Immature Platelets As a Predictor of Disease Severity and Mortality in Sepsis and Septic Shock: A Systematic Review

Abstract

Sepsis is associated with high morbidity and mortality, and short-term mortality remains above 30% despite relevant supportive and antibiotic treatments. The aim of this systematic review was to summarize and discuss the current evidence of the association of an increased number of circulating immature platelets with disease severity and mortality in patients with sepsis or septic shock. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered at the PROSPERO database (registration number: CRD42018104326). A systematic literature search was performed in PubMed, Web of Science, Scopus, and Embase on June 20, 2018, without time restrictions. The included studies were quality-assessed by the National Institutes of Health's Quality Assessment Tools. In total, 14 studies were included. The parameters used for the determination of platelet maturity were mean platelet volume, immature platelets fraction, reticulated platelet percentage, and absolute immature platelets count. Nine studies reported significantly increased immature platelet markers in nonsurvivors of septic shock compared with survivors, as well as in patients with severe sepsis or septic shock compared with patients without severe sepsis and septic shock. Six of these nine studies demonstrated that increased immature platelet markers were predictors of mortality and/or disease severity (area under the receiver operating curve: 0.599–0.886). This review suggests that an increased number of circulating immature platelets is associated with increased disease severity and mortality in patients with sepsis and septic shock. Larger studies are needed to confirm whether immature platelets should be routinely monitored to support the prediction of disease severity and mortality in septic patients.

The role of platelets in sepsis

“…A recent systematic review concludes that an increase in circulating immature platelets is associated with severe sepsis and increased mortality. 23 This indicates that platelet production is not only maintained but also increased in sepsis.…”

“…The immature platelet fraction and the mean platelet volume (MPV) are additional platelet biomarkers that can be monitored to assess platelet production. A recent systematic review concludes that an increase in circulating immature platelets is associated with severe sepsis and increased mortality 23 . This indicates that platelet production is not only maintained but also increased in sepsis.…”

Role of immature platelet fraction (IPF) in sepsis patients: A systematic review

“…[ 1 ] In spite of expanding information regarding its pathogenesis, death rates as high as 30% are still being detected, even with the best possible management. [ 2 ] Early finding is one of the most significant difficulties in the management of sepsis, as deferral in sepsis acknowledgement increases sepsis-related mortality. [ 2 ] Microcirculatory changes and coagulation abnormalities are thought to play vital roles in sepsis by activating platelets and resulting in end-organ damage.…”

Immature Platelet Dynamics in Immune-Mediated Thrombocytopenic States

“…Infectious processes may lead to decreases in mature platelets as the body fends off the infectious agent(s). Notably, even though thrombocytopenia can be seen in infections, A-IPCs are generally maintained so that at least platelet production attempts to keep up with the higher consumption (52); yet such A-IPC increases appear to correlate with higher mortality risk and disease severity in septic patients (53). These increases in immature platelets have been reported to occur earlier in patients prior to sepsis onset (54), which may be predictive of subsequent decreases in mature platelet counts once infection sets in Muronoi et al (55).…”