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Proceedings ofReanimation 2022, theFrench Intensive CareSociety InternationalCongress Pierre BayMarc Pineton de ChambrunVincent Rothstein2022 год

Proceedings of Reanimation 2022, the French Intensive Care Society International Congress
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Аннотация: Rationale: Up to 15% of critically ill patients receive platelets in intensive care units (ICU) (1).Both preventive and therapeutic platelet transfusions (PT) are not fully supported by high levels of evidence and the benefits of platelet transfusion remain subject to debates in some settings.This study aims to describe the efficacy of PT in ICU, and its impact on patients' outcomes.Patients and methods/Materials and methods: From June 2018 to November 2019, we conducted a prospective multicenter observational study recruiting patients that received at least one PT in one of the 9 participating ICUs.Inefficacy of preventive PT was defined as a Corrected Count Increment (CCI, that adjusts for the transfused platelet dose and the body weight) < 7 at 18 to 24 h after PT.Factors associated with transfusion inefficacy were assessed by performing an univariate analysis and in a mixed effect model.Results: Of the 310 included patients, 119 patients (38.4%) received curative PT while 191 patients (61.6%) were treated preventively.Of the 975 transfusion episodes, 765 were given in prevention of bleeding because of low platelet count and 210 in treatment of active bleeding.PT efficacy according to the CCI was assessed in 679 preventive transfusion.Inefficacy criteria were met in 297 episodes (43.7%).Demographic and baseline characteristics associated with preventive PT inefficacy in the univariate analysis were younger age (57.7 years [Interquartile range (IQR) 44.5-66.6]versus 62.5 [53.1-69.5];p = 0.01); immunosuppression (69.9% versus 51.8%; p = 0.025) and lower haemoglobin (8.5 g/dL [7.4-10] versus 9.7 g/dL [7.8-11.5];p = 0.0028).Among clinical features, PT inefficacy was associated with higher heart pulse (106 [92-120] versus 99 ; p < 0.0001) and higher temperature prior to ]; p = 0.016), both possible surrogate of sepsis.Interestingly, ABO compatibility did not affect PT efficacy.The mixed effect model identified haemoglobin (Estimate (E): 1.83 [Confidence Interval 95% (CI) 0.56-3.11];p = 0.0051), heart pulse before transfusion (Estimate: -0.17 [-0.3 to -0.03]; p = 0.016), curative anticoagulation (E: 14.1 [4.36; 23.77]; p = 0.008), chronic kidney injury (E: 20.12 [0.86; 39.37]; p = 0.008) and mean age of platelet transfused (E: -3.21 [-5.61; -0.81]; p = 0.009) being independently associated with the CCI.Conclusion: Almost half of preventive PT in ICU do not meet efficacy criteria based on the CCI.Further research is warranted to investigate whether changes in the identified independent risk factors for PT inefficacy improve patients' outcomes.
Год издания: 2022
Авторы: Pierre Bay, Marc Pineton de Chambrun, Vincent Rothstein, Matthieu Mahévas, Nicolas de Prost, Antoine Roux, Benjamin Zuber, Dominique Israëł-Biet, B. Hervier, Abdellatif Tazi, Luc Mouthon, A. Mékinian, C. Deligny, Raphaël Borie, Claude Meurice Jean, Pascaline Priou, Alain Meyer, Laurent Savale, Luc de Saint Martin, Pierre-Yves Brilliet, Philippe Khafagy, Olivier Benveniste, Hilario Nunès, Yves Allenbach, Y. Uzunhan
Издательство: Springer Nature
Источник: Annals of Intensive Care
Ключевые слова: Cardiac Arrest and Resuscitation, Disaster Response and Management
Другие ссылки: Annals of Intensive Care (PDF)
Annals of Intensive Care (HTML)
HAL (Le Centre pour la Communication Scientifique Directe) (PDF)
HAL (Le Centre pour la Communication Scientifique Directe) (HTML)
HAL (Le Centre pour la Communication Scientifique Directe) (HTML)
PubMed Central (HTML)
PubMed (HTML)