TY - JOUR
T1 - Platelets and mortality in bloodstream infection
T2 - a multicenter cohort study
AU - Adelman, Max W.
AU - Casarin, Stefano
AU - Kurian, James
AU - Miller, William R.
AU - Connor, Ashton
AU - Hsu, Enshuo
AU - Sanghvi, Aarjav A.
AU - Xu, Jiaqiong
AU - Auld, Sara C.
AU - Jones, Stephen L.
AU - Corry, David
AU - Arias, Cesar A.
AU - Nigo, Masayuki
N1 - Publisher Copyright:
© 2025 European Society of Clinical Microbiology and Infectious Diseases
PY - 2025/10
Y1 - 2025/10
N2 - Objective: The objective of this study was to determine whether thrombocytopenia is independently associated with mortality in patients with bloodstream infections (BSIs) and compare the impact of platelets on mortality with that of white blood cells and neutrophils. Methods: This retrospective cohort study used the following two U.S. cohorts of patients with BSIs: (1) patients at a multihospital network in the metropolitan Houston, Texas, area between July 01, 2016 and June 17, 2023, and (2) patients in the publicly available Medical Information Mart for Intensive Care (MIMIC)-IV database (2008–2022). We included patients who had their platelets checked in the 48 hours before positive blood culture collection. We created multivariable logistic regression models to determine whether 30-day in-hospital mortality was impacted by the degree of thrombocytopenia (severe [platelets <50 k/μL], moderate [50–99 k/μL], mild [100–149 k/μL], and none [≥150 k/μL]). Results: We included 21105 patients in the Houston cohort and 2710 in the MIMIC-IV cohort, and 30-day mortality in the Houston cohort was 12.0% (2524/21105) and was significantly associated with the platelet count. After controlling for confounders, the adjusted odds ratio (aOR) for 30-day mortality with severe thrombocytopenia was 4.66 (95% CI, 3.91–5.55); aOR for moderate thrombocytopenia was 2.61 (95% CI, 2.25–3.02); and aOR for mild thrombocytopenia was 1.55 (95% CI, 1.37–1.76), all compared with normal platelet counts (≥150 k/μL). The adjusted odds of death with severe thrombocytopenia were greater than those with neutropenia, leukopenia, or leukocytosis. Results were similar in multiple sensitivity analyses and in the MIMIC-IV cohort. Discussion: Thrombocytopenia was independently associated with mortality among patients with BSIs. Platelet counts can provide clinicians a readily available way to risk-stratify patients with BSI, and future research should examine the mechanisms by which platelets are protective in BSI.
AB - Objective: The objective of this study was to determine whether thrombocytopenia is independently associated with mortality in patients with bloodstream infections (BSIs) and compare the impact of platelets on mortality with that of white blood cells and neutrophils. Methods: This retrospective cohort study used the following two U.S. cohorts of patients with BSIs: (1) patients at a multihospital network in the metropolitan Houston, Texas, area between July 01, 2016 and June 17, 2023, and (2) patients in the publicly available Medical Information Mart for Intensive Care (MIMIC)-IV database (2008–2022). We included patients who had their platelets checked in the 48 hours before positive blood culture collection. We created multivariable logistic regression models to determine whether 30-day in-hospital mortality was impacted by the degree of thrombocytopenia (severe [platelets <50 k/μL], moderate [50–99 k/μL], mild [100–149 k/μL], and none [≥150 k/μL]). Results: We included 21105 patients in the Houston cohort and 2710 in the MIMIC-IV cohort, and 30-day mortality in the Houston cohort was 12.0% (2524/21105) and was significantly associated with the platelet count. After controlling for confounders, the adjusted odds ratio (aOR) for 30-day mortality with severe thrombocytopenia was 4.66 (95% CI, 3.91–5.55); aOR for moderate thrombocytopenia was 2.61 (95% CI, 2.25–3.02); and aOR for mild thrombocytopenia was 1.55 (95% CI, 1.37–1.76), all compared with normal platelet counts (≥150 k/μL). The adjusted odds of death with severe thrombocytopenia were greater than those with neutropenia, leukopenia, or leukocytosis. Results were similar in multiple sensitivity analyses and in the MIMIC-IV cohort. Discussion: Thrombocytopenia was independently associated with mortality among patients with BSIs. Platelet counts can provide clinicians a readily available way to risk-stratify patients with BSI, and future research should examine the mechanisms by which platelets are protective in BSI.
KW - Bacteraemia
KW - Bloodstream infection
KW - Platelet
KW - Sepsis
KW - Thrombocytopenia
UR - https://www.scopus.com/pages/publications/105013231827
UR - https://www.scopus.com/inward/citedby.url?scp=105013231827&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2025.07.021
DO - 10.1016/j.cmi.2025.07.021
M3 - Article
C2 - 40744277
AN - SCOPUS:105013231827
SN - 1198-743X
VL - 31
SP - 1733
EP - 1736
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 10
ER -