Thrombocytopenia as a Predictor of Severity of Pneumonia in a Tertiary Care Center in Nepal
Introduction: Community-acquired pneumonia is an infectious disease with a global burden. Thrombocytopenia can be an effective and inexpensive tool in predicting the severity of pneumonia which can be useful in the primary care level. The objectives were to identify the clinical and laboratory predictors of hospitalized patients with pneumonia, determine the incidence of thrombocytopenia in those patients, its association with severity, compare it with leucocyte count, assess severity using clinical prediction scores, need of mechanical ventilation, need of transfer to intensive care unit and mortality.
Methods: After informed consent, diagnosed and admitted cases of community-acquired pneumonia were examined after which patients' demographic and clinical data as well as laboratory parameters including white cell count and platelets were filled in proforma. Clinical prediction scores for pneumonia were calculated and the need for mechanical ventilation, inotropes, transfusions as well as mortality assessed. Patients were followed up until discharge to see the severity of pneumonia.
Results: The incidence of thrombocytopenia among patients with pneumonia was 36.9% (41 out of 111). The overall mortality rate was 9%. More pneumonia patients having thrombocytopenia (14.6%) died than pneumonia patients having leukocytosis (13.8%). There was a significant association between thrombocytopenia and severity of pneumonia, both alone, (p = 0.007, OR = 4.03) and on adjusting for the WBC and GCS (p=0.017, OR = 3.81).Significant associations were found between thrombocytopenia and the need for ICU in patients with pneumonia (p=0.001), mechanical ventilation (p = 0.001), presence of edema, confusion, age variation (p=0.024) and septic shock (p=0.021).
Conclusion: Thrombocytopenia can serve as an effective predictor of the severity of pneumonia.