Platelet Indices and Their Kinetics Predict Mortality in Patients of Sepsis

Abstract

Platelet indices are inexpensive, easily accessible parameters and potentially useful prognostic indicators in sepsis. In this study we explore the differences in platelet indices and their kinetics between sepsis survivors and non-survivors. A retrospective cohort-study of 97 cases of culture-positive sepsis at a tertiary-care center in North India. Demographics, clinical and laboratory parameters at admission were assessed. Platelet count (PLT), mean-platelet-volume (MPV), platelet-distribution-width (PDW) and plateletcrit (PCT) on admission, and third, fifth and last days of hospitalization were analyzed. Fractional change in platelet indices (ΔMPV 72h, ΔPDW 72h , ΔPCT 72h , and ΔPLT 72h ) by day-3 were calculated. Unpaired and paired t-tests were used to compare survivors with non-survivors, and to study the change in platelet indices with time. Logistic regression was used for multivariate analysis. ROC-curves and optimum cut-offs to predict mortality were obtained. There were 64 survivors. Non-survivors had significantly higher ΔMPV 72h, ΔPDW 72h, day-1 MPV and PDW, and lower ΔPLT 72h . MPV and PDW increased, and PLT decreased with time among non-survivors. Trends were reversed in survivors. Only MPV and PDW showed significant change by day-3. Both were independent predictors of mortality on multivariate analysis, alongside ΔMPV 72h and ΔPLT 72h . On ROC analysis, MPV, PDW, ΔMPV 72h, ΔPDW 72h and ΔPLT 72h effectively predicted mortality. Cut-off for MPV was 10.25 fL (sensitivity = 93.9%, specificity = 60.9%), and PDW, 12.6% (sensitivity = 84.8%, specificity = 51.6%). A rise in MPV and a fall in PLT was associated with mortality in this study. MPV and PDW values at admission are effective predictors of mortality and may be used in conjunction with traditional parameters.

Detection of Sepsis in Platelets Using MicroRNAs and Membrane Antigens

“…Patients with septic shock evaluated in this study had high hematological failure, showing a positive correlation between thrombocytopenia and sepsis. Our results corroborate those of the study by Mangalesh et al [ 17 ] in which a high MPV and low platelet count were significantly associated with sepsis severity and mortality.…”

Neutrophil-to-Lymphocyte Ratio for the Prediction of the Presence and Severity of Coronary Artery Disease

“…[2][3][4][5][6] We have previously demonstrated the utility of NLR in various disease conditions including CAD. [6][7][8][9][10][11] In our analysis of NLR as a predictor of CAD severity rather than the diagnosis of CAD, we found that it was a significant predictor among both sexes.The authors 1 also show that low-density lipoprotein (LDL) and total cholesterol were not significant predictors of the presence of CAD in their population, which is an uncommon finding when compared with reports from Western populations. Likewise, as more data on NLR from different ethnicities are collated, more light will be shed on the ethnicity and sex-specific complex mechanisms behind CAD.The authors describe NLR as an effective risk marker for CAD among males, when compared with non-CAD patients, and report no significant results for female patients.…”

Systemic inflammatory response index over neutrophil–lymphocyte ratio and monocyte–lymphocyte ratio: comparison of prognostic performance in predicting major adverse cardiac events

“…Due to integrating both the neutrophil–lymphocyte ratio (NLR) and the monocyte–lymphocyte ratio (MLR) into one index, the SIRI should theoretically outperform both its components. The diagnostic and prognostic utility of the NLR and MLR has been confirmed previously in several disease conditions including cardiovascular diseases [ 2 , 3 ].…”