Time course of platelet counts in relation to the neurologic outcome in patients undergoing targeted temperature management after cardiac arrest

Hyo Joon Kim; Kyu Nam Park; Soo Hyun Kim; Byung Kook Lee; Sang Hoon Oh; Kyung Woon Jeung; In Soo Cho; Chun Song Youn

doi:10.1016/j.resuscitation.2019.05.019

Time course of platelet counts in relation to the neurologic outcome in patients undergoing targeted temperature management after cardiac arrest

Resuscitation. 2019 Jul:140:113-119. doi: 10.1016/j.resuscitation.2019.05.019. Epub 2019 May 24.

Authors

Hyo Joon Kim¹, Kyu Nam Park¹, Soo Hyun Kim¹, Byung Kook Lee², Sang Hoon Oh¹, Kyung Woon Jeung², In Soo Cho³, Chun Song Youn⁴

Affiliations

¹ Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
² Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea.
³ Department of Emergency Medicine, Hanil General Hospital, Korea Electric Power Medical Corporation, Seoul, South Korea.
⁴ Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea. Electronic address: ycs1005@catholic.ac.kr.

PMID: 31132395
DOI: 10.1016/j.resuscitation.2019.05.019

Abstract

Background: Thrombocytopenia is common and associated with mortality in critically ill patients. However, the time course of platelet counts and its association with the neurologic outcome after out-of-hospital cardiac arrest (OHCA) are not well known. The purpose of this study is to describe the time course of platelet counts in relation to the neurologic outcome in patients undergoing targeted temperature management (TTM) after CA.

Methods: Review of consecutive patients receiving TTM after out-of-hospital CA between 2009 and 2016. The blood sample was collected daily until 7 days. The primary outcome was poor neurologic outcome at 6 months after CA defined as Cerebral Performance Category of 3-5 and secondary outcome was mortality at 6 months.

Results: A total of 261 consecutive patients treated with TTM after OHCA between 2009 and 2016. One hundred seventy-five patients (67.0%) had poor neurologic outcomes 6 months after CA. The changes in the platelet counts over time between the good and poor outcome groups were statistically significant (p < 0.001). The platelet counts declined during TTM in both groups. The platelet counts recovered to the normal range at the end of the first week in the good neurologic outcome group. However, the platelet counts remained low in the poor outcome group. Low platelet counts on the 7th day were associated with poor neurologic outcomes (aOR 0.975, 95% CI, 0.961-0.989) and mortality at 6 months (aOR 0.986, 95% CI, 0.975-0.997) after adjusting for covariates.

Conclusion: The changes in platelet counts in OHCA patients have a biphasic pattern that is significantly different in patients with good neurologic outcomes and those with poor neurologic outcomes at 6 months. A low platelet count 7 days after CA was associated with a poor neurologic outcome and mortality at 6 months.

Keywords: Cardiac arrest; Hypothermia; Induced; Outcome; Platelets; Thrombocytopenia.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Female
Health Status Indicators
Humans
Hypothermia, Induced*
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / blood
Out-of-Hospital Cardiac Arrest / therapy*
Platelet Count*
Prognosis
Retrospective Studies
Time Factors