255 - Evaluation of Thrombocytopenia prior to Continuous Kidney Replacement Therapy Initiation: Analysis of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)

Poster Number: 255
Publication Number: 255.25

Abby M. Basalely, Cohen Children's Medical Center, West Hempstead, NY, United States; Natalja L. Stanski, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Dana Fuhrman, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; JANGDONG SEO, Cincinnati Children's Hospital, Bloomington, IN, United States; Nicholas Ollberding, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Katja M. Gist, Children's Hospital Medical Center (Cincinnati), Cincinnati, OH, United States; Shina Menon, University of Washington School of Medicine, Seattle, WA, United States

Background: Thrombocytopenia is common, estimated to occur in 15-50% in critically ill patients, and is independently associated with mortality. Studies of adults in the Acute Renal Failure Trial Network demonstrate that thrombocytopenia prior to CKRT initiation is an independent risk factor for mortality and lack of renal recovery. However, the outcomes associated with thrombocytopenia before CKRT initiation in pediatric patients are unknown.

Objective: We aimed to (1) describe the incidence of thrombocytopenia in pediatric patients prior to CKRT initiation and (2) evaluate the risk factors and outcomes of patients with thrombocytopenia prior to CKRT initiation in a large multinational pediatric CKRT cohort.

Design/Methods: The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) study is a retrospective international multi-center study (32 centers, 7 nations) of patients aged 0-25 years treated with CKRT for Acute Kidney Injury (AKI) or Fluid Overload (FO) from 2018-2021. For this analysis, patients with a diagnosis of chronic thrombocytopenia, hematological malignancy, atypical hemolytic uremic syndrome, or thrombotic thrombocytopenic purpura were excluded. The primary exposure variable was baseline thrombocytopenia defined by platelets < 100 × 103/μL recorded prior to CKRT initiation. The primary outcome was survival to ICU discharge.

Results: A total of 781 patients met inclusion criteria. Baseline thrombocytopenia was seen in 497 patients (63.6%) and was most commonly seen in patients admitted for shock, infection and major trauma N=183 (37%). Patients with baseline thrombocytopenia had higher median PRISM-III scores (15 vs 13, p< 0.001), higher PELOD scores at CKRT initiation (7 vs 5, p< 0.001), and greater FO (9% vs 6%, p < 0.001) at initiation compared to those with platelet count >100 × 103/μL (Table 1). There were no significant differences in CKRT technical characteristics between those with and without thrombocytopenia. Baseline thrombocytopenia was associated with higher ICU mortality [OR (95% CI) 1.44 (1.06-1.97)] in bivariate analysis. However, this association was not significant after adjusting for age, PRISMIII, PELOD, and Fluid Overload [OR(95% CI) 0.79 (0.54, 1.16)].

Conclusion(s):

This is the largest study to evaluate the epidemiology and outcomes of thrombocytopenia prior to CKRT in pediatric patients. Like adult studies, baseline thrombocytopenia was common and associated with higher severity of illness. We plan to conduct further analyses, including evaluation of platelet trends throughout the CKRT course and the influence of modality and filter types.
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