Abstract Body: Background:
Platelet counts reflect dynamic interactions between thrombosis, inflammation, and hemostasis during critical illness. Although early thrombocytopenia is associated with adverse outcomes, the prognostic importance of early platelet trajectory patterns has not been well defined in large multicenter intensive care cohorts.
Objectives:
The objective of this study was to evaluate the association between early platelet trajectory patterns during the first 48 hours of intensive care unit admission and in-hospital mortality.
Methods:
Data from the eICU Collaborative Research Database (version 2.0) were analyzed. Adult first intensive care unit admissions with at least two platelet measurements within the first 48 hours were included. Platelet trajectories were classified into clinically interpretable groups based on change over time, including stable normal platelet counts, recovering thrombocytopenia, progressive thrombocytopenia, and persistent thrombocytopenia. 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:
Distinct platelet trajectory patterns were observed during the first 48 hours of intensive care. In-hospital mortality differed across trajectory groups. Compared with patients with stable platelet trajectories, patients with progressive thrombocytopenia and persistent thrombocytopenia demonstrated higher odds of in-hospital mortality after multivariable adjustment. Patients with recovering thrombocytopenia demonstrated intermediate risk.
Conclusions:
In a large multicenter intensive care cohort, early platelet trajectory patterns were independently associated with in-hospital mortality. Progressive and persistent thrombocytopenia identified patients at particularly high risk, underscoring the importance of dynamic platelet assessment as a marker of dysregulated hemostasis and thrombo-inflammatory biology in critical illness.