A meta-analysis of risk factors associated with platelet transfusion refractoriness

Background Platelet transfusion refractoriness (PTR) remains an intractable issue in clinical practice, and is common in hematological patients. At present, it is believed that both immune and non-immune factors play a role. We conducted a meta-analysis of various risk factors which may contribute to PTR. Methods PubMed, Embase, Cochrane library, and Web of Science were selected as research database platforms. Citations included were further assessed for quality and bias using the Newcastle–Ottawa Scale. All analyses were performed using Review Manager Version 5.4 and STATA 16.0. Results The preliminary search revealed 1069 publications, and 17 (5929 patients in total) were ultimately included in the quantitative analysis. The following variables were associated with the occurrence of PTR: fever (OR = 2.26, 95%CI 2.00–2.55, p < 0.00001), bleeding (OR = 2.10, 95%CI 1.36–3.24, p = 0.0008), female sex (OR = 2.06, 95%CI 1.13–3.75, p = 0.02), antibiotic use (OR = 2.94, 95%CI 1.54–5.59, p = 0.001), and infection (OR = 2.19, 95%CI 1.20–4.03, p = 0.01). Antibodies involved in immune activation were a higher risk factor (OR = 4.17, 95%CI 2.36–7.36, p < 0.00001), and splenomegaly was nearly significant (OR = 1.73, 95%CI 0.97–3.07, p = 0.06). Conclusions We identified some important risk factors for PTR, but further research is needed to identify the many other possible elements that may contribute to or mediate PTR.