Abstract Body: Background:
Platelets play a central role in thrombosis and hemostasis and are dynamically altered during critical illness through consumption, inflammation, and dysregulated coagulation. However, the prognostic significance of early thrombocytopenia across diverse intensive care settings remains incompletely characterized.
Objectives:
The objective of this study was to evaluate the association between early platelet count abnormalities and in-hospital mortality in a large multicenter intensive care cohort.
Methods:
Data from the eICU Collaborative Research Database (version 2.0) were analyzed. Adult first intensive care unit admissions were included. The exposure was the minimum platelet count within the first 24 hours of intensive care unit admission, categorized as less than 100 x10^3 per microliter, 100 to 149 x10^3 per microliter, and 150 x10^3 per microliter or greater. The primary outcome was in-hospital mortality. Multivariable logistic regression models adjusted for age, sex, intensive care unit type, and Acute Physiology and Chronic Health Evaluation physiologic variables were used to assess associations.
Results:
The cohort included 152,413 adult first intensive care unit admissions, with first-24-hour platelet values available in 125,705 patients. In-hospital mortality occurred in 7.4 percent (6,471 of 87,410) of patients with platelet counts 150 x10^3 per microliter or greater, 8.6 percent (2,093 of 24,321) of patients with platelet counts 100 to 149 x10^3 per microliter, and 18.1 percent (2,530 of 13,974) of patients with platelet counts less than 100 x10^3 per microliter. After multivariable adjustment, platelet counts less than 100 x10^3 per microliter were independently associated with higher odds of in-hospital mortality compared with platelet counts 150 x10^3 per microliter or greater (adjusted odds ratio 1.89, 95 percent confidence interval 1.77 to 2.01; p less than 0.001). Platelet counts 100 to 149 x10^3 per microliter were not independently associated with mortality after adjustment.
Conclusions:
In a large multicenter intensive care cohort, early thrombocytopenia was independently associated with nearly two-fold higher odds of in-hospital mortality. These findings underscore the importance of early platelet abnormalities as markers of dysregulated hemostasis and thrombo-inflammatory biology in critical illness.