Association between platelets and in-hospital mortality in critically ill patients with tumours: a retrospective cohort study

Abstract

ObjectivesPlatelet count is an independent predictor of mortality in patients with cancer. It remains unknown whether the platelet count is related to in-hospital mortality in severely ill patients with tumours.DesignA retrospective study based on a dataset from a multicentre cohort.SettingThis was a secondary analysis of data from one Electronic Intensive Care Unit Collaborative Research Database survey cycle (2014–2015).ParticipantsThe data pertaining to severely ill patients with tumours were collected from 208 hospitals located across the USA. This study initially a total of 200 859 participants. After the population was limited to patients with combined tumours and platelet deficiencies, the remaining 2628 people were included in the final data analysis.Primary and secondary outcome measuresThe main measure was the platelet count, and the main outcome was in-hospital mortality.ResultsAfter adjustment for the covariates, the platelet count had a curvilinear relationship with in-hospital mortality (p<0.001). The first inflection point was 18.4 (per 10 change). On the left side of the first inflection point (platelet count ≤184 'x10ˆ9/L), an increase of 10 in the platelet count was negatively associated with in-hospital mortality (OR 0.92, 95% CI 0.89 to 0.95, p<0.001). The second inflection point was 44.5 (per 10 change). Additional increases of 10 in the platelet count thereafter were positively associated with hospital mortality (OR 1.13, 95% CI 1.00 to 1.28, p=0.0454). The baseline platelet count was in the range of 184 'x10ˆ9/L–445 'x10ˆ9/L(p=0.0525), and the hospital mortality was lower than the baseline platelet count in other ranges.ConclusionsThe relationship between platelet count and in-hospital mortality in critically ill patients with tumours was curvilinear. The lowest in-hospital mortality was associated with platelet count between 184 'x10ˆ9/Land 445 'x10ˆ9/L. This indicates that both high and low platelet count should receive attention in clinical practice.

Factors associated with in-hospital and outpatient survival of patients with different types of stage IV cancer and venous thromboembolism

“… 26 Moreover, the platelet count threshold associated with a higher risk of mortality was <184,000/µL in previous studies. 19 , 27 Thrombocytopenia has also been associated with a higher risk of recurrence. 28 This may be related to the fact that some patients receive subtherapeutic doses of anticoagulants or may even require suspension of treatment.…”