Abstract
ObjectiveTo assess the prognostic and diagnostic value of whole blood impedance aggregometry in patients with sepsis and SIRS and to compare with whole blood parameters (platelet count, haemoglobin, haematocrit and white cell count).MethodsWe performed an observational, prospective study in the acute setting. Platelet function was determined using whole blood impedance aggregometry (multiplate) on admission to the Emergency Department or Intensive Care Unit and at 6 and 24 hours post admission. Platelet count, haemoglobin, haematocrit and white cell count were also determined.Results106 adult patients that met SIRS and sepsis criteria were included. Platelet aggregation was significantly reduced in patients with severe sepsis/septic shock when compared to SIRS/uncomplicated sepsis (ADP: 90.7±37.6 vs 61.4±40.6; p<0.001, Arachadonic Acid 99.9±48.3 vs 66.3±50.2; p = 0.001, Collagen 102.6±33.0 vs 79.1±38.8; p = 0.001; SD ± mean)). Furthermore platelet aggregation was significantly reduced in the 28 day mortality group when compared with the survival group (Arachadonic Acid 58.8±47.7 vs 91.1±50.9; p<0.05, Collagen 36.6±36.6 vs 98.0±35.1; p = 0.001; SD ± mean)). However haemoglobin, haematocrit and platelet count were more effective at distinguishing between subgroups and were equally effective indicators of prognosis. Significant positive correlations were observed between whole blood impedance aggregometry and platelet count (ADP 0.588 p<0.0001, Arachadonic Acid 0.611 p<0.0001, Collagen 0.599 p<0.0001 (Pearson correlation)).ConclusionsReduced platelet aggregometry responses were not only significantly associated with morbidity and mortality in sepsis and SIRS patients, but also correlated with the different pathological groups. Whole blood aggregometry significantly correlated with platelet count, however, when we adjust for the different groups we investigated, the effect of platelet count appears to be non-significant.
Highlights
Sepsis is a life threatening condition and common complication of critical illness [1]
Platelet aggregometry and full blood count were assessed in a total of 106 patients that met SIRS criteria
Reduced platelet aggregometry measurements were observed in patients with severe sepsis and septic shock when compared to SIRS and uncomplicated sepsis
Summary
Sepsis is a life threatening condition and common complication of critical illness [1]. It is characterised by a systemic inflammatory response to an ongoing infectious process and can lead to hypotension, multi organ dysfunction (MOD) and death [2]. Systemic inflammation can have non-infectious causes such as burns, pancreatitis and ketoacidosis, and is termed systemic. Number Male (%) Age (Years) Primary Site of Infection. Respiratory Tract (%) Urinary Tract (%) GI Tract (%) Other (%) Comorbidities Diabetes Mellitus (%) COPD (%) Congestive Heart Failure (%) Active Cancer (%) 28 Day Mortality (%) SOFA Score Hospital LOS (days).
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