Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

TY - JOUR

T1 - Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

AU - Anthon, Carl Thomas

AU - Pène, Frédéric

AU - Perner, Anders

AU - Azoulay, Elie

AU - Puxty, Kathryn

AU - Van De Louw, Andry

AU - Barratt-Due, Andreas

AU - Chawla, Sanjay

AU - Castro, Pedro

AU - Póvoa, Pedro

AU - Coelho, Luis

AU - Metaxa, Victoria

AU - Kochanek, Matthias

AU - Liebregts, Tobias

AU - Kander, Thomas

AU - Hästbacka, Johanna

AU - Andreasen, Jo Bønding

AU - Péju, Edwige

AU - Nielsen, Lene Bjerregaard

AU - Hvas, Christine Lodberg

AU - Dufranc, Etienne

AU - Canet, Emmanuel

AU - Lundqvist, Linda

AU - Wright, Christopher John

AU - Schmidt, Julien

AU - Uhel, Fabrice

AU - Ait-Oufella, Hafid

AU - Krag, Mette

AU - Cos Badia, Elisabet

AU - Díaz-Lagares, Cándido

AU - Menat, Sophie

AU - Voiriot, Guillaume

AU - Clausen, Niels Erikstrup

AU - Lorentzen, Kristian

AU - Kvåle, Reidar

AU - Hildebrandt, Thomas

AU - Holten, Aleksander Rygh

AU - Strand, Kristian

AU - Tzalavras, Asterios

AU - Bestle, Morten Heiberg

AU - Klepstad, Pål

AU - Fernandez, Sara

AU - Vimpere, Damien

AU - Paulino, Carolina

AU - Graça, Carina

AU - Lueck, Catherina

AU - Juhl, Christian Svendsen

AU - Costa, Carolina

AU - Bådstøløkken, Per Martin

AU - Miranda, Teresa

AU - Lêdo, Lia Susana Aires

AU - Sousa Torres, Joao Carlos

AU - Granholm, Anders

AU - Møller, Morten Hylander

AU - Russell, Lene

AU - PLOT-ICU Collaborators and the Nine-I Study Group

N1 - © 2023. The Author(s).

PY - 2023/11

Y1 - 2023/11

N2 - PURPOSE: Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients.METHODS: We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses.RESULTS: We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4-46.1) had thrombocytopenia; 23.4% (20-26) had thrombocytopenia at ICU admission, and 19.8% (17.6-22.2) developed thrombocytopenia during their ICU stay. Absence of acquired immune deficiency syndrome (AIDS), non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19-2.42).CONCLUSION: Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.

AB - PURPOSE: Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients.METHODS: We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses.RESULTS: We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4-46.1) had thrombocytopenia; 23.4% (20-26) had thrombocytopenia at ICU admission, and 19.8% (17.6-22.2) developed thrombocytopenia during their ICU stay. Absence of acquired immune deficiency syndrome (AIDS), non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19-2.42).CONCLUSION: Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.

KW - Adult

KW - Humans

KW - Male

KW - Female

KW - Middle Aged

KW - Platelet Transfusion/adverse effects

KW - Cohort Studies

KW - Prospective Studies

KW - Thrombocytopenia/epidemiology

KW - Intensive Care Units

KW - Hemorrhage/etiology

KW - Retrospective Studies

U2 - 10.1007/s00134-023-07225-2

DO - 10.1007/s00134-023-07225-2

M3 - SCORING: Journal article

C2 - 37812225

VL - 49

SP - 1327

EP - 1338

JO - INTENS CARE MED

JF - INTENS CARE MED

SN - 0342-4642

IS - 11

ER -