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. 2023 Nov;49(11):1327-1338.
doi: 10.1007/s00134-023-07225-2. Epub 2023 Oct 9.

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

Carl Thomas Anthon  1 , Frédéric Pène  2 , Anders Perner  1   3   4 , Elie Azoulay  4 , Kathryn Puxty  5 , Andry Van De Louw  6 , Andreas Barratt-Due  7 , Sanjay Chawla  8   9 , Pedro Castro  10 , Pedro Póvoa  11   12   13 , Luis Coelho  11   12 , Victoria Metaxa  14 , Matthias Kochanek  15 , Tobias Liebregts  16 , Thomas Kander  17   18 , Johanna Hästbacka  19   20 , Jo Bønding Andreasen  21 , Edwige Péju  2 , Lene Bjerregaard Nielsen  22 , Christine Lodberg Hvas  23 , Etienne Dufranc  24 , Emmanuel Canet  25 , Linda Lundqvist  17 , Christopher John Wright  26 , Julien Schmidt  27 , Fabrice Uhel  28   29 , Hafid Ait-Oufella  30 , Mette Krag  3   31 , Elisabet Cos Badia  32 , Cándido Díaz-Lagares  33   34 , Sophie Menat  35 , Guillaume Voiriot  36 , Niels Erikstrup Clausen  37 , Kristian Lorentzen  38 , Reidar Kvåle  39   40 , Thomas Hildebrandt  41 , Aleksander Rygh Holten  42   43 , Kristian Strand  44 , Asterios Tzalavras  16 , Morten Heiberg Bestle  3   45 , Pål Klepstad  46   47 , Sara Fernandez  48 , Damien Vimpere  49 , Carolina Paulino  12   50 , Carina Graça  51 , Catherina Lueck  52 , Christian Svendsen Juhl  53 , Carolina Costa  54 , Per Martin Bådstøløkken  55 , Teresa Miranda  11 , Lia Susana Aires Lêdo  56 , Joao Carlos Sousa Torres  57 , Anders Granholm  1 , Morten Hylander Møller  1   3 , Lene Russell  58   59   60   61 ; on behalf of the PLOT-ICU Collaborators and the Nine-I Study Group
Collaborators, Affiliations

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

Carl Thomas Anthon et al. Intensive Care Med. 2023 Nov.

Erratum in

  • Correction: Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU).
    Anthon CT, Pène F, Perner A, Azoulay E, Puxty K, Van De Louw A, Barratt-Due A, Chawla S, Castro P, Póvoa P, Coelho L, Metaxa V, Kochanek M, Liebregts T, Kander T, Hästbacka J, Andreasen JB, Péju E, Nielsen LB, Hvas CL, Dufranc E, Canet E, Lundqvist L, Wright CJ, Schmidt J, Uhel F, Ait-Oufella H, Krag M, Cos Badia E, Díaz-Lagares C, Menat S, Voiriot G, Clausen NE, Lorentzen K, Kvåle R, Hildebrandt T, Holten AR, Strand K, Tzalavras A, Bestle MH, Klepstad P, Fernandez S, Vimpere D, Paulino C, Graça C, Lueck C, Juhl CS, Costa C, Bådstøløkken PM, Miranda T, Lêdo LSA, Sousa Torres JC, Granholm A, Møller MH, Russell L; the PLOT-ICU Collaborators and the Nine-I Study Group. Anthon CT, et al. Intensive Care Med. 2024 Jan;50(1):154-155. doi: 10.1007/s00134-023-07291-6. Intensive Care Med. 2024. PMID: 38078947 Free PMC article. No abstract available.

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.

Keywords: Bleeding; Critical illness; Intensive care unit; Platelet transfusion; Thrombocytopenia; Thrombosis.

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Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
The trajectories of thrombocytopenia. Trajectories of thrombocytopenia in all patients (A) and exclusively in those who had thrombocytopenia (B). The severity of baseline- and ICU thrombocytopenia was based on the platelet count at baseline and the nadir platelet during ICU stay, respectively. The flows are coloured according to the baseline severity. Patients whose thrombocytopenia remained unchanged (i.e., unchanged severity) from baseline throughout their ICU stay are represented by flows moving between identical colours. Patients whose thrombocytopenia got better or worse (i.e., decreased or increased severity) during their ICU stay compared to their starting point at baseline are represented by flows moving between different colours. Only 22 patients had less severe thrombocytopenia during their ICU stay compared to their starting point at baseline (represented by flows mowing from “warmer” to “colder” colour tones)
Fig. 2
Fig. 2
In-ICU platelet transfusions and indications. Number of in-ICU platelet transfusions used in patients with- and without thrombocytopenia. Patients with severe- and very severe thrombocytopenia received 93% of all in-ICU platelet transfusions and in patients with very severe thrombocytopenia, 76% of in-ICU transfusions were prophylactic. We did not collect data on indications for 57 platelet transfusions used during surgery, thus these are excluded (see ESM 22 for details)
See this image and copyright information in PMC

References

    1. Strauss R, Wehler M, Mehler K, et al. Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med. 2002;30:1765–1771. doi: 10.1097/00003246-200208000-00015. - DOI - PubMed
    1. Crowther MA, Cook DJ, Meade MO, et al. Thrombocytopenia in medical-surgical critically ill patients: prevalence, incidence, and risk factors. J Crit Care. 2005;20:348–353. doi: 10.1016/j.jcrc.2005.09.008. - DOI - PubMed
    1. Greinacher A, Selleng S. How i evaluate and treat thrombocytopenia in the intensive care unit patient. Blood. 2016;128:3032–3042. doi: 10.1182/blood-2016-09-693655. - DOI - PubMed
    1. Hui P, Cook DJ, Lim W, et al. The frequency and clinical significance of thrombocytopenia complicating critical illness: a systematic review. Chest. 2011;139:271–278. doi: 10.1378/CHEST.10-2243. - DOI - PubMed
    1. Jonsson AB, Rygård SL, Hildebrandt T, et al. Thrombocytopenia in intensive care unit patients: a scoping review. Acta Anaesthesiol Scand. 2021;65:2–14. doi: 10.1111/AAS.13699. - DOI - PubMed