group 3 — early thrombocytopenia. The ICU mortality rate was significantly higher in groups 2 and 3 (25.9% and 22% vs. 9.3%, respectively, P = 0.034). An APACHE II > 27, a TISS > 25 following the first 24 hours of ICU stay , an age higher than 70, male gender and total parenteral nutrition were independent predictors of ICU and hospital mortality in this study population.

CONCLUSION: It may be considered that hypophosphatemia and thrombocytopenia in the early stage of sepsis, even when severe and coexisting, reflect the degree of initial illness severity of sepsis. However, further investigations need to be done for a better understanding of the potential clinical role of these features in the septic critically ill population.

Get Citation

Keywords

sepsis, severe sepsis, septic shock; sepsis, outcome; hypophosphatemia, thrombocytopenia

About this article
Title

Clinical outcome of critically ill patients with thrombocytopenia and hypophosphatemia in the early stage of sepsis

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 48, No 5 (2016)

Pages

294-299

Published online

2016-11-11

DOI

10.5603/AIT.a2016.0053

Pubmed

27834985

Bibliographic record

Anaesthesiol Intensive Ther 2016;48(5):294-299.

Keywords

sepsis
severe sepsis
septic shock
sepsis
outcome
hypophosphatemia
thrombocytopenia

Authors

Evgeni Brotfain
Andrei Schwartz
Avi Boniel
Leonid Koyfman
Matthew Boyko
Ruslan Kutz
Moti Klein

References (19)
  1. Dellinger RP, Levy HM, Carlet JM, et al. Surviving sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Crit Care Med . 2008; 36: 1394–1396.
  2. Shor R, Halabe A, Rishver S, et al. Severe hypophosphatemia in sepsis as a mortality predictor. Ann Clin Lab Sci. 2006; 36(1): 67–72.
  3. Nguyen TC, Carcillo JA. Bench-to-bedside review: thrombocytopenia-associated multiple organ failure--a newly appreciated syndrome in the critically ill. Crit Care. 2006; 10(6): 235–247.
  4. Bugg NC, Jones JA. Hypophosphatemia. Anesthesia. 1998; 53: 895–902.
  5. Riedler GF, Scheitlin WA. Hypophosphataemia in septicaemia: higher incidence in gram-negative than in gram-positive infections. Br Med J. 1969; 1(5646): 753–756.
  6. Schwartz A, Gurman G, Cohen G, et al. Association between hypophosphatemia and cardiac arrhythmias in the early stages of sepsis. Eur J Intern Med. 2002; 13(7): 434–438.
  7. Suzuki S, Egi M, Schneider AG, et al. Hypophosphatemia in critically ill patients. J Crit Care. 2013; 28(4): 536.e9–536.19.
  8. von Landenberg P, Shoenfeld Y. New approaches in the diagnosis of sepsis. Isr Med Assoc J. 2001; 3(6): 439–442.
  9. Venkata C, Kashyap R, Farmer JC, et al. Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcome. J Intensive Care. 2013; 1(1): 9–14.
  10. Saglikes Y, Massry SG, Iseki K, et al. Effect of phosphate depletion on blood pressure and vascular reactivity to norepinephrine and angiotensin II in the rat. Am J Physiol. 1985; 248(1 Pt 2): F93–F99.
  11. Brautbar N, Leibovici H, Massry SG. On the mechanism of hypophosphatemia during acute hyperventilation: evidence for increased muscle glycolysis. Miner Electrolyte Metab. 1983; 9(1): 45–50.
  12. O'Connor LR, Wheeler WS, Bethune JE. Effect of hypophosphatemia on myocardial performance in man. N Engl J Med. 1977; 297(17): 183–187.
  13. Geerse DA, Bindels AJ, Kuiper MA, et al. Treatment of hypophosphatemia in the intensive care unit: a review. Crit Care. 2010; 147: 1–8.
  14. Cohen J, Kogan A, Sahar G, et al. Hypophosphatemia following open heart surgery: incidence and consequences. Eur J Cardiothorac Surg. 2004; 26(2): 306–310.
  15. Bogdonoff D, Williams M, Stone D. Thrombocytopenia in the critically ill patient. Journal of Critical Care. 1990; 5(3): 186–205.
  16. Lee KH, Hui KP, Tan WC. Thrombocytopenia in sepsis: a predictor of mortality in the intensive care unit. Singapore Med J. 1993; 34(3): 245–246.
  17. Akca S, Haji-Michael P, de Mendonça A, et al. Time course of platelet counts in critically ill patients. Crit Care Med. 2002; 30(4): 753–756.
  18. Zazzo JF, Troché G, Ruel P, et al. High incidence of hypophosphatemia in surgical intensive care patients: efficacy of phosphorus therapy on myocardial function. Intensive Care Med. 1995; 21(10): 826–831.
  19. Farrokhi F, Chandra P, Smiley D, et al. Glucose variability is an independent predictor of mortality in hospitalized patients treated with total parenteral nutrition. Endocr Pract. 2014; 20(1): 41–45.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

VM Media sp. z o.o. VM Group sp.k., Grupa Via Medica, Świętokrzyska 73 St., 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl