Pediatric demographic association with hospital mortality in platelets- and plasma-transfused young pediatric patients — a mixed cohort study

Abstract

Demographic and biochemical variations in newborn children as compared to adults are attributable to variable prognosis to blood transfusions. Aims of this mixed cohort study of Platelets with/without Plasma (PLT/PZ); only Plasma (PZ) transfusions in ≤ 24 months children is as follows: An Association of demography towards hospital mortality, and an association of laboratory investigations (LI) with hospital mortality. PLT/PZ (n = 72) and PZ (n = 79) children ≤ 24 months were followed up for a total length of hospital stay (LOS(D)). We calculated the Odds Ratio (OR) of demographic, and laboratory parameters for mortality, survival studies of demographic, laboratory parameters , Kaplan Meier Survival curve, Log-Rank significance (KMLR) and Multivariable regression (r2) with outcome as death. The present study is in 2019–2022. Higher OR for hospital-based mortality for PLT/PZ and PZ cohort were age ≤ 1 m, weight ≤ 1500 g, preterm, gestational age ≤ 34 weeks, hospital length of stay {LOS(D)} 0–7 days, APGAR score ≤ 5, and Hb ≤ 7 g/dl. High OR, mortality was observed with Female gender, Length of stay before first transfusion {LOS(F)}, 0-7d, WHO Grade of bleeding (GOB) 4, PT>50 sec, INR>1·7, aPTT >75sec, PLT counts (μl) ≤25000/μl (PLT/PZ) and GOB 3, 4 (PZ). Higher OR for mortality was also observed with a lower derangement of coagulative parameters PT≤50s, INR ≤1·7, aPTT ≤75s (PZ). Higher survival was observed for (PLT/PZ) LOS(F) 0–7 days across age (m), weight (g) (P = 0·002; < 0·01), and INR ≤ 1·7; aPTT ≤ 75 s across LOS(D) (P < 0·01,0·018); (PZ) LOS(D) ≤ 7 days across age (m) and weight (g) (P = 0·036, 0·001); and GOB across LOS(D) (PLT/PZ; PZ) (P = 0·052, 0·005). Demography (PLT/PZ) r2 = 50·36% (P = 0·021), laboratory investigations r2 = 10·44% (P = 0·47), LOS(F) (P = 0·010), LOS(D) (P = 0·003), and GOB (P = 0·03) were the predictors. Demography (PZ) r2 (P = 0·095), investigations r2 = 8·79% (P = 0·254), LOS(D) (P = 0·026), and GOB (P = 0·012) were the predictors. PLT/PZ, demographic parameters, were significant cause of mortality with LOS(F), LOS(D), and GOB as predictors. PZ, demography attributed to mortality with LOS(D), and GOB as predictors. A higher OR of morality with lower derangement of laboratory profile is indicative of unnecessary transfusions in the age group. Laboratory investigations by themselves are not significant predictors of mortality.