NEW data from a retrospective cohort study found that platelet transfusion was associated with an increased risk of acute kidney injury (AKI) among patients with sepsis and severe thrombocytopenia. The findings suggested that prophylactic platelet transfusion in the absence of active bleeding may warrant caution, although the study did not establish a causal relationship.
Researchers evaluated 1,413 adults who met Sepsis-3 criteria, had platelet counts below 50×10^9/L, and had no active bleeding. Of these patients, 640 received platelets within 48 hours of sepsis onset, while 773 did not. The primary outcome was stage 2 or higher AKI based on creatinine criteria within a 7-day window.
After propensity score matching, AKI occurred in 64.9% of patients who received platelet transfusions compared with 55.3% of those who did not. Platelet transfusion remained associated with higher odds of AKI after adjustment (odds ratio [OR]: 1.55; 95% CI: 1.15–2.09; p=0.004).
The researchers also identified a borderline dose response, with the odds of AKI increasing by 3% for each additional 1 mL/kg of platelet transfusion (OR: 1.03; p=0.037). Restricted cubic spline analysis supported a linear association, with no evidence of non-linearity (p=0.72).
The direction of the association remained consistent across 12 sensitivity analyses. A landmark analysis excluding patients whose AKI developed before their first transfusion also found an association (adjusted OR: 1.32; p=0.044). However, platelet transfusion was not associated with 30-day all-cause mortality after adjustment (p=0.877).
The association between platelet transfusion and AKI was attenuated after adjustment for concurrent red blood cell transfusion (adjusted OR: 1.24; p=0.132). This indicated that co-transfusion may have acted as a relevant confounding factor.
The researchers therefore concluded that prophylactic platelet transfusion was associated with a higher AKI risk across several analytical approaches, but the retrospective design and attenuation following blood product adjustment prevented causal conclusions.
For clinicians managing patients with sepsis and severe thrombocytopenia, the findings support caution around liberal platelet transfusion. Prospective studies are needed to determine whether platelet transfusion directly contributes to AKI and to clarify the clinical implications of transfusion strategies in this population.
Karanci Y, Ciyiltepe F. Association between platelet transfusion and acute kidney injury in septic patients with severe thrombocytopenia. Sci Rep. 2026;DOI:10.1038/s41598-026-61246-7.
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