Objectives
To investigate the independent association of platelet transfusion with hospital mortality
and key relevant clinical outcomes in cardiac surgery.
Design
A single-center, propensity score-matched, retrospective, cohort study.
Setting
At an American tertiary teaching hospital data from the Medical Information Mart for
Intensive Care III and IV databases from 2001 to 2019.
Participants
Consecutive adults undergoing coronary artery bypass graft and/or cardiac valvular
surgery.
Interventions
Platelet transfusion during perioperative intensive care unit (ICU) admission.
Measurements and Main Results
Overall, 12,043 adults met the study inclusion criteria. Of these, 1,621 (13.5%) received
apheresis-leukoreduced platelets, with a median of 1.19 units per recipient (IQR:
0.93-1.19) at a median of 1.78 hours (IQR: 0.75-4.25) after ICU admission. The platelet
count was measured in 1,176 patients (72.5%) before transfusion, with a median count
of 120 × 109/L (IQR: 89.0-157.0), and only 53 (3.3%) had platelet counts below 50 × 109/L. After propensity matching of 1,046 platelet recipients with 1,046 controls, perioperative
platelet transfusion carried no association with in-hospital mortality (odds ratio
[OR]: 1.28; 99% CI: 0.49-3.35; p = 0.4980). However, it was associated with a pattern
of decreased odds of suspected infection (eg, respiratory infection, urinary tract
infection, septicaemia, or other; OR: 0.70; 99% CI: 0.50-0.97; p = 0.0050), days in
the hospital (adjusted mean difference [AMD]: 0.86; 99% CI: -0.27 to 1.98; p = 0.048),
or days in intensive care (AMD 0.83; 99% CI: -0.15 to 1.82; p = 0.0290).
Conclusions
Platelet transfusion was not associated with hospital mortality, but it was associated
with decreased odds of suspected infection and with shorter ICU and hospital stays.
Key Words
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References
- Hemostatic and thrombotic issues in cardiac surgery.Semin Thromb Hemost. 2015; 41: 84-90
- Profiling clinical platelet and plasma use to inform blood supply and contingency planning: PUPPY, the prospective utilization of platelets and plasma study.Transfusion. 2016; 56: 2455-2465
- Transfusion practice varies widely in cardiac surgery: Results from a national registry.J Thorac Cardiovasc Surg. 2014; 147 (e1681): 1684-1690
- Variation in platelet transfusion practices in cardiac surgery.Innovations. 2019; 14: 134-143
- Platelet transfusion: A clinical practice guideline from the AABB.Ann Intern Med. 2015; 162: 205-213
- 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery.Eur J Cardiothorac Surg. 2018; 53: 79-111
- Patient blood management guidelines: Module 2 perioperative.2012 (Available at) (Accessed May 20, 2022)
- Does a platelet transfusion independently affect bleeding and adverse outcomes in cardiac surgery?.Anesthesiology. 2017; 126: 441-449
- The association between platelet transfusion and adverse outcomes after coronary artery bypass surgery.Eur J Cardiothorac Surg. 2015; 48: e102-e109
- Blood transfusion and infection after cardiac surgery.Ann Thorac Surg. 2013; 95: 2194-2201
- The effect of platelet transfusion on death in the intensive care unit.Blood. 2016; 128: 3850
- Postoperative complications associated with transfusion of platelets and plasma in cardiac surgery.Transfusion. 2011; 51: 2603-2610
- Transfusion of red blood cells, fresh frozen plasma, or platelets is associated with mortality and infection after cardiac surgery in a dose-dependent manner.Anesth Analg. 2020; 130: 488-497
- Platelet transfusion is not associated with increased mortality or morbidity in patients undergoing cardiac surgery.Transfusion. 2018; 58: 1218-1227
- Preoperative identification of cardiac surgery patients at risk of receiving a platelet transfusion: The Australian Cardiac Surgery Platelet Transfusion (ACSePT) risk prediction tool.Transfusion. 2020; 60: 2272-2283
- Statistical primer: Sample size and power calculations—why, when and how?.Eur J Cardiothorac Surg. 2018; 54: 4-9
- Impact of patient blood management guidelines on blood transfusions and patient outcomes during cardiac surgery.J Thorac Cardiovasc Surg. 2020; 160: 437-445
- The role of fibrinogen and fibrinogen concentrate in cardiac surgery: An international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology.Anaesthesia. 2019; 74: 1589-1600
- Bleeding management practices of Australian cardiac surgeons, anesthesiologists and perfusionists: A cross-sectional national survey incorporating the Theoretical Domains Framework (TDF) and COM-B model.J Multidiscip Healthc. 2020; 13: 27-41
- MIMIC-III, a freely accessible critical care database.Sci Data. 2016; 3160035
Johnson A, Bulgarelli L, Pollard T, et al. MIMIC-IV (version 1.0). PhysioNet. Available at: https://physionet.org/content/mimiciv/1.0/. Accessed 01 May 2022.
