Evaluation of hemostatic biomarker abnormalities that precede platelet count decline in critically ill patients with sepsis

Koyama, Kansuke; Madoiwa, Seiji; Tanaka, Shinichiro; Koinuma, Toshitaka; Wada, Masahiko; Sakata, Asuka; Ohmori, Tsukasa; Mimuro, Jun; Nunomiya, Shin; Sakata, Yoichi

doi:10.1016/j.jcrc.2012.10.069

Cited by 17 publications

(15 citation statements)

References 36 publications

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“…WBC count is known to be a part of the inflammatory response and to increase in direct proportion to its severity. In contrast, there are studies showing that the PLT count can decrease in inverse proportion to the severity of the inflammatory response [19].…”

Section: Discussionmentioning

confidence: 96%

Diagnostic Value of Mean Platelet Volume in Acute Appendicitis

Kılıç¹

2016

Ann Clin Anal Med

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Anahtar KelimelerOrtalama Trombosit Hacmi; Cerrahi; Akut Apandisit; Acil Servis Abstract Aim: The diagnosis of acute appendicitis for patients referred to the emergency department with the complaint of abdominal pain remains challenging. In this study, we investigated the diagnostic value of mean platelet volume in acute appendicitis. Material and Method: This clinical research study was performed retrospectively and included patients referred to the emergency department between January 1 and December 31, 2013, with the complaint of abdominal pain and were then discharged without a specific diagnosis in comparison to patients with a proven diagnosis of acute appendicitis. Control patients were selected using a randomization method from among patients of the same age and gender as acute appendicitis patients. The acute appendicitis group was subdivided into complicated and noncomplicated cases according to the pathology results. The Mann-Whitney U test for continuous variables and the chi-square test for categorical data were used. Results: This clinical research study was performed with 316 acute appendicitis patients and an equal number of control patients; 188 of the patients were male. Among the acute appendicitis patients, 67 presented with complicated acute appendicitis and 249 with noncomplicated acute appendicitis. The median mean platelet volume of the acute appendicitis versus control patients was 8.03 fL (IQR: 1.86; min: 5.53, max: 14.40) and 8.10 fL (IQR: 1.38; min: 5.70, max: 13.90), respectively (p=0.193). The platelet counts in the complicated and noncomplicated groups were 235 K/µL (IQR: 70; min: 116, max: 649) and 261 K/µL (IQR: 87; min: 124, max: 537), respectively (p<0.001). Discussion: Mean platelet volume is not a useful guide in the diagnosis of acute appendicitis for patients referred to the emergency department with the complaint of abdominal pain.

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Section: Discussionmentioning

confidence: 96%

Diagnostic Value of Mean Platelet Volume in Acute Appendicitis

Kılıç¹

2016

Ann Clin Anal Med

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“…A possible reason for marked thrombocytopenia and decreased PCT in deceased IFD infants may be that the severity of thrombocytopenia was directly related to the presence of disseminated intravascular coagulation (DIC). Platelet activation, consumption, and destruction may occur at the endothelial cell surface as a result of thrombin generation and fibrin meshwork formation secondary to coagulation activation [ 28 ]. A significant decrease in platelet count in IFD neonates may indicate the presence of DIC which can easily lead to death.…”

Section: Discussionmentioning

confidence: 99%

Platelet Parameters and (1, 3)-β-D-Glucan as a Diagnostic and Prognostic Marker of Invasive Fungal Disease in Preterm Infants

