Abstract: FR-PO127
Association of Changes in Platelet and White Blood Cell Counts with Hospital Mortality in Patients with AKI requiring CRRT: A Multicenter Cohort Study
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Braun, Chloe Grace, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Bui, Lan N., Samford University, Birmingham, Alabama, United States
- Cama-Olivares, Augusto, Universidad Peruana Cayetano Heredia, Lima, Peru
- Liu, Lucas Jing, University of Kentucky, Lexington, Kentucky, United States
- Takeuchi, Tomonori, The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Ortiz-Soriano, Victor M., Brookwood Baptist Health, Birmingham, Alabama, United States
- Lambert, Joshua, University of Cincinnati, Cincinnati, Ohio, United States
- Tolwani, Ashita J., The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Kashani, Kianoush, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- Neyra, Javier A., The University of Alabama at Birmingham, Birmingham, Alabama, United States
Background
The relationship of platelet and white blood cell counts and adverse outcomes has been extensively studied in diverse critically ill populations. These parameters have seldom been studied in patients with AKI requiring CRRT. Given that the delivery of CRRT may directly impact these parameters, we aim to examine the association of changes in platelet and white blood cell (WBC) counts from pre-CRRT to during CRRT with hospital mortality.
Methods
Multicenter retrospective cohort study of 1,413 critically ill adult patients with AKI that required CRRT at two academic medical centers between 2011 and 2021. Platelet and WBC count change from pre- to during CRRT was assessed as a percentage and categorized by SD groups (<1 SD, within 1 SD, and >1 SD of the mean). Multivariable LASSO regression and interaction analyses were utilized to investigate associations with hospital mortality.
Results
Hospital mortality occurred in 53.2% of patients. In models adjusting for demographics, comorbidity, baseline kidney function, and SOFA scores, >1 SD platelet count drop during CRRT (>62% from pre-CRRT) was independently associated with hospital mortality (aOR: 1.82, 95% CI: 1.06, 3.13), while >1 SD WBC count increase during CRRT (>136% from pre-CRRT) exhibited non-significant increased mortality (aOR 1.41, 95% CI: 0.88, 2.29). Four high-risk patient phenotypes were identified from interaction analyses: 1. Pre-CRRT low platelet count that remained low, 2. Pre-CRRT normal platelet count with a drop of >1 SD, 3. Pre-CRRT elevated WBC count that remained high and 4. Normal or elevated pre-CRRT WBC count that increased to >1 SD.
Conclusion
In critically ill adult patients with AKI requiring CRRT, a drop in platelets and an increase in WBC from pre-CRRT to during CRRT can assist in patient phenotyping and mortality risk-classification. Further discovery and validation of relevant CRRT patient phenotypes is needed to better guide CRRT delivery.
Clinically Relevant Phenotypes
| Phenotype | Pre-CRRT mean platelet count (x103) | Drop in platelets during CRRT | Pre-CRRT mean WBC count (x103) | Rise in WBC during CRRT | Observed odds of hospital mortality | Model adjusted odds (25, 75p) of hospital mortality |
| 1 (n=71) | <55 | 34 to 62% | 2.1 to 27 | -59 to 136% | 1.22 | 1.42 (1.07, 1.85) |
| 2 (n=63) | 55 to 263 | >62% | 2.1 to 27 | -59 to 136% | 1.74 | 1.61 (1.14, 2.17) |
| 3 (n=37) | 55 to 263 | 34 to 62% | >27 | -59 to 136% | 2.08 | 1.88 (1.13, 3.35) |
| 4 (n=41) | 55 to 263 | 34 to 62% | 2.1 to 27 | >136% | 2.15 | 1.73 (1.22, 2.15) |
Funding
- NIDDK Support