Consumption-like Thrombocytopenia Phenotype Predicts ICU Mortality with Particular Relevance in Patients with Malignancy: A Retrospective Single-Center Cohort Study of 2188 Patients
Journal of Clinical Medicine, cilt.15, sa.12, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 15 Sayı: 12
- Basım Tarihi: 2026
- Doi Numarası: 10.3390/jcm15124720
- Dergi Adı: Journal of Clinical Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Chemical Abstracts Core, EMBASE, Academic Search Ultimate (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: thrombocytopenia, intensive care unit, mean platelet volume, platelet phenotype, mortality, malignancy, critical illness
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Thrombocytopenia develops in roughly one in three intensive care unit (ICU) patients and is associated with worse outcomes. Most prognostic studies treat it as a single entity defined by platelet count (PLT) alone. We examined whether classifying the dominant pathophysiological direction (peripheral consumption versus impaired production), using admission mean platelet volume (MPV), adds prognostic information beyond the count itself. Methods: We analyzed 2188 consecutive adults admitted to a tertiary medical ICU between 2019 and 2023. Patients were classified as: normal platelet count (PLT ≥ 150 × 109/L), consumption-like thrombocytopenia (PLT < 150 × 109/L with elevated MPV), or production-like thrombocytopenia (PLT < 150 × 109/L with normal or low MPV). The primary outcome was all-cause ICU mortality. Multivariable logistic regression adjusted for age, APACHE II score, albumin, creatinine, and malignancy. A prespecified malignancy subgroup analysis included a phenotype interaction term. Results: Of 2188 patients (median age 70 years; 57.6% male), 717 (32.8%) had thrombocytopenia; of these, 703 with available MPV were classified: 249 consumption-like and 454 production-like; the three groups were similar in age and sex distribution (p = 0.002 for age; p = 0.876 for sex). Active malignancy was present in 585 patients (26.7%) and was more frequent in the consumption-like group (34.5% vs. 25.2% PLT-normal; p = 0.008). Overall ICU mortality was 44.4% and differed across phenotypic groups (52.0% consumption-like vs. 46.7% production-like vs. 42.4% PLT-normal; p = 0.010). In the full cohort, consumption-like thrombocytopenia was independently associated with ICU death (OR 1.46, 95% CI 1.08–1.99; p = 0.016); production-like was not (OR 1.12; p = 0.302). In patients with malignancy, the adjusted OR was 2.48 (95% CI 1.37–4.48; p = 0.003); a formal interaction test was significant [interaction OR 2.12 (95% CI 1.08–4.15; p = 0.029)]. Among patients without malignancy, no association was found (OR 1.18; p = 0.397). Conclusions: Classifying thrombocytopenic ICU patients by mechanism rather than count alone identified a higher-risk subgroup. Consumption-like thrombocytopenia was independently associated with ICU death; production-like was not. The association was substantially stronger in patients with malignancy. The classification requires only the standard blood count and adds no testing burden.