Association of platelets with multiple organic failure in septic patients
Main Article Content
Keywords
Sepsis, Platelets, Acute Kidney Injury
Abstract
Background: Sepsis is a proinflammatory and procoagulant condition; platelet abnormalities constitute the main alteration, with thrombocytopenia being the most prevalent. This variation is due to multiple mechanisms, primarily the formation of microcirculatory thrombi, which leads to increased consumption. A potential association between decreased platelet counts and poor prognosis has been previously described.
Objective: To establish the association between platelet counts and multiple organ failure (MOF) in septic patients in the intensive care unit.
Material and methods: A single-center, cross-sectional, retrospective study including patients older than 18 years with a diagnosis of sepsis, with or without MOF, excluding those with COVID-19. Serum platelet levels were collected upon admission to the intensive care unit. The Mann-Whitney U test, ROC curve analysis, and binary logistic regression were used.
Results: A total of 93 septic patients were included (46.2% with MOF). Those with MOF had lower platelet counts (149 vs. 217.5 × 10^9/L; p = 0.003), with 174 × 10^9/L identified as the best cutoff point (AUC 0.710). Platelets were also associated with MOF (OR 8.53; p = 0.003); however, in the multivariable analysis, acute kidney injury was the main factor associated with MOF (OR 27.8; p ≤ 0.001).
Conclusions: A decrease in platelet count is a risk factor associated with MOF in septic patients in the intensive care unit.
References
1. La Via L, Sangiorgio G, Stefani S, et al. The Global Burden of Sepsis and Septic Shock. Epidemiologia. 2024;5(3):456-478. doi: 10.3390/epidemiologia5030032.
2. Ikuta KS, Swetschinski LR, Robles-Aguilar G, et al. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2022;400(10369):2221-48. doi: 10.1016/S0140-6736(22)02185-7
3. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. The Lancet. 2020;395(10219):200-11. doi: 10.1016/S0140-6736(19)32989-7.
4. Gorordo-Delsol L, Merinos-Sánchez G, Estrada-Escobar R, et al. Sepsis y choque séptico en los servicios de urgencias de México: estudio multicéntrico de prevalencia puntual. Gac. Méd. Méx. 2020; 156(6):495-501. doi:10.24875/GMM.M21000492.
5. Sun GD, Zhang Y, Mo SS, et al. Multiple Organ Dysfunction Syndrome Caused by Sepsis: Risk Factor Analysis. Int J Gen Med. 2021;14:7159-7164. doi: 10.2147/IJGM.S328419.
6. Arora J, Mendelson AA, Fox-Robichaud A. Sepsis: network pathophysiology and implications for early diagnosis. Am J Physiol Regul Integr Comp Physiol. 2023;324(5):R613-R624. doi: 10.1152/ajpregu.00003.2023.
7. Guarino M, Perna B, Cesaro AE, et al. 2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department. J Clin Med. 2023;12(9):3188. doi: 10.3390/jcm12093188.
8. Srdić T, Đurašević S, Lakić I, et al. From Molecular Mechanisms to Clinical Therapy: Understanding Sepsis-Induced Multiple Organ Dysfunction. Int J Mol Sci. 2024;25(14):7770. doi: 10.3390/ijms25147770.
9. Asim M, Amin F, El-Menyar A. Multiple organ dysfunction syndrome: Contemporary insights on the clinicopathological spectrum. Qatar Med J. 2020;2020(1):22. doi: 10.5339/qmj.2020.22.
10. Ishikawa S, Teshima Y, Otsubo H, et al. Risk prediction of biomarkers for early multiple organ dysfunction in critically ill patients. BMC Emerg Med. 2021;21(1):132. doi: 10.1186/s12873-021-00534-z.
11. Shimazui T, Nakada TA, Yazaki M, et al. Blood Interleukin-6 Levels Predict Multiple Organ Dysfunction in Critically Ill Patients. Shock. 2021;55(6):790-795. doi: 10.1097/SHK.0000000000001678.
12. Gremmel T, Frelinger AL, Michelson AD. Platelet Physiology. Semin Thromb Hemost. 2024;50(8):1173-1186. doi: 10.1055/s-0044-1786387.
13. Chen Y, Zhong H, Zhao Y, et al. Role of platelet biomarkers in inflammatory response. Biomark Res. 2020;8:28. doi: 10.1186/s40364-020-00207-2.
14. Alqeeq BF, Ayyad M, Albandak M, et al.The clinical significance of thrombocytopenia in sepsis and septic shock: a systematic review and meta-analysis. BMC Anesthesiol. 2025;25(1):327. doi: 10.1186/s12871-025-03188-7.
15. Chiscano-Camón L, Plata-Menchaca E, Ruiz-Rodríguez JC, et al. Fisiopatología del shock séptico. Med Intensiva. 2022;46 Suppl 1:1-13, doi: 10.1016/j.medine.2022.03.010.
16. Venkata C, Kashyap R, Christopher Farmer J, et al. Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcome. J Intensive Care. 30;1(1):9. doi: 10.1186/2052-0492-1-9.
17. Burunsuzoğlu B, Saltürk C, Karakurt Z, et al. Thrombocytopenia: A risk factor of mortality for patients with sepsis in the intensive care unit. Turk Toraks Dergisi. 2016 17(1):7-14. doi: 10.5578/ttj.17.1.002.
18. Setarehaseman A, Mohammadi A, Maitta RW. Thrombocytopenia in Sepsis. Life 2025;15(2):274. doi: 10.3390/life15020274.
19. Bayraktar YŞ, Açıkgöz A, Eyiol H, et al. The Incidence of Thrombocytopenia and Its Association with Mortality in Patients with Sepsis Followed in Intensive Care Unit. Eurasian J Emerg Med 2023;22(1):24-27, doi: 10.4274/eajem.galenos.2022.21549.
20. Péju E, Fouqué G, Charpentier J, et al. Clinical significance of TCP in patients with septic shock: an observational retrospective study. J Crit Care. 2023;76:154293. 10.1016/j.jcrc.2023.154293.
21. Singer M, Deutschman CS, Seymour C, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801–10, doi: 10.1001/jama.2016.0287.
22. Gauer RL, Whitaker DJ. Thrombocytopenia: Evaluation and Management. Am Fam Physician. 2022;106(3):288-298.
23. Jiménez-Zarazúa O, González-Carrillo P, VélezRamírez L, et al. Survival in septic shock associated with thrombocytopenia. Heart Lung. 2021;50(2):268-276. doi: 10.1016/j.hrtlng.2020.12.011.
24. Hua Y, Wang R, Yang J, et al. Platelet count predicts mortality in patients with sepsis: A retrospective observational study. Medicine. 2023;102(38):e35335. doi: 10.1097/MD.0000000000035335.
25. Wang Z, Dong S, Qin Y. The Relationship Between Acute Kidney Injury in Sepsis Patients and Coagulation Dysfunction and Prognosis. Open Access Emerg Med. 2024;16:145. doi: 10.2147/OAEM.S453632.
