Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Carl Thomas Anthon; Frédéric Pène; Anders Perner; Elie Azoulay; Kathryn Puxty; Andry Van De Louw; Andreas Barratt-Due; Sanjay Chawla; Pedro Castro; Pedro Póvoa; Luis Coelho; Victoria Metaxa; Matthias Kochanek; Tobias Liebregts; Thomas Kander; Johanna Hästbacka; Jo Bønding Andreasen; Edwige Péju; Lene Bjerregaard Nielsen; Christine Lodberg Hvas; Etienne Dufranc; Emmanuel Canet; Linda Lundqvist; Christopher John Wright; Lene Russell; The PLOT-ICU Collaborators and the Nine-I Study Group

doi:10.1007/s00134-023-07225-2

Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Carl Thomas Anthon
, Frédéric Pène
, Anders Perner
, Elie Azoulay
, Kathryn Puxty
, Andry Van De Louw
, Andreas Barratt-Due
, Sanjay Chawla
, Pedro Castro
, Pedro Póvoa
, Luis Coelho
, Victoria Metaxa
, Matthias Kochanek
, Tobias Liebregts
, Thomas Kander
, Johanna Hästbacka
, Jo Bønding Andreasen
, Edwige Péju
, Lene Bjerregaard Nielsen
, Christine Lodberg Hvas

Etienne Dufranc, Emmanuel Canet, Linda Lundqvist, Christopher John Wright, Lene Russell^*, The PLOT-ICU Collaborators and the Nine-I Study Group

^*Corresponding author for this work

Rigshospitalet
Hospital Cochin
University of Copenhagen
Paris Hospitals and Paris Descartes University
Glasgow Royal Infirmary
The Pennsylvania State University
Oslo University Hospital
Memorial Sloan-Kettering Cancer Center
Weill Cornell Medicine
University of Barcelona
San Francisco Xavier Hospital
NOVA University Lisbon
King's College London
University Hospital Cologne
Essen University Hospital
Lund University
Skåne University Hospital
University of Helsinki
Tampere University Hospital
Aalborg University Hospital
Aarhus University Hospital
Hospital Henri Mondor
University Hospital of Nantes
the Queen Elisabeth University Hospital
Copenhagen University Hospital

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

Purpose: Thrombocytopenia (platelet count < 150 × 10⁹/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. 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.

Original language	English
Journal	Intensive Care Medicine
Volume	49
Issue number	11
Pages (from-to)	1327-1338
ISSN	0342-4642
DOIs	https://doi.org/10.1007/s00134-023-07225-2
Publication status	Published - Nov 2023

Funding

Open access funding provided by Royal Library, Copenhagen University Library. This study was funded by the Research Council of Rigshospitalet, the Ehrenreich’s Foundation, and the Dagmar Marshalls Foundation. The Memorial Sloan Kettering Cancer Center part of the study was supported by the Core Grant, Grant/Award Number: P30CA008748; Department of Anaesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America. None of the funders had any influence on the design, conduct or reporting of the study. The Department of Intensive Care at Rigshospitalet (CTA, AG, MHM, AP, LR) has received funding for other projects from the Novo Nordisk Foundation, Sygeforsikringen ‘danmark’, and Pfizer and has conducted contract research for AM-Pharma. FP has received honoraria for consulting and lectures from Gilead and an institutional grant from Alexion Pharma. AP has received honoraria from Novartis for participation in an advisory board. EA has received research grants from MSD Avenir and Alexion and honoraria for lectures from Alexion, Sanofi and Pfizer. . AVDL has received honoraria from Sanofi for participation in an advisory board. PC has received consulting fees from Sanofi, Gilead, Alexion and Janssen and honoraria for lectures from Merck Sharp & Dohme, Gilead, Alexion and Pfizer. PP has received consulting fees from Sanofi and Gilead and honoraria from Merck Sharp & Dohme, Gilead, Mundipharma and Pfizer for academic and educational work. JH has received consulting fees from Paion and honoraria for lectures from the Finnish Medical Association, Laboratory Medicine and Duodecim. EC received fees for lectures and conference talks and had travel and accommodation expenses related to attending scientific meetings covered by Gilead, Shionogi B.V. and Sanofi-Genzyme. ARH has received honoraria from Pfizer for lectures. MHB has received consulting fees from AM-pharma and Inotrem. Full disclosure forms from all authors are available on the publisher’s website.