- PhysioBank, PhysioToolkit, and PhysioNet: Components of a new research resource for complex physiologic signals.Circulation. 2000; 101: e215-e220
- Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies.BMJ. 2007; 335: 806-808
- The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement.PLoS Med. 2015; 12e1001885
- Anti-D alloimmunization after D-incompatible platelet transfusions: A 14-year single-institution retrospective review.Transfusion. 2014; 54: 650-654
- Assessing inpatient platelet ordering practice: Evaluation of computer provider order entry overrides.Vox Sanguinis. 2021; 116: 702-712
- Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit.JAMA. 2017; 317: 290-300
- Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).JAMA. 2016; 315: 775-787
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424
- Multivariate imputation by chained equations in R.J Stat Softw. 2011; 45: 1-67
- Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.Pharma Stat. 2011; 10: 150-161
- MatchThem: Matching and weighting after multiple imputation.R J. 2021; 13: 292-305
- Platelet transfusion in cardiac surgery: A systematic review and meta-analysis.Ann Thorac Surg. 2021; 111: 607-614
- Transfusion increases the risk of postoperative infection after cardiovascular surgery.J Am Coll Surg. 2006; 202: 131-138
- A comparison of transfusion-related adverse reactions among apheresis platelets, whole blood-derived platelets, and platelets subjected to pathogen reduction technology as reported to the National Healthcare Safety Network Hemovigilance Module.Transfusion Med Rev. 2021; 35: 78-84
- Platelets: Essential components of the immune system.Curr Trends Immunol. 2015; 16: 65
- The immune nature of platelets revisited.Transfusion Med Rev. 2020; 34: 209-220
- Role of platelets in detection and regulation of infection.Arterioscler Thromb Vasc Biol. 2021; 41: 70-78
- Universal definition of perioperative bleeding in adult cardiac surgery.J Thorac Cardiovasc Surg. 2014; 147: 1458-1463
- The association of blood transfusion with mortality after cardiac surgery: Cause or confounding?(CME).Transfusion. 2013; 53: 19-27
- Postoperative acute kidney injury following intraoperative blood product transfusions during cardiac surgery.Perfusion. 2018; 33: 62-70
- Association between transfusion of blood products and acute kidney injury following cardiac surgery.Acta Anaesthesiol Scand. 2020; 64: 1397-1404
- Risk scores to facilitate preoperative prediction of transfusion and large volume blood transfusion associated with adult cardiac surgery.Br J Anaesth. 2015; 114: 757-766
- Development and validation of Transfusion Risk Understanding Scoring Tool (TRUST) to stratify cardiac surgery patients according to their blood transfusion needs.Transfusion. 2006; 46: 1120-1129
- Pressure-dependent changes in haematocrit and plasma volume during anaesthesia, a randomised clinical trial.Acta Anaesthesiol Scand. 2016; 60: 560-568
- Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: Updated systematic review and meta-analysis.Br J Anaesth. 2017; 118: 823-833
- Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion.Transfus Med. 2020; 30: 369-376
- Improving platelet transfusion safety: Biomedical and technical considerations.Blood Transfus. 2016; 14: 109
Article info
Publication history
Published online: December 16, 2022
Publication stage
In Press Corrected ProofFootnotes
Support for this project was provided solely from institutional and/or departmental sources.
The datasets used and/or analyzed during the current study are available from Physionet: MIMIC-IV: https://physionet.org/content/mimiciv/1.0/ and MIMIC-III: https://physionet.org/content/mimiciii/1.4/.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
