Platelet aggregation in severe sepsis.
Severe sepsis and multiple organ distress syndrome remain a diagnostic and therapeutic challenge for intensive therapy. Platelet activating factor forms a bridge between inflammation and clot formation. Our study surveys the effect of severe sepsis on platelet function and focuses on spontaneous aggregation in severely ill patients. Daily arterial blood samples were collected from 45 patients (average age of 60.7 ± 13) for five consecutive days following admission and 30 healthy controls. Platelet aggregation was measured using adrenaline (ADR), adenosine diphosphate (ADP), collagen (COL) and normal saline (SAL). Clinical status was observed using Multiple Organ Dysfunction Score (MODS) and Sequential Organ Failure Assessment (SOFA) score systems. Inducible aggregation deteriorated in septic patients in all 5 days with ADR, ADP and COL (P < 0.05) while SAL aggregation was increased during intensive care. Low platelet patients showed weak inducible aggregation with ADP throughout, with ADR on the 2nd, 3rd, 4th and 5th days and with COL on the 1st, 2nd and 3rd days. SAL aggregation showed no significance. No significant difference was seen between platelet functions comparing survivors and non-survivors. In the spontaneous aggregative group, platelet count was insignificantly higher, while procalcitonin levels were lower in 1st, 3rd and 4th days and no significant difference was observed in lactate levels. We demonstrated the presence of spontaneous platelet activity while overall inducible platelet aggregation is significantly deteriorated in septic patients. There were significant differences in inducible aggregation between normal and low platelet count groups. Inducible platelet function had no predictive value in the outcome.
Woth
Gábor
G
Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Pécs, Ifjúság u 13, Pécs 7624, Hungary.
Varga
Adrienn
A
Ghosh
Subhamay
S
Krupp
Miklós
M
Kiss
Tamás
T
Bogár
Lajos
L
Mühl
Diana
D
D000328:Adult; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood*; D010974:Platelet Aggregation; D010979:Platelet Function Tests; D018805:Sepsis / Q000097:blood*; D012720:Severity of Illness Index; D013997:Time Factors
Drugs Aging. 2007;24(4):345-50
17432927
Crit Care. 2003 Feb;7(1):85-90
12617745
Singapore Med J. 1993 Jun;34(3):245-6
8266183
Curr Opin Anaesthesiol. 2009 Apr;22(2):261-6
19390252
Crit Care Med. 2003 Apr;31(4):1250-6
12682500
J Leukoc Biol. 2008 Mar;83(3):536-45
18032692
Platelets. 2009 Feb;20(1):50-7
19172522
J Thromb Haemost. 2004 Dec;2(12):2096-102
15613012
Intensive Care Med. 1996 Jul;22(7):707-10
8844239
Semin Thromb Hemost. 2008 Jul;34(5):417-24
18956281
Crit Care Med. 2009 Mar;37(3):975-9
19237906
Crit Care Med. 1995 Oct;23(10):1638-52
7587228
Crit Care Med. 2006 Feb;34(2):344-53
16424713
Crit Care. 2008;12(6):R158
19091069
Crit Care Med. 2000 Apr;28(4):977-83
10809269
Chest. 1994 Sep;106(3):899-903
8082375
Platelets. 1998;9(3-4):223-5
16793706
Am J Respir Crit Care Med. 2002 Jul 1;166(1):98-104
12091178
Clin Hemorheol Microcirc. 2004;30(2):107-15
15004335
Blood Coagul Fibrinolysis. 2007 Oct;18(7):661-7
17890954
Crit Care. 2004 Aug;8(4):222-6
15312201
Crit Care Med. 2008 Jan;36(1):296-327
18158437
Crit Care Med. 1995 Feb;23(2):376-93
7867363
Cardiovasc Res. 1998 Oct;40(1):223-9
9876335
Crit Care Med. 2002 May;30(5 Suppl):S294-301
12004251
Ann Emerg Med. 2006 Jul;48(1):28-54
16781920
Crit Care. 2006;10(4):222
16879728
J Infect Dis. 2000 Jan;181(1):176-80
10608764