Impact of Thrombocytopenia on Outcomes in Hospitalized Patients With Pneumonia, Chronic Obstructive Pulmonary Disease, and Asthma: A Nationwide Study (2016-2020).

Background

Pneumonia (PNA), chronic obstructive pulmonary disease (COPD), and asthma affect millions of patients every year, and thrombocytopenia is a common finding inside the hospital. In this analysis, the authors aim to investigate the impact of thrombocytopenia in patients admitted due to PNA, COPD, or asthma in terms of all-cause mortality, length of stay, resource utilization, and need for intubation.

Methods

This is an analysis of the National Inpatient Sample Database for the years 2016-2020. Patients admitted with a primary diagnosis of PNA, COPD, or asthma, with or without a secondary diagnosis of thrombocytopenia, were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. The primary outcome was all-cause mortality. Secondary outcomes were length of stay, resource utilization, and intubation during admission. Univariate analysis was done, and variables such as age, gender, race, Charlson comorbidity index, hospital location, size, region, teaching status, and insurance with p<0.2 were considered for adjustment on a subsequent multivariate analysis. STATA v.13 (StataCorp LLC, College Station, TX) was used for statistical analysis. Data were considered statistically significant if p-value <0.05.

Results

Among 2,993,792 adult patients admitted with a primary diagnosis of PNA, 148,260 (4.95%) had thrombocytopenia. Of 2,637,483 admitted due to COPD, 77,160 (2.92%) had thrombocytopenia. Of 491,990 admitted due to asthma, 6,300 (1.28%) had thrombocytopenia. Thrombocytopenia was associated with significantly increased in-hospital mortality across all three conditions (PNA: OR 2.31; COPD: OR 2.99; asthma: OR 7.26; all p<0.001), along with prolonged length of stay, higher resource utilization, and increased intubation rates. Strikingly, patients with asthma had an increased in-hospital mortality by 626% compared to patients without thrombocytopenia.

Conclusion

PNA, COPD, and asthma patients with concomitant thrombocytopenia experienced significant adverse in-hospital outcomes. Further investigation is warranted to determine whether interventions targeting thrombocytopenia can mitigate these negative consequences.