Keywords

Bleeding
Critical illness
Intensive care unit
Platelet transfusion
Thrombocytopenia
Thrombosis
Hemorrhage/etiology
Intensive Care Units
Prospective Studies
Humans
Middle Aged
Male
Thrombocytopenia/epidemiology
Adult
Female
Retrospective Studies
Platelet Transfusion/adverse effects
Cohort Studies

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1 Comment/debate

Correction: Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)
Anthon, C. T., Pène, F., Perner, A., Azoulay, E., Puxty, K., Van De Louw, A., Barratt-Due, A., Chawla, S., Castro, P., Póvoa, P., Coelho, L., Metaxa, V., Kochanek, M., Liebregts, T., Kander, T., Hästbacka, J., Andreasen, J. B., Péju, E., Nielsen, L. B. & Hvas, C. L. & 31 others, Dufranc, E., Canet, E., Lundqvist, L., Wright, C. J., Schmidt, J., Uhel, F., Ait-Oufella, H., Krag, M., Cos Badia, E., Díaz-Lagares, C., Menat, S., Voiriot, G., Clausen, N. E., Lorentzen, K., Kvåle, R., Hildebrandt, T., Holten, A. R., Strand, K., Tzalavras, A., Bestle, M. H., Klepstad, P., Fernandez, S., Vimpere, D., Paulino, C., Graça, C., Lueck, C., Juhl, C. S., Costa, C., Bådstøløkken, P. M., Miranda, T. & the PLOT-ICU Collaborators and the Nine-I Study Group, Jan 2024, In: Intensive Care Medicine. 50, 1, p. 154-155
Research output: Contribution to journal › Comment/debate › Research › peer-review

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Cite this

Anthon, C. T., Pène, F., Perner, A., Azoulay, E., Puxty, K., Van De Louw, A., Barratt-Due, A., Chawla, S., Castro, P., Póvoa, P., Coelho, L., Metaxa, V., Kochanek, M., Liebregts, T., Kander, T., Hästbacka, J., Andreasen, J. B., Péju, E., Nielsen, L. B., ... The PLOT-ICU Collaborators and the Nine-I Study Group (2023). Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU). Intensive Care Medicine, 49(11), 1327-1338. https://doi.org/10.1007/s00134-023-07225-2

@article{3fad97e74f484344ae4bda65d16ce35e,

title = "Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)",

abstract = "Purpose: Thrombocytopenia (platelet count < 150 {\texttimes} 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. 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{\textendash}46.1) had thrombocytopenia; 23.4\% (20{\textendash}26) had thrombocytopenia at ICU admission, and 19.8\% (17.6{\textendash}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{\textendash}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.",

keywords = "Bleeding, Critical illness, Intensive care unit, Platelet transfusion, Thrombocytopenia, Thrombosis, Hemorrhage/etiology, Intensive Care Units, Prospective Studies, Humans, Middle Aged, Male, Thrombocytopenia/epidemiology, Adult, Female, Retrospective Studies, Platelet Transfusion/adverse effects, Cohort Studies",

author = "Anthon, \{Carl Thomas\} and Fr{\'e}d{\'e}ric P{\`e}ne and Anders Perner and Elie Azoulay and Kathryn Puxty and \{Van De Louw\}, Andry and Andreas Barratt-Due and Sanjay Chawla and Pedro Castro and Pedro P{\'o}voa and Luis Coelho and Victoria Metaxa and Matthias Kochanek and Tobias Liebregts and Thomas Kander and Johanna H{\"a}stbacka and Andreasen, \{Jo B{\o}nding\} and Edwige P{\'e}ju and Nielsen, \{Lene Bjerregaard\} and Hvas, \{Christine Lodberg\} and Etienne Dufranc and Emmanuel Canet and Linda Lundqvist and Wright, \{Christopher John\} and Lene Russell and \{The PLOT-ICU Collaborators and the Nine-I Study Group\}",

note = "Funding Information: Open access funding provided by Royal Library, Copenhagen University Library. This study was funded by the Research Council of Rigshospitalet, the Ehrenreich{\textquoteright}s Foundation, and the Dagmar Marshalls Foundation. The Memorial Sloan Kettering Cancer Center part of the study was supported by the Core Grant, Grant/Award Number: P30CA008748; Department of Anaesthesiology \& Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America. None of the funders had any influence on the design, conduct or reporting of the study. Funding Information: The Department of Intensive Care at Rigshospitalet (CTA, AG, MHM, AP, LR) has received funding for other projects from the Novo Nordisk Foundation, Sygeforsikringen {\textquoteleft}danmark{\textquoteright}, and Pfizer and has conducted contract research for AM-Pharma. FP has received honoraria for consulting and lectures from Gilead and an institutional grant from Alexion Pharma. AP has received honoraria from Novartis for participation in an advisory board. EA has received research grants from MSD Avenir and Alexion and honoraria for lectures from Alexion, Sanofi and Pfizer. . AVDL has received honoraria from Sanofi for participation in an advisory board. PC has received consulting fees from Sanofi, Gilead, Alexion and Janssen and honoraria for lectures from Merck Sharp \& Dohme, Gilead, Alexion and Pfizer. PP has received consulting fees from Sanofi and Gilead and honoraria from Merck Sharp \& Dohme, Gilead, Mundipharma and Pfizer for academic and educational work. JH has received consulting fees from Paion and honoraria for lectures from the Finnish Medical Association, Laboratory Medicine and Duodecim. EC received fees for lectures and conference talks and had travel and accommodation expenses related to attending scientific meetings covered by Gilead, Shionogi B.V. and Sanofi-Genzyme. ARH has received honoraria from Pfizer for lectures. MHB has received consulting fees from AM-pharma and Inotrem. Full disclosure forms from all authors are available on the publisher{\textquoteright}s website. ",

