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. 2017 Dec;5(1):32.
doi: 10.1186/s40635-017-0145-2. Epub 2017 Jul 12.

Sepsis prediction in critically ill patients by platelet activation markers on ICU admission: a prospective pilot study

Nathalie Layios  1   2 , Céline Delierneux  2 , Alexandre Hego  2 , Justine Huart  2 , Christian Gosset  3 , Christelle Lecut  3 , Nathalie Maes  4 , Pierre Geurts  5 , Arnaud Joly  5 , Patrizio Lancellotti  2   6 , Adelin Albert  4 , Pierre Damas  1 , André Gothot  3 , Cécile Oury  7
Affiliations

Sepsis prediction in critically ill patients by platelet activation markers on ICU admission: a prospective pilot study

Nathalie Layios et al. Intensive Care Med Exp. 2017 Dec.

Abstract

Background: Platelets have been involved in both immune surveillance and host defense against severe infection. To date, whether platelet phenotype or other hemostasis components could be associated with predisposition to sepsis in critical illness remains unknown. The aim of this work was to identify platelet markers that could predict sepsis occurrence in critically ill injured patients.

Methods: This single-center, prospective, observational, 7-month study was based on a cohort of 99 non-infected adult patients admitted to ICUs for elective cardiac surgery, trauma, acute brain injury, and post-operative prolonged ventilation and followed up during ICU stay. Clinical characteristics and severity score (SOFA) were recorded on admission. Platelet activation markers, including fibrinogen binding to platelets, platelet membrane P-selectin expression, plasma soluble CD40L, and platelet-leukocytes aggregates were assayed by flow cytometry at admission and 48 h later, and then at the time of sepsis diagnosis (Sepsis-3 criteria) and 7 days later for sepsis patients. Hospitalization data and outcomes were also recorded.

Methods: Of the 99 patients, 19 developed sepsis after a median time of 5 days. These patients had a higher SOFA score at admission; levels of fibrinogen binding to platelets (platelet-Fg) and of D-dimers were also significantly increased compared to the other patients. Levels 48 h after ICU admission no longer differed between the two patient groups. Platelet-Fg % was an independent predictor of sepsis (P = 0.0031). By ROC curve analysis, cutoff point for Platelet-Fg (AUC = 0.75) was 50%. In patients with a SOFA cutoff of 8, the risk of sepsis reached 87% when Platelet-Fg levels were above 50%. Patients with sepsis had longer ICU and hospital stays and higher death rate.

Conclusions: Platelet-bound fibrinogen levels assayed by flow cytometry within 24 h of ICU admission help identifying critically ill patients at risk of developing sepsis.

Keywords: Biomarker; Fibrinogen; Flow cytometry; Platelet markers; Prediction; SOFA; Sepsis.

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Conflict of interest statement

Ethics approval and consent to participate

The experimental protocol was approved by the ethics committee of the University of Liège Academic Hospital (CHU) (reference number B707201111981). Written informed consent was obtained from each participant or next of kin prior to sampling in agreement with the recommendations of the Declaration of Helsinki for investigations involving human subjects.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Serial measurements of levels of platelet-bound fibrinogen (platelet-Fg) for patients who developed sepsis. Platelet-Fg levels were analyzed by flow cytometry on the day of ICU admission (T1), after 48 h (T2), at the time of sepsis diagnosis (Tx), and 7 days later (Tx + 7). Median values of percentages of Fg-positive platelets and IQR are shown (P value: Kruskal-Wallis test)
Fig. 2
Fig. 2
Predictive value of platelet-Fg (%) obtained at admission. ROC curve analysis of sepsis prediction based on platelet-Fg is shown
See this image and copyright information in PMC

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