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Bongiovanni D, Han J, Klug M, Kirmes K, Viggiani G, von Scheidt M, Schreiner N, Condorelli G, Laugwitz KL, Bernlochner I. Role of Reticulated Platelets in Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2022; 42:527-539. [PMID: 35321562 DOI: 10.1161/atvbaha.121.316244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human platelets differ considerably with regard to their size, RNA content and thrombogenicity. Reticulated platelets (RPs) are young, hyper-reactive platelets that are newly released from the bone marrow. They are larger and contain more RNA compared to older platelets. In comparison to more mature platelets, they exhibit a significantly higher thrombogenicity and are known to be elevated in patients with an increased platelet turnover such as, diabetics and after acute myocardial infarction. Several studies have shown that RPs correlate with an insufficient antiplatelet response to aspirin and specific P2Y12 receptor inhibitors. In addition, RPs are promising novel biomarkers for the prediction of adverse cardiovascular events in cardiovascular disease. However, the reason for RPs intrinsic hyper-reactivity and their association with ischemic events is not completely understood and the biology of RPs is still under investigation. We here present a structured review of preclinical and clinical findings concerning the role of RPs in cardiovascular disease.
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Affiliation(s)
- Dario Bongiovanni
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (D.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (D.B., G.C.).,IRCCS Humanitas Research Hospital, Department of Cardiovascular Medicine, Rozzano, Milan, Italy (D.B., G.C.)
| | - Jiaying Han
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.)
| | - Melissa Klug
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,Experimental Bioinformatics, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Germany (M.K.)
| | - Kilian Kirmes
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.)
| | - Giacomo Viggiani
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.)
| | - Moritz von Scheidt
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.).,Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (M.v.S.)
| | - Nina Schreiner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.)
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (D.B., G.C.).,IRCCS Humanitas Research Hospital, Department of Cardiovascular Medicine, Rozzano, Milan, Italy (D.B., G.C.)
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.)
| | - Isabell Bernlochner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.)
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Barale C, Melchionda E, Morotti A, Russo I. Prothrombotic Phenotype in COVID-19: Focus on Platelets. Int J Mol Sci 2021; 22:ijms222413638. [PMID: 34948438 PMCID: PMC8705811 DOI: 10.3390/ijms222413638] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 infection is associated with a broad spectrum of presentations, but alveolar capillary microthrombi have been described as a common finding in COVID-19 patients, appearing as a consequence of a severe endothelial injury with endothelial cell membrane disruption. These observations clearly point to the identification of a COVID-19-associated coagulopathy, which may contribute to thrombosis, multi-organ damage, and cause of severity and fatality. One significant finding that emerges in prothrombotic abnormalities observed in COVID-19 patients is that the coagulation alterations are mainly mediated by the activation of platelets and intrinsically related to viral-mediated endothelial inflammation. Beyond the well-known role in hemostasis, the ability of platelets to also release various potent cytokines and chemokines has elevated these small cells from simple cell fragments to crucial modulators in the blood, including their inflammatory functions, that have a large influence on the immune response during infectious disease. Indeed, platelets are involved in the pathogenesis of acute lung injury also by promoting NET formation and affecting vascular permeability. Specifically, the deposition by activated platelets of the chemokine platelet factor 4 at sites of inflammation promotes adhesion of neutrophils on endothelial cells and thrombogenesis, and it seems deeply involved in the phenomenon of vaccine-induced thrombocytopenia and thrombosis. Importantly, the hyperactivated platelet phenotype along with evidence of cytokine storm, high levels of P-selectin, D-dimer, and, on the other hand, decreased levels of fibrinogen, von Willebrand factor, and thrombocytopenia may be considered suitable biomarkers that distinguish the late stage of COVID-19 progression in critically ill patients.
