Abstract Background: Thrombocytopenia is common among sepsis patients. Platelet transfusion is frequently administered to increase platelet counts but its clinical impacts remains unclear in sepsis-induced thrombocytopenia. Therefore, we intended to explore the association between platelet transfusion and mortality in patients with sepsis-induced thrombocytopenia.Methods: The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. Sepsis patients were divided into two groups: platelet transfusion group (PT group) and no platelet transfusion group (NPT group). The primary outcome was 28-day mortality, and secondary outcomes were the length of ICU stay (LOS-ICU) and survival days at 28 days. Propensity-score matching was used to reduce the imbalance. Results: 1733 patients were included: 296 patients were in the PT group and 1437 in the NPT group. Overall, 655 patients died by day 28. After propensity score matching, 294 paired patients constituted each group. 28-day mortality did not decrease in PT patients comparing with NPT patients (120(40.54%) vs. 535(37.23%) deaths; p=0.29). LOS-ICU was similar between the PT group and the NPT group (5.84(2.68-11.78) vs. 4.94(2.18-12.72); p=0.44). After confounders were adjusted, it showed no difference between the PT group and the NPT group in 28-day mortality (hazard ratio [HR], 1.28;95% confidence interval [CI], 0.96 - 1.17; p=0.09) or LOS-ICU (odds ratio [OR], 0.09; 95%CI, -1.45 - 1.62; p=0.91). Survival days at 28 days showed no difference between the groups according to Kaplan-Meier survival estimates. After propensity score matching, platelet transfusion was also not associated with 28-mortality or LOS-ICU.Conclusions: In the propensity score-matched analysis, it showed that platelet transfusion maybe not associated with 28-day mortality and the length of ICU stay in patients with sepsis-induced thrombocytopenia.