Early thrombocytopenia is associated with an increased risk of mortality in patients with traumatic brain injury treated in the intensive care unit : a Finnish Intensive Care Consortium study

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Lillemäe , K , Luostarinen , T , Reinikainen , M , Bendel , S , Laitio , R , Hoppu , S , Ala-Kokko , T , Niemi , T , Skrifvars , M B & Raj , R 2022 , ' Early thrombocytopenia is associated with an increased risk of mortality in patients with traumatic brain injury treated in the intensive care unit : a Finnish Intensive Care Consortium study ' , Acta Neurochirurgica , vol. 164 , no. 10 , pp. 2731-2740 . https://doi.org/10.1007/s00701-022-05277-9

Title: Early thrombocytopenia is associated with an increased risk of mortality in patients with traumatic brain injury treated in the intensive care unit : a Finnish Intensive Care Consortium study
Author: Lillemäe, Kadri; Luostarinen, Teemu; Reinikainen, Matti; Bendel, Stepani; Laitio, Ruut; Hoppu, Sanna; Ala-Kokko, Tero; Niemi, Tomi; Skrifvars, Markus B.; Raj, Rahul
Contributor organization: HUS Perioperative, Intensive Care and Pain Medicine
Clinicum
Anestesiologian yksikkö
HUS Musculoskeletal and Plastic Surgery
Department of Diagnostics and Therapeutics
University of Helsinki
Hyvinkää Hospital Area
HUS Emergency Medicine and Services
HUS Neurocenter
Neurokirurgian yksikkö
Date: 2022-10
Language: eng
Number of pages: 10
Belongs to series: Acta Neurochirurgica
ISSN: 0001-6268
DOI: https://doi.org/10.1007/s00701-022-05277-9
URI: http://hdl.handle.net/10138/349906
Abstract: Background Coagulopathy after traumatic brain injury (TBI) is associated with poor prognosis. Purpose To assess the prevalence and association with outcomes of early thrombocytopenia in patients with TBI treated in the intensive care unit (ICU). Methods This is a retrospective multicenter study of adult TBI patients admitted to ICUs during 2003-2019. Thrombocytopenia was defined as a platelet count < 100 x 10(9)/L during the first day. The association between thrombocytopenia and hospital and 12-month mortality was tested using multivariable logistic regression, adjusting for markers of injury severity. Results Of 4419 patients, 530 (12%) had early thrombocytopenia. In patients with thrombocytopenia, hospital and 12-month mortality were 26% and 48%, respectively; in patients with a platelet count > 100 x 10(9)/L, they were 9% and 22%, respectively. After adjusting for injury severity, a higher platelet count was associated with decreased odds of hospital mortality (OR 0.998 per unit, 95% CI 0.996-0.999) and 12-month mortality (OR 0.998 per unit, 95% CI 0.997-0.999) in patients with moderate-to-severe TBI. Compared to patients with a normal platelet count, patients with thrombocytopenia not receiving platelet transfusion had an increased risk of 12-month mortality (OR 2.2, 95% CI 1.6-3.0), whereas patients with thrombocytopenia receiving platelet transfusion did not (OR 1.0, 95% CI 0.6-1.7). Conclusion Early thrombocytopenia occurs in approximately one-tenth of patients with TBI treated in the ICU, and it is an independent risk factor for mortality in patients with moderate-to-severe TBI. Further research is necessary to determine whether this is modifiable by platelet transfusion.
Subject: Traumatic brain injury
Low platelet count
Thrombocytopenia
Platelet transfusion
Long-term outcome
One-year mortality
NEUROTRAUMA EFFECTIVENESS RESEARCH
PROGRESSIVE HEMORRHAGIC INJURY
TIME-COURSE
COAGULOPATHY
TRANSFUSION
COAGULATION
PLATELET
MODERATE
OUTCOMES
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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