Transfusion of platelets, but not of red blood cells, is independently associated with nosocomial infections in the critically ill

Engele, Leo J.; Straat, Marleen; Rooijen, Ingeborg H. M. van; Vooght, Karen M.K. de; Cremer, Olaf L.; Schultz, Marcus J.; Bos, Lieuwe D. J.; Juffermans, Nicole P.

doi:10.1186/s13613-016-0173-1

Cited by 35 publications

(41 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Beyond hemostasis, PLTs are complex and may also mediate immune and inflammatory effects and have been associated with thrombosis and infection to which certain populations may be more susceptible. In the PATCH trial, which randomized 190 patients with intracranial hemorrhage on anti‐PLT medications to receive or not receive PLT transfusions, functional outcomes were worse in the transfused group, and in an observational ICU study, PLT transfusions were found to be an independent predictor of venous thromboembolism (HR, 3.2; 95% CI, 1.2‐8.4) .…”

Section: Discussionmentioning

confidence: 99%

The association between platelet transfusions and mortality in patients with critical illness

et al. 2019

View full text Add to dashboard Cite

BACKGROUND: Platelet (PLT) transfusions are frequently administered in the setting of critical illness but their clinical impacts remain unknown. This study examined the association between PLT transfusions and death in a large intensive care unit (ICU) patient population. STUDY DESIGN AND METHODS: Using a transfusionregistry spanning 2008 to 2015, this study assessed effect of in-ICU PLT transfusions on ICU and in-hospital mortality using a stratified, time-dependent Cox proportional hazards model adjusted for illness severity, thrombocytopenia, and other confounders. Patients with known malignancy were excluded. Exposure to PLT transfusions were analyzed dichotomously (ever or never transfused) and continuously (number of transfusions). Medical, general surgery, and cardiac surgery subgroups were analyzed separately. RESULTS:Overall 32,842 adult patients were admitted to ICU, and 4927 patients received PLT transfusion(s). Crude in-ICU and in-hospital mortality were higher for PLT-transfused patients compared to nontransfused patients (9.2% vs. 6.7% and 12.3% vs. 9.3%, respectively). After confounders were adjusted for, PLT transfusions (ever vs. never) were not associated with increased mortality in ICU (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.60-1.02; p = 0.06) or in hospital (HR, 0.89; 95% CI, 0.68-1.09; p = 0.41). Continuous exposure analysis also showed no association between PLT transfusions and death. PLT transfusions have a protective effect on in-hospital mortality in the subgroup of general surgery patients (HR, 0.71; 95% CI, 0.51-0.99; p = 0.04; ever or never analysis). CONCLUSION:Platelet transfusions were not associated with increased risk of death in critically ill patients. Further studies are required to identify subgroups for which PLT transfusions may be beneficial.ABBREVIATIONS: HR = hazard ratio; ICU = intensive care unit; IQR(s) = interquartile range(s); MODS(s) = multiorgan dysfunction score(s). From the RESULTS Patient demographicsBetween 2008 and 2015, a total of 32,842 nononcology adult patients were admitted to one of three participating ICUs (Fig. 1). Median (IQR) age at admission was 66 (54-76) years and 11,944 (36.5%) of patients were female. Median (IQR) duration of ICU stay was 2 (1-4) days. Thrombocytopenia Volume 59, June 2019 TRANSFUSION 1963 PLT TRANSFUSION AND DEATH IN THE ICU * Data are reported as number (%) or median (IQR). † Cardiac surgery with cardiopulmonary bypass. ‡ Bleeding disorders include qualitative PLT defects, von Willebrand's disease, acquired factor deficiencies. § Mechanical ventilation may either be invasive or noninvasive. k MODS = multiple organ dysfunction score at baseline (range, 0-20). MODS were available for 29,550 (90.0%) of the overall patient population.

show abstract

Section: Discussionmentioning

confidence: 99%

The association between platelet transfusions and mortality in patients with critical illness

et al. 2019

View full text Add to dashboard Cite

show abstract

“…A limited range in possible storage time will automatically limit the differences. In several studies an association between PLT transfusions and risk of all‐cause infection has been reported . However, confounding by indication could be a potential explanation for these findings, since patients receiving PLT transfusions are at an inherently different risk of infection than those not receiving PLT transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…In several studies an association between PLT transfusions and risk of all-cause infection has been reported. [28][29][30] However, confounding by indication could be a potential explanation for these findings, since patients receiving PLT transfusions are at an inherently different risk of infection than those not receiving PLT transfusions. We investigated differences in storage time, since PLT products are released on a first-in-first-out basis, without consideration of the patients' prognoses.…”