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Affiliation(s)
| | | | | | - Isabella Russo
- Correspondence: ; Tel.: +39-011-6705447; Fax: +39-011-9038639
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Barrett TJ, Bilaloglu S, Cornwell M, Burgess HM, Virginio VW, Drenkova K, Ibrahim H, Yuriditsky E, Aphinyanaphongs Y, Lifshitz M, Xia Liang F, Alejo J, Smith G, Pittaluga S, Rapkiewicz AV, Wang J, Iancu-Rubin C, Mohr I, Ruggles K, Stapleford KA, Hochman J, Berger JS. Platelets contribute to disease severity in COVID-19. J Thromb Haemost 2021; 19:3139-3153. [PMID: 34538015 PMCID: PMC8646651 DOI: 10.1111/jth.15534] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Heightened inflammation, dysregulated immunity, and thrombotic events are characteristic of hospitalized COVID-19 patients. Given that platelets are key regulators of thrombosis, inflammation, and immunity they represent prime candidates as mediators of COVID-19-associated pathogenesis. The objective of this study was to understand the contribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the platelet phenotype via phenotypic (activation, aggregation) and transcriptomic characterization. APPROACH AND RESULTS In a cohort of 3915 hospitalized COVID-19 patients, we analyzed blood platelet indices collected at hospital admission. Following adjustment for demographics, clinical risk factors, medication, and biomarkers of inflammation and thrombosis, we find platelet count, size, and immaturity are associated with increased critical illness and all-cause mortality. Bone marrow, lung tissue, and blood from COVID-19 patients revealed the presence of SARS-CoV-2 virions in megakaryocytes and platelets. Characterization of COVID-19 platelets found them to be hyperreactive (increased aggregation, and expression of P-selectin and CD40) and to have a distinct transcriptomic profile characteristic of prothrombotic large and immature platelets. In vitro mechanistic studies highlight that the interaction of SARS-CoV-2 with megakaryocytes alters the platelet transcriptome, and its effects are distinct from the coronavirus responsible for the common cold (CoV-OC43). CONCLUSIONS Platelet count, size, and maturity associate with increased critical illness and all-cause mortality among hospitalized COVID-19 patients. Profiling tissues and blood from COVID-19 patients revealed that SARS-CoV-2 virions enter megakaryocytes and platelets and associate with alterations to the platelet transcriptome and activation profile.
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Affiliation(s)
- Tessa J Barrett
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Seda Bilaloglu
- Department of Population Health, New York University Langone Health, New York, New York, USA
| | - Macintosh Cornwell
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Hannah M Burgess
- Department of Microbiology, New York University Langone Health, New York, New York, USA
| | - Vitor W Virginio
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Kamelia Drenkova
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Homam Ibrahim
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Eugene Yuriditsky
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Yin Aphinyanaphongs
- Department of Population Health, New York University Langone Health, New York, New York, USA
| | - Mark Lifshitz
- Department of Pathology, New York University Langone Health, New York, New York, USA
| | - Feng Xia Liang
- DART Microscopy Laboratory, New York University Langone Health, New York, New York, USA
| | - Julie Alejo
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Grace Smith
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stefania Pittaluga
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy V Rapkiewicz
- Department of Pathology, NYU Winthrop Hospital, New York University Langone Health, Mineola, New York, USA
| | - Jun Wang
- Department of Pathology, New York University Langone Health, New York, New York, USA
| | - Camelia Iancu-Rubin
- Department of Pathology, Molecular and Cell-Based Medicine, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ian Mohr
- Department of Microbiology, New York University Langone Health, New York, New York, USA
| | - Kelly Ruggles
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Kenneth A Stapleford
- Department of Microbiology, New York University Langone Health, New York, New York, USA
| | - Judith Hochman
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Jeffrey S Berger
- Department of Medicine, New York University Langone Health, New York, New York, USA
- Department of Surgery, New York University Langone Health, New York, New York, USA
