Association Between Platelet Levels and 28-Day Mortality in Patients With Sepsis: A Retrospective Analysis of a Large Clinical Database MIMIC-IV

Wang, Danni; Wang, Suning; Wu, Hao; Gao, Jiansheng; Huang, Kairong; Xu, Danhong; Huang-yao, RU

doi:10.3389/fmed.2022.833996

Cited by 17 publications

(16 citation statements)

References 35 publications

(35 reference statements)

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“…Whereas the PESI and sPESI demonstrated the same limitations in our two unselected cohorts, PATHOS score is based on fundamental and easily available items used to assess circulatory shock, pulmonary dysfunction, acute cardiac damage, and platelet count (the latter being an independent predictor of IHM in more conditions than just PE). 8,[28][29][30] According to our results, the positive overall NRIs in the comparisons between PATHOS and PESI and PATHOS and sPESI confirm that PATHOS has better discrimination accuracy than the older measures, showing that a net percentage of 31% (PATHOS vs. PESI) and 29% (PATHOS vs. sPESI) of patients without IHM were correctly reclassified by the new measure. Thus, compared with the other two scores, PATHOS has a higher ability to estimate patients at low risk for IHM than the PESI and sPESI.…”

Section: Discussionsupporting

confidence: 69%

“…Notably, our two cohorts are very different in terms of demographic and clinical characteristics due to their different locations and resident populations, so they reflect the actual variety of patients and the need for a simple and effective score in an emergency setting. Whereas the PESI and sPESI demonstrated the same limitations in our two unselected cohorts, PATHOS score is based on fundamental and easily available items used to assess circulatory shock, pulmonary dysfunction, acute cardiac damage, and platelet count (the latter being an independent predictor of IHM in more conditions than just PE) [ 8 , 28 – 30 ]. According to our results, the positive overall NRIs in the comparisons between PATHOS and PESI and PATHOS and sPESI confirm that PATHOS has better discrimination accuracy than the older measures, showing that a net percentage of 31% (PATHOS vs. PESI) and 29% (PATHOS vs. sPESI) of patients without IHM were correctly reclassified by the new measure.…”

Section: Discussionmentioning

confidence: 99%

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Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score

Spampinato¹,

Covino²,

Passaro³

et al. 2022

Clin Exp Emerg Med

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Objective: According to the 2019 European Society of Cardiology (ESC) guidelines on PE, prognosis is calculated using the Pulmonary Embolism Severity Index (PESI), a complex score with debated validity, or simplified PESI (sPESI), and ESC class risk. We have developed and validated a new risk score for in-hospital mortality (IHM) of patients with PE in the emergency department.Methods: This retrospective, dual-center cohort study was conducted in the emergency departments of two third-level university hospitals. Patients aged >18 years with a contrast-enhanced computed tomography-confirmed PE were included. Clinical variables and laboratory tests were evaluated blindly to IHM. Multivariable logistic regression was performed to identify the new score's predictors, and the new score was compared with the PESI, sPESI, and shock index.Results: A total of 1,358 patients were included in this study: 586 in the derivation cohort and 772 in the validation cohort, with a global 10.6% of IHM. Platelet count, age, troponin, heart rate, oxygenation, and systolic blood pressure were identified as independent predictors and are included in the PATHOS score. The PATHOS score showed good calibration and high discrimination, with an area under the receiver operating characteristics curve of 0.83 (95% confidence interval [CI], 0.77-0.89) in the derivation population and 0.74 (95% CI, 0.68-0.80) in the validation cohort, which is significantly higher than the PESI, sPESI, and shock index in both cohorts (P<0.01 for all comparisons). Conclusion:PATHOS is a simple and effective prognostic score for predicting IHM in patients with PE in an emergency setting.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score

Spampinato¹,

Covino²,

Passaro³

et al. 2022

Clin Exp Emerg Med

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“…In COVID-19 patients, platelets coordinate with neutrophils to release NETs, which can induce platelet-neutrophil aggregates with thrombocytopenia ( 38 , 39 ). These can activate the procoagulant cascade, which is associated with the prognosis of septic death and microvascular thrombosis and subsequent organ dysfunction ( 40 , 41 ). Consistent with our findings, a recent study from Thailand found that PWR can be an accurate predictor of in-hospital mortality in patients with severe COVID-19 pneumonia ( 42 ).…”

Section: Discussionmentioning

confidence: 99%

Role of increased neutrophil extracellular trap formation on acute kidney injury in COVID-19 patients

Kim

Lee

et al. 2023

Front. Immunol.