et al. 2015

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The diagnosis of neonatal invasive fungal disease (IFD) is difficult and often delayed. The platelet parameters and (1, 3)-β-D-Glucan (BG) may be useful for diagnosing IFD, but their diagnostic performance are not well characterized in neonates. We studied 63 preterm infants with IFD, 160 preterm infants without sepsis (preterm control), and 41 preterm infants with bacterial sepsis. Platelet parameters at the first day of onset of IFD and at the fourteenth day after antifungal treatment were evaluated. Serum BG was measured. Platelet count (PC), plateletcrit (PCT), and platelet distribution width (PDW) values were significantly lower, and mean platelet volume (MPV) values significantly higher in the IFD versus preterm control infants. PC and PCT values were much lower in infants with IFD versus bacterial sepsis, and there were significant differences in BG value between the two groups. After 14 days of antifungal treatment, significant elevations in PC, PCT, PDW and reductions in MPV levels in IFD group were observed. Receiver operating characteristic (ROC) curves showed that PC and PCT were strong predictors of IFD. The PC and PCT cut-offs for predicting IFD were 119.5 (sensitivity 78%, specificity 95%) and 0.21 (sensitivity 83%, specificity 85%), respectively. There were significant differences in PC and PCT levels between deceased and survived patients. The PC and PCT cut-offs for predicting deceased IFD were 39 (sensitivity 62%, specificity 86%) and 0.04 (sensitivity 50%, specificity 95%), respectively. The sensitivity in diagnosing IFD by a BG cutoff of ≥10pg/ml was 68.3% and specificity was 75.6%. PC and PCT levels in the BG ≥400 pg/ml group were significantly lower compared to the BG<400 pg/ml group. Platelet parameters and BG could be useful biomarkers for the diagnosis and prognosis of neonatal IFD.

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“…Various excellent markers are known: PIC and α 2 PI are essential markers for evaluating fibrinolytic activation [ 7 , 9 – 11 ]; protein C is an anticoagulant factor for evaluating the prognosis [ 74 , 82 – 84 ]; PAI-1 is a fibrinolytic inhibitory factor [ 73 , 85 – 89 ]; HMGB-1 is a nuclear molecule [ 90 , 91 ]; and e-XDP is a fibrin degradation product of granulocyte elastase [ 92 – 97 ].…”

Section: Reviewmentioning

confidence: 99%

Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis

et al. 2016

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Disseminated intravascular coagulation (DIC) is a serious disease that, in the presence of underlying disease, causes persistent, generalized, marked coagulation activation. Early treatment based on an appropriate diagnosis is very important for improving patients’ prognosis, to which end diagnostic criteria play a key role. Several criteria have been proposed, but each has its strengths and weaknesses, and improved criteria are needed. Widespread use of coagulofibrinolytic markers has elucidated that the pathology of DIC differs greatly as a function of the underlying disease. Thus, discriminating use of DIC diagnostic criteria that take underlying diseases into account is important.DIC diagnostic criteria that are well known in Japan include the Japanese Ministry of Health and Welfare’s old DIC diagnostic criteria (JMHW criteria), the International Society on Thrombosis and Haemostasis’s DIC diagnostic criteria (ISTH criteria), and the Japanese Association for Acute Medicine’s acute-stage DIC diagnostic criteria (JAAM criteria). Those criteria have their respective drawbacks: the sensitivity of the ISTH criteria is poor, the JAAM criteria cannot be applied to all underlying diseases, and the JMHW criteria have poor sensitivity in the case of infections, do not use molecular markers, and result in misdiagnosis. The Japanese Society on Thrombosis and Hemostasis’s newly proposed provisional draft DIC diagnostic criteria (new criteria) use diagnostic criteria classifications of “hematopoietic disorder type”, “infectious type”, and “basic type” based on the underlying pathology. For the hematopoietic disorder type the platelet count is omitted from the score, while for the infectious type, fibrinogen is omitted from the score. Also, points are added if the platelet count decreases with time. In the new criteria, molecular markers and antithrombin activity have been newly included, and as a countermeasure for misdiagnosis, 3 points are deducted if there is liver failure. In this paper, we discuss various problems encountered with DIC diagnosis, and we describe the new criteria together with the events that led to their creation.These new diagnostic criteria take into account the underlying diseases of wide area, and we expect that they will serve clinicians well due to the above adaptations and improvements.

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Evaluation of hemostatic biomarker abnormalities that precede platelet count decline in critically ill patients with sepsis

Cited by 17 publications

References 36 publications

Diagnostic Value of Mean Platelet Volume in Acute Appendicitis

Diagnostic Value of Mean Platelet Volume in Acute Appendicitis

Platelet Parameters and (1, 3)-β-D-Glucan as a Diagnostic and Prognostic Marker of Invasive Fungal Disease in Preterm Infants

Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis

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