Early predictive value of platelet function for clinical outcome in sepsis

Yan Cao; Wenfeng Ma; Zhengyu Liu; Yanfang Pei; Yimin Zhu; Fang Chen; Lianhong Zou; Yu Jiang; Xiehong Liu; Jie Huang; Weiwei Xiao; Xiaotong Han

doi:10.1016/j.jinf.2022.02.004

Early predictive value of platelet function for clinical outcome in sepsis

J Infect. 2022 May;84(5):628-636. doi: 10.1016/j.jinf.2022.02.004. Epub 2022 Feb 10.

Authors

Yan Cao¹, Wenfeng Ma², Zhengyu Liu³, Yanfang Pei¹, Yimin Zhu⁴, Fang Chen⁴, Lianhong Zou⁴, Yu Jiang⁴, Xiehong Liu⁴, Jie Huang¹, Weiwei Xiao⁵, Xiaotong Han⁶

Affiliations

¹ Department of Emergency, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61 Western Jiefang Road, Changsha, Hunan 410005, China.
² Department of Emergency, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China.
³ Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China; Clinical Research Center for Heart Failure of Hunan Province, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
⁴ Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
⁵ Department of Emergency, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61 Western Jiefang Road, Changsha, Hunan 410005, China. Electronic address: csxiaoweiwei@163.com.
⁶ Department of Emergency, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No.61 Western Jiefang Road, Changsha, Hunan 410005, China. Electronic address: xiaotong_han@sina.com.

PMID: 35150766
DOI: 10.1016/j.jinf.2022.02.004

Abstract

Objective: Sepsis is the leading course of morbidity and mortality in critically ill patients. This study aimed to evaluate the predictive value of the platelet aggregation for mortality in patients with sepsis. In addition, the relationship between impaired mitochondria and the platelet aggregation was explored.

Method: This was a prospective, observational cohort study. The platelet aggregation rate in response to adenosine diphosphate (ADP) was assessed. The primary outcome was 28-day mortality. Platelet mitochondrial parameters, including adenosine triphosphate(ATP), mitochondrial membrane potential (MMP) and mitochondrial permeability transition pore (mPTP) opening, were measured. Platelet mitochondrial ultrastructure was observed using transmission electron microscopy.

Results: 86 patients with 65 survivors and 21 non-survivors were enrolled. Platelets of non-survivors with sepsis were hyporesponsive to ADP, in terms of maximal aggregation rate (P < 0.001). Receiver operating characteristic curves analysis demonstrated that the AUC estimated 28-day mortality for platelet aggregation rate was 0.814. At the optimal cut-off value of 35.8% for platelet aggregation rate, the sensitivity was 86.2% and the specificity was 66.7%. Kaplan-Meier analysis showed that a platelet aggregation rate of less than 35.8% was associated closely with poor survival. After adjusting for lactate by Cox regression analysis, platelet aggregation rate was identified as an independent predictor for the probability of 28-day mortality. Compared with survivors, non-survivors showed a significant reduction in platelet ATP and MMP-index (both P < 0.001), and a remarkable increase in mPTP opening (P < 0.001). ATP and MMP-index were positively correlated with platelet aggregation rate (R square=0.75, R square=0.44, respectively).

Conclusion: Platelet aggregation rate could be an early predictive biomarker for mortality in sepsis. Impaired platelet mitochondrial activity affects platelet aggregation and correlates with the severity of sepsis.

Keywords: Platelet aggregation rate; Platelet mitochondria; Predictive value; Sepsis.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adenosine Diphosphate
Adenosine Triphosphate
Humans
Prognosis
Prospective Studies
ROC Curve
Sepsis*

Substances

Adenosine Diphosphate
Adenosine Triphosphate