Critical Care Research and Practice

Research Article

Prevalence, Risk Factors, and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients: A Retrospective Cohort Study

Table 2

General characteristics of patients by platelet transfusion refractoriness status based on the platelet increment (<10000 × 10⁶/L) definition.


A. Patient characteristics		Total (N = 259)	Refractory (N = 142)	Nonrefractory (N = 117)	value

Age (years)	Median (Q1, Q3)	58.0 (43.5, 70.0)	57.0 (42.2, 68.0)	60.0 (46.0, 72.0)	0.11
Male sex	N (%)	149 (57.5)	81 (57.0)	68 (58.1)	0.86
Body mass index (kg/m²)	Median (Q1, Q3)	27.3 (22.4, 32.3)	27.9 (22.3, 32.9)	26.6 (22.6, 31.4)	0.40
Obese >30 kg/m²	N (%)	94 (37.5)	54 (39.4)	40 (35.1)	0.60
Body surface area (m²)	Median (Q1, Q3)	1.8 (1.6, 1.9)	1.8 (1.7, 1.9)	1.8 (1.6, 1.9)	0.42
Admission category	N (%)
Medical		220 (84.9)	125 (88.0)	95 (81.2)	0.03
Surgical		30 (11.6)	16 (11.3)	14 (12.0)
Trauma		9 (3.5)	1 (0.7)	8 (6.8)
Chronic cardiac disease/238 patients^∗	N (%)	35 (15.2)	18 (13.6)	17 (17.3)	0.44
Chronic immune disease/238 patients^∗	N (%)	89 (38.7)	47 (35.6)	42 (42.9)	0.26
Chronic liver disease/238 patients^∗	N (%)	48 (20.9)	35 (26.5)	13 (13.3)	0.01
Chronic respiratory disease/238 patients^∗	N (%)	17 (7.4)	12 (9.1)	5 (5.1)	0.25
Chronic renal disease/238 patients∗	N (%)	29 (12.6%)	14 (10.6%)	15 (15.3%)	0.29
APACHE II score	Median (Q1, Q3)	25.0 (20.0, 30.0)	25.0 (21.0, 30.0)	24.0 (20.0, 28.5)	0.40
Glasgow Coma Scale on ICU admission	Median (Q1, Q3)	14.0 (9.5, 15.0)	14.0 (9.0, 15.0)	14.0 (10.0, 15.0)	0.97
Mechanical ventilation/238 patients∗	N (%)	191 (83.0)	110 (83.3)	81 (82.7)	0.89
PaO₂/FiO₂ratio	Median (Q1, Q3)	178.5 (113.2, 270.5)	176.0 (112.2, 258.0)	182.0 (114.0, 282.5)	0.38
Shock	N (%)	164 (63.3)	91 (64.1)	73 (62.4%)	0.78
Sepsis	N (%)	155 (59.8%)	88 (62.0)	67 (57.3)	0.44
Septic shock	N (%)	149 (57.5%)	84 (59.2)	65 (55.6)	0.56
DIC likelihood score	Median (Q1, Q3)	5.0 (4.0, 6.0)	5.0 (4.0, 6.0)	5.0 (4.0, 5.0)	0.04
Active bleeding	N (%)	52 (20.1)	27 (19.0)	25 (21.4)	0.64
Active cancer	N (%)	92 (35.5)	47 (33.1)	45 (38.5)	0.37
Hematological cancer	N (%)	75 (29.0)	38 (26.8)	37 (31.6)	0.39
Organ transplant	N (%)	13 (5.0)	9 (6.3%)	4 (3.4)	0.28
Spleen size (cm)	Median (Q1, Q3)	11.5 (9.4, 14.0)	12.5 (10.5, 14.4)	10.7 (8.9, 13.2)	0.001
Splenomegaly/178 patients∗	N (%)				0.046
Present		65 (36.5)	40 (43.5)	25 (29.1)
Absent		113 (63.5)	52 (56.5)	61 (70.9)
Platelet count on ICU admission (x10⁶/L)	Median (Q1, Q3)	53500.0 (28000.0, 98800.0)	49000.0 (26000.0, 93000.0)	59000.0 (35000.0, 108000.0)	0.11
Thrombocytopenia on admission (<150000 x 10⁶/L)	N (%)	226 (87.6%)	123 (87.2%)	103 (88.0%)	0.85
Severe thrombocytopenia on admission (<50000 x 10⁶/L)	N (%)	118 (45.7%)	72 (51.1%)	46 (39.3%)	0.06
Lowest platelet count during ICU stay (x10⁹/L)	Median (Q1, Q3)	18.0 (10.0, 29.0)	14.0 (7.0, 28.0)	19.0 (11.0, 34.0)	0.001
INR	Median (Q1, Q3)	1.6 (1.3, 2.0)	1.6 (1.3, 2.2)	1.6 (1.2, 2.0)	0.38
Lactic acid (mmol/L)	Median (Q1, Q3)	2.9 (1.7, 6.0)	2.9 (1.5, 5.9)	3.0 (1.8, 6.1)	0.47
Creatinine (μmol/L)	Median (Q1, Q3)	142.5 (73.8, 256.2)	145.0 (82.2, 260.2)	134.5 (65.8, 232.0)	0.33
Bilirubin (μmol/L)	Median (Q1, Q3)	40.0 (19.0, 107.2)	40.0 (19.0, 106.0)	40.0 (19.5, 107.5)	0.99
Platelet transfusion refractoriness (CCI definition)/256 patients∗	N (%)	146 (57.0%)	139 (98.6%)	7 (6.1%)	<0.001

