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

Anthon, Carl Thomas ; Pène, Frédéric ; Perner, Anders ; Barratt-Due, Andreas ; Chawla, Sanjay ; Kander, Thomas LU orcid ; Hästbacka, Johanna ; Andreasen, Jo Bønding ; Péju, Edwige and Nielsen, Lene Bjerregaard , et al. (2023) In Intensive Care Medicine 49(11). p.1327-1338
Abstract

PURPOSE: Thrombocytopenia (platelet count < 150 × 10
9/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... (More)

PURPOSE: Thrombocytopenia (platelet count < 150 × 10
9/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.

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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Intensive Care Medicine
volume
49
issue
11
pages
1327 - 1338
publisher
Springer
external identifiers
  • scopus:85173919249
  • pmid:37812225
ISSN
0342-4642
DOI
10.1007/s00134-023-07225-2
language
English
LU publication?
yes
additional info
© 2023. The Author(s).
id
5ad84c4d-9a8b-4be8-bf10-bdabcc91a10a
date added to LUP
2023-10-15 15:10:07
date last changed
2024-04-20 13:27:55
@article{5ad84c4d-9a8b-4be8-bf10-bdabcc91a10a,
  abstract     = {{<p>PURPOSE: Thrombocytopenia (platelet count &lt; 150 × 10<br>
 9/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.<br>
 </p><p>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.</p><p>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).</p><p>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.</p>}},
  author       = {{Anthon, Carl Thomas and Pène, Frédéric and Perner, Anders and Barratt-Due, Andreas and Chawla, Sanjay and Kander, Thomas and Hästbacka, Johanna and Andreasen, Jo Bønding and Péju, Edwige and Nielsen, Lene Bjerregaard and Hvas, Christine Lodberg and Dufranc, Etienne and Canet, Emmanuel and Lundqvist, Linda and Wright, Christopher John and Voiriot, Guillaume and Clausen, Niels Erikstrup and Lorentzen, Kristian and Kvåle, Reidar and Hildebrandt, Thomas and Holten, Aleksander Rygh and Strand, Kristian and Tzalavras, Asterios and Bestle, Morten Heiberg and Klepstad, Pål and Fernandez, Sara and Vimpere, Damien and Paulino, Carolina and Costa, Carolina and Bådstøløkken, Per Martin and Miranda, Teresa and Russell, Lene}},
  issn         = {{0342-4642}},
  language     = {{eng}},
  month        = {{10}},
  number       = {{11}},
  pages        = {{1327--1338}},
  publisher    = {{Springer}},
  series       = {{Intensive Care Medicine}},
  title        = {{Thrombocytopenia and platelet transfusions in ICU patients : an international inception cohort study (PLOT-ICU)}},
  url          = {{http://dx.doi.org/10.1007/s00134-023-07225-2}},
  doi          = {{10.1007/s00134-023-07225-2}},
  volume       = {{49}},
  year         = {{2023}},
}