Section: Discussionmentioning

confidence: 99%

Storage time of platelet concentrates and all‐cause bacteremia in hematologic patients

et al. 2017

View full text Add to dashboard Cite

BACKGROUND:Extension of storage time of platelet (PLT) concentrates may result in an increased risk of bacteremia, directly via transfusion of contaminated products or indirectly via transfusion-related immunomodulation. We aimed to quantify the association of storage time of PLT concentrates and all-cause bacteremia in hematologic patients. STUDY DESIGN AND METHODS:We established a cohort of hematologic patients who received a PLT transfusion between 2005 and 2015. Cases were defined as patients with a bacteremia the day after transfusion and matched to as many controls as possible. A conditional logistic regression was performed, stratified by storage medium. RESULTS:Among 3514 patients receiving 36,032 PLT concentrates stored in plasma, 613 cases of bacteremia were found. The relative risk of all-cause bacteremia the day after transfusion was 0.80 (95% confidence interval [CI], 0.58-1.12) for PLT concentrates stored 3 to 4 days and 0.67 (95% CI, 0.49-0.92) for at least 5 days, compared to no more than 2 days. Among 1527 patients receiving 11,822 PLT concentrates stored in PLT additive solution, 182 cases of bacteremia were found. The relative risk of all-cause bacteremia was 1.14 (95% CI, 0.70-1.84) for PLT concentrates stored for 3 to 4 days and 1.19 (95% CI, 0.70-2.01) for at least 5 days, compared to not more than 2 days.CONCLUSION: Storage time of PLT concentrates was not associated with increased occurrence of all-cause bacteremia the day after transfusion. If anything, fewer cases of bacteremia occurred with increasing storage time of PLT concentrates in plasma. These bacteremias are not directly caused by transfusion of a contaminated product and the underlying mechanism warrants further research. (PLTs) is an important aspect of supportive care in the treatment of patients with hematologic malignancies, to prevent or treat bleeding complications during periods of severe thrombocytopenia. T ransfusion of platelets1,2 The concurrent neutropenia predisposes these patients to infectious complications. 3Transfusions can directly cause bacterial infections via transmission of bacteria through contaminated products. In particular PLT concentrates may carry this risk, as these are stored at room temperature, allowing bacterial proliferation. This is clearly illustrated by several case reports of severe bacterial sepsis after transfusion of contaminated PLT concentrates. [4][5][6][7] In an attempt to reduce this risk, storage time is limited to 3.5 days in Japan and to 4 or 5 days in the United States and Germany. trial in the United States, which aimed to investigate the safety of 7 days' storage with the implementation of early testing, was terminated early due to concerns about the residual risk of transfusion of contaminated PLT concentrates.12 However, storage up to 7 days in combination with bacterial screening is allowed in, among other countries, Spain, the United Kingdom, Sweden, and the Netherlands. 11 Bacterial screening does not eliminate the risk of septic reactions completely as false-negative re...

show abstract

“…However, most studies to date have failed to sufficiently characterize or account for individual differences in pretransfusion immune function. Additionally, patients who are transfused with RBCs often also receive other blood products, which may have different or additive TRIM effects . Overall, much work remains to understand interactions between individual blood product characteristics and patient‐specific risk factors with respect to clinical consequences of TRIM.…”

Section: Future Directionsmentioning

confidence: 99%

Mechanisms of red blood cell transfusion‐related immunomodulation

et al. 2018

Self Cite

View full text Add to dashboard Cite

Red blood cell (RBC) transfusion is common in critically ill, postsurgical, and posttrauma patients in whom both systemic inflammation and immune suppression are associated with adverse outcomes. RBC products contain a multitude of immunomodulatory mediators that interact with and alter immune cell function. These interactions can lead to both proinflammatory and immunosuppressive effects. Defining clinical outcomes related to immunomodulatory effects of RBCs in transfused patients remains a challenge, likely due to complex interactions between individual blood product characteristics and patient-specific risk factors. Unpacking these complexities requires an in-depth understanding of the mechanisms of immunomodulatory effects of RBC products. In this review, we outline and classify potential mediators of RBC transfusion-related immunomodulation and provide suggestions for future research directions.

show abstract

Transfusion of platelets, but not of red blood cells, is independently associated with nosocomial infections in the critically ill

Cited by 35 publications

References 24 publications

The association between platelet transfusions and mortality in patients with critical illness

The association between platelet transfusions and mortality in patients with critical illness

Storage time of platelet concentrates and all‐cause bacteremia in hematologic patients

Mechanisms of red blood cell transfusion‐related immunomodulation

Contact Info

Product

Resources

About