Platelet Counts and Risk of Severe Retinopathy of Prematurity: A Bayesian Model-Averaged Meta-Analysis

Background: We aimed to conduct a systematic review and Bayesian model-averaged meta-analysis (BMA) on the association between platelet counts and severe retinopathy of prematurity (ROP). Methods: We searched for studies reporting on platelet counts (continuous variable) or thrombocytopenia (categorical variable) and severe ROP or aggressive posterior ROP (APROP). The timing of platelet counts was divided into Phase 1 (<2 weeks) and Phase 2 (around ROP treatment). BMA was used to calculate Bayes factors (BFs). The BF₁₀ is the ratio of the probability of the data under the alternative hypothesis (H₁) over the probability of the data under the null hypothesis (H₀). Results: We included 21 studies. BMA showed an association between low platelet counts and severe ROP. The evidence was strong (BF₁₀ = 13.5, 7 studies) for phase 1 and very strong (BF₁₀ = 51.0, 9 studies) for phase 2. Thrombocytopenia (<100 × 10⁹/L) in phase 2 was associated with severe ROP (BF₁₀ = 28.2, 4 studies). Following adjustment for publication bias, only the association of severe ROP with thrombocytopenia remained with moderate evidence in favor of H₁ (BF₁₀ = 4.30). Conclusions: Thrombocytopenia is associated with severe ROP. However, the evidence for this association was tempered when results were adjusted for publication bias.