Association between thrombocytopenia and 180-day prognosis of COVID-19 patients in intensive care units: A two-center observational study

Abstract

Background: Thrombocytopenia has been proved to be associated with hospital mortality in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. However, the detailed association of thrombocytopenia with subsequent progression of organ functions and long-term prognosis in critically ill COVID-19 patients remains to be explored.

Methods: Medical records of 167 confirmed cases of critically ill COVID-19 from February 16 to March 21, 2020 were collected in this two-center retrospective study. 180-day's outcome and clinical organ development in patients with thrombocytopenia and non-thrombocytopenia were analyzed.

Findings: Among all 167 patients, the median age was 66 years and 67.07% were male. Significant differences were noticed in laboratory findings including white blood cells, blood urea, total bilirubin, lactate dehydrogenase and SOFA score between groups of thrombocytopenia and non-thrombocytopenia. Older age, lower platelet count and longer activated partial thromboplastin time at admission were determined to be risk factors of 28-day mortality, and all three, together with higher white blood cells were risk factors of 180-day mortality. Subsequent changes of six-point ordinal scale score, oxygenation index, and SOFA score in patients with thrombocytopenia showed marked worsening trends compared with patients without thrombocytopenia. Patients with thrombocytopenia had significantly higher mortality not only in 28 days, but also in 90 days and 180 days. The time-course curves in non-survival group showed a downtrend of platelet count and oxygenation index, while the curve of six-point ordinal scale kept an uptrend. Kaplan-Meier analysis indicated that patients with thrombocytopenia had much lower probability of survival (p<0.01).

Interpretation: The thrombocytopenia was associated with the deterioration of respiratory function. Baseline platelet count was associated with subsequent and long-term mortality in critically ill COVID-19 patients.

Fig 1. Time curves of platelet count, six-point ordinal scale score and oxygenation index.

Shaded areas show the standard error while the curves show the means of platelet count, six-point ordinal scale and oxygenation index. a. Time curve of platelet count and oxygenation index of non-survival group. b. Time curve of platelet count and six-point ordinal scale of non-survival group. c. Time curve of platelet count and oxygenation index of survival group. d. Time curve of platelet count and six-point ordinal scale of survival group.

Fig 2. Survival curve in patients with thrombocytopenia and non-thrombocytopenia.