Analysis of Hospital Outcomes for Thrombocytopenic Emergencies: A National Inpatient Sample Database Study

Background

Thrombocytopenia is defined as a platelet count of less than <150,000/microliter and is the most common cause of inpatient hematological consultation. Thrombocytopenia severity can be subdivided into mild (100,000 to 149,000/microliter), moderate (50,000 to 99,000/ microliter) and severe (<50,000/ microliter) . Severe thrombocytopenia could become an emergent problem, and it is essential to recognize it as it could be life-threatening if severe and profound bleeding occurs. However, some conditions causing severe thrombocytopenia are emergencies in themselves due to the increased morbidity and mortality if not recognized and managed promptly. These include thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC), heparin-induced thrombocytopenia (HIT), and drug-induced immune thrombocytopenia (DITP). It's essential to consider these diagnoses initially for any patient with thrombocytopenia. This study aims to analyze hospital outcomes for thrombocytopenic emergencies for prompt diagnosis and treatment.

Methods

A retrospective analysis of the NIS database from 2016 to 2020 was conducted. The prevalence of thrombotic emergencies, patient demographics, and clinical outcomes were examined.

Results

We found 310919 patients with thrombotic thrombocytopenic purpura (TTP). Of them, 56% were females, while 44% were males (p-value 0.01). The mean age of patients was 57 years, the mean length of Stay (LOS) was six days (p-value 0.01), and total hospital charges were $ 84351 (p-value 0.01), mortality was 3.6% (aOR 1.2 ([95% CI: 1.0-3.1), p-value <0.001). It was also found to be associated with an increased risk of complications, including AKI in 18% of the patients (aOR 1.3 [95% CI: 1.2-1.5], p-value <0.001), stroke in 0.03% of the patients (aOR 1.15 [95% CI: 1.05- 1.2], p-value 0.03) and hemorrhage in 0.2% of the patients (aOR, 1.9 [95% CI: 0.9-3 ], p-value 0.7).

A total of 227,510 patients were detected with a primary diagnosis of disseminated intravascular coagulation (DIC). Of them, 51% were females, while 49% were males (p-value 0.2). The mean age was 57 years, the mean LOS was 14 days (p-value <0.1), and the total hospital cost was $292,173 (p-value <0.01). The mortality rate In DIC patients was found to be 48% (aOR 1.2 [95% CI: 1.0-1.5], p-value <0.001). It was also found to be associated with increased risk of AKI in 66% of patients ( aOR 1.04 [95% CI: 1.0-1.5], p-value <0.001], stroke in 0.01% of patients (aOR 1.0 [95% CI: 0.9-1.1], p-value 0.2) but there was decreased risk of bleeding (aOR 0.9 [95% CI 0.9-1.2], p-value 0.9), although it was not significant (p-value >0.05).

A total of 731,89 patients were detected with heparin-induced thrombocytopenia (HIT). Of them, 47% of the patients were females, while 53% were male. The mean age of the patients was 63 years (p-value 0.02), the mean LOS was 14 days (aOR 1.3 [95% CI: 0.9-1.3, p-value 0,3), and total charges were $234,901 (p-value 0.01). The mortality rate was 11% (aOR 1.01 [95% CI: 1.0-1.2], p-value 0.01). It was also found to be associated with increased odds of AKI in 43% of patients (aOR 1.01 [95% CI (1.00-1.02), p-value <0.001), stroke in 0.06% of the patients although it was not significant (p-value >0.05). However, there were lower odds of developing bleeding observed in HIT patients (aOR 0.95 [95% CI: 0.91-0.99 ], p-value 0.3).

We found 1411724 patients with a diagnosis of drug-induced immune thrombocytopenia (DITP). Of them, 43% of the patients were females, while 57% were males. The mean age of the patients was 58 years (p-value 0.01), mean LOS was eight days (p-value 0.8), and total hospital charges were $101,449 (p-value < 0.01). The mortality was 6.2% (aOR 1.02 [95% Ci: 1.03- 1.3], p-value 0.00). It was associated with increased risk of AKI in 30% of the patients (aOR 1.1 [95% CI: 1.01-1.3[, p-value <0.001), increased risk of stroke in 0.01% of the patients (aOR 1.1 [95% CI: 0.9-1.3], p-value 0.06), and bleeding in 0.1% of the patients (aOR 1.3, [95% Ci: 0.9-1.03], p-value 0.2).

Conclusion

Our study shows the outcomes of patients who were hospitalized with thrombocytopenic emergencies. The mortality was observed to be highest in patients with DIC patients, along with increased association with other adverse outcomes. Hence, timely recognition and management of hematological malignancies are needed to improve the outcome.

No relevant conflicts of interest to declare.