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BackgroundA strong association between elevated neutrophil extracellular trap (NET) levels and poor clinical outcomes in patients with coronavirus infection 2019 (COVID-19) has been reported. However, while acute kidney injury (AKI) is a common complication of COVID-19, the role of NETs in COVID-19-associated AKI is unclear. We investigated the association between elevated NETs and AKI and the prognostic role of NETs in COVID-19 patients.MethodsTwo representative markers of NETs, circulating nucleosomes and myeloperoxidase-DNA, were measured in 115 hospitalized patients. Serum levels of interleukin [IL]-6, monocyte chemotactic protein-1 [MCP-1], plasma von Willebrand factor (vWF) and urinary biomarkers of renal tubular damage (β2-microglobulin [β2M] and kidney injury molecule 1 [KIM-1]) were measured.ResultsAKI was found in 43 patients (37.4%), and pre-existing chronic kidney disease (CKD) was a strong risk factor for AKI. Higher circulating NET levels were a significant predictor of increased risk of initial ICU admission, in-hospital mortality (adjusted HR 3.21, 95% CI 1.08–9.19) and AKI (OR 3.67, 95% CI 1.30-10.41), independent of age, diabetes, pre-existing CKD and IL-6 levels. There were strong correlations between circulating nucleosome levels and urinary KIM-1/creatinine (r=0.368, p=0.001) and β2M (r=0.218, p=0.049) levels. NETs were also strongly closely associated with serum vWF (r = 0.356, p<0.001), but not with IL-6 or MCP-1 levels.ConclusionsElevated NETs were closely associated with AKI, which was a strong predictor of mortality. The close association between NETs and vWF may suggest a role for NETs in COVID-19-associated vasculopathy leading to AKI.

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“…As platelet count is a simple, cheap, and easily available biomarker and has been independently associated with disease severity and mortality risk in intensive care unit (ICU) H5 (40)(41)(42) , it has been rapidly adopted as a potential biomarker for COVID-19 patients. The number of platelets was reported to be significantly reduced in COVID-19 patients (43,44) 49) The previous meta-analysis reported that platelets were not an appropriate marker for considering the severity of COVID-19 disease.…”

Section: Discussionmentioning

confidence: 99%

A hospital-based study to assess various biomarkers for prognostic prediction of clinical outcome in COVID-19 disease

Padhi

Shaw

Khatoon

et al. 2022

Preprint

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COVID-19 pandemic has inflicted a painful unforgettable number of deaths throughout the world. Hematological inflammatory and organ-specific biomarkers are universally practiced in helping clinical decisions in various infectious diseases. Accordingly, their role in predicting progression and severity, and fatal outcome of COVID-19 was investigated to take initial appropriate treatment measures to reduce associated mortality. Methods: The retrospective analysis of a total of 126 COVID-19 cases representing mild, moderate, severe, and succumbed cases were assessed for the pattern of hematological, inflammatory, and organ-specific biomarkers. Results: A total of 126 proven cases of SARS-CoV-2 infection were retrospectively analyzed for the association of various biomarkers with the COVID-19 disease progression. The CBC analysis showed that the median TLC was high for the severe group of both males (12.49 x 103/mcl) and females (14.23 x103/mcl). Similarly, the neutrophil count was also found high in the severe group, whereas the monocytes count showed low median values in severe cases, but both these parameters had no significant difference among the males and the females. The platelet count showed a significant difference (p=0.018) among the non-severe and severe groups between males and females. Among inflammatory markers, D-dimer, CRP, LDH, and APTT showed a higher median value in severe cases among both the males and females while ESR value was higher in non-severe cases and ferritin showed similar values in both severe and non-severe cases. The liver and kidney function parameters were also analyzed and a significant P-value was found for ALP (p=0.004), ALT (p=0.032), and AST (p=0.009) in the non-severe vs. severe category of COVID-19 patients. Discussion: High TLC, neutrophilia, lymphopenia, thrombocytopenia, and eosinopenia are the potential risk factor for the progression of COVID-19 disease for severe and fatal outcomes. Inflammatory markers of D-dimer, CRP, LDH, APTT, and ferritin above normal range also carries the potential risk of severe and fatal outcome in COVID-19 disease. Higher ALT, AST, and serum creatinine may also carry a poor prognosis.

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Association Between Platelet Levels and 28-Day Mortality in Patients With Sepsis: A Retrospective Analysis of a Large Clinical Database MIMIC-IV

Cited by 17 publications

References 35 publications

Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score

Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score

Role of increased neutrophil extracellular trap formation on acute kidney injury in COVID-19 patients

A hospital-based study to assess various biomarkers for prognostic prediction of clinical outcome in COVID-19 disease

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