Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Carl Thomas Anthon, Frédéric Pène, Anders Perner, Elie Azoulay, Kathryn Puxty, Andry Van De Louw, Andreas Barratt-Due, Sanjay Chawla, Pedro Castro, Pedro Póvoa, Luis Coelho, Victoria Metaxa, Matthias Kochanek, Tobias Liebregts, Thomas Kander, Johanna Hästbacka, Jo Bønding Andreasen, Edwige Péju, Lene Bjerregaard Nielsen, Christine Lodberg HvasEtienne Dufranc, Emmanuel Canet, Linda Lundqvist, Christopher John Wright, Julien Schmidt, Fabrice Uhel, Hafid Ait-Oufella, Mette Krag, Elisabet Cos Badia, Cándido Díaz-Lagares, Sophie Menat, Guillaume Voiriot, Niels Erikstrup Clausen, Kristian Lorentzen, Reidar Kvåle, Thomas Hildebrandt, Aleksander Rygh Holten, Kristian Strand, Asterios Tzalavras, Morten Heiberg Bestle, Pål Klepstad, Sara Fernandez, Damien Vimpere, Carolina Costa, Carina Graça, Christian Svendsen Juhl, Per Martin Bådstøløkken, Anders Granholm, Morten Hylander Møller, Lene Russell*, on behalf of the PLOT-ICU Collaborators and the Nine-I Study Group, Frederik Bestle (Member of study group)

*Corresponding author for this work
7 Citations (Scopus)


PURPOSE: Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients.

METHODS: We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses.

RESULTS: We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4-46.1) had thrombocytopenia; 23.4% (20-26) had thrombocytopenia at ICU admission, and 19.8% (17.6-22.2) developed thrombocytopenia during their ICU stay. Absence of acquired immune deficiency syndrome (AIDS), non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19-2.42).

CONCLUSION: Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.

Original languageEnglish
JournalIntensive Care Medicine
Issue number11
Pages (from-to)1327-1338
Number of pages12
Publication statusPublished - Nov 2023


  • Bleeding
  • Critical illness
  • Intensive care unit
  • Platelet transfusion
  • Thrombocytopenia
  • Thrombosis
  • Hemorrhage/etiology
  • Intensive Care Units
  • Prospective Studies
  • Humans
  • Middle Aged
  • Male
  • Thrombocytopenia/epidemiology
  • Adult
  • Female
  • Retrospective Studies
  • Platelet Transfusion/adverse effects
  • Cohort Studies


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