B. Transfusion characteristics		Total (N = 1357)	Refractory (N = 926)	Nonrefractory (N = 431)	value
Platelet product type	N (%)				0.06
Apheresis		138 (10.2%)	98 (10.6%)	40 (9.3%)
Apheresis-irradiated		196 (14.4%)	124 (13.4%)	72 (16.7%)
Pooled		750 (55.3%)	508 (54.9%)	242 (56.1%)
Pooled-irradiated		182 (13.4%)	123 (13.3%)	59 (13.7%)
Mixed∗∗∗		91 (6.7%)	73 (7.9%)	18 (4.2%)
Platelet count prior to transfusion (x10⁶/L)	Median (Q1, Q3)	31000.0 (17000.0, 52000.0)	31000.0 (16000.0, 52000.0)	33000.0 (18000.0, 54000.0)	0.17
Number of transfusion episodes per patient	Median (Q1, Q3)	4.0 (2.0, 6.0)	5.0 (3.0, 8.0)	3.0 (2.0, 4.0)	<0.001
Number of platelet concentrates per transfusion episode∗∗	Median (Q1, Q3)	1.0 (1.0, 2.0)	1.0 (1.0, 2.0)	1.0 (1.0, 1.0)	<0.001
Time to next platelet transfusion (days)	Median (Q1, Q3)	1.0 (1.0, 2.0)	1.0 (1.0, 2.0)	1.0 (1.0, 2.3)	0.006
Platelet increment (x10⁶/L)	Median (Q1, Q3)	6000.0 (−5000.0, 24000.0)	2000 (−8000, 14000)	21000.0 (9000.0, 42000.0)	<0.001
Corrected count increment (x10⁶/L)	Median (Q1, Q3)	2800.0 (−2000.0, 10800.0)	600.0 (−3700.0, 5800.0)	10300.0 (3800.0, 18800.0)	<0.001

^∗For patients with missing data, the denominator is the number of patients with valid observations. For the calculation of percentages, only valid observations are used in the numerator and denominator. ∗∗Six units of single donor platelets prepared from whole blood were pooled to produce a single pooled platelet concentrate.^∗∗∗Mixed indicates aggregate transfusions that were derived from transfusions with 2 or more different platelet products. APACHE: Acute Physiologic Assessment and Chronic Health Evaluation; CCI: corrected count increment DIC: disseminated intravascular coagulation; ICU: intensive care unit; INR: International Normalized Ratio, Q1: first quartile, Q3: third quartile.