Prevalence, Risk Factors, and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients: A Retrospective Cohort Study

Saeed Arabi; Abdullah O Almahayni; Abdulrahman A Alomair; Emad M Masuadi; Moussab Damlaj; Hasan M Al-Dorzi

doi:10.1155/2021/5589768

Prevalence, Risk Factors, and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients: A Retrospective Cohort Study

Crit Care Res Pract. 2021 Sep 23:2021:5589768. doi: 10.1155/2021/5589768. eCollection 2021.

Authors

Saeed Arabi^{1

2}, Abdullah O Almahayni^{1

2}, Abdulrahman A Alomair^{1

2}, Emad M Masuadi^{1

2}, Moussab Damlaj^{1

2

3}, Hasan M Al-Dorzi^{1

2

4}

Affiliations

¹ College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
² King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
³ Department of Oncology, King Abdulaziz Medical City-Riyadh, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
⁴ Intensive Care Department, King Abdulaziz Medical City-Riyadh, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.

Abstract

Background: Refractoriness to platelet transfusion is an understudied phenomenon in critically ill patients. Our objective was to evaluate the prevalence, risk factors, and clinical outcomes of platelet refractoriness among patients in a tertiary-care intensive care unit (ICU).

Methods: A retrospective cohort study included all patients (age >14 years) who were admitted to a tertiary-care medical-surgical ICU between 2011 and 2016 and received ≥2 platelet transfusions during their ICU stay. We calculated platelet increment (PI) and corrected count increment (CCI).

Results: A total of 267 patients were enrolled in the study, collectively receiving 1357 transfusions with a median of 4.0 (interquartile range: 2.0, 6.0) transfusions per patient. The median pretransfusion platelet count was 31000.0 × 10⁶/L (interquartile range: 16000.0, 50000.0). The median PI was 6000 × 10⁶/L. The prevalence of platelet transfusion refractoriness was 54.8% based on PI < 10000 × 10⁶/L and 57.0% based on CCI <5000. Patients admitted under hepatology/liver transplant had the highest rates of platelet refractoriness (69.6%), while those under general surgery had the lowest rate (43.2%). Younger age, nontrauma admission, and larger spleen size were associated with platelet refractoriness. Finally, refractoriness was associated with increased length of stay in the ICU (p = 0.02), but not with mortality.

Conclusions: Platelet transfusion refractoriness was highly (>50%) prevalent in ICU patients. However, it was not associated with increased mortality.