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) | p 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/m 2 ) | 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 (m 2 ) | 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 |
| PaO 2 /FiO 2 ratio | 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 (x10 6 /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 10 6 /L) | N (%) | 226 (87.6%) | 123 (87.2%) | 103 (88.0%) | 0.85 |
| Severe thrombocytopenia on admission (<50000 x 10 6 /L) | N (%) | 118 (45.7%) | 72 (51.1%) | 46 (39.3%) | 0.06 |
| Lowest platelet count during ICU stay (x10 9 /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) | p 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 (x10 6 /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 (x10 6 /L) | Median (Q1, Q3) | 6000.0 (−5000.0, 24000.0) | 2000 (−8000, 14000) | 21000.0 (9000.0, 42000.0) | <0.001 |
| Corrected count increment (x10 6 /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.