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Usefulness of Thrombocytopenia and Changes in Platelet Counts as Prognostic Markers in Pediatric Intensive Care Units
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Yoon Hee Kim, Hyun Bin Park, Min Jung Kim, Hwan Soo Kim, Hee Seon Lee, Yoon Ki Han, Kyung Won Kim, Myung Hyun Sohn, Kyu Earn Kim
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Korean J Crit Care Med. 2013;28(2):93-100.
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DOI: https://doi.org/10.4266/kjccm.2013.28.2.93
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 Abstract
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- BACKGROUND
Thrombocytopenia has been shown to be a useful predictor of mortality in adult intensive care units (ICUs).
The aim of this study is to assess whether the level of platelet count at ICU admission and the changes in platelet counts can predict mortality in the pediatric ICU (PICU).
METHODS
Platelet counts were checked daily for at least 4 days in a total of 303 children who were admitted to the ICU. We compared the initial platelet counts and changes in platelet counts between survivors and non-survivors. A multivariable logistic regression model, a receiver operating characteristic curve and a linear mixed model were used.
RESULTS
The initial platelet count was significantly lower in non-survivors when compared to survivors. Multivariate analysis demonstrated that platelet count <120 x 10(9)/L (Odds ratio, 4.913; 95% confidence interval 2.451-9.851; p < 0.0001) was an independent predictor of mortality. In the case of children with thrombocytopenia (<120 x 10(9)/L) at admission to the ICU, the platelet counts increased serially in survivors, whereas non-survivors maintained their decreased platelet counts. In the case of children without thrombocytopenia, the platelet counts decreased most on day 3 in non-survivors.
CONCLUSIONS
At admission to the ICU, thrombocytopenia defined as a platelet count <120 x 10(9)/L can be a useful predictor of mortality in children. In children who had initial thrombocytopenia, the serial increase of platelet counts can be related to increased survival, whereas in children who did not have initial thrombocytopenia, more than a 10% decrease of platelet counts on day 3 can be related to mortality.
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A Case Report of Rapidly Progressive Empyema Caused by Pulmonary Actinomycosis: A Case Report
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Seong Joon Park, Young Chel Ahn, Soo Kyung Park, Min Jung Kim, Se Hun Kang, Hang Jea Jang, Younsuck Koh
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Korean J Crit Care Med. 2010;25(4):249-252.
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DOI: https://doi.org/10.4266/kjccm.2010.25.4.249
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Abstract
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- Pulmonary actinomycosis is an indolent and slowly progressive infectious disease, accompanied by pleural effusion and empyema in about 50% of cases. The size of the effusion is usually small, though, and it responds to appropriate antibiotics. We report a case of rapidly progressing, severe empyema leading to respiratory failure that was caused by pulmonary actinomycosis. A 57-year-old man presented with pleuritic chest pain for 5 days. The initial plain chest radiograph and CT scan showed pleural effusion. Gross pus was observed during the thoracentesis and laboratory test of pleural effusion revealed empyema. In spite of empirical antibiotics and chest tube drainage, the empyema rapidly progressed and the patient reached respiratory failure. Mechanical ventilation applied and decortication via video-assisted thoracotomy was performed.
Microscopic examination of both the pleural and adjacent lung biopsy specimen revealed actinomycosis.
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