Background
Methods
Study design
Study population
Eligibility criteria | |
Study I | 1. Patients who were 18 to 80 years of age. |
2. Patients meet the criteria for sepsis which defined by the surviving sepsis campaign. | |
2.1 Patients had a documented or suspected infection | |
2.2 Patients had some of the following conditions: | |
2.2.1 Fever (>38.3 °C) or Hypothermia (<36 °C) | |
2.2.2 Heart rate >90 beats/min; | |
2.2.3 White blood cell count >12 × 109/L or <4 × 109/L | |
2.2.4 Tachypnea | |
2.2.5 Altered mental status | |
2.2.6 Significant edema or positive fluid balance (>20 mL/kg/24 h) | |
2.2.7 Plasma procalcitonin more than two SD above the normal value | |
2.2.8 Arterial hypoxemia (PaO2/FiO2 <300) | |
2.2.9 Creatinine increase >44.2 μmol/L | |
2.2.10 Arterial hypotension (SBP <90 mmHg, MAP <70 mmHg) | |
2.2.11 Coagulation abnormalities (INR >1.5 or APTT >60 s) | |
2.2.12 Thrombocytopenia (platelet count <100 × 109/L) | |
2.2.13 Hyperbilirubinemia (plasma total bilirubin >70 mmol/L) | |
2.2.14 Hyperlactatemia (>1 mmol/L) | |
2.2.15 Decreased capillary refill or mottling | |
3. Patients whose platelet counts were under 100 × 109/L. | |
Study II | 1. Patients whose platelet counts were under 50 × 109/L. |
2. Patients meet the criteria for severe sepsis which defined by the surviving sepsis campaign. | |
2.1 Patients had sepsis-induced tissue hypoperfusion or organ dysfunctionn (any of the following thought to be due to the infection) | |
2.1.1 Sepsis-induced hypotension | |
2.1.2 Hyperlactatemia (>2 mmol/L) | |
2.1.3 Urine output <0.5 mL/kg/h for more than 2 h despite adequate fluid resuscitation | |
2.1.4 Acute lung injury with PaO2/FiO2 <250 | |
2.1.5 Creatinine >2.0 mg/dL (176.8 mol/L) | |
2.1.6 Bilirubin >2 mg/dL (34.2 mol/L) | |
2.1.7 Coagulation abnormalities (INR >1.5) | |
2.1.8 Thrombocytopenia (platelet count <100 