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

Buoro, Sabrina; Manenti, Barbara; Seghezzi, Michela; Dominoni, Paola; Barbui, Tiziano; Ghirardi, Arianna; Carobbio, Alessandra; Marchesi, Gianmariano; Riva, Ivano; Nasi, Alessandra; Ottomano, Cosimo; Lippi, Giuseppe

doi:10.1136/jclinpath-2017-204643

Cited by 18 publications

(22 citation statements)

References 24 publications

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“…Increased levels of IPF were found to significantly correlate with infection as determined by positive blood cultures (positive blood culture: mean IPF 4.86%; negative blood culture: mean IPF 1.79%, p < 0.0001) even if patients were non-thrombocytopenic, indicating subliminal platelet consumption [116]. IPF increased before the onset of sepsis by a median of 2 days [117,119,121], was independent from other coagulation parameters [118,120] and predicted mortality [119,122]. The diagnostic performance of IPF (AUC = 0.82 [121], AUC = 0.87 [120]) in the discrimination of septic patients from non-septic patients was comparable with current biomarkers of infection such as c-reactive protein (CRP; AUC = 0.81 [121], AUC = 0.94 [120]) and procalcitonin (AUC = 0.92) [120].…”

Section: Infectionmentioning

confidence: 96%

“…While the cause of thrombocytopenia in sepsis may be multifactorial, increased platelet consumption due to an uncontrolled procoagulant response with thrombin formation and septic coagulopathy play a main role [114,115]. In this respect it was recognized that reticulated platelets provide meaningful information for the diagnosis and follow-up of patients with sepsis [116][117][118][119][120][121][122]. Increased levels of IPF were found to significantly correlate with infection as determined by positive blood cultures (positive blood culture: mean IPF 4.86%; negative blood culture: mean IPF 1.79%, p < 0.0001) even if patients were non-thrombocytopenic, indicating subliminal platelet consumption [116].…”

Section: Infectionmentioning

confidence: 99%

“…IPF increased before the onset of sepsis by a median of 2 days [117,119,121], was independent from other coagulation parameters [118,120] and predicted mortality [119,122]. The diagnostic performance of IPF (AUC = 0.82 [121], AUC = 0.87 [120]) in the discrimination of septic patients from non-septic patients was comparable with current biomarkers of infection such as c-reactive protein (CRP; AUC = 0.81 [121], AUC = 0.94 [120]) and procalcitonin (AUC = 0.92) [120]. Of note, the prognostic efficiency of absolute IPF count to identify patients 2 days before sepsis onset was superior to that of CRP by multivariate analysis [121].…”

Section: Infectionmentioning

confidence: 99%

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Reticulated platelets – clinical application and future perspectives

Meintker

Krause

2020

Journal of Laboratory Medicine

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Reticulated platelets are immature platelets freshly released from the bone marrow into the circulation and contain vestigial amounts of ribonucleic acid. Thus, they can serve as an indicator for the activity of thrombopoiesis. Despite the current lack of a standardized reference method, two types of hematology analyzers have incorporated a fully automated measurement of reticulated platelets. The “immature platelet fraction” (IPF; Sysmex XE-/XN-series) has some clinical utility in the differential diagnosis of thrombocytopenia. This is less clear for “reticulated platelets” (retPLT; Abbott CELL-DYN Sapphire/Alinity HQ). The usefulness of these parameters in the prediction of platelet recovery after chemotherapy or stem cell transplantation and as a decision aid for platelet transfusions has not been unequivocally confirmed. Recent findings have shown an association of reticulated platelets with an adverse risk in patients with coronary artery disease and stroke as well as resistance to anti-platelet therapy. Furthermore, a role of reticulated platelets for the prediction of sepsis was indicated. However, validation in larger prospective trials is necessary to establish the clinical benefit of reticulated platelets in these conditions. This review gives an overview of the available analytical methods and summarizes the current knowledge regarding the clinical application of reticulated platelets.

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Section: Infectionmentioning

confidence: 96%

Section: Infectionmentioning

confidence: 99%

Section: Infectionmentioning

confidence: 99%

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Reticulated platelets – clinical application and future perspectives

Meintker

Krause

2020

Journal of Laboratory Medicine

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“…Notably, even though thrombocytopenia can be seen in infections, A-IPCs are generally maintained so that at least platelet production attempts to keep up with the higher consumption (52); yet such A-IPC increases appear to correlate with higher mortality risk and disease severity in septic patients (53). These increases in immature platelets have been reported to occur earlier in patients prior to sepsis onset (54), which may be predictive of subsequent decreases in mature platelet counts once infection sets in Muronoi et al (55). In this regard %-IPF has been reported as highly sensitive in identifying patients with sepsis regardless of extent of infection or severity (56,57).…”

Section: Immature Platelets During Infectious Processesmentioning

confidence: 99%

Immature Platelet Dynamics in Immune-Mediated Thrombocytopenic States

Reeves

Maitta

2020

Front. Med.

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A major challenge encountered by clinicians is differentiating presentations characterized by significant thrombocytopenia due to overlapping clinical symptoms and signs in the setting of ambiguous laboratory results. Immature platelets represent the youngest platelets that can be measured in peripheral blood by current hematology analyzers. These young platelets are larger, with higher RNA content recently released from the bone marrow. Thrombocytopenic presentations caused directly or indirectly by immune responses can lead to compensatory bone marrow responses seeking to normalize the platelet count; thus obtaining absolute immature platelet counts may be informative while triaging patients. Over the last decade, their use has expanded beyond being an early biomarker of bone marrow reconstitution post-hematopoietic stem cell transplantation to being used to establish bone marrow responses to infection and thrombocytopenias due to immune etiologies. Its accessibility as part of more detailed platelet indices obtained with routine laboratories makes it a promising option to understand the bone marrow's real-time response to disease states characterized by thrombocytopenia. This review will look at the immature platelet count as a biomarker, while presenting current attempts trying to understand how it could be used in thrombocytopenias occurring secondary to a given immune etiology.

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“…IPF levels have been found significantly higher in patients with gestational hypertension compared to controls [ 7 ]. IPF has been reported to have a comparable efficiency to C-reactive protein (CRP) in discriminating patients who had sepsis and those who had not and to be predicting the risk of developing sepsis in patients admitted to intensive care unit [ 8 ]. IPF could be used as a screening tool for bacterial infection in hospitalised patients with neutrophilia with significant correlation to blood culture positivity [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

Georgakopoulou

Mermigkis

Mantzouranis

et al. 2020

Cureus

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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 ...

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

Abstract: IPF# and RET% may provide valuable clinical information for predicting the risk of developing sepsis, thus allowing early management of patients before the onset of clinically evident systemic infections.

Cited by 18 publications

References 24 publications

Reticulated platelets – clinical application and future perspectives

Reticulated platelets – clinical application and future perspectives

Immature Platelet Dynamics in Immune-Mediated Thrombocytopenic States

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

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