Thrombocytopenia in intensive care unit patients: A scoping review

Abstract

Background Thrombocytopenia is frequent in intensive care unit (ICU) patients and may be associated with adverse outcomes. We aimed to assess the incidence, risk factors, and outcomes associated with thrombocytopenia in adult ICU patients. Methods We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Review and Meta‐analyses extension for Scoping Reviews (PRISMA‐ScR) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included study reports on adult ICU patients with thrombocytopenia and assessed patient‐important outcomes, including mortality and health‐related quality‐of‐life. Results We included a total of 70 studies comprising a total of 215 098 patients; 57 were cohort studies. The incidence of thrombocytopenia varied from 8 to 56 per 100 admissions (very low quality of evidence). We identified several risk factors including age, sepsis, and higher disease severity (low quality of evidence). Thrombocytopenia was associated with bleeding, use of life support, length of stay in the ICU, and increased mortality (low/very low quality of evidence). Data on platelet transfusion before invasive procedures and transfusion thresholds were limited. No studies assessed the benefits and harms of thromboprophylaxis in ICU patients with thrombocytopenia. Conclusions Thrombocytopenia is common and associated with increased morbidity and mortality in adult ICU patients. Several risk factors for thrombocytopenia exists, but the evidence‐base on management strategies, including transfusion thresholds and thromboprophylaxis in ICU patients is very limited.

Association of longitudinal platelet count trajectory with ICU mortality: A multi-cohort study

“…Most ICU patients experience inflammatory stress or infection, while platelets induce the proliferation, maturation, and activation of immune cells and interact with Toll-like receptors (TLRs) (32), which can recognize pathogen or virus, and are involved in the immune response (33). Thrombocytopenia is a common sign of poor prognosis in ICU patients (34). The decline of platelet count may result in weakened immune function, while the increased platelet count may reflect the elimination of pathogens and the recovery of immune defense (35)(36)(37), which contributes to the recovery of ICU patients.…”

Prophylactic platelet transfusions in hospitalised patients with thrombocytopenia—Protocol for a systematic review with meta‐analysis

“…Prophylactic platelet transfusion is a frequent intervention in hospitalised patients with thrombocytopenia, but the optimal transfusion strategy outside the haematological setting is unclear. Thrombocytopenia is associated with adverse outcomes, including increased risk of bleeding, 1 but transfusion of platelet concentrate has variable 14 and potential adverse effects including increased risk of thrombosis and death 23‐25 . The outlined systematic review will provide an overview of the certainty of evidence on the benefits and harms of prophylactic platelet transfusions in hospitalised patients, and the results will provide guidance regarding transfusion of platelets.…”

“…Thrombocytopenia is a condition with low platelet levels in the blood, typically defined as a platelet count less than 150 × 10 9 /L, and​is associated with increased rates of bleeding, transfusion requirements, and mortality 1 . Thrombocytopenia is common in hospitalised patients, including patients with haematological malignancies, 2 patients receiving chemotherapy, 3 patients with chronic liver disease, 4 and critically ill patients admitted to the intensive care unit (ICU) 5,6 …”

Platelet transfusions and thrombocytopenia in intensive care units: Protocol for an international inception cohort study (PLOT‐ICU)

“…The cause of thrombocytopenia in critically ill patients is often multifactorial 9 and may be a marker of illness severity and/or a consequence of critical illness 6 . Several risk factors for thrombocytopenia have been proposed and it has been associated with increased rates of bleeding, transfusion requirements, length of hospital stay and mortality 4 . However, uncertainty exists as the current evidence mainly consists of small single‐centre observational studies, some with methodological issues, low external validity and conflicting results 4 …”