Kinetics of mean platelet volume predicts mortality in patients with septic shock


Autoři: Fanny Vardon-Bounes aff001;  Marie-Pierre Gratacap aff002;  Samuel Groyer aff001;  Stéphanie Ruiz aff001;  Bernard Georges aff001;  Thierry Seguin aff001;  Cédric Garcia aff003;  Bernard Payrastre aff002;  Jean-Marie Conil aff001;  Vincent Minville aff001
Působiště autorů: Anesthesiology and Critical Care Unit, Toulouse University Hospital, Toulouse, France aff001;  INSERM UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Equipe 11, Toulouse, France aff002;  Hematology laboratory, Toulouse University Hospital, Toulouse, France aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223553

Souhrn

Introduction

Thrombocytopenia is well recognized as a poor prognosis sign associated with increased mortality and prolonged Intensive Care Unit (ICU) stay, particularly in septic patients. Mean platelet volume (MPV) could represent a relevant predictive marker of mortality. Here we investigated whether MPV kinetics during the first 15 days after hospital admission has a potential prognostic value for clinical outcome in septic shock.

Methods

We performed a retrospectively analysis of a cohort of 301 septic patients admitted in ICU. Three-month mortality was the primary endpoint. The prognostic value of the covariates of interest was ascertained by multidimensional analysis. We proposed a classification and regression trees analysis to predict survival probability.

Results

MPV kinetics was significantly different between 90-day survivors and non-survivors when followed during 15 days (except on day 3). 10-day MPV >11.6fL was an independent predictive factor of 90-day mortality (Hazard Ratio (HR) 3.796, 95% Confidence Interval (CI) [1.96–7.35], p = 0.0001) in multivariate analysis. Base excess on day 4 <1.9mmol/L was also a predictive factor of mortality (HR 2.972, 95%CI [1.38–6.40], p = 0.0054.

Conclusion

MPV increase during the first 15 days after ICU admission in non-survivors was observed during septic shock and 10-day MPV >11.6fL was an independent predictive factor of 90-day mortality. This could be explained by the emergent response to acute platelet loss during septic shock, leading to megakaryocyte rupture to produce new but potentially immature platelets in the circulation. Therefore, continuous monitoring of MPV may be a useful parameter to stratify mortality risk in septic shock.

Klíčová slova:

Blood – Blood counts – Intensive care units – Multivariate analysis – Platelets – Sepsis – Thrombocytopenia – Lactic acid


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Článek vyšel v časopise

PLOS One


2019 Číslo 10