Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Anthon CT

PROVIDER: S-EPMC10622358 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

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Publications

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

Anthon Carl Thomas CT Pène Frédéric F Perner Anders A Azoulay Elie E Puxty Kathryn K Van De Louw Andry A Barratt-Due Andreas A Chawla Sanjay S Castro Pedro P Póvoa Pedro P Coelho Luis L Metaxa Victoria V Kochanek Matthias M Liebregts Tobias T Kander Thomas T Hästbacka Johanna J Andreasen Jo Bønding JB Péju Edwige E Nielsen Lene Bjerregaard LB Hvas Christine Lodberg CL Dufranc Etienne E Canet Emmanuel E Lundqvist Linda L Wright Christopher John CJ Schmidt Julien J Uhel Fabrice F Ait-Oufella Hafid H Krag Mette M Cos Badia Elisabet E Díaz-Lagares Cándido C Menat Sophie S Voiriot Guillaume G Clausen Niels Erikstrup NE Lorentzen Kristian K Kvåle Reidar R Hildebrandt Thomas T Holten Aleksander Rygh AR Strand Kristian K Tzalavras Asterios A Bestle Morten Heiberg MH Klepstad Pål P Fernandez Sara S Vimpere Damien D Paulino Carolina C Graça Carina C Lueck Catherina C Juhl Christian Svendsen CS Costa Carolina C Bådstøløkken Per Martin PM Miranda Teresa T Lêdo Lia Susana Aires LSA Sousa Torres Joao Carlos JC Granholm Anders A Møller Morten Hylander MH Russell Lene L

Intensive care medicine 20231009 11

<h4>Purpose</h4>Thrombocytopenia (platelet count < 150 × 10<sup>9</sup>/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.<h4>Methods</h4>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 evaluate ...[more]

PMID: 37812225

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Project description:BackgroundThrombocytopenia is frequently encountered in critically ill patients, often resulting in prophylactic transfusion of platelets for the prevention of bleeding complications. However, the efficacy of this practice remains unclear. The objective of this study was to determine the relationship between prophylactic platelet transfusion and bleeding complications in critically ill patients.MethodsThis is a retrospective cohort study of adults admitted to surgical, medical, or combined medical-surgical intensive care units (ICUs) at a single academic institution between January 1, 2009, and December 31, 2013. Inclusion criteria included age ≥18 years and a platelet count measured during ICU admission. Propensity-matched analyses were used to evaluate associations between prophylactic platelet transfusions and the outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of ICU and hospital-free days and changes in sequential organ failure assessment scores.ResultsA total of 40,693 patients were included in the investigation with 3227 (7.9%) receiving a platelet transfusion and 1065 (33.0%) for which platelet transfusion was prophylactic in nature. In propensity-matched analyses, 994 patients with prophylactic platelet transfusion were matched to those without a transfusion. Patients receiving prophylactic platelets had significantly higher red blood cell transfusion rates (odds ratio 7.5 [5.9-9.5]; P < .001), fewer ICU-free days (mean [standard deviation] 20.8 [9.1] vs 22.7 [8.3] days; P = .004), fewer hospital-free days (13.0 [9.7] vs 15.8 [9.4] days; P < .001), and less improvement in sequential organ failure assessment scores (mean decrease of 0.2 [3.6] vs 1.8 [3.3]; P < .001) in the subsequent 24 hours. These findings appeared robust, persisting in multiple predefined sensitivity analyses.ConclusionsProphylactic administration of platelets in the critically ill was not associated with improved clinical outcomes, though residual confounding may exist. Further investigation of platelet transfusion strategies in this population is warranted.

Project description:ObjectiveThe aim of this study was to describe the frequency, attribution, outcome and predictors of seizures in systemic lupus erythematosus (SLE).MethodsThe Systemic Lupus International Collaborating Clinics, or SLICC, performed a prospective inception cohort study. Demographic variables, global SLE disease activity (SLE Disease Activity Index 2000), cumulative organ damage (SLICC/American College of Rheumatology Damage Index (SDI)) and neuropsychiatric events were recorded at enrolment and annually. Lupus anticoagulant, anticardiolipin, anti-β(2) glycoprotein-I, antiribosomal P and anti-NR2 glutamate receptor antibodies were measured at enrolment. Physician outcomes of seizures were recorded. Patient outcomes were derived from the SF-36 (36-Item Short Form Health Survey) mental component summary and physical component summary scores. Statistical analyses included Cox and linear regressions.ResultsThe cohort was 89.4% female with a mean follow-up of 3.5±2.9 years. Of 1631 patients, 75 (4.6%) had ≥1 seizure, the majority around the time of SLE diagnosis. Multivariate analysis indicated a higher risk of seizures with African race/ethnicity (HR (CI): 1.97 (1.07 to 3.63); p=0.03) and lower education status (1.97 (1.21 to 3.19); p<0.01). Higher damage scores (without neuropsychiatric variables) were associated with an increased risk of subsequent seizures (SDI=1:3.93 (1.46 to 10.55); SDI=2 or 3:1.57 (0.32 to 7.65); SDI≥4:7.86 (0.89 to 69.06); p=0.03). There was an association with disease activity but not with autoantibodies. Seizures attributed to SLE frequently resolved (59/78 (76%)) in the absence of antiseizure drugs. There was no significant impact on the mental component summary or physical component summary scores. Antimalarial drugs in the absence of immunosuppressive agents were associated with reduced seizure risk (0.07 (0.01 to 0.66); p=0.03).ConclusionSeizures occurred close to SLE diagnosis, in patients with African race/ethnicity, lower educational status and cumulative organ damage. Most seizures resolved without a negative impact on health-related quality of life. Antimalarial drugs were associated with a protective effect.

Dataset Information

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

Purpose

Methods

Results

Conclusion

Publications

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

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