Association of the immature platelet fraction with sepsis diagnosis and severity

Abstract

Management of Sepsis would greatly benefit from the incorporation of simple and informative new biomarkers in clinical practice. Ideally, a sepsis biomarker should segregate infected from non-infected patients, provide information about prognosis and organ-specific damage, and be accessible to most healthcare services. The immature platelet fraction (IPF) and immature reticulocyte fraction (IRF) are new analytical parameters of the complete blood count, that have been studied as biomarkers of several inflammatory conditions. Recently, a study performed in critically-ill patients suggested that IPF could be a more accurate sepsis biomarker than C-reactive protein (CRP) and procalcitonin. In this retrospective study we evaluated the performance of IPF and IRF as biomarkers of sepsis diagnosis and severity. 41 patients admitted to two intensive care units were evaluated, 12 of which with severe sepsis or septic shock, and 11 with non-complicated sepsis. Significantly higher IPF levels were observed in patients with severe sepsis/ septic shock. IPF correlated with sepsis severity scores and presented the highest diagnostic accuracy for the presence of sepsis of all studied clinical and laboratory parameters. No significant differences were observed in IRF levels. Our results suggest that IPF levels could be used as a biomarker of sepsis diagnosis and severity.

Impact of diabetes mellitus on immature platelet fraction and its association with coronary artery disease

“…In fact, a raise in the circulating IPF has been reported also in inflammatory conditions not associated with direct thrombotic risk, as in infectious disorders and even in sepsis, and moreover, we recently documented no impact of IPF levels on angiographic findings in a large unselected cohort of patients . In effect, in our population of patients with diabetes, the rate of patients with acute presentation inversely related with the levels of IPF suggesting that the dysregulations of thrombocytes turnover induced by diabetes could prevent the elevation of RPs previously reported in the settings of ACS.…”

Immature platelet fraction predicts coagulopathy-related platelet consumption and mortality in patients with sepsis

“…Several studies have demonstrated the clinical utility of IPF in laboratory diagnosis of thrombocytopenia due to peripheral platelet destruction, particularly autoimmune thrombocytopenic purpura and thrombotic thrombocytopenic purpura [12,13]. The IPF was recently introduced as a novel diagnostic biomarker for infection and developing sepsis [14,15]. To our knowledge, however, no studies have evaluated the clinical value of IPF for coagulopathy or its prognostic value in patients with sepsis.…”

“…In other studies, an increased IPF was related to suspected bacterial infection and the severity of sepsis [15,27]. Although none of those studies examined the coagulation profile of participants in detail, IPF elevation suggested the onset of severe infection or sepsis.…”

“…Platelets are divided into two groups-mature and immature-according to the intensity of cell fluorescence, which correlates with the RNA content and is consequently higher in immature platelets. The IPF corresponds to the fraction (%) of immature platelets in the total platelet population [14,15]. The AIPC was calculated as the absolute number of immature platelets per unit volume (%IPF × platelet count).…”

Innovative haematological parameters for early diagnosis of sepsis in adult patients admitted in intensive care unit

“…Notably, the IPF% correlates with positivity of blood cultures,15 tends to increase before the onset of sepsis and is the only parameter whose values seem to vary independently from those of conventional coagulation tests 11. Finally, IPF% correlates with the scores conventionally used for assessing the severity of sepsis 13. The early increase of IPF may also be useful for understanding the underlying mechanisms of sepsis, thus allowing to identify a subset of patients with worse prognosis 14…”