Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)
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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.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Intensive Care Medicine |
| Vol/bind | 49 |
| Udgave nummer | 11 |
| Sider (fra-til) | 1327-1338 |
| Antal sider | 12 |
| ISSN | 0342-4642 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Correction: DOI 10.1007/s00134-023-07291-6
Funding Information:
This study was performed on behalf of the “Caring for critically ill immunocompromised patients: Multinational Network (Nine-I)” study group. PLOT-ICU Collaborators: Ahmed Khalil, Ahmed Yehia, Haney Salem, Hesham Farahat, Manu Sudevan, Melissa Biggart, Nirmeen Fatima, Mohammed Elkhonezy, Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK; Anne-Marie Bunzel, Rine M. Siegumfeldt, Stine R. Vestergaard; Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg University, Aalborg, Denmark; Juliette Pelle, Minh-Pierre Lê, Clara Vigneron, Morgane Bertrix, Paul Cirera, Driss Laghlam, Swann Bredin, Nathalie Marin, Médecine Intensive & Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France; Maria Toppenberg, Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Brice Benelli, Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri-Mondor, Assistance Publique–Hôpitaux de Paris, Paris, France. Amélie Seguin, Charlotte Garret, Florian Guillotin, Gauthier Blonz, Jean-Baptiste Lascarrou, Jérémie Lemarie, Luc Desmedt, Maïté Agbakou, Mathieu Carpentier, Maëlle Martin, Naïla Benkalfate, Olivier Zambon, Paul Decamps, Pauline L. Wilquin, Soraya Benguerfi, Médecine Intensive Réanimation, CHU de Nantes, Université de Nantes, Nantes, France; John Gardner, Critical Care Unit, Queen Elizabeth University Hospital, Glasgow, UK; Natalie Remor, Sheila Carr, Gloria Yang, Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Coralie Gernez, Ingrid Thiry, Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, DMU ESPRIT, Paris, France; Louai Missri, Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France; Moritz K. G. Denneborg Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark; Katherine Brown, Department of Intensive Care, Glasgow Royal Infirmary, Glasgow, UK; Vanessa Casares, Intensive Care Department, Vall d’Hebron Hospital Universitari, Barcelona, Spain; Mirka Sivula, Elina Lappi, Leena Pettilä, Jonna Heinonen, Minttu Saario, Department of Perioperative and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Manal K. Mecheri, Alezandre Elabbadi, Cyrielle Desnos; Antoine Lafarge, Olfa Mghirbi, Médecine Intensive & Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France; Brit Å. Sjøbø, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Cecilie Christoffersen, Department of Anaesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Frederik H. Bestle, Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark; Claudia Lemos, Department of Intensive Care, Hospital Central do Funchal, Funchal, Portugal;Cristiana V. Gonçalves, Nuno M. B. Jacinto, Monica P. Anselmo, Intensive Care Unit, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal; Marius M. Hoeper, Interdisciplinary Intensive Care Unit, Department for Respiratory Diseases and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany; Marja Hoff, Department of Intensive Care B203, Akershus University Hospital, Akershus, Norway; Pedro M. Simões Freire, Department of Intensive Care Medicine, Unit 2, Hospital Egaz Moniz-CHLO, EPE, Lisbon, Portugal.
Funding Information:
Open access funding provided by Royal Library, Copenhagen University Library. This study was funded by the Research Council of Rigshospitalet, the Ehrenreich’s Foundation, and the Dagmar Marshalls Foundation. The Memorial Sloan Kettering Cancer Center part of the study was supported by the Core Grant, Grant/Award Number: P30CA008748; Department of Anaesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America. None of the funders had any influence on the design, conduct or reporting of the study.
Funding Information:
The Department of Intensive Care at Rigshospitalet (CTA, AG, MHM, AP, LR) has received funding for other projects from the Novo Nordisk Foundation, Sygeforsikringen ‘danmark’, and Pfizer and has conducted contract research for AM-Pharma. FP has received honoraria for consulting and lectures from Gilead and an institutional grant from Alexion Pharma. AP has received honoraria from Novartis for participation in an advisory board. EA has received research grants from MSD Avenir and Alexion and honoraria for lectures from Alexion, Sanofi and Pfizer. . AVDL has received honoraria from Sanofi for participation in an advisory board. PC has received consulting fees from Sanofi, Gilead, Alexion and Janssen and honoraria for lectures from Merck Sharp & Dohme, Gilead, Alexion and Pfizer. PP has received consulting fees from Sanofi and Gilead and honoraria from Merck Sharp & Dohme, Gilead, Mundipharma and Pfizer for academic and educational work. JH has received consulting fees from Paion and honoraria for lectures from the Finnish Medical Association, Laboratory Medicine and Duodecim. EC received fees for lectures and conference talks and had travel and accommodation expenses related to attending scientific meetings covered by Gilead, Shionogi B.V. and Sanofi-Genzyme. ARH has received honoraria from Pfizer for lectures. MHB has received consulting fees from AM-pharma and Inotrem. Full disclosure forms from all authors are available on the publisher’s website.
Publisher Copyright:
© 2023, The Author(s).
ID: 375195943