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

机译：ICU入院时血小板活化标志物对重症患者败血症的预测：一项前瞻性研究

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BackgroundPlatelets 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. MethodsThis 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. MethodsOf 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. ConclusionsPlatelet-bound fibrinogen levels assayed by flow cytometry within 24?h of ICU admission help identifying critically ill patients at risk of developing sepsis.
机译：背景技术血小板已经参与了免疫监视和宿主抵抗严重感染的防御。迄今为止，在严重疾病中血小板表型或其他止血成分是否可能与脓毒症易感性相关。这项工作的目的是确定可以预测重症患者受伤后败血症发生的血小板标志物。方法这项单中心，前瞻性，观察性，为期7个月的研究基于99例接受ICU择期心脏手术，创伤，急性脑损伤以及术后长期通气并在ICU期间随访的未感染成年患者的队列研究留。入院时记录临床特征和严重程度评分（SOFA）。血小板活化标志物，包括纤维蛋白原与血小板的结合，血小板膜P-选择素表达，血浆可溶性CD40L和血小板白细胞聚集体，均在入院时和48小时后，然后在败血症诊断时通过流式细胞术进行测定（败血症- 3个标准）和败血症患者7天后。还记录了住院数据和结果。方法：99例患者中位数为5天后，有19例发展为败血症。这些患者入院时的SOFA评分较高;与其他患者相比，血纤蛋白原与血小板结合的水平（血小板-Fg）和D-二聚体水平也显着提高。两组患者在ICU入院后48h的水平不再存在差异。血小板-Fg％是败血症的独立预测因子（P ＝ 0.0031）。通过ROC曲线分析，血小板-Fg的临界点（AUCα＝α0.75）为50％。 SOFA截止值为8的患者，当血小板Fg水平高于50％时，败血症的风险达到87％。败血症患者的ICU和住院时间更长，死亡率更高。结论在ICU入院24小时之内通过流式细胞术测定的血小板结合纤维蛋白原水平有助于鉴定处于患败血症风险的重症患者。

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