Department of Anesthesiology and Intensive Care, Friedrich Schiller University Hospital, Jena, Germany.
J Crit Care. 2012 Jun;27(3):232-41. doi: 10.1016/j.jcrc.2011.06.016. Epub 2011 Aug 19.
The aim of this study was to investigate the epidemiology of and outcome from heparin-induced thrombocytopenia type II (HIT) in surgical intensive care unit (ICU) patients.
All 13,948 patients admitted to a university hospital surgical ICU between January 2004 and March 2008 were included in this retrospective cohort study.
Of 349 patients with a clinical suspicion of HIT, 88 patients had platelet factor 4/heparin antibodies using enzyme-linked immunosorbent assay. The prevalence and incidence of HIT were 0.82% and 0.63%, respectively. The complication rate was 43.5%, and the ICU and hospital mortality rates were 23.9% and 33%, respectively. In a multivariable analysis, the nadir platelet count (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P = .048) was the only factor independently associated with risk of death in these patients. In a nested matched case-control analysis, mortality rates were similar in patients with HIT and in the matched controls. However, complication rates were higher, and ICU and hospital lengths of stay were longer in patients with HIT compared with those of the control group.
In this cohort of surgical ICU patients, HIT was associated with increased morbidity but not mortality rates compared with a nested matched control group. The nadir platelet count was independently associated with a higher risk of in hospital death in these patients.
本研究旨在调查外科重症监护病房（ICU）患者肝素诱导的血小板减少症 II 型（HIT）的流行病学和结局。
本回顾性队列研究纳入了 2004 年 1 月至 2008 年 3 月期间入住一所大学医院外科 ICU 的 13948 名患者。
在 349 例临床疑似 HIT 的患者中，88 例患者使用酶联免疫吸附试验检测到血小板因子 4/肝素抗体。HIT 的患病率和发病率分别为 0.82%和 0.63%。并发症发生率为 43.5%，ICU 死亡率和住院死亡率分别为 23.9%和 33%。多变量分析显示，血小板计数最低值（比值比，1.03；95%置信区间，1.01-1.05；P =.048）是这些患者死亡风险的唯一独立相关因素。在嵌套匹配病例对照分析中，HIT 患者和匹配对照组的死亡率相似。然而，与对照组相比，HIT 患者的并发症发生率更高，ICU 和住院时间更长。
在本外科 ICU 患者队列中，与嵌套匹配对照组相比，HIT 与更高的发病率但非死亡率相关。血小板计数最低值与这些患者住院死亡风险的增加独立相关。
