Prevalence and Outcomes of Thrombocytopenia at ICU Admission Among Critically Ill Patients in a Resource‐Limited Setting

BACKGROUND: Thrombocytopenia is a common hematologic abnormality among critically ill patients and may reflect underlying sepsis or multi-organ dysfunction. In low- and middle-income countries (LMICs), constrained transfusion capacity and delayed presentation may amplify its prognostic significance. This study evaluated the association between thrombocytopenia and ICU mortality at a tertiary hospital in Malawi. METHODS: We performed a retrospective analysis of patients admitted to the Kamuzu Central Hospital (KCH) Intensive Care Unit (ICU) in Lilongwe, Malawi, from 2016 to 2018. Platelet count was categorized as ≤ 50,000/μL (severe thrombocytopenia), 50,000-150,000/μL (thrombocytopenia), and ≥ 150,000/μL (normal). Bivariate and multivariable logistic regression analyses were performed to identify predictors of mortality. Bivariate analyses and multivariable logistic regression were used to identify factors associated with mortality. RESULTS: Among 498 patients, 95 (19.1%), 70 (14.1%), and 37 (7.4%) have mild, moderate, and severe thrombocytopenia, respectively. The overall incidence of critical illness thrombocytopenia is 40%. Overall ICU mortality was 51.2% (n = 255), with higher mortality among those with severe thrombocytopenia compared to normal platelet counts (70.3% vs. 50.7%). After adjustment for confounders, severe thrombocytopenia remained independently associated with mortality (OR 2.57, 95% CI 1.18-5.58, p = 0.02). CONCLUSION: Thrombocytopenia, particularly platelet counts ≤ 50,000/μL, is independently associated with increased mortality among critically ill patients in resource-limited ICUs. In contexts with limited transfusion and diagnostic capacity, platelet count may serve as a practical and accessible prognostic marker to identify high-risk patients and guide early intervention.