Abstract
Background - Platelet transfusion is relatively common in patients hospitalized in intensive care units (ICU). Both ICU-acquired infections and thromboembolic events have been reported after platelet transfusion. We sought to explore risk-factors of these complications.
Materials and methods - We conducted a ancillary analysis of a multicenter prospective observational study including critically ill patients who received at least one platelet transfusion in one of the 9 participating ICUs. Patients' characteristics were compared according to the occurrence of post platelet transfusion
ICU-acquired infections (blood stream infections and ventilator-associated pneumonia) and thromboembolic events. Factors associated with those outcomes were assessed by univariable and multivariable Fine and Gray regression.
Results - Of the 310 included patients, 64 patients (20.6%) and 14 patients (4.5%) experienced at least one ICU-acquired infection and a thromboembolic event after platelet transfusion, respectively. Fifty patients (78.1%) developed blood stream infection (BSI), 32 (50%) experienced ventilator associated pneumonia (VAP) and 18 (28.1%) had both VAP and BSI. Independent risk factors for post platelet transfusion ICU-acquired infection included a platelet count at ICU admission <109/L (protective) (subdistribution Harard Ratio (sHR) 0.52 95% CI [0.31-0.89] p=0.016), multiple platelet transfusion prior to infection occurrence (sHR 2.15 [1.25-3.71] p=0.005) and a Simplified Acute Physiology Score (SAPS) II>50 (sHR 3.67 [2.16-6.25] p<0.001). While, the unique variable independently associated with thrombotic event occurring after platelet transfusion in adjusted Fine-Gray regression was a SAPS II >50 (sHR 4.27 [1.18-15.39] p=0.027).
Discussion - In this prospective multicenter study, the risk of hospital-acquired infection after platelet transfusion increased in patients receiving multiple platelet transfusions and with patient severity at ICU admission.
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Authors
Florian Reizine
Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France; Service de Réanimation Polyvalente, CH de Vannes, Vannes, France
Sarah Le Marec Service de Médecine Intensive Réanimation, Université de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Brest, France
Zoe McQuilten Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
Anthony Le Meur Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
Maëlys Consigny Service de Biostatistiques, CHU de Brest, Brest, France
Florian Berteau
Service de Réanimation Polyvalente, CH de Morlaix, Morlaix, France
Laetitia Bodenes Service de Médecine Intensive Réanimation, Université de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Brest, France
Marie Geslain Département d’Anesthésie-Réanimation, Université de Bretagne occidentale, CHU de Brest, Brest, France
Catherine Le Niger
Unité d’Hémovigilance, CHU de Brest, Brest, France
Julien Huntzinger Service de Réanimation Polyvalente, CH de Vannes, Vannes, France
Yoann Launey
Service de Réanimation Chirurgicale, CHU de Rennes, Rennes, France
Jean-Baptiste Thibert
Etablissement Français du Sang Bretagne, Rennes, France
Jean Reignier Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, Nantes, France
Pierre-Yves Egreteau
Service de Réanimation Polyvalente, CH de Morlaix, Morlaix, France
Jean-Marc Tadié Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France
Olivier Huet UFR de Médecine de Brest, Université de Bretagne Occidentale, Brest, France
Francois Beloncle
Service de Médecine Intensive Réanimation, CHU d’Angers, Angers, France
Stephan Ehrmann
Service de Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriggerSEP F-CRIN Research Network, CHU de Tours et Centre d’Études des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France
Cécile Aubron
Service de Médecine Intensive Réanimation, Université de Bretagne Occidentale, Centre Hospitalo-Universitaire de Brest, Brest, France
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