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



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.


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.


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.


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


1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315: 801–10. doi: 10.1001/jama.2016.0287 26903338

2. Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C, Hahn EG. Thrombocytopenia in patients in the medical intensive care unit: Bleeding prevalence, transfusion requirements, and outcome*. Critical Care Medicine. Critical Care Medicine; 2002;30: 1765–1771. doi: 10.1097/00003246-200208000-00015 12163790

3. Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, et al. Thrombocytopenia and prognosis in intensive care. Critical Care Medicine. 2000;28: 1871–1876. doi: 10.1097/00003246-200006000-00031 10890635

4. Baughman RP, Lower EE, Flessa HC, Tollerud DJ. Thrombocytopenia in the intensive care unit. Chest. 1993;104: 1243–1247. doi: 10.1378/chest.104.4.1243 8404200

5. Stéphan F, Hollande J, Richard O, Cheffi A, Maier-Redelsperger M, Flahault A. Thrombocytopenia in a surgical ICU. Chest. 1999;115: 1363–1370. doi: 10.1378/chest.115.5.1363 10334154

6. Moreau D, Timsit J-F, Vesin A, Garrouste-Orgeas M, de Lassence A, Zahar J-R, et al. Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays. Chest. 2007;131: 1735–1741. doi: 10.1378/chest.06-2233 17475637

7. Aydemir H, Piskin N, Akduman D, Kokturk F, Aktas E. Platelet and mean platelet volume kinetics in adult patients with sepsis. Platelets. 2015;26: 331–335. doi: 10.3109/09537104.2012.701027 22731700

8. Kim CH, Kim SJ, Lee MJ, Kwon YE, Kim YL, Park KS, et al. An Increase in Mean Platelet Volume from Baseline Is Associated with Mortality in Patients with Severe Sepsis or Septic Shock. Lazzeri C, editor. PLoS ONE. Public Library of Science; 2015;10: e0119437. doi: 10.1371/journal.pone.0119437 25742300

9. Patel SR, Hartwig JH, Italiano JE. The biogenesis of platelets from megakaryocyte proplatelets. J Clin Invest. 2005;115: 3348–3354. doi: 10.1172/JCI26891 16322779

10. Oh GH, Chung SP, Park YS, Hong JH, Lee HS, Chung HS, et al. Mean Platelet Volume to Platelet Count Ratio as a Promising Predictor of Early Mortality in Severe Sepsis. Shock. 2017;47: 323–330. doi: 10.1097/SHK.0000000000000718 27504801

11. Thon JN, Montalvo A, Patel-Hett S, Devine MT, Richardson JL, Ehrlicher A, et al. Cytoskeletal mechanics of proplatelet maturation and platelet release. J Cell Biol. 2010;191: 861–874. doi: 10.1083/jcb.201006102 21079248

12. Machlus KR, Thon JN, Italiano JE. Interpreting the developmental dance of the megakaryocyte: a review of the cellular and molecular processes mediating platelet formation. Br J Haematol. 2014;165: 227–236. doi: 10.1111/bjh.12758 24499183

13. Nishimura S, Nagasaki M, Kunishima S, Sawaguchi A, Sakata A, Sakaguchi H, et al. IL-1α induces thrombopoiesis through megakaryocyte rupture in response to acute platelet needs. J Cell Biol. 2015;209: 453–466. doi: 10.1083/jcb.201410052 25963822

14. Speiser JL, Karvellas CJ, Shumilak G, Sligl WI, Mirzanejad Y, Gurka D, et al. Predicting in-hospital mortality in pneumonia-associated septic shock patients using a classification and regression tree: a nested cohort study. Journal of Intensive Care. 2018;6: 66. doi: 10.1186/s40560-018-0335-3 30349726

15. Gunebakmaz O, Kaya MG, Kaya EG, Ardic I, Yarlioglues M, Dogdu O, et al. Mean platelet volume predicts embolic complications and prognosis in infective endocarditis. Int J Infect Dis. 2010;14: e982–5. doi: 10.1016/j.ijid.2010.05.019 20851017

16. Cho SY, You E, Lee HJ, Lee W-I, Park TS. Mean platelet volume shows a significant positive correlation with hs-CRP in Korean patients with various disease conditions. Clin Lab. 2014;60: 1775–1777. 25651726

17. Colkesen Y, Muderrisoglu H. The role of mean platelet volume in predicting thrombotic events. Clin Chem Lab Med. 2012;50: 631–634. doi: 10.1515/CCLM.2011.806 22112054

18. Zampieri FG, Ranzani OT, Sabatoski V, de Souza HP, Barbeiro H, da Neto LMC, et al. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Ann Intensive Care. 2014;4: 20. doi: 10.1186/s13613-014-0020-1 25520853

19. Breslow A, Kaufman RM, Lawsky AR. The effect of surgery on the concentration of circulating megakaryocytes and platelets. Blood. 1968;32: 393–401. 5675977

20. Leibovitch I, Ben Chaim J, Raviv G, Mor Y, Avigad I, Goldwasser B. Quantitative changes in platelet counts following major urological pelvic surgery. Eur Urol. 1993;24: 350–354. doi: 10.1159/000474327 8262101

21. Fagher B, Sjögren A, Sjögren U. Platelet counts in myocardial infarction, angina pectoris and peripheral artery disease. Acta Med Scand. 1985;217: 21–26. doi: 10.1111/j.0954-6820.1985.tb01629.x 3976430

22. Smith-Erichsen N. Serial determinations of platelets, leucocytes and coagulation parameters in surgical septicemia. Scand J Clin Lab Invest Suppl. 1985;178: 7–14. 3867123

23. Guida JD, Kunig AM, Leef KH, McKenzie SE, Paul DA. Platelet count and sepsis in very low birth weight neonates: is there an organism-specific response? Pediatrics. 2003;111: 1411–1415. doi: 10.1542/peds.111.6.1411 12777561

24. Manzoni P, Mostert M, Galletto P, Gastaldo L, Gallo E, Agriesti G, et al. Is thrombocytopenia suggestive of organism-specific response in neonatal sepsis? Pediatr Int. 2009;51: 206–210. doi: 10.1111/j.1442-200X.2008.02689.x 19405917

25. Chung SP, Yune HY, Park YS, You JS, Hong JH, Kong T, et al. Usefulness of mean platelet volume as a marker for clinical outcomes after out-of-hospital cardiac arrest: a retrospective cohort study. J Thromb Haemost. 2016;14: 2036–2044. doi: 10.1111/jth.13421 27437641

26. Yazici S, Yazici M, Erer B, Calik Y, Ozhan H, Ataoglu S. The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity. Platelets. 2010;21: 122–125. doi: 10.3109/09537100903474373 20050760

27. Yazici S, Yazici M, Erer B, Erer B, Calik Y, Bulur S, et al. The platelet functions in patients with ankylosing spondylitis: anti-TNF-alpha therapy decreases the mean platelet volume and platelet mass. Platelets. 2010;21: 126–131. doi: 10.3109/09537100903470306 20050759

28. Thiery-Antier N, Binquet C, Vinault S, Meziani F, Boisramé-Helms J, Quenot J-P, et al. Is Thrombocytopenia an Early Prognostic Marker in Septic Shock? Critical Care Medicine. 2016;44: 764–772. doi: 10.1097/CCM.0000000000001520 26670473

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2019 Číslo 10