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Liu C, Görlich D, Lowell CA, Italiano JE, Rossaint J, Bender M, Zarbock A, Margraf A. Thrombopoietin levels in sepsis and septic shock - a systematic review and meta-analysis. Clin Chem Lab Med 2024; 62:999-1010. [PMID: 38037809 DOI: 10.1515/cclm-2023-0792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES Sepsis is a life-threatening condition implicating an inadequate activation of the immune system. Platelets act as modulators and contributors to immune processes. Indeed, altered platelet turnover, thrombotic events, and changes in thrombopoietin levels in systemic inflammation have been reported, but thrombopoietin-levels in sepsis and septic-shock have not yet been systematically evaluated. We therefore performed a meta-analysis of thrombopoietin (TPO)-levels in patients with sepsis. METHODS Two independent reviewers screened records and full-text articles for inclusion. Scientific databases were searched for studies examining thrombopoietin levels in adult sepsis and septic-shock patients until August 1st 2022. RESULTS Of 95 items screened, six studies met the inclusion criteria, including 598 subjects. Both sepsis and severe sepsis were associated with increased levels of thrombopoietin (sepsis vs. control: standardized mean difference 3.06, 95 % CI 1.35-4.77; Z=3.50, p=0.0005) (sepsis vs. severe sepsis: standardized mean difference -1.67, 95 % CI -2.46 to -0.88; Z=4.14, p<0.0001). TPO-levels did not show significant differences between severe sepsis and septic shock patients but differed between sepsis and inflammation-associated non-septic controls. Overall, high heterogeneity and low sample size could be noted. CONCLUSIONS Concluding, increased levels of thrombopoietin appear to be present both in sepsis and severe sepsis with high heterogeneity but thrombopoietin does not allow to differentiate between severe sepsis and septic-shock. TPO may potentially serve to differentiate sepsis from non-septic trauma and/or tissue damage related (systemic) inflammation. Usage of different assays and high heterogeneity demand standardization of methods and further large multicenter trials.
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Affiliation(s)
- Chang Liu
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Clifford A Lowell
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Joseph E Italiano
- Department of Surgery, Harvard Medical School and Vascular Biology Program, Boston Children's Hospital, Boston, MA, USA
| | - Jan Rossaint
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Markus Bender
- Institute of Experimental Biomedicine - Chair I, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Margraf
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Lupia E, Capuano M, Vizio B, Schiavello M, Bosco O, Gelardi M, Favale E, Pivetta E, Morello F, Husain S, Keshavjee S, Del Sorbo L, Montrucchio G. Thrombopoietin participates in platelet activation in COVID-19 patients. EBioMedicine 2022; 85:104305. [PMID: 36242922 PMCID: PMC9556163 DOI: 10.1016/j.ebiom.2022.104305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 08/24/2022] [Accepted: 09/28/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The pathogenesis of coronavirus disease 2019 (COVID-19) is characterized by enhanced platelet activation and diffuse hemostatic alterations, which may contribute to immunothrombosis/thromboinflammation and subsequent development of target-organ damage. Thrombopoietin (THPO), a growth factor essential to megakariocyte proliferation, is known to prime platelet activation and leukocyte-platelet interaction. In addition, THPO concentrations increase in several critical diseases, such as acute cardiac ischemia and sepsis, thus representing a potential diagnostic and prognostic biomarker. Furthermore, several data suggest that interleukin (IL)-6 is one of the most important inflammatory mediators involved in these phenomena, which led to explore the potential therapeutic role of IL-6 inhibitors. In this prospective cohort study, we aimed to study THPO and IL-6 concentrations in COVID-19 patients at the time of first clinical evaluation in the Emergency Department (ED), and to investigate their potential use as diagnostic and prognostic biomarkers. In addition, we sought to explore the role of THPO contained in plasma samples obtained from COVID-19 patients in priming in vitro platelet activation and leukocyte-platelet interaction. METHODS We enrolled 66 patients presenting to the ED with symptoms suggestive of COVID-19, including 47 with confirmed COVID-19 and 19 in whom COVID-19 was excluded (Non-COVID-19 patients). As controls, we also recruited 18 healthy subjects. In vitro, we reproduced the effects of increased circulating THPO on platelet function by adding plasma from COVID-19 patients or controls to platelet-rich plasma or whole blood obtained by healthy donors, and we indirectly studied the effect of THPO on platelet activation by blocking its biological activity. FINDINGS THPO levels were higher in COVID-19 patients than in both Non-COVID-19 patients and healthy subjects. Studying THPO as diagnostic marker for the diagnosis of COVID-19 by receiver-operating-characteristic (ROC) statistics, we found an area under the curve (AUC) of 0.73, with an optimal cut-off value of 42.60 pg/mL. IL-6 was higher in COVID-19 patients than in healthy subjects, but did not differ between COVID-19 and Non-COVID-19 patients. THPO concentrations measured at the time of diagnosis in the ED were also higher in COVID-19 patients subsequently developing a severe disease than in those with mild disease. Evaluating THPO as biomarker for severe COVID-19 using ROC analysis, we found an AUC of 0.71, with an optimal cut-off value of 57.11 pg/mL. IL-6 was also higher in severe than in mild COVID-19 patients, with an AUC for severe COVID-19 of 0.83 and an optimal cut-off value of 23 pg/ml. THPO concentrations correlated with those of IL-6 (r=0.2963; p=0.043), and decreased 24 h after the administration of tocilizumab, an IL-6 receptor blocking antibody, showing that the increase of THPO levels depends on IL-6-stimulated hepatic synthesis. In vitro, plasma obtained from COVID-19 patients, but not from healthy subjects, primed platelet aggregation and leukocyte-platelet binding, and these effects were reduced by inhibiting THPO activity. INTERPRETATION Increased THPO may be proposed as an early biomarker for the diagnosis of COVID-19 and for the identification of patients at risk of developing critical illness. Elevated THPO may contribute to enhance platelet activation and leukocyte-platelet interaction in COVID-19 patients, thus potentially participating in immunothrombosis/thromboinflammation. FUNDING This work was supported by Ministero dell'Università e della Ricerca Scientifica e Tecnologica (MURST) ex 60% to GM and EL.
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Affiliation(s)
- Enrico Lupia
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy,Corresponding author at: Department of Medical Sciences, University of Turin, via Genova 3, 10126 Turin, Italy.
| | - Marialessia Capuano
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy,School of Specialization in Emergency Medicine, University of Turin, Turin, Italy
| | - Barbara Vizio
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Ornella Bosco
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Gelardi
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy,School of Specialization in Emergency Medicine, University of Turin, Turin, Italy
| | - Edoardo Favale
- School of Specialization in Internal Medicine, University of Turin, Turin, Italy
| | - Emanuele Pivetta
- Department of Medical Sciences, University of Turin, Turin, Italy,School of Specialization in Internal Medicine, University of Turin, Turin, Italy
| | - Fulvio Morello
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy
| | - Shahid Husain
- University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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