ICU-acquired infections and thrombo-embolic events in critically ill patients receiving platelet transfusion: a...

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.

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.

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).

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.