Association Between Platelet Transfusion and ICU Mortality Within 28 Days Among Patients With Intracranial Hemorrhage Complicated by Thrombocytopenia: A Propensity Score-Matched Cohort Study.

BACKGROUND Thrombocytopenia is common among patients with traumatic or non-traumatic intracranial hemorrhage admitted to the neuro-intensive care unit (neuro-ICU). The association between platelet transfusion and short-term outcomes in this population remains unclear. This study evaluated the association between platelet transfusion and ICU mortality within 28 days. MATERIAL AND METHODS We analyzed 936 neuro-ICU patients with intracranial hemorrhage complicated by thrombocytopenia, including 173 who received platelet transfusions and 763 who did not. After propensity score matching (PSM), 113 matched pairs were obtained. Cox proportional hazards models, Kaplan-Meier analysis, restricted cubic spline analysis, and exploratory subgroup analyses were used to assess the associations of platelet transfusion status and transfusion volume with ICU mortality within 28 days. RESULTS After PSM, ICU mortality within 28 days did not significantly differ between the transfusion and non-transfusion groups (P=0.292), nor did survival time (P=0.576). Cox regression and Kaplan-Meier analyses showed no significant association between platelet transfusion status and mortality (all P>0.05). Exploratory subgroup analyses suggested heterogeneity among patients with pneumonia (P=0.007, interaction P=0.010) and heart failure (P=0.074, interaction P=0.043). Higher transfusion volume was associated with higher mortality in unadjusted analyses; this association was not significant after multivariable adjustment. CONCLUSIONS Platelet transfusion was not independently associated with ICU mortality within 28 days among neuro-ICU patients with intracranial hemorrhage complicated by thrombocytopenia. Exploratory subgroup findings in patients with pneumonia or heart failure should be interpreted cautiously and require further validation.