Platelet Counts and Risk of Severe Retinopathy of Prematurity: A Bayesian Model-Averaged Meta-Analysis

We aimed to conduct a systematic review and Bayesian model-averaged meta-analysis (BMA) on the association between platelet counts and severe retinopathy of prematurity (ROP).

We searched for studies reporting on platelet counts (continuous variable) or thrombocytopenia (categorical variable) and severe ROP or aggressive posterior ROP (APROP). The timing of platelet counts was divided into Phase 1 (<2 weeks) and Phase 2 (around ROP treatment). BMA was used to calculate Bayes factors (BFs). The BF₁₀ is the ratio of the probability of the data under the alternative hypothesis (H₁) over the probability of the data under the null hypothesis (H₀).

We included 21 studies. BMA showed an association between low platelet counts and severe ROP. The evidence was strong (BF₁₀ = 13.5, 7 studies) for phase 1 and very strong (BF₁₀ = 51.0, 9 studies) for phase 2. Thrombocytopenia (<100 × 10⁹/L) in phase 2 was associated with severe ROP (BF₁₀ = 28.2, 4 studies). Following adjustment for publication bias, only the association of severe ROP with thrombocytopenia remained with moderate evidence in favor of H₁ (BF₁₀ = 4.30).

Thrombocytopenia is associated with severe ROP. However, the evidence for this association was tempered when results were adjusted for publication bias.