Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)

Purpose Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. Methods We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. Results We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4–46.1) had thrombocytopenia; 23.4% (20–26) had thrombocytopenia at ICU admission, and 19.8% (17.6–22.2) developed thrombocytopenia during their ICU stay. Non-AIDS-, non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19–2.42). Conclusion Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.publishedVersio

Moving the eyes along the mental number line : Comparing SNARC effects with saccadic and manual responses

Contains fulltext : 64748.pdf (publisher's version ) (Open Access)Bimanual parity judgments about numerically small (large) digits are faster with the left (right) hand, even though parity is unrelated to numerical magnitude per se (the SNARC effect; Dehaene, Bossini, & Giraux, 1993). According to one model, this effect reflects a space-related representation of numerical magnitudes (mental number line) with a genuine left-to-right orientation. Alternatively, it may simply reflect an overlearned motor association between numbers and manual responses—as, for example, on typewriters or computer keyboards—in which case it should be weaker or absent with effectors whose horizontal response component is less systematically associated with individual numbers. Two experiments involving comparisons of saccadic and manual parity judgment tasks clearly support the first view; they also establish a vertical SNARC effect, suggesting that our magnitude representation resembles a number map, rather than a number line.14 p