Risk factors of thrombocytopenia in adults receiving extracorporeal membrane oxygenation support: A single center retrospective cohort study

Objectives To investigate the risk factors associated with thrombocytopenia in patients undergoing extracorporeal membrane oxygenation (ECMO) support. Methods This retrospective cohort study included 230 patients who received ECMO support during January 2018 to December 2024. Clinical data collected included age, gender, causes of ECMO, medical history, vital signs, laboratory test results, complications and outcomes. The patients were divided into the thrombocytopenia group and the control group based on whether the patient's platelet count was less than 150*10 9 /L. The differences in clinical data between the two groups were compared. Moreover, risk factors associated with thrombocytopenia were identified using univariate and multivariate regression analyses. Results In this study, a total of 230 patients undergoing ECMO were involved. The mean age of patients was 52 ± 8 years with 119 (51.7%) males and 111 (48.3%) females. The age, sex distribution, reasons for ECMO, previous medical history, temperature, respiration rate, heart rate, mean arterial pressure, white blood cells, hemoglobin, C-reactive protein, platelets, total bilirubin, alanine aminotransferase, aspartate aminotransferase, prothrombin time, activated partial thromboplastin time, blood lactate between two groups showed no statistically significant differences ( P  > 0.05) while the APACHE II score (24(20,28) vs 21(17,24)) was higher in thrombocytopenia group ( P  < 0.05). The bleeding events were significantly higher (62.4% vs 15.7%), in-hospital survival (49.7% vs 62.9%) was lower, the duration of ICU stay (19(16,23) vs 18 (14,22)) was longer, and more platelet (30(10,40) vs 15 (10,20)) and plasma transfusions (600(400,800) vs 450 (200,600)) in thrombocytopenia group ( P  < 0.05). Logistic regression analysis showed that APACHE II score, rotational speed over the first 48 h, with sepsis, the heparin doseage before ECMO, use of continuous renal replacement therapy (CRRT) and intra-aortic balloon pump (IABP) during ECMO were risk factors associated with thrombocytopenia. Conclusions The incidence of thrombocytopenia in patients receiving ECMO is high and may be associated with poor prognosis. Patients with higher APACHE II score, higher rotational speed during the first 48 h, sepsis, higher heparin doseage before ECMO initiation, and the use of CRRT or IABP may at an increased risk of developing thrombocytopenia.