Platelet morphological indices on Intensive Care Unit admission predict mortality in septic but not in non-septic patients

The Underestimated Role of Platelets in Severe Infection a Narrative Review

Beyond their role in hemostasis, platelets have emerged as key contributors in the immune response; accordingly, the occurrence of thrombocytopenia during sepsis/septic shock is a well-known risk factor of mortality and a marker of disease severity. Recently, some studies elucidated that the response of platelets to infections goes beyond a simple fall in platelets count; indeed, sepsis-induced thrombocytopenia can be associated with—or even anticipated by—several changes, including an altered morphological pattern, receptor expression and aggregation. Of note, alterations in platelet function and morphology can occur even with a normal platelet count and can modify, depending on the nature of the pathogen, the pattern of host response and the severity of the infection. The purpose of this review is to give an overview on the pathophysiological interaction between platelets and pathogens, as well as the clinical consequences of platelet dysregulation. Furthermore, we try to clarify how understanding the nature of platelet dysregulation may help to optimize the therapeutic approach.

Platelet indices as prognostic markers in the critically ill patient

Platelet indices such as mean platelet volume (MPV), platelet (PLT) count, plateletcrit (PCT), and platelet distribution width (PDW) describe platelet morphology and proliferation kinetics. Our study aimed to evaluate the utility of platelet indices as prognostic markers in critically ill patients. This was an observational, descriptive study conducted on 106 critically ill adults for 24 months in the Medical Intensive Care Units of a tertiary care hospital. Analysis of the data was done using statistical software R version 3.6.0 and MS Excel. The mean age of patients was 42.3±5.8 years. Non-survivors had lower PLT count and PCT when compared to survivors. PDW and MPV were higher for non-survivors when compared to survivors. PLT count of <90,000 cells/cu mm displayed the highest sensitivity (94%), while PDW demonstrated the highest specificity (96%) in predicting mortality among critically ill patients. Abnormally low PLT count, high PDW, and high MPV values are associated with severe illness and put the patients at high risk of death as compared to patients with normal PLT indices.