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Jose J, Magoon R, Makhija N. Immature Platelet Fraction and COVID-19: Maturing prognostic links! JOURNAL OF CARDIAC CRITICAL CARE TSS 2021. [DOI: 10.1055/s-0041-1732836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractPrompted by the combination of an ever-evolving comprehension of the platelet activation as a pivotal perpetuator of an ongoing systemic inflammatory process and an encouraging literature on the prognostic role of immature platelet fraction (IPF) in septic and prothrombotic settings, we present an elaborated account of the possible prognostic links between IPF and Coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Jes Jose
- Department of Cardiac Anesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, India
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Delshad M, Safaroghli-Azar A, Pourbagheri-Sigaroodi A, Poopak B, Shokouhi S, Bashash D. Platelets in the perspective of COVID-19; pathophysiology of thrombocytopenia and its implication as prognostic and therapeutic opportunity. Int Immunopharmacol 2021; 99:107995. [PMID: 34304001 PMCID: PMC8295197 DOI: 10.1016/j.intimp.2021.107995] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Abstract
Despite endorsed and exponential research to improve diagnostic and therapeutic strategies, efforts have not yet converted into a better prospect for patients infected with the novel coronavirus (2019nCoV), and still, the name of SARS-CoV-2 is coupled with numerous unanswered questions. One of these questions is concerning how this respiratory virus reduces the number of platelets (PLTs)? The results of laboratory examinations showed that about a quarter of COVID-19 cases experience thrombocytopenia, and more remarkably, about half of these patients succumb to the infection due to coagulopathy. These findings have positioned PLTs as a pillar in the management as well as stratifying COVID-19 patients; however, not all the physicians came into a consensus about the prognostic value of these cells. The current review aims to unravel the contributory role of PLTs s in COVID-19; and also to summarize the original data obtained from international research laboratories on the association between COVID-19 and PLT production, activation, and clearance. In addition, we provide a special focus on the prognostic value of PLTs and their related parameters in COVID-19. Questions on how SARS-CoV-2 induces thrombocytopenia are also responded to. The last section provides a general overview of the most recent PLT- or thrombocytopenia-related therapeutic approaches. In conclusion, since SARS-CoV-2 reduces the number of PLTs by eliciting different mechanisms, treatment of thrombocytopenia in COVID-19 patients is not as simple as it appears and serious cautions should be considered to deal with the problem through scrutiny awareness of the causal mechanisms.
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Affiliation(s)
- Mahda Delshad
- Department of Laboratory Sciences, School of Allied Medical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Ava Safaroghli-Azar
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Pourbagheri-Sigaroodi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Poopak
- Department of Hematology, Faculty of Paramedical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Shervin Shokouhi
- Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Tauseef A, Zafar M, Arshad W, Thirumalareddy J, Sood A, Farooque U, Nair S, Mirza M. Role of immature platelet fraction (IPF) in sepsis patients: A systematic review. J Family Med Prim Care 2021; 10:2148-2152. [PMID: 34322405 PMCID: PMC8284229 DOI: 10.4103/jfmpc.jfmpc_2293_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/24/2020] [Accepted: 02/13/2021] [Indexed: 12/01/2022] Open
Abstract
Sepsis is extremely common amongst critically ill patients and requires early diagnosis. Hence, identifying a biomarker that could acknowledge sepsis at its prior stage is of vital significance. Immature platelets are a percentage of circulating platelets that contain RNA and is a newer parameter that is measured using automated hematology analyzers in diagnosing sepsis. This review article discusses 10 articles that reveal the role of immature platelet fraction in predicting the onset of sepsis and its relationship with mortality in sepsis. Literature search was done using PubMed, Scopus and Google Scholar and words like platelet indices and immature platelet fraction were typed in the search bar. The aim of this review article is to present a precise form of data that talk about immature platelet fraction (IPF) and its association with the severity and mortality of sepsis. Five out of 10 articles suggest that immature platelet fraction can predict the onset of sepsis and eight out of 10 articles suggest that increased IPF values are associated with high mortality.
