Thrombocytopenia in Staphylococcus aureus bacteremia: risk factors and prognostic importance
A Gafter-Gvili, N Mansur, A Bivas… - Mayo Clinic …, 2011 - Elsevier
A Gafter-Gvili, N Mansur, A Bivas, N Zemer-Wassercug, J Bishara, L Leibovici, M Paul
Mayo Clinic Proceedings, 2011•ElsevierOBJECTIVE To identify risk factors and outcomes associated with thrombocytopenia at
sepsis onset in Staphylococcus aureus bacteremia. PATIENTS AND METHODS This single-
center, retrospective, cohort study consists of all adult patients with a first episode of clinical
S aureus bacteremia between April 1, 1988, and September 30, 1994, and between January
1, 1999, and December 31, 2007. Thrombocytopenia was defined as a platelet count less
than 150× 10 9/L. The primary outcome was 30-day all-cause mortality. Risk factors for 30 …
sepsis onset in Staphylococcus aureus bacteremia. PATIENTS AND METHODS This single-
center, retrospective, cohort study consists of all adult patients with a first episode of clinical
S aureus bacteremia between April 1, 1988, and September 30, 1994, and between January
1, 1999, and December 31, 2007. Thrombocytopenia was defined as a platelet count less
than 150× 10 9/L. The primary outcome was 30-day all-cause mortality. Risk factors for 30 …
OBJECTIVE
To identify risk factors and outcomes associated with thrombocytopenia at sepsis onset in Staphylococcus aureus bacteremia.
PATIENTS AND METHODS
This single-center, retrospective, cohort study consists of all adult patients with a first episode of clinical S aureus bacteremia between April 1, 1988, and September 30, 1994, and between January 1, 1999, and December 31, 2007. Thrombocytopenia was defined as a platelet count less than 150 × 109/L. The primary outcome was 30-day all-cause mortality. Risk factors for 30-day all-cause mortality were identified using univariate and multivariable analyses. Multivariable analysis was conducted using forward step logistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for risk of death.
RESULTS
A total of 1052 patients had clinical S aureus bacteremia. Thrombocytopenia at sepsis onset was present in 235 patients (22.3%). Thrombocytopenia was associated with community-acquired bacteremia, infections caused by methicillin-sensitive S aureus, high-magnitude bacteremia (defined as >4 positive blood cultures [≥3 separate positive blood culture sets]), and endocarditis. Patients with thrombocytopenia presented more commonly with severe sepsis reflected by septic shock and acute renal failure. Thirty-day mortality was significantly higher among patients with thrombocytopenia (132/235 [56.2%]) vs those without thrombocytopenia (281/817 [34.4%]; P<.001). Higher mortality was associated with the degree of thrombocytopenia. In multivariable analysis, thrombocytopenia at baseline remained an independent risk factor for 30-day mortality (OR, 2.82; 95% CI, 1.87-4.24). The adjusted association between thrombocytopenia and death remained similar among the 917 patients with monomicrobial bacteremia (OR, 2.88; 95% CI, 1.83-4.53) and the 945 patients who did not die within the first 48 hours (OR, 2.88; 95% CI, 1.87-4.45.).
CONCLUSION
We observed a strong association between thrombocytopenia at sepsis onset and all-cause mortality in S aureus bacteremia, possibly related to mechanisms other than sepsis alone.
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