year = "2023",

month = nov,

doi = "10.1007/s00134-023-07225-2",

language = "English",

volume = "49",

pages = "1327--1338",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer Science+Business Media",

number = "11",

}

Anthon, CT, Pène, F, Perner, A, Azoulay, E, Puxty, K, Van De Louw, A, Barratt-Due, A, Chawla, S, Castro, P, Póvoa, P, Coelho, L, Metaxa, V, Kochanek, M, Liebregts, T, Kander, T, Hästbacka, J, Andreasen, JB, Péju, E, Nielsen, LB, Hvas, CL, Dufranc, E, Canet, E, Lundqvist, L, Wright, CJ, Russell, L & The PLOT-ICU Collaborators and the Nine-I Study Group 2023, 'Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)', Intensive Care Medicine, vol. 49, no. 11, pp. 1327-1338. https://doi.org/10.1007/s00134-023-07225-2

TY - JOUR

T1 - Thrombocytopenia and platelet transfusions in ICU patients

T2 - an international inception cohort study (PLOT-ICU)

AU - Anthon, Carl Thomas

AU - Pène, Frédéric

AU - Perner, Anders

AU - Azoulay, Elie

AU - Puxty, Kathryn

AU - Van De Louw, Andry

AU - Barratt-Due, Andreas

AU - Chawla, Sanjay

AU - Castro, Pedro

AU - Póvoa, Pedro

AU - Coelho, Luis

AU - Metaxa, Victoria

AU - Kochanek, Matthias

AU - Liebregts, Tobias

AU - Kander, Thomas

AU - Hästbacka, Johanna

AU - Andreasen, Jo Bønding

AU - Péju, Edwige

AU - Nielsen, Lene Bjerregaard

AU - Hvas, Christine Lodberg

AU - Dufranc, Etienne

AU - Canet, Emmanuel

AU - Lundqvist, Linda

AU - Wright, Christopher John

AU - Russell, Lene

AU - The PLOT-ICU Collaborators and the Nine-I Study Group

N1 - Funding Information: Open access funding provided by Royal Library, Copenhagen University Library. This study was funded by the Research Council of Rigshospitalet, the Ehrenreich’s Foundation, and the Dagmar Marshalls Foundation. The Memorial Sloan Kettering Cancer Center part of the study was supported by the Core Grant, Grant/Award Number: P30CA008748; Department of Anaesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America. None of the funders had any influence on the design, conduct or reporting of the study. Funding Information: The Department of Intensive Care at Rigshospitalet (CTA, AG, MHM, AP, LR) has received funding for other projects from the Novo Nordisk Foundation, Sygeforsikringen ‘danmark’, and Pfizer and has conducted contract research for AM-Pharma. FP has received honoraria for consulting and lectures from Gilead and an institutional grant from Alexion Pharma. AP has received honoraria from Novartis for participation in an advisory board. EA has received research grants from MSD Avenir and Alexion and honoraria for lectures from Alexion, Sanofi and Pfizer. . AVDL has received honoraria from Sanofi for participation in an advisory board. PC has received consulting fees from Sanofi, Gilead, Alexion and Janssen and honoraria for lectures from Merck Sharp & Dohme, Gilead, Alexion and Pfizer. PP has received consulting fees from Sanofi and Gilead and honoraria from Merck Sharp & Dohme, Gilead, Mundipharma and Pfizer for academic and educational work. JH has received consulting fees from Paion and honoraria for lectures from the Finnish Medical Association, Laboratory Medicine and Duodecim. EC received fees for lectures and conference talks and had travel and accommodation expenses related to attending scientific meetings covered by Gilead, Shionogi B.V. and Sanofi-Genzyme. ARH has received honoraria from Pfizer for lectures. MHB has received consulting fees from AM-pharma and Inotrem. Full disclosure forms from all authors are available on the publisher’s website.

PY - 2023/11

Y1 - 2023/11

N2 - Purpose: Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. 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.

AB - Purpose: Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. 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.

KW - Bleeding

KW - Critical illness

KW - Intensive care unit

KW - Platelet transfusion

KW - Thrombocytopenia

KW - Thrombosis

KW - Hemorrhage/etiology

KW - Intensive Care Units

KW - Prospective Studies

KW - Humans

KW - Middle Aged

KW - Male

KW - Thrombocytopenia/epidemiology

KW - Adult

KW - Female

KW - Retrospective Studies

KW - Platelet Transfusion/adverse effects

KW - Cohort Studies

U2 - 10.1007/s00134-023-07225-2

DO - 10.1007/s00134-023-07225-2

M3 - Journal article

C2 - 37812225

AN - SCOPUS:85173919249

SN - 0342-4642

VL - 49

SP - 1327

EP - 1338

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 11

ER -

Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

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Correction: Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Cite this