The Importance of Abnormal Platelet Count in Patients with Clostridioides difficile Infection

Abstract

Background: Clostridium difficile infection (CDI) causes morbidity and mortality. Platelets have been increasingly recognized as an important component of innate and adaptive immunity. We aimed to assess the incidence of thrombocytopenia and thrombocytosis in CDI and the effect of an abnormal platelet count on clinical outcomes. Methods: This single-center, retrospective cohort study consisted of all adult patients hospitalized in Rabin Medical Center between 1 January 2013 and 31 December 2018 with laboratory confirmed CDI. The primary outcome was 30-day all-cause mortality. Risk factors for 30-day all-cause mortality were identified by univariable and multivariable analyses, using logistic regression. Results: A total of 527 patients with CDI were included. Among them 179 (34%) had an abnormal platelet count: 118 (22%) had thrombocytopenia and 61 (11.5%) had thrombocytosis. Patients with thrombocytosis were similar to control patients other than having a significantly higher white blood cell count at admission. Patients with thrombocytopenia were younger than control patients and were more likely to suffer from malignancies, immunosuppression, and hematological conditions. In a multivariable analysis, both thrombocytosis (OR 1.89, 95% CI 1.01–3.52) and thrombocytopenia (OR 1.70, 95% CI 1.01–2.89) were associated with 30-days mortality, as well as age, hypoalbuminemia, acute kidney injury, and dependency on activities of daily living. A sensitivity analysis restricted for patients without hematological malignancy or receiving chemotherapy revealed increased mortality with thrombocytosis but not with thrombocytopenia. Conclusions: In this retrospective study of hospitalized patients with CDI, we observed an association between thrombocytosis on admission and all-cause mortality, which might represent a marker for disease severity. Patients with CDI and thrombocytopenia also exhibited increased mortality, which might reflect their background conditions and not the severity of the CDI. Future studies should assess thrombocytosis as a severity marker with or without the inclusion of the WBC count.

Causal relationship between psoriasis vulgaris and dementia: Insights from Mendelian randomization analysis

“…Although peripheral immune cells cannot enter the central nervous system, abnormal peripheral immune function may also exacerbate neuroinflammation and promote neuronal injury by interacting with central nervous system resident immune cells 58,59 . Apart from the function of blood coagulation, platelets are increasingly regarded as an important part of innate immunity and adaptive immunity 60 . Until now, the presence of aberrant platelet‐related indices and its association with vascular dementia remains inconclusive in terms of being a risk factor.…”

“…58,59 Apart from the function of blood coagulation, platelets are increasingly regarded as an important part of innate immunity and adaptive immunity. 60 Until now, the presence of aberrant platelet-related indices and its association with vascular dementia remains inconclusive in terms of being a risk factor. A MVMR investigation was carried out to ascertain the potential impact of platelet-related indices (MPV, PDW and PLT) on the causal association between psoriasis vulgaris and VaD.…”

Platelets promote human macrophages-mediated macropinocytosis of Clostridioides difficile

“…In the context of CDI, the studies are scarce and generally evaluate the importance of the platelet count in the severity of the disease. Some reports propose that an increased platelets number is associated with a better prognosis (Byrn et al, 2012;Lee et al, 2014;Yan et al, 2017;Allegretti et al, 2020;Zhao et al, 2020), while other studies associate this to worse outcomes (Albrich and Rimland, 2007;Pant et al, 2009;Mihaȋlaȇ t al., 2019;Nseir et al, 2019;Phanchana et al, 2020;Buchrits et al, 2021). In severe cases of C. difficile infection, the intestine fails in its function as a barrier to both intestinal bacterial and toxins, allowing them to reach the portal circulation and developing extra-intestinal CDI (Lowenkron et al, 1996;Libby and Bearman, 2009;Steele et al, 2012;Abid and Bischof, 2019;Olsen et al, 2023).…”

“…Moreover, inflammation in the gut can induce platelet activation and migration (Gaertner et al, 2017;Shannon, 2021;Trivigno et al, 2023), then platelets attached to the activated endothelium promote monocyte migration (Huilcaman et al, 2022;Trivigno et al, 2023). Beneficial or detrimental roles related to clinical symptoms have been reported for platelets counts during CDI (Pant et al, 2009;Byrn et al, 2012;Lee et al, 2014;Yan et al, 2017;Mihaȋlăet al, 2019;Nseir et al, 2019;Allegretti et al, 2020;Phanchana et al, 2020;Zhao et al, 2020;Buchrits et al, 2021). Nevertheless, their modulatory functions on immune responses against C. difficile have not been addressed.…”

Platelet Indices Are the Promising Biomarkers in Monitoring Disease Activities in Patients with Syphilis

“…Platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW) are the most commonly used indicators to evaluate platelet activation and function. Increased PLT was found in community-acquired pneumonia, septic arthritis, active pulmonary tuberculosis (PTB), Clostridium difficile infection (CDI), and bronchiolitis (Buchrits et al, 2021;Mirsaeidi et al, 2010;Sulai and Tefferi, 2012). Decreased MPV and PDW were noted in adult tuberculosis during disease exacerbation and human immunodeficiency virus (HIV)-infected individuals (Korniluk et al, 2019;Nkambule et al, 2015).…”