Association between basal platelet count and all-cause mortality in critically ill patients with acute respiratory failure: a secondary analysis from the eICU collaborative research database.

ABSTRACT

BACKGROUND: Evidence regarding the correlation between platelet count and all-cause mortality in critically ill patients with acute respiratory failure (ARF) is limited. Therefore, the aim of the study was to evaluate whether platelet count was associated with all-cause mortality in critical patients with ARF by using the electronic intensive care unit (eICU) Collaborative Research Database (eICU-CRD). METHODS: In this retrospective multicenter cohort study, the data of 26961 patients with ARF hospitalized in ICUs between 2014 and 2015 were collected. The independent variable was log2 basal platelet count, and the dependent variables were all-cause in-hospital and ICU mortality. Covariates including demographic data, Acute Physiology and Chronic Health Evaluation (APACHE) IV score, supportive treatment, and comorbidities were collected. RESULTS: In the fully adjusted model, log2 basal platelet count was negatively associated with all-cause mortality both in hospital [RR 0.87, 95% CI 0.84-0.91] and in ICU [RR 0.87, 95% CI 0.83-0.92]. A non-linear relationship between log2 basal platelet count and all-cause in-hospital and ICU mortality was identified by the nonlinearity test. The inflection points we got were 6.83 and 6.86 respectively (after inverse log2 logarithmic conversion, the platelet counts were 114×109/L and 116×109/L, respectively). On the right side of the inflection point, however, no association was observed between blood platelets and all-cause in-hospital (RR 0.96, 95% CI 0.88-1.03) and ICU mortality (RR 0.97, 95% CI 0.91-1.04). CONCLUSIONS: For patients with ARF in ICU, platelet count was negatively associated with all-cause in-hospital and ICU mortality when the platelet count was less than 114×109/L and 116×109/L respectively, but when the platelet count was higher, we failed to observe a correlation between them. The safe ranges of platelet count for hospital stay and ICU stay were 78×109/L-145×109/L and 89×109/L-147×109/L respectively.