Mean platelet volume to platelet count ratio as a predictor of mortality in septic patients
Keywords:Mean platelet volume, Sepsis, Shock
Background: Sepsis is a major cause of mortality among critically ill patients. The complex pathophysiology involves infection with systemic inflammatory response. Early detection of sepsis, helps not only is stratification of risk, but also for monitoring its progression and efficacy of therapeutic interventions. At present there are only few reliable prognostic tools to predict severity and mortality in sepsis. This study evaluates the usefulness of mean platelet value in prognosticating patient admitted with sepsis.
Methods: We enrolled 200 patients prospectively, that have been admitted to our Medical ICU for sepsis over 2 years from 2018–2020. Changes in platelet indices, including mean platelet volume to platelet count ratio, were compared between survivors and non-survivors by using student’s t test. The prognostic value of mean platelet volume to platelet count ratio for 28-day mortality was ascertained by multivariate logistic regression.
Results: Total 39 (19.5 %) patients expired within 28 days of ICU admission. MPV increased during the first 72 hours of hospital stay for both survivor and non survivors. Mean platelet volume to platelet count ratio was significantly higher in non survivors (P<0.001) as compared to survivors. In multivariate cox regression, mean platelet volume to platelet count ratio was an independent predictor of 28-day mortality, after adjusting for plausible confounders.
Conclusions: Mean platelet volume to platelet count ratio is an independent risk factor for poor clinical outcomes. Hence monitoring mean platelet volume can prove as a simple tool to stratify the risk of mortality in septic patients.
Rangel-Frausto MS, Piettet D, Costigan M, Hwang T, Davis CS, Wenzel RP (1995). The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. J Am Med Assoc. 273:117-23.
Li ZQ, Liu W, Park KS, et al. Defining a second epitope for heparin induced thrombocytopenia/ thrombosis antibodies using KKO, a murine HIT – like monoclonal antibody. Blood. 2002;99:1230-6.
Cohen J, Vincent JL et al. Sepsis : a road map for future research. Lancet Infect Dis 2015;15:581-614
Suh JS, Malik MI, Aster RH, Visentin GP. Characterization of the humoral immune response in heparin – induced thrombocytopenia. Am J Hematol. 1997;54:196–201
Bakovic D, Pivac N, Eterovic D, et al. Changes in platelet size and spleen in response to selective and non –selective beta-adrenoceptor blockade in hypertensive patients. CLin Exp Pharmacol Physiol. 2009:36:441–6
Yazicici S, Yazici M, Erer B et al. The platelet indices in patients with Rheumatoid arthritis : Mean platelet volume reflect disease activity. Platelets. 2010;21:122–5.
Shen J, Ran ZH, Zhang Y, Cai Q, Yin HM, Zhou XT, et al. Biomarkers of altered coagulation and fibrino-
Chu SG, Becker RC et al. Mean platelet volume as a predictor of cardiovascular risk: a systemic review and meta – analysis. J Thromb Haemost 2018;8:148–56.
Sansanayudh N, Anothaisintawee T, Muntham D, McEvoy M, Attia J, Thakkinstian. Mean platelet volume and coronary artery disease : a systemic review and meta-analysis. Int J Cardiol 2014;175:433-40.
Kim CH, Kim SJ, Lee MJ. An increase in mean platelet volume from baseline is associated with mortality in patients with severe sepsis or septic shock. Plos One. 2015;10:e119437
Akca S, Haji-Michael P, de Mendonca A, Suter P, Levi M, Vincent JL. Time course of platelet counts incritically ill patients. Crit Care Med. 2002;30:753-6.
Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombo-sis and inflammation? Curr Pharm Des. 2011;17:47–58.
1Zampieri. An increase in Mean Platelet volume after admission is associated with higher mortality in critically ill patients. Anna Intens Care. 2014,4.20
Eberhardt, F. Lessig, K. Schreter, N. Kellner, M. Fuchs, A. Sablotzki, M. Ludewig, A. Hartmann, A. Pöge, T. Gruenewald, Klinikum St. Georg, Infectious Diseases/ Tropical Medicine, Leipzig/ DE, Klinikum St. Georg, Anesthesiology/ ICU care, Leipzig/ DE, Klinikum St. Georg, Cardiology/ ICU care, Leipzig/ DE, Klinikum St. Geog, Laboratory Medicine/ Micorbiology, Leipzig/ DE, Mean platelet volume is an outcome marker in sepsis patients. 15th ICD Bangkok, Thailand, June 13-16, 2012
Beechi C. Department of Medical and Surgical critical care, Section of Anaesthesia and Intensive care, University of Florence, Florence, Italy. Minerva Anestesiol. 2006;72(9):749-56.
Oh, Geun Ho, Chung, Sung Phil, Park, Yoo seok et al. Mean Platelet volume to platelet count ratio as a promising predictor of early mortality is severe sepsis. Shock. 2017;47(3):323-30
Gumembakmaz. Mean platelet volume predicts Embolic complications in Infective Endocarditis. Int J Infect Diseas. 2010;982-5
Narci H, Turk E, Karagulle E. Baskent University faculty of Medicine, Anakara, Turkey. The role of Mean Platelet Volume in the diagnosis of Acute Appendicitis: A Retrospective Case-controlled study. Iran Red Crescent Med J. 2013;15(12).