Incidence,predictors,and prognosis of thrombocytopenia among patients undergoing intra-aortic balloon pumping in the intensive care unit:a propensity score analysis

OBJECTIVE To explore the incidence,predictors,and prognosis of intra-aortic balloon pumping(IABP)-related thrombocytopenia in critically ill patients.METHODS This multi-center study used the eICU Collaborative Research Database V1.2,comprising data on>130,000 patients from multiple intensive care units(ICUs)in America between 2014 and 2015.A total of 710 patients undergoing IABP were included.Thrombocytopenia was defined as a drop in platelet count>50%from baseline.From the cohort,167 patients who developed thrombocytopenia were matched 1:1 with 167 patients who did not,after propensity score(PS)matching.The associations between IABP-related thrombocytopenia and clinical outcomes were examined by multivariable logistic regression.RESULTS Among 710 patients undergoing IABP,249 patients(35.07%)developed thrombocytopenia.The APACHE IVa score was a predictor of thrombocytopenia[adjusted odds ratio(OR)=1.09,95%confidence interval(CI):1.02−1.15].After 1:1 PS matching,in-hospital mortality(adjusted OR=0.76,95%CI:0.37−1.56)and in-ICU mortality(adjusted OR=0.74,95%CI:0.34−1.63)were similar between the thrombocytopenia and non-thrombocytopenia groups.However,major bleeding occurred more frequently in the thrombocytopenia group(adjusted OR=2.54,95%CI:1.54−4.17).In-hospital length of stay(LOS)and in-ICU LOS were significantly longer in patients who developed thrombocytopenia than in those who did not(9.71 vs.7.36,P<0.001;5.13 vs.2.83,P<0.001).CONCLUSIONS Among patients undergoing IABP in the ICUs,thrombocytopenia was not associated with a difference in inhospital mortality or in-ICU mortality;however,thrombocytopenia was significantly associated with a greater risk of major bleeding and increased in-ICU and in-hospital LOS.