Incidence and predictors of linezolid-associated thrombocytopenia in critically ill patients: nomogram development based on comprehensive screening of over 70 factors.

Abstract

Background: Linezolid-associated thrombocytopenia (LAT) is a significant complication in intensive care unit (ICU) patients, increasing bleeding risk and leading to treatment discontinuation. This study aims to assess LAT incidence, identify risk and protective factors, and develop a predictive nomogram.

Research design and methods: This retrospective cohort study included 422 adult ICU patients treated with linezolid. Over 70 clinical, demographic, laboratory, and therapeutic variables were analyzed. Logistic regression identified key risk and protective factors for LAT, and a nomogram was developed for risk prediction.

Results: LAT occurred in 39.8% of patients. Risk factors included linezolid therapy > 10 days (OR 5.80, p < 0.01), solid organ tumor (OR 2.18, p = 0.03), hemodialysis (OR 5.12, p < 0.01), elevated lactate (OR 1.13, p = 0.03), and vasopressor use (OR 4.48, p < 0.01). Protective factors were surgery (OR 0.34, p < 0.01), IV N-acetylcysteine (OR 0.12, p < 0.01), oral N-acetylcysteine (OR 0.17, p < 0.01), higher baseline platelets (OR 0.79, p = 0.05), and acetaminophen (OR 0.42, p < 0.01). The nomogram showed strong discrimination (AUC 0.834, p < 0.001).

Conclusions: LAT is common in ICU patients and associated with adverse outcomes. Prolonged therapy, solid organ tumors, dialysis, high lactate, and vasopressor use increase risk; high platelet counts, N-acetylcysteine, and IV acetaminophen decrease risk. External validation and prospective trials are warranted.