Evaluation of Immature Platelet Fraction in Lower Respiratory Tract Infections: A Retrospective Study

Abstract

Introduction Immature platelet fraction (IPF) is a parameter of an automated hematologic analyzer and is related to platelet size and cytoplasmic RNA content. It reflects thrombopoiesis and is often used as the marker of platelet activity. IPF has been evaluated mostly in hematologic disorders and has also been evaluated in patients with gestational hypertension, sepsis, autoimmune diseases and in hospitalised patients with neutrophilia. Platelets, asides from the maintenance of hemostasis, release inflammatory mediators that can modify leukocyte and endothelial responses to various inflammatory stimuli. Lower respiratory tract infections are the leading cause of death from infections worldwide. The role of platelets in lower respiratory tract infections has been reported in many studies. IPF, which is related to platelet activation, has not been evaluated in patients with lower respiratory tract infections. Methods The study involved patients who fulfilled the criteria of community-acquired pneumonia (CAP) and aspiration pneumonia (AP). In addition, age and sex-matched healthy controls were involved. Whole blood samples were collected from healthy controls and from the patients on admission. The mean IPF% and C-reactive protein (CRP) levels were measured in patients with CAP, in patients with AP and in healthy controls. The mean IPF% values in patients with infection were compared to mean IPF% values in healthy controls. The mean IPF% values were compared to mean CRP levels in patients with infection. Additionally, the mean IPF% values in patients that died in the first 14 days were compared to the mean IPF% values in patients that were alive. The statistical analysis of data was performed with the Statistical Package for the Social Sciences (SPSS) for Windows, Version 13.0 (SPSS Inc, Chicago, IL). Results The study population consisted of 45 patients (27 patients with CAP and 18 patients with AP), 27 males and 18 females, with a mean age of 72.11 ± 16.4 years and 39 healthy controls, 22 males and 17 females with a mean age of 64.2 ± 14.8 years. The mean CRP levels in patients with infection were 155.2±119.1 mg/dl. The mean IPF% value of patients with infection was 2.76 ± 2.27 and the mean IPF% value of controls was 1.72 ± 0.77 (p < 0.006). The IPF% value in patients with CAP was 2.55 ± 2.02 and in patients with AP 3.07 ± 2.64 (p = 0.595). The mean IPF% value in patients with infection had no linear correlation with CRP value in these patients (r = 0.076, p = 0.62). The mean IPF% value in all patients that died in the first 14 days was 3.75 ± 2.44 and the mean IPF% value in all patients alive was 2.35 ± 2.11 (p = 0.06). The mean IPF% value in patients with CAP who died in the first 14 days of hospitalisation was 5.54 ± 3.17 and in patients with CAP who were alive was 1.87 ± 0.72 (p = 0.06). The mean IPF% value in patients with AP who died was 2.63 ± 0.85 and in patients with AP who were alive was 3.41 ± 3.51 (p = 0.554). Conclusions Mean IPF% value is greater in patients with lower respiratory tract infections, including CAP and AP, compared to healthy controls. There is no linear correlation between IPF values and CRP values in patients with lower respiratory tract infections. In addition, there is a difference in mean IPF% value between patients who died in the first 14 days of hospitalisation compared to those who were alive, but not statistically significant.

Keywords: immature platelet fraction; platelets; respiratory infections.

Figure 1. Comparison of IPF% values between infected and healthy controls

11, 30, 51, 56, 74: outliers; 62, 70: extreme values. IPF, immature platelet fraction

Figure 2. Comparison of IPF% values between groups

11, 30, 51, 56, 74: outliers; 62, 70: extreme values. IPF, immature platelet fraction

Figure 3. Correlation between IPF% and CRP values in infected patients.

CRP, C-reactive protein; IPF, immature platelet fraction

Figure 4. People alive/dead in each group of infection in the first 14 days of hospitalisation

Figure 5. Comparison of IPF% values between dead and alive patients in the first 14 days

30, 69, 74: outliers; 43, 47, 80: extreme values; IRF, immature platelet fraction