Platelet transfusion and mortality in patients with sepsis‐induced thrombocytopenia: A propensity score matching analysis

Abstract

Thrombocytopenia is common among sepsis patients. Platelet transfusion is frequently administered to increase platelet counts but its clinical impacts remain unclear in sepsis-induced thrombocytopenia. The goal of this study was to explore the association between platelet transfusion and mortality in patients with sepsis-induced thrombocytopenia based on the Medical Information Mart for Intensive Care (MIMIC) III database. In this study, we included 1733 patients with sepsis-induced thrombocytopenia, and these patients were divided into two groups: platelet transfusion group (PT group) and no platelet transfusion group (NPT group). Propensity-score matching was used to reduce the imbalance. We found that patients in the PT group had a higher in-hospital mortality as compared with the NPT group. Furthermore, in the subgroup of age (>60 years), gender (female), sequential organ failure assessment score (≤8), simpli ed acute physiology score (≤47), platelet count (>27/nL), congestive heart failure, platelet transfusion was associated with increased in-hospital mortality. However, there was no signi cant difference in the 90-day mortality and the length of ICU stays (LOS-ICU) between these two groups. All these results remain stable after adjustment for confounders and in the comparisons after propensity score matching. In conclusion, platelet transfusion was associated with increased in-hospital mortality in patients with sepsis-induced thrombocytopenia.

Platelet P2Y12 signalling pathway in the dysregulated immune response during sepsis

“…No change was noted when clopidogrel–aspirin‐treated platelets were reinfused in mice. This is in line with another study where platelet transfusion did not appear to increase the outcome of sepsis (Wu et al, 2022). Also, we have investigated an LPS‐induced model of inflammation and noted that inflammation was more severe in P2Y 12 deficient mice compared with the control group (Liverani, Kilpatrick, et al, 2014).…”

“…The study of Bedet and colleagues was performed on both males and females, but the data were not analysed separately and did not take into account the normally higher platelet count in females. Other studies confirmed that a decrease in platelet production can be one of the causes of thrombocytopenia, but unfortunately, platelet transfusion did not appear to alter the outcome of sepsis (Wu et al, 2022). Moreover, thrombocytopenia has been associated with the presence of autoantibodies against platelets (Aghabeigi et al, 2012), suggesting that platelets may be aggressively phagocyted during sepsis.…”

How I diagnose and treat neonatal thrombocytopenia

“…78 This could represent a clearer signal suggesting adverse immune effects can result from liberal platelet transfusion. 128,129 In addition, angiogenic signals may precipitate bleeding during a vulnerable period of neonatal brain development, potentially provided by adult platelets. 130,131 Figure Legend…”

Special Communication: Response to “Ensuring a Reliable Platelet Supply in the United States”

“…Poorer outcomes are seen in patients receiving platelet transfusions including significant transfusion reactions such as transfusion-related circulatory overload, transfusionrelated acute lung injury, allergic/anaphylactic reactions, alongside increased nosocomial infections, admission to critical care units, thrombosis, length of stay, and mortality. [3][4][5][6][7][8] Most platelet components are not administered therapeutically for hemorrhage; instead, they are commonly given prophylactically to nonbleeding patients before minimally invasive elective procedures or for various levels of thrombocytopenia not associated with bleeding risk. 9 These prophylactic platelets do not assure the prevention of bleeding and have been associated with increased bleeding episodes in certain clinical scenarios.…”