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Affiliation(s)
- Abubakar Tauseef
- Internal Medicine Department, Creighton University Hospital Program, Omaha, Nebraska, USA
| | - Maryam Zafar
- Internal Medicine Department, Dow University of Health Sciences, Karachi, Pakistan
| | - Wafa Arshad
- Internal Medicine Department, Dow University of Health Sciences, Karachi, Pakistan
| | - Joseph Thirumalareddy
- Internal Medicine Department, Creighton University Hospital Program, Omaha, Nebraska, USA
| | - Akshat Sood
- Internal Medicine Department, Creighton University Hospital Program, Omaha, Nebraska, USA
| | - Umar Farooque
- Internal Medicine Department, Dow University of Health Sciences, Karachi, Pakistan
| | - Sunil Nair
- Internal Medicine Department, Creighton University Hospital Program, Omaha, Nebraska, USA
| | - Mohsin Mirza
- Internal Medicine Department, Creighton University Hospital Program, Omaha, Nebraska, USA
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Al Saleh K, AlQahtani RM. Platelet count patterns and patient outcomes in sepsis at a tertiary care center: Beyond the APACHE score. Medicine (Baltimore) 2021; 100:e25013. [PMID: 33950914 PMCID: PMC8104228 DOI: 10.1097/md.0000000000025013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 02/12/2021] [Indexed: 01/04/2023] Open
Abstract
Acute physiology and chronic health evaluation II (APACHE-II) scoring system is used to classify disease severity of patients in the intensive care unit. However, several limitations render the scoring system inadequate in identifying risk factors associated with outcomes. Little is known about the association of platelet count patterns, and the timing of platelet count and other hematologic parameters in predicting mortality in patients with sepsis.This retrospective observational study included 205 septic shock patients, with an overall mortality of 47.8%, enrolled at a tertiary care hospital in Riyadh, Kingdom of Saudi Arabia between 2018 and 2020. Bivariate and multivariate regression analyses were used to identify hematologic risk factors associated with mortality. We used the bivariate Pearson Correlation test to determine correlations between the tested variables and APACHE-II score.Two platelet count patterns emerged: patients with a decline in platelet count after admission (group A pattern, 93.7%) and those with their lowest platelet count at admission (group B pattern, 6.3%). The lowest mean platelet count was significantly lower in nonsurvivors (105.62 ± 10.67 × 103/μL) than in survivors (185.52 ± 10.81 × 103/μL), P < .001. Bivariate Pearson correlation revealed that the lowest platelet count and platelet count decline were significantly correlated with APACHE-II score (r = -0.250, P < .01), (r = 0.326, P < .001), respectively. In multiple logistic regression analysis, the independent mortality risk factors were degree of platelet count decline in group A (odds ratio, 1.028 [95% confidence interval: 1.012-1.045], P = .001) and platelet pattern in group B (odds ratio, 6.901 [95% confidence interval: 1.446-32.932], P = .015). The patterns, values, subsets, and ratios of white blood cell count were not significantly associated with mortality.Nadir platelet count and timing, and degree of platelet count decline are useful markers to predict mortality in early septic shock. Therefore, platelet count patterns might enhance the performance of severity scoring systems in the intensive care unit.
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Affiliation(s)
| | - Rakan M. AlQahtani
- Department of Critical Care, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
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8
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Platelets parameters in septic shock: clinical usefulness and prognostic value. Blood Coagul Fibrinolysis 2021; 31:421-425. [PMID: 33065574 DOI: 10.1097/mbc.0000000000000937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Septic shock is a common cause of admission in the ICUs. Despite tremendous improvement in the management modalities, mortality remains high. Early diagnosis and prompt resuscitation are required to improve prognosis. Therefore, identifying a biomarker that could reveal the sepsis at its earlier stage is of paramount importance. In this regards, platelet parameters, such as mean platelet volume, immature platelet fraction and platelet-derived microparticles have been investigated as possible sepsis biomarkers. In fact, haemostasis disturbances are one of the hallmark of septic shock where platelets play a pivotal role in orchestrating the inflammatory response of the host. Moreover, these parameters could have a prognostic value as the severity of the multiorgan dysfunction is correlated with the inflammatory reaction.
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Abstract
This study aimed to explore the association between the percentage of reticulated platelets (RP%) and infection, and analyze the value of combined measurement of RP% with other inflammatory indicators in diagnosing infection. A total of 190 patients with signs and symptoms suspicious of infection were included in the infection group, and 70 healthy subjects with comparable percentages of gender and age were included in the control group. Peripheral white blood cell (WBC) count, percentage of neutrophils (N%), platelet count, C-reactive protein (CRP), procalcitonin (PCT), RP%, and axillary temperature were recorded. Dynamic changes in RP% with infection were measured to analyze the association between RP% and infection. The receiver operating characteristic curve was used to evaluate the value of each inflammatory indicator in diagnosing infection and analyze the diagnostic value of the combined adoption of multiple inflammatory indicators. RP% was significantly higher in the infection group than in the noninfection and control groups. The sensitivity and specificity for diagnosing infection were, respectively, 91.78% and 93.18% when RP% and CRP were used in combination, 90.41% and 90.90% when RP% and PCT were used in combination, and 100% and 100% when RP%, CRP, and PCT were used in combination. RP% changed dynamically with the progression of infection and recovered to lower than 5.5% at 2 to 7 days before the body temperature recovered to a normal level. The diagnostic value of RP% was the highest. A combined use with CRP/PCT could improve the sensitivity and specificity in the early diagnosis of infectious diseases.
