Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis

Abstract In sepsis-associated coagulopathies and disseminated intravascular coagulation, relative platelet reductions may reflect coagulopathy severity. However, limited evidence supports their clinical significance and most sepsis-associated coagulopathy criteria focus on the absolute platelet coun...

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Autores principales:	Daisuke Kasugai, Masayuki Ozaki, Kazuki Nishida, Yukari Goto, Kunihiko Takahashi, Shigeyuki Matsui, Naoyuki Matsuda
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/03f6853122b648d1b9c6f02797fa2d55
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spelling	oai:doaj.org-article:03f6853122b648d1b9c6f02797fa2d552021-12-02T16:24:50ZRelative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis10.1038/s41598-021-93635-52045-2322https://doaj.org/article/03f6853122b648d1b9c6f02797fa2d552021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-93635-5https://doaj.org/toc/2045-2322Abstract In sepsis-associated coagulopathies and disseminated intravascular coagulation, relative platelet reductions may reflect coagulopathy severity. However, limited evidence supports their clinical significance and most sepsis-associated coagulopathy criteria focus on the absolute platelet counts. To estimate the impact of relative platelet reductions and absolute platelet counts on sepsis outcomes. A multicenter retrospective observational study was performed using the eICU Collaborative Research Database, comprising 335 intensive care units (ICUs) in the United States. Patients with sepsis and an ICU stay > 2 days were included. Estimated effects of relative platelet reductions and absolute platelet counts on mortality and coagulopathy-related complications were evaluated. Overall, 26,176 patients were included. Multivariate mixed-effect logistic regression analysis revealed marked in-hospital mortality risk with larger platelet reductions between days one and two, independent from the resultant absolute platelet counts. The adjusted odds ratio (OR) [95% confidence intervals (CI)] for in-hospital mortality was 1.28[1.23–1.32], 1.86[1.75–1.97], 2.99[2.66–3.36], and 6.05[4.40–8.31] for 20–40%, 40–60%, 60–80%, and > 80% reductions, respectively, when compared with a < 20% decrease in platelets (P < 0.001 for each). In the multivariate logistic regression analysis, platelet reductions ≥ 11% and platelet counts ≤ 100,000/μL on day 2 were associated with high coagulopathy-related complications (OR [95%CI], 2.03 and 1.18; P < 0.001 and P < 0.001), while only platelet reduction was associated with thromboembolic complications (OR [95%CI], 1.43 [1.03–1.98], P < 0.001). The magnitude of platelet reductions represent mortality risk and provides a better signature of coagulopathies in sepsis; therefore, it is a plausible criterion for sepsis-associated coagulopathies.Daisuke KasugaiMasayuki OzakiKazuki NishidaYukari GotoKunihiko TakahashiShigeyuki MatsuiNaoyuki MatsudaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Daisuke Kasugai Masayuki Ozaki Kazuki Nishida Yukari Goto Kunihiko Takahashi Shigeyuki Matsui Naoyuki Matsuda Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis
description	Abstract In sepsis-associated coagulopathies and disseminated intravascular coagulation, relative platelet reductions may reflect coagulopathy severity. However, limited evidence supports their clinical significance and most sepsis-associated coagulopathy criteria focus on the absolute platelet counts. To estimate the impact of relative platelet reductions and absolute platelet counts on sepsis outcomes. A multicenter retrospective observational study was performed using the eICU Collaborative Research Database, comprising 335 intensive care units (ICUs) in the United States. Patients with sepsis and an ICU stay > 2 days were included. Estimated effects of relative platelet reductions and absolute platelet counts on mortality and coagulopathy-related complications were evaluated. Overall, 26,176 patients were included. Multivariate mixed-effect logistic regression analysis revealed marked in-hospital mortality risk with larger platelet reductions between days one and two, independent from the resultant absolute platelet counts. The adjusted odds ratio (OR) [95% confidence intervals (CI)] for in-hospital mortality was 1.28[1.23–1.32], 1.86[1.75–1.97], 2.99[2.66–3.36], and 6.05[4.40–8.31] for 20–40%, 40–60%, 60–80%, and > 80% reductions, respectively, when compared with a < 20% decrease in platelets (P < 0.001 for each). In the multivariate logistic regression analysis, platelet reductions ≥ 11% and platelet counts ≤ 100,000/μL on day 2 were associated with high coagulopathy-related complications (OR [95%CI], 2.03 and 1.18; P < 0.001 and P < 0.001), while only platelet reduction was associated with thromboembolic complications (OR [95%CI], 1.43 [1.03–1.98], P < 0.001). The magnitude of platelet reductions represent mortality risk and provides a better signature of coagulopathies in sepsis; therefore, it is a plausible criterion for sepsis-associated coagulopathies.
format	article
author	Daisuke Kasugai Masayuki Ozaki Kazuki Nishida Yukari Goto Kunihiko Takahashi Shigeyuki Matsui Naoyuki Matsuda
author_facet	Daisuke Kasugai Masayuki Ozaki Kazuki Nishida Yukari Goto Kunihiko Takahashi Shigeyuki Matsui Naoyuki Matsuda
author_sort	Daisuke Kasugai
title	Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis
title_short	Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis
title_full	Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis
title_fullStr	Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis
title_full_unstemmed	Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis
title_sort	relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/03f6853122b648d1b9c6f02797fa2d55
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Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis

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