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 (9.71vs. 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 in-hospital 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.