title: Evaluation of hemostatic biomarker abnormalities that precede platelet count decline in critically ill patients with sepsis.
abstract: OBJECTIVE
  The hemostatic biomarkers for early diagnosis of sepsis-associated coagulopathy have not been identified. The purpose of this study was to evaluate hemostatic biomarker abnormalities preceding a decrease in platelet count, which is a surrogate indicator of overt coagulopathy in sepsis.
  
  
  METHODS
  Seventy-five septic patients with a platelet count more than 80×10(3)/μL were retrospectively analyzed. Hemostatic biomarkers at intensive care unit admission were compared between patients with and patients without a subsequent decrease in platelet count (≥30% within 5 days), and the ability of biomarkers to predict a decrease in platelet count was evaluated.
  
  
  RESULTS
  Forty-two patients (56.0%) developed a subsequent decrease in platelet count. Severity of illness, incidence of organ dysfunction, and 28-day mortality rate were higher in patients with a subsequent decrease in platelet count. There were significant differences between patients with and patients without a subsequent decrease in platelet count in prothrombin time-international normalized ratio, fibrinogen, thrombin-antithrombin complex, antithrombin, protein C (PC), plasminogen, and α2-plasmin inhibitor (α2-PI). Receiver operating characteristic curve analysis showed that PC (area under the curve, 0.869; 95% confidence interval, 0.699-0.951) and α2-PI (area under the curve, 0.885; 95% confidence interval, 0.714-0.959) were strong predictors of a subsequent decrease in platelet count.
  
  
  CONCLUSIONS
  Decreased PC and α2-PI activity preceded a decrease in platelet count in intensive care unit patients with sepsis.
authors.affiliation: Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Research Division of Cell and Molecular Medicine, Center of Molecular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. Electronic address: k_koyama@jichi.ac.jp.
authors.forename: Kansuke
authors.initials: K
authors.lastname: Koyama
authors.forename: Seiji
authors.initials: S
authors.lastname: Madoiwa
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Koinuma
authors.forename: Masahiko
authors.initials: M
authors.lastname: Wada
authors.forename: Asuka
authors.initials: A
authors.lastname: Sakata
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ohmori
authors.forename: Jun
authors.initials: J
authors.lastname: Mimuro
authors.forename: Shin
authors.initials: S
authors.lastname: Nunomiya
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Sakata
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D001778:Blood Coagulation Disorders / Q000175:diagnosis*; D016638:Critical Illness / Q000401:mortality; D005260:Female; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008297:Male; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis / Q000401:mortality
chemical_list: D015415:Biomarkers
keywords: Coagulopathy; Critically ill; Early diagnosis; Platelet; Protein C; Sepsis; α(2)-Plasmin inhibitor