Thrombocytopenia in the ICU before and during the pandemic of the new coronavirus infection COVID-19: a comparative retrospective cohort study

Abstract

INTRODUCTION: Thrombocytopenia is common in critically ill patients. Its development is associated with a high risk of bleeding and other complications, including adverse outcomes. ОBJECTIVE: To analyze the incidence, severity, predictive significance of thrombocytopenia in critically ill patients before and during coronavirus infection. MATERIALS AND METHODS: The observational study included patients from intensive care units of a multidisciplinary hospital at different periods: before the COVID-19 and during the period when the hospital was operating as a СOVID hospital. Patients from all intensive care units, excluding the hematology unit, were analyzed. RESULTS: Non-infectious period. Among 314 patients, 91 cases of thrombocytopenia were identified, representing 29 %. Severe thrombocytopenia among them was noted in 35 % (n = 32). The main etiological causes: performing extracorporeal procedures, liver disease, ischemic stroke, acute coronary syndrome. The infectious period. Thrombocytopenia occurred more frequently than in non-COVID patients (in 209 of 396 patients — 52.8 %) and was more uniform in severity. The most frequent cause of thrombocytopenia was a combination of sepsis, acute liver injury, performance of extracorporeal procedures and specific drug therapy of COVID-19 infection. CONCLUSIONS: According to our data, thrombocytopenia in the intensive care units of a multidisciplinary hospital (non-infectious period) occurred in one-third of critically ill patients. COVID 19 infection demonstrated an increased incidence of thrombocytopenia in critical patients (in the presented study up to half of the patients). Severe thrombocytopenia is more common in patients of non-infectious period (35 % vs 20%). In patients with coronavirus infection, thrombocytopenia was more frequently associated with a bleeding clinic (6.2 % vs 2.2 %), with less prognostic value as a criterion for adverse outcome: the presence of thrombocytopenia increased the risk of death by 5.5 times (95 % CI 2.979–10.031) in noninfectious and by 1.54 times (95 % CI 1.3–1.82) in COVID-19 infection.