title: Immature platelet fraction predicts coagulopathy-related platelet consumption and mortality in patients with sepsis.
abstract: BACKGROUND
  The diagnostic and prognostic value of immature platelet fraction (IPF) in sepsis has not been determined. This study aimed to assess whether IPF is an early predictor of platelet decline due to coagulopathy and is associated with mortality in patients with sepsis.
  
  
  METHODS
  In total, 149 patients with a platelet count of ≥80×10(3)/μL on intensive care unit admission (101 with sepsis, 48 controls without sepsis) were prospectively evaluated. We measured IPF on admission and observed for development of subsequent platelet count decline (defined as a >30% decrease or <80×10(3)/μL) in 5days, and mortality at 28days. The absolute immature platelet count (AIPC) was calculated to evaluate thrombopoiesis.
  
  
  RESULTS
  Forty-seven patients with sepsis subsequently developed a decrease in platelet count. The IPF was highest in patients whose platelet count decreased, followed by patients without a decrease in platelet count and controls (median, 4.3% [3.1%-8.1%] vs. 3.7% [2.6%-4.6%] vs. 2.1% [1.6%-3.5%], respectively; P<0.0001). The AIPC was similar in patients with and without a decrease in platelet count (7.6 [4.2-10.0] vs. 5.9 [4.2-8.7]×10(3)/μL, respectively; P=0.32). Coagulation derangement was more severe in patients who did than did not subsequently develop a decreased platelet count. Cox regression and receiver operator characteristic curve analysis revealed that IPF was a strong independent predictor of mortality, with accuracy similar to a standard prognostic scoring system.
  
  
  CONCLUSIONS
  The admission IPF in septic patients predicts a subsequent decrease in platelet count, indicating platelet consumption with ongoing coagulopathy and risk of poor prognosis.
authors.affiliation: Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Department of Emergency Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. Electronic address: m00093tm@jichi.ac.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Muronoi
authors.affiliation: Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Kansuke
authors.initials: K
authors.lastname: Koyama
authors.affiliation: Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Nunomiya
authors.affiliation: Department of Surgery, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Wada
authors.affiliation: Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Koinuma
authors.affiliation: Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Shima
authors.affiliation: Department of Emergency Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Suzukawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation; D001792:Blood Platelets / Q000473:pathology*; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000150:complications* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000150:complications* / Q000401:mortality / Q000473:pathology; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications / Q000401:mortality / Q000473:pathology; D034061:Thrombopoiesis
keywords: Coagulopathy; Disseminated intravascular coagulation; Immature platelet fraction; Mortality; Sepsis; Thrombocytopenia