An increase in mean platelet volume from baseline is associated with mortality in patients with severe sepsis or septic shock

Chan Ho Kim, Seung Jun Kim, Mi Jung Lee, Young Eun Kwon, Yung Ly Kim, Kyoung Sook Park, Han Jak Ryu, Jung Tak Park, Seung Hyeok Han, Tae-Hyun Yoo, Shin-Wook Kang, Hyung Jung Oh, Chan Ho Kim, Seung Jun Kim, Mi Jung Lee, Young Eun Kwon, Yung Ly Kim, Kyoung Sook Park, Han Jak Ryu, Jung Tak Park, Seung Hyeok Han, Tae-Hyun Yoo, Shin-Wook Kang, Hyung Jung Oh

Abstract

Introduction: Mean platelet volume (MPV) is suggested as an index of inflammation, disease activity, and anti-inflammatory treatment efficacy in chronic inflammatory disorders; however, the effect of MPV on sepsis mortality remains unclear. Therefore, we investigated whether the change in MPV between hospital admission and 72 hours (ΔMPV72h-adm) predicts 28-day mortality in severe sepsis and/or septic shock.

Methods: We prospectively enrolled 345 patients admitted to the emergency department (ED) who received standardized resuscitation (early goal-directed therapy) for severe sepsis and/or septic shock between November 2007 and December 2011. Changes in platelet indices, including ΔMPV72h-adm, were compared between survivors and non-survivors by linear mixed model analysis. The prognostic value of ΔMPV72h-adm for 28-day mortality was ascertained by Cox proportional hazards model analysis.

Results: Thirty-five (10.1%) patients died within 28 days after ED admission. MPV increased significantly during the first 72 hours in non-survivors (P = 0.001) and survivors (P < 0.001); however, the rate of MPV increase was significantly higher in non-survivors (P = 0.003). Nonetheless, the difference in the platelet decline rate over the first 72 hours did not differ significantly between groups (P = 0.360). In multivariate analysis, ΔMPV72h-adm was an independent predictor of 28-day mortality, after adjusting for plausible confounders (hazard ratio, 1.44; 95% confidence interval, 1.01-2.06; P = 0.044).

Conclusions: An increase in MPV during the first 72 hours of hospitalization is an independent risk factor for adverse clinical outcomes. Therefore, continuous monitoring of MPV may be useful to stratify mortality risk in patients with severe sepsis and/or septic shock.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of study patients.
Fig 1. Flow diagram of study patients.
From November 2001 to December 2011, 451 patients who received early-goal directed therapy (EGDT) in the emergency department (ED) were assessed for possible enrollment according to inclusion and exclusion criteria, and 345 patients were included in the final analysis.
Fig 2. Comparison of trends in the…
Fig 2. Comparison of trends in the platelet indices between survivors and non-survivors during the first 72 hours after emergency department admission.
(A) The rate of mean platelet volume increase over the first 72 hours in non-survivors was significantly different from that observed in survivors (P = 0.003). (B) The rate of platelet count decline over the first 72 hours was comparable between the 2 groups (P = 0.360).
Fig 3. Receiver operating characteristic (ROC) curves…
Fig 3. Receiver operating characteristic (ROC) curves of baseline MPV and ΔMPV72h-adm for 28-day all-cause mortality.
Area under the curve (AUC) of baseline MPV and ΔMPV72h-adm were 0.653 and 0.698, respectively.

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