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Updated: Jul 29, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Association between Platelet Transfusion and Delirium in Critically Ill Children
Matthew Nelligan1, Marianne E Nellis2, Elizabeth A Mauer2
1Morgan Stanley Children's Hospital, NewYork-Presbyterian Columbia University, New York, NY 10032, USA.
Insights
Platelet transfusions may increase the risk of delirium in critically ill children. Reducing platelet transfusions may help prevent delirium in pediatric intensive care unit patients.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Neuroscience
Background:
- Delirium is a common, serious, and preventable issue in pediatric intensive care units (PICUs).
- Inflammation is a suspected factor in delirium development.
- Platelet transfusions might enhance pro-inflammatory responses.
Purpose of the Study:
- To investigate the association between platelet transfusion and delirium in critically ill children.
- To determine if platelet transfusion increases the risk of delirium in the PICU.
Main Methods:
- A single-center retrospective cohort study was conducted.
- Included children admitted to the PICU between 2014 and 2018 who received platelet transfusions.
- A marginal structural model (MSM) was used to analyze the relationship between platelet transfusion and next-day delirium, accounting for time-dependent confounders.
Main Results:
- Platelet transfusion was independently associated with an increased risk of next-day delirium (aOR 1.75).
- Each 1 cc/kg increase in platelet transfusion correlated with a 9% rise in the odds of next-day delirium (OR 1.09).
- A dose-response relationship was observed between platelet transfusion and delirium.
Conclusions:
- Platelet transfusion is linked to an increased likelihood of delirium in critically ill children.
- Minimizing platelet transfusions, when clinically appropriate, may reduce delirium risk in this population.
Abstract:
Delirium is a frequent, serious, and preventable complication in critically ill children. Inflammation has been implicated as a mechanism for the development of delirium. Platelet transfusions may potentiate the body's pro-inflammatory responses. We hypothesized that receipt of platelets would be associated with delirium development in a pediatric intensive care unit (PICU). We performed a single-center retrospective cohort analysis including children admitted to the PICU between 2014 and 2018 who were transfused platelets within the first 14 days of admission. Data obtained included severity of illness, level of respiratory support, exposure to medications and blood products, as well as daily cognitive status. To account for time-dependent confounding, a marginal structural model (MSM) was constructed to delineate the relationship between platelet transfusion and next-day delirium. MSM demonstrated a 75% increase in the development of next-day delirium after transfusion of platelets (aOR 1.75, 95% CI 1.03-2.97). For every 1 cc/kg of platelet transfused, odds of next-day delirium increased by 9% (odds ratio 1.09, 95% CI 1.03-1.51). We reported an independent association between platelet transfusion and next-day delirium/coma after accounting for time-dependent confounders, with a dose-response effect. Minimizing platelet transfusions as much as clinically feasible may decrease delirium risk in critically ill children.
