Buchrits Shira, Gafter-Gvili Anat, Bishara Jihad, Atamna Alaa, Ayada Gida, Eynath Yair, Avni Tomer
Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 49100, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel.
J Clin Med. 2021 Jun 30;10(13):2957. doi: 10.3390/jcm10132957.
infection (CDI) causes morbidity and mortality. Platelets have been increasingly recognized as an important component of innate and adaptive immunity. We aimed to assess the incidence of thrombocytopenia and thrombocytosis in CDI and the effect of an abnormal platelet count on clinical outcomes.
This single-center, retrospective cohort study consisted of all adult patients hospitalized in Rabin Medical Center between 1 January 2013 and 31 December 2018 with laboratory confirmed CDI. The primary outcome was 30-day all-cause mortality. Risk factors for 30-day all-cause mortality were identified by univariable and multivariable analyses, using logistic regression.
A total of 527 patients with CDI were included. Among them 179 (34%) had an abnormal platelet count: 118 (22%) had thrombocytopenia and 61 (11.5%) had thrombocytosis. Patients with thrombocytosis were similar to control patients other than having a significantly higher white blood cell count at admission. Patients with thrombocytopenia were younger than control patients and were more likely to suffer from malignancies, immunosuppression, and hematological conditions. In a multivariable analysis, both thrombocytosis (OR 1.89, 95% CI 1.01-3.52) and thrombocytopenia (OR 1.70, 95% CI 1.01-2.89) were associated with 30-days mortality, as well as age, hypoalbuminemia, acute kidney injury, and dependency on activities of daily living. A sensitivity analysis restricted for patients without hematological malignancy or receiving chemotherapy revealed increased mortality with thrombocytosis but not with thrombocytopenia.
In this retrospective study of hospitalized patients with CDI, we observed an association between thrombocytosis on admission and all-cause mortality, which might represent a marker for disease severity. Patients with CDI and thrombocytopenia also exhibited increased mortality, which might reflect their background conditions and not the severity of the CDI. Future studies should assess thrombocytosis as a severity marker with or without the inclusion of the WBC count.
艰难梭菌感染（CDI）可导致发病和死亡。血小板已越来越被视为先天性和适应性免疫的重要组成部分。我们旨在评估CDI患者中血小板减少症和血小板增多症的发生率，以及血小板计数异常对临床结局的影响。
这项单中心回顾性队列研究纳入了2013年1月1日至2018年12月31日期间在拉宾医疗中心住院且实验室确诊为CDI的所有成年患者。主要结局是30天全因死亡率。采用逻辑回归，通过单变量和多变量分析确定30天全因死亡率的危险因素。
共纳入527例CDI患者。其中179例（34%）血小板计数异常：118例（22%）有血小板减少症，61例（11.5%）有血小板增多症。血小板增多症患者与对照患者相似，但入院时白细胞计数显著更高。血小板减少症患者比对照患者年轻，更易患恶性肿瘤、免疫抑制和血液系统疾病。在多变量分析中，血小板增多症（比值比1.89，95%置信区间1.01 - 3.52）和血小板减少症（比值比1.70，95%置信区间1.01 - 2.89）均与30天死亡率相关，年龄、低白蛋白血症、急性肾损伤和日常生活活动依赖也与之相关。一项针对无血液系统恶性肿瘤或未接受化疗患者的敏感性分析显示，血小板增多症会增加死亡率，但血小板减少症不会。
在这项对住院CDI患者的回顾性研究中，我们观察到入院时血小板增多症与全因死亡率之间存在关联，这可能代表疾病严重程度的一个指标。CDI合并血小板减少症的患者死亡率也有所增加，这可能反映了他们的基础疾病状况，而非CDI的严重程度。未来的研究应评估血小板增多症作为严重程度指标的情况，无论是否纳入白细胞计数。
