Evaluation of the delta of immature platelet fraction as a predictive biomarker of inflammatory response after cardiac surgery

Abstract

<jats:sec><jats:title>Aims</jats:title><jats:p>Cardiac surgery (CS) can induce an inflammatory response (IR) that is associated with poorer outcomes. Immature platelets are among the factors that may be associated with IR development. We aimed to evaluate whether immature platelet fraction (IPF) could be a predictive biomarker for IR and whether IPF could improve the prognosis assessment of IR for Acute Physiologic and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) following CS.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Three-hundred and twenty-seven (327) patients who underwent CS were enrolled during the study period. IR was defined according to the need for vasopressor support (&gt;48 hours). Perioperative variables and outcomes were registered in our database. IPF was measured immediately following CS and at 24 hours by Sysmex XN analyzer and the difference between both measurements (ΔIPF) was calculated. To assess the relationship between ΔIPF and IR, univariate and multivariate logistic regression were performed. To analyse the additive value of ΔIPF in APACHE II and SOFA scores in predicting IR, an area under the receiver operating characteristic (AUROC) curve was calculated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 327 patients included, 60 patients (18.3%) developed IR. Multivariate analysis showed ΔIPF was significantly associated with IR (OR: 1.26; 95% CI: 1.01 to 1.56; p=0.038). The combination of ΔIPF with scores improved the AUROC for IR prediction: 0.629 vs 0.728 (p=0.010) for APACHE II and 0.676 vs 0.715 (p=0.106) for SOFA.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>These findings suggested that ΔIPF may be a useful and low-cost biomarker for the early identification of patients at risk of IR development.</jats:p></jats:sec>

Biomaker evaluation for major adverse cardiovascular event development in patients undergoing cardiac Surgery

“…Previous studies demonstrated the association of IPF with inflammatory response complications but only one of these was performed in CS patients [17]. IPF levels may be useful as a biomarker for the early identification of patients at risk of inflammatory response development after CS.…”

“…They are metabolically and enzymatically more active than mature platelets and have a greater prothrombotic activity, which is closely related with decompensated inflammatory status [16]. In addition, IPF has recently shown an association between inflammatory response and outcomes after CS [17]. In consequence, it seems likely that IPF may be associated with MACE after CS.…”

Role of Reticulated Platelets in Cardiovascular Disease

“…41 Studies from several research groups confirmed that RPs determined by automated hematology analyzers had a modest but significant correlation with RP levels determined by TO staining and flow cytometry. 39,[42][43][44][45][46][47] However, these analyzers have different reference ranges and only showed modest correlations between each other requiring the usage of the same system when applied in multicenter clinical trials. Thus, clinical trials using different analyzer systems cannot be directly compared.…”

Immune Cell Plasticity in Inflammation: Insights into Description and Regulation of Immune Cell Phenotypes

“…Occurrence of immature platelets in sepsis patients is well-documented and can serve as a predictor for mortality and identification of sepsis patients [ 198 , 199 , 200 ]. Equally, the immature platelet fraction can aid in identification of inflammatory complications in cardiac surgery patients [ 201 ]. Inflammatory changes, such as increased IL-1β levels, indeed favor megakaryocyte rupture, potentially leading to observable changes in platelet numbers and phenotypes [ 202 ].…”