Background and objectives: Thrombocytopenia is common among sepsis patients. Platelet transfusions are frequently administered to increase platelet counts, but their 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.
Materials and methods: The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. Septic patients with severe thrombocytopenia (a platelet count ≤ 50/nl) were included in the study and were divided into two groups: a platelet transfusion group (PT group) and a no platelet transfusion group (NPT group). The primary outcome was in-hospital mortality, and the secondary outcomes were the length of intensive care unit (ICU) stay (LOS-ICU) and 90-day mortality. Propensity score matching multivariable logistic regression was used to reduce the imbalance.
Results: A total of 1733 patients were included: 296 patients were included in the PT group and 1437 patients were included in the NPT group. After propensity score matching, 296 paired patients constituted each group. Crude hospital mortality was significantly higher in the PT group than in the NPT group (145 [48.99%] vs. 567 [39.46%], p = 0.002). In the extended multivariable logistic models for hospital mortality, the odds ratio (OR) of receiving a platelet transfusion was consistently significant in all six models (OR range, 1.340-1.525, p < 0.05 for all). In the following subgroups, platelet transfusion was associated with increased in-hospital mortality: age > 60 years; sex: female; sequential organ failure assessment score ≤8; simplified acute physiology score ≤ 47; platelet count >29/nl and the complication of congestive heart failure. However, there were no significant differences in the 90-day mortality rate (170 [57.43%] vs. 741 [51.57%], p = 0.066) or the LOS-ICU (5.84 [2.68-11.78] vs. 4.94 [2.18-12.72], p = 0.442) between the two groups. All these results remained stable after adjustment for confounders and in the comparisons after propensity score matching.
Conclusions: The propensity score-matched analysis showed that platelet transfusion was associated with increased in-hospital mortality in septic patients with severe thrombocytopenia (a platelet count ≤ 50/nl). However, it was not associated with 90-day mortality or the length of ICU stay.
Keywords: 90-day; mortality; platelet transfusion; propensity score matching; sepsis-induced thrombocytopenia.
© 2022 International Society of Blood Transfusion.