Profiling causes of thrombocytopenia and hospitalization outcomes among adult non-HIV medical patients at tertiary hospitals in Rwanda: case of CHUK and King Faisal hospital

Abstract

Background: A wide spectrum of factors affect platelet count in a patient. The severity of thrombocytopenia with associated medical conditions poses a relative risk of bleeding with adverse hospitalization outcomes. In this study, we aimed at determining the incidence, clinical characteristics, common factors, and immediate hospitalization outcomes of patients with thrombocytopenia at CHUK and KFH. Methods: This was a prospective and cross-sectional study among a cohort of HIV-negative hospitalized medical patients with thrombocytopenia. It was conducted over 8 months from October 2021 through May 2022. Data from enrolled patients were analyzed and frequencies and proportions were expressed as percentages. Bivariate and multivariate analyses were conducted to determine significant factors associated with thrombocytopenia at a p-value of ˂0.05. Results: Our cohort comprised 194 patients with thrombocytopenia. The incidence was 13.4 %. Cases of mild thrombocytopenia were the most common at 51.03%, followed by moderate thrombocytopenia at 31.9%, and cases with severe thrombocytopenia represented 17.01%.The most affected group were elderly patients (age ˃ 61) representing 34.5% , mean age 50 (IQR: 3856) ,males 1.6 times than females Among identified factors associated with thrombocytopenia , sepsis ranked first at 17.01% ( OR 2 ,95%CI [1.152-4.611] , p=0.036) ,chronic liver disease came second in 13.4% ( OR 2.47 ;95% CI[ 2.43-4.13]; p=0.041) , thirdly came malignancies at 11.85% (OR 3.5 ,95% CI [1.052-4.576] , p=0.045 ) , malaria at 8.24% (OR 12.6 ; 95%CI [2.44-15.46] , p=0.021), megaloblastic anemia in 5.15% (OR 14.63; 95% CI [ 1.300-16.36] , p=0.031). Chemotherapy, enoxaparin, and aspirin use proved an association with thrombocytopenia. Minor bleeding was the most common complication (WHO grade I-II) in 19 patients representing 9.79% (OR 4.23, 95%CI [1.23-15.2], p=0.022). At discharge, 57.73% of patients had normalized platelet counts while 42.27% had persistent thrombocytopenia. Conclusion: Thrombocytopenia is common in medical wards, especially in the elderly. Timely investigations to make a diagnosis and treatment make a difference in patients with thrombocytopenia and prevention of its adverse outcome