• Chia-Ter Chao, Hung-Bin Tsai, Chih-Kang Chiang, Jenq-Wen Huang, and COGENT (COhort of GEriatric Nephrology in NTUH) study group.
• Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan.
• Scand J Trauma Resus. 2017 Feb 10; 25 (1): 11.

BackgroundFew studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We investigated whether thrombocytopenia was a risk factor for AKI in geriatric patients with medical illnesses.MethodsA prospective cohort study was conducted, by recruiting elderly (≥65 years) patients who visited the emergency department (ED) for medical illnesses during 2014. They all received hemogram for platelet count determination, and were stratified according to the presence of thrombocytopenia (platelets, <150 K/μL) during their initial ED evaluation. They were prospectively followed up during their ED stay. We analyzed the relationship between the diagnosis of thrombocytopenia and subsequent AKI after ED stay, using Cox proportional hazard modeling, with platelet count as a continuous variable or thrombocytopenia as a categorical variable.ResultsOf 136 elderly patients (mean age of 80.7 ± 8.2 years, 40% with chronic kidney disease, and 39% with diabetes) enrolled, 22.8% presented with thrombocytopenia, without differences in baseline renal function. After a mean ED stay of 4.4 ± 2.1 days, 41.9% developed AKI (52.6% Kidney Disease Improving Global Outcomes [KDIGO] grade 1, 24.6% grade 2, and 22.8% grade 3). Patients with higher AKI severity had stepwise lower platelet counts compared to those without AKI. The Cox proportional hazard model revealed that lower platelet count as a continuous variable (hazard ratio [HR] 0.984, 95% confidence interval [CI] 0.975-0.994) and as a categorical variable (presence of thrombocytopenia) (HR 1.86, 95% CI 1.06-3.27) increased the risk of AKI. The sensitivity analyses accounting for nephrotoxic medications use, including non-steroidal anti-inflammatory drugs, vancomycin, and contrast, yielded similar results.DiscussionThrombocytopenia is common among ED-visiting elderly, and the potential relationship between platelet counts and the risk of AKI suggests the utility of checking hemogram for those at-risk ofdeveloping adverse renal events.ConclusionThrombocytopenia on initial presentation might indicate an increased risk of AKI among elderly patients with medical illnesses.

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