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

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

Purpose: Thrombocytopenia (platelet count &lt; 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. Absence of acquired immune deficiency syndrome (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

La névrose orientale (les voyageurs en Orient au XlXème siècle face à l'Islam)

Péju Pierre. La névrose orientale (les voyageurs en Orient au XlXème siècle face à l'Islam). In: Horizons Maghrébins - Le droit à la mémoire, N°14-15, 1989. La notion d' « Occident Musulman » / Louis Massignon homme de dialogue des cultures. pp. 96-104

Pæonia peregrina Retz, dans les Alpes méridionales, et plus généralement dans la France du Sud-Est

Péju G. Pæonia peregrina Retz, dans les Alpes méridionales, et plus généralement dans la France du Sud-Est. In: Annales de la Société linnéenne de Lyon, tome 66, Année 1919. 1920. pp. 75-77

Proposal to Extend Access to Loans for Serious Illnesses Using Open Data

In France, access to a loan requires one to obtain loan insurance and the presence of a pathology in the applicant may be a reason for refusal. Improving knowledge of health risks and pooling risks are two methods of broadening access to loans. We attempt to analyse these possibilities using open data and risk pooling scenarios. We find that the removal of medical selection can be ensured if the current framework is adjusted. We also demonstrate how to use open data to estimate loan insurance premiums for a variety of diseases. We take two examples: breast cancer and type 1 diabetes. Broadening access to borrowing would be beneficial for patients and for the development of the economy associated with these projects

La part du sphinx : roman / Pierre Péju

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Proposal to Extend Access to Loans for Serious Illnesses Using Open Data

In France, access to a loan requires one to obtain loan insurance and the presence of a pathology in the applicant may be a reason for refusal. Improving knowledge of health risks and pooling risks are two methods of broadening access to loans. We attempt to analyse these possibilities using open data and risk pooling scenarios. We find that the removal of medical selection can be ensured if the current framework is adjusted. We also demonstrate how to use open data to estimate loan insurance premiums for a variety of diseases. We take two examples: breast cancer and type 1 diabetes. Broadening access to borrowing would be beneficial for patients and for the development of the economy associated with these projects

Clinical significance of thrombocytopenia in patients with septic shock: An observational retrospective study

International audiencePurpose: Whether thrombocytopenia in critically ill patients accounts for a bystander of severity or drives specific complications is unclear. We addressed the effect of thrombocytopenia on septic shock, with emphasis on intensive care unit (ICU)-acquired bleeding, infections and thrombotic complications. Materials and methods: A retrospective (2008–2019) single-center study of patients with septic shock. Thrombocytopenia was assessed over the first seven days and was defined as severe (nadir 150 G/L). Outcomes were ICU mortality and ICU-acquired complications defined by severe bleeding, infections and thrombotic events during the ICU stay. Results: The study comprised 1024 patients. Severe, mild and relative thrombocytopenia occurred in 33%, 40% and 9% of patients. The in-ICU mortality rate was 27%, independently associated with severe thrombocytopenia. ICU-acquired infections, hemorrhagic and thrombotic complications occurred in 27.5%, 13.3% and 11.6% of patients, respectively. Patients with severe, mild or relative thrombocytopenia exhibited higher incidences of bleeding events (20.3%, 15.3% and 14.4% vs. 3.6% in non-thrombocytopenic, p < 0.001), infections (35.2%, 21.9% and 33.3% vs. 23.1% in non-thrombocytopenic, p < 0.001) and thrombotic events (14.6%, 10.8% and 17.8% vs. 7.8% in non-thrombocytopenic, p = 0.03). Only severe thrombocytopenia remained independently associated with increased risk of bleeding. Conclusions: Severe thrombocytopenia was independently associated with ICU mortality and increased risk of bleeding, but not with infectious and thrombotic events