Platelet Transfusion in Patients With Sepsis and Thrombocytopenia: A Propensity Score-Matched Analysis Using a Large ICU Database

Abstract

PurposeSepsis with thrombocytopenia is highly prevalent in critically ill intensive care unit (ICU) patients and is associated with adverse outcomes. Platelet transfusion is the primary treatment of choice. However, evidence for the beneficial effects of platelet transfusion in patients with sepsis and thrombocytopenia is scarce and low in quality. This study aimed to evaluate the association between platelet transfusion and mortality among ICU patients with sepsis and thrombocytopenia.Patients and MethodsUsing the Medical Information Mart for Intensive Care III database (v. 1.4), the outcomes of sepsis patients with platelet counts of ≤ 150,000/μL were compared between those who did and did not receive platelet transfusion. The primary outcomes were 28- and 90-day all-cause mortalities. The secondary outcomes were red blood cell (RBC) transfusion, ICU-free days, and hospital-free days. Propensity score matching was employed to assemble a cohort of patients with similar baseline characteristics.ResultsAmong 7,765 eligible patients, 677 received platelet transfusion and were matched with 677 patients who did not receive platelet transfusion according to propensity scores. Platelet transfusion, as compared with no platelet transfusion, was associated with an increased risk of 28-day all-cause mortality [36.9 vs. 30.4%, odds ratio (OR), 1.21; 95% confidence interval (CI), 1.01–1.46; p = 0.039], increased risk of 90-day all-cause mortality (50.8 vs. 44.6%, OR, 1.13; 95% CI, 1.00–1.31; p = 0.048), fewer mean (standard deviation) 28-day ICU-free days (15.88 ± 8.97 vs. 18.64 ± 8.33 days, p < 0.001), and fewer hospital-free days (10.29 ± 8.49 vs. 11.43 ± 8.85 days, p = 0.017). The rate of RBC transfusion was not significantly different between the platelet transfusion and non-transfusion groups (p = 0.149). The results were maintained across several subgroup and sensitivity analyses.ConclusionIn this study, platelet transfusion was associated with higher 28- and 90-day all-cause mortalities. These results suggest the potential hazards of platelet transfusion in ICU patients with sepsis and thrombocytopenia.

Four Assessment Tools for Predicting Mortality and Adverse Events in Surgical Patients With Sepsis and Septic Shock: A Comparative Study

“…The discrimination of mPIRO for mortality was better than that of PIRO. The findings of this study support those of previous studies showing thrombocytopenia to be an independent predictor of mortality and a poor prognostic indicator of clinical outcomes in patients with surgical sepsis (Assinger et al, 2019;He et al, 2022). In patients with sepsis, platelet consumption is commonly seen during bacterial infections (Giustozzi et al, 2021).…”

“…In patients with sepsis, platelet consumption is commonly seen during bacterial infections (Giustozzi et al, 2021). Thrombocytopenia severity is strongly associated with sepsis severity (He et al, 2022).…”

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.…”