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Affiliation(s)
| | | | - Bai-xia Yang
- Department of Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Schoergenhofer C, Hobl EL, Staudinger T, Speidl WS, Heinz G, Siller-Matula J, Zauner C, Reiter B, Kubica J, Jilma B. Prasugrel in critically ill patients. Thromb Haemost 2017; 117:1582-1587. [PMID: 28692105 PMCID: PMC6292180 DOI: 10.1160/th17-03-0154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/20/2017] [Indexed: 12/16/2022]
Abstract
While prasugrel is indicated for the treatment of myocardial infarction, its effects in the most severely affected patients requiring intensive care is unknown, so that we measured the antiplatelet effects and sparse pharmacokinetics of prasugrel in critically ill patients. Twenty-three patients admitted to medical intensive care units, who were treated with 10 mg prasugrel once daily, were included in this prospective trial. Critically ill patients responded poorly to daily prasugrel treatment: adenosine diphosphate (ADP)-induced aggregation in whole blood classified 65 % (95 % confidence intervals (CI) 43-84 %) of patients as having high on treatment platelet reactivity, platelet function under high shear rates even 74 % (95 %CI 52-90 %). There was only limited additional inhibition provided 2 hours after the next dose of prasugrel. In contrast, insufficient inhibition of the target was only seen in 26 % (95 %CI 10-48 %) of patients as measured by the vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) assay. Low effective plasma levels of prasugrel active metabolite were measured at trough [0.5 (quartiles 0.5-1.1) ng/ml at baseline], and 2 hours after intake [5.7 (3.8-9.8) ng/ml], but showed coefficients of variation of ~70 %. In sum, inhibition of platelet aggregation by prasugrel is not uniform but highly variable in critically ill patients, similar to clopidogrel in a general population. The pharmacokinetic measurements indicate that poor absorption/metabolism of prasugrel may partly contribute while inflammation induced heightened intrinsic platelet reactivity may also play a role.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bernd Jilma
- Bernd Jilma, MD, Währinger Gürtel 18-20, 1090 Vienna, Austria, Tel.: +43 1 40400 29810, Fax: +43 1 40400 29980, E-mail:
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Akinosoglou K, Perperis A, Theodoraki S, Alexopoulos D, Gogos C. Sepsis favors high-on-clopidogrel platelet reactivity. Platelets 2017. [PMID: 28635374 DOI: 10.1080/09537104.2017.1319919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
High-on-treatment platelet reactivity (HPR) is associated with ischemic events in patients on antiplatelet therapy with a history of cardiovascular disease. On the other hand, recent data have associated sepsis with adverse cardiovascular events in patients admitted with bacteremia or respiratory infection. We aimed to assess P2Y12-mediated platelet reactivity (PR) during sepsis and recovery in patients under clopidogrel. This was a prospective observational study. Incoming patients presenting with signs/symptoms of sepsis already on a maintenance dose of clopidogrel of 75 mg qd for cardiovascular events were included in this study. Patients were assessed for their PR on presentation and following septic syndrome, using the VerifyNow point-of-care P2Y12 assay. Patients were excluded in the presence of evidence of noncompliance to antiplatelet regimen or in need of discontinuation during this study. Twenty-two septic patients on clopidogrel were included in this study (Supplemental Figure S1). Clopidogrel was administered for previous stroke, coronary, and peripheral artery disease in 27.3, 40.9, and 31.8% of patients, respectively. The main site of infection was respiratory tract followed by urinary tract, while the same amounts of gram-negative and -positive pathogens were isolated. HPR was noted in 77% and 29% of patients during sepsis and recovery, respectively, presenting a significant decrease in P2Y12 reaction units values during follow-up [240.7 ± 58.3 versus 179.5 ± 58.4, 95% CI (-102.7, -39.76), p = 0.0002]. Five patients died of infection, while no adverse cardiovascular events were noted in our study. Our study shows that sepsis may favor HPR, which is reversed when recovery occurs. This finding may underlie the adverse cardiovascular events in patients admitted with sepsis, possibly requiring alteration of antiplatelet regimen during the inflammation period.
