Is platelet transfusion associated with hospital-acquired infections in critically ill patients?

Abstract

BackgroundPlatelets are commonly transfused to critically ill patients. Reports suggest an association between platelet transfusion and infection. However, there is no large study to have determined whether platelet transfusion in critically ill patients is associated with hospital-acquired infection.MethodsWe conducted a multi-centre study using prospectively maintained databases of two large academic intensive care units (ICUs) in Australia. Characteristics of patients who received platelets in ICUs between 2008 and 2014 were compared to those of patients who did not receive platelets. Association between platelet administration and infection (bacteraemia and/or bacteriuria) was modelled using multiple logistic regression and Cox regression, with blood components as time-varying covariates. A propensity covariate adjustment was also performed to verify results.ResultsOf the 18,965 patients included, 2250 (11.9%) received platelets in ICU with a median number of 1 platelet unit (IQR 1–3) administered. Patients who received platelets were more severely ill at ICU admission (mean Acute Physiology and Chronic Health Evaluation III score 65 (SD 29) vs 52 (SD 25), p < 0.01) and had more comorbidities (31% vs 19%, p < 0.01) than patients without platelet transfusion. Invasive mechanical ventilation (87% vs 57%, p < 0.01) and renal replacement therapy (20% vs 4%, p < 0.01) were more frequently administered in patients receiving platelets than in patients without platelets. On univariate analysis, platelet transfusion was associated with hospital-acquired infection in the ICU (7.7% vs 1.4%, p < 0.01). After adjusting for confounders, including other blood components administered, patient severity, centre, year, and diagnosis category, platelet transfusions were independently associated with infection (adjusted OR 2.56 95% CI 1.98–3.31, p < 0.001). This association was also found in survival analysis with blood components as time-varying covariates (adjusted HR 1.85, 95% CI 1.41–2.41, p < 0.001) and when only bacteraemia was considered (adjusted OR 3.30, 95% CI 2.30–4.74, p <0.001). Platelet transfusions remained associated with infection after propensity covariate adjustment.ConclusionsAfter adjustment for confounders, including patient severity and other blood components, platelet transfusion was independently associated with ICU-acquired infection. Further research aiming to better understand this association and to prevent this complication is warranted.

Platelet transfusion is not associated with increased mortality or morbidity in patients undergoing cardiac surgery

“…Similar to our findings, studies by Karkouti and colleagues and Sreeram and coworkers assessing patients receiving nonleukoreduced and leukoreduced cellular blood products, respectively, reported no association between transfusion and infection . In contrast, a recent study assessing platelet transfusion in critically ill intensive care unit (ICU) patients demonstrated that after adjustment for patient severity and other blood component use, platelet transfusion in this patient population was independently associated with ICU‐acquired infection …”

“…16,18 In contrast, a recent study assessing platelet transfusion in critically ill intensive care unit (ICU) patients demonstrated that after adjustment for patient severity and other blood component use, platelet transfusion in this patient population was independently associated with ICU-acquired infection. 20 WBC-mediated transfusion-related immunomodulation is a transient immunosuppression that may occur following transfusion of allogeneic blood. 21 While the exact mechanisms, and many are proposed, are not yet established, it is hypothesized that WBC release of cytokines modulates the balance between a Type 1 and Type 2 immune response, leading to increased rates in postoperative bacterial infections, organ dysfunction, and length of stay.…”

Platelet safety strategies in Japan: impact of short shelf life on the incidence of septic reactions

“…Another reason is that most patients who are transfused with PC are immunocompromised and thus vulnerable to bacterial infection. 1,2 Significant numbers of septic reactions and fatal outcomes related to PC transfusion have been reported from many countries. [3][4][5][6] Various interventions to mitigate these consequences of PC transfusion have been proposed, as follows.…”

“…The major reason for this compared with red cell or plasma components is a high bacterial load derived from storing PC at 20‐24°C, which enables vigorous bacterial proliferation in PC during the preservation process. Another reason is that most patients who are transfused with PC are immunocompromised and thus vulnerable to bacterial infection . Significant numbers of septic reactions and fatal outcomes related to PC transfusion have been reported from many countries …”

Investigation of the Opposite Capacities of Erythropoietin and U-74389G on Platelet Crit Levels

“…Marly Voquer et al [15] ascribed the stronger clot in the FIBTEM assay of rotational thromboelastometry at a stronger contribution of platelets in feline blood of people than cats. Aubron et al [16] independently associated platelet transfusion with 5.5-fold more hospital-acquired infections in the ICU (p < 0.01), with 2.56%-fold more infections (p < 0.001). Navas Carrillo et al [17] described the formation of luminal thrombi secondary to platelet activation and the release of thrombogenic elements within the atherosclerotic lesions in acute coronary syndromes.…”