Abstract
The thrombotic microangiopathy (TMA) score based on the development and morphological characteristics of schistocytes is a rapid, simple biomarker that is easily obtained from the complete blood cell count by an automated blood cell analyzer. We aimed to determine whether the TMA score is associated with 30-day mortality of patients with early-stage septic shock. This observational cohort study was retrospectively conducted based on a prospective emergency department (ED) registry (June 2015–December 2016). We analyzed the TMA score at ED admission and 24 h later. The primary endpoint was all-cause mortality within 30 days of ED admission. A total of 221 patients were included. Increased TMA scores at time 0 (odds ratio (OR), 1.972; 95% confidence interval (CI), 1.253–3.106; p = 0.003) and at time 24 (OR, 1.863; 95% CI, 1.863–3.066; p = 0.014) were strong predictors of 30-day mortality. Increased predictability of 30-day mortality was closely associated with TMA scores ≥2 at time 0 (OR, 4.035; 95% CI, 1.651–9.863; p = 0.002) and ≥3 at time 24 (OR, 5.639; 95% CI, 2.190–14.519; p < 0.001). Increased TMA scores significantly predicted 30-day mortality for patients with severe sepsis and septic shock and can be helpful when determining the initial treatment strategies without additional costs or effort.
Highlights
Sepsis is defined as life-threatening acute dysfunction of the organs due to a dysregulated response to infection [1,2,3]
Among various mechanisms of sepsis-induced organ failure, sepsis is significantly associated with the activation of the coagulation cascade that sometimes leads to disseminated intravascular coagulation (DIC), which is its more severe clinical form [18]
The International Council for Standardization in Hematology (ICSH) recommended that the presence of >1% schistocytes on a peripheral blood smear without other moderate red blood cells (RBCs) changes is an important criterion for the diagnosis of thrombotic microangiopathy (TMA); Lesesve et al suggested that the presence of >1% schistocytes was frequently related to various circumstances in which the increased schistocyte count indicated severe infection, pregnancy, and leukemia [10,20,21]
Summary
Sepsis is defined as life-threatening acute dysfunction of the organs due to a dysregulated response to infection [1,2,3]. Since there are no completely effective pharmacological treatments for sepsis, early recognition, proper management, and immediate treatment with appropriate antibiotics are important and should be implemented to reduce the burden of subsequent disease [4]. The Acute Physiological and Chronic Health Evaluation (APACHE) II score and the Sequential Organ Failure Assessment (SOFA) score have been commonly used for critically ill patients because of their ability to reflect disease severity and represent organ dysfunction, respectively, their rapid measurement is complicated [5]. The application of new biomarkers that quickly and predict the development of severe complications and mortality in sepsis may improve the prognosis of patients by allowing early aggressive treatment and innovative preventive and therapeutic options [6,7,8]. The development of schistocytes in the blood reflects the possibility of thrombocytopenia-associated multiple organ failure (TAMOF) [9]
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