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Affiliation(s)
- Karolina Akinosoglou
- a Department of Internal Medicine and Infectious Diseases , University Hospital of Patras , Rio , Patras , Greece
| | - Angelos Perperis
- b Department of Cardiology , University Hospital of Patras , Rio , Patras , Greece
| | - Spyridoula Theodoraki
- c Department of Internal Medicine , University Hospital of Patras , Rio, Patras, Greece
| | | | - Charalambos Gogos
- a Department of Internal Medicine and Infectious Diseases , University Hospital of Patras , Rio , Patras , Greece
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Wu Q, Xu X, Ren J, Liu S, Liao X, Wu X, Hu D, Wang G, Gu G, Kang Y, Li J. Association between the -159C/T polymorphism in the promoter region of the CD14 gene and sepsis: a meta-analysis. BMC Anesthesiol 2017; 17:11. [PMID: 28122493 PMCID: PMC5264438 DOI: 10.1186/s12871-017-0303-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/16/2017] [Indexed: 02/05/2023] Open
Abstract
Background The association between CD14-159C/T polymorphism and sepsis has been assessed but results of current studies appeared conflicting and inconstant. This analysis was aimed to determine whether the CD14-159C/T polymorphism confers susceptibility to sepsis or is associated with increased risk of death from sepsis. Method The authors conducted a comprehensive search of PubMed, EMBASE, ISI Web of Science, Cochrane library, ScienceDirect, Wiley Online Library and CNKI databases according to a prespecified protocol. Language limits were restricted to English and Chinese. Two reviewers independently selected the articles and extracted relevant data onto standardized forms. Disagreements were settled by discussion and suggestions from senior consultants. The strength of association were evaluated by odds ratio (OR) and 95% confidence interval (CI). Studies failed to fit the Hardy-Weinberg-Equilibrium were excluded. Results The research identified a total of 2317 full-text articles of which 14 articles met the predefined inclusion criteria. Meta-analysis was performed for allele frequency of C versus T, as well as genotypes CC + CT versus TT (dominant model), CC versus TT + CT (recessive model), CT versus TT and CC versus TT (additive model). All control samples were in Hardy-Weinberg proportion. No significant association between CD14-159C/T polymorphism and sepsis susceptibility or mortality were detected in the overall population. Nonetheless, subgroup analysis of Asian ethnicity revealed significant association between the CD14-159C/T polymorphism and susceptibility to sepsis in additive model (CC versus TT: OR = 0.52, 95% CI 0.29–0.92, p = 0.03) and recessive model (CC versus CT + TT: OR = 0.50, 95% CI 0.30–0.84, p = 0.009). Of note, three out of the five papers included in the subgroup focused exclusively on burn ICU patients. Conclusions This meta-analysis demonstrated that CD14-159C/T polymorphism is likely to be associated with susceptibility to sepsis in Asian population, especially for the TT genotype. However, bias may rise for etiologic reasons because the majority of subjects in the subgroup came from burn ICU. CD14-159C/T polymorphism is not relevant to sepsis mortality in any genetic models, regardless of the ethnicities. Due to the exploratory nature of the study, no adjustment for multiple testing was adopted, and therefore the results should be interpreted with precaution. Well-designed studies with larger sample size and more ethnic groups are required to further validate the results. Electronic supplementary material The online version of this article (doi:10.1186/s12871-017-0303-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qin Wu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China.,Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaomeng Xu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Jianan Ren
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China.
| | - Song Liu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuwen Wu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Dong Hu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Gefei Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Guosheng Gu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhong Shan Road, Nanjing, 210002, China
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Wu Q, Ren J, Hu D, Wu X, Li G, Wang G, Gu G, Chen J, Li R, Li Y, Hong Z, Ren H, Zhao Y, Li J. Monocyte subsets and monocyte-platelet aggregates: implications in predicting septic mortality among surgical critical illness patients. Biomarkers 2016; 21:509-16. [DOI: 10.3109/1354750x.2016.1160290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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