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Войти в исследования Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU).
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Anthon Carl Thomas, Pène Frédéric, Perner Anders, Azoulay Elie, Puxty Kathryn, Van De Louw Andry, Barratt-Due Andreas, Chawla Sanjay, Castro Pedro, Póvoa Pedro, Coelho Luis, Metaxa Victoria, Kochanek Matthias, Liebregts Tobias, Kander Thomas, Hästbacka Johanna, Andreasen Jo Bønding, Péju Edwige, Nielsen Lene Bjerregaard, Hvas Christine Lodberg, Dufranc Etienne, Canet Emmanuel, Lundqvist Linda, Wright Christopher John, Schmidt Julien, Uhel Fabrice, Ait-Oufella Hafid, Krag Mette, Cos Badia Elisabet, Díaz-Lagares Cándido, Menat Sophie, Voiriot Guillaume, Clausen Niels Erikstrup, Lorentzen Kristian, Kvåle Reidar, Hildebrandt Thomas, Holten Aleksander Rygh, Strand Kristian, Tzalavras Asterios, Bestle Morten Heiberg, Klepstad Pål, Fernandez Sara, Vimpere Damien, Paulino Carolina, Graça Carina, Lueck Catherina, Juhl Christian Svendsen, Costa Carolina, Bådstøløkken Per Martin, Miranda Teresa, Lêdo Lia Susana Aires, Sousa Torres Joao Carlos, Granholm Anders, Møller Morten Hylander, Russell Lene, on behalf of the PLOT-ICU Collaborators and the Nine-I Study Group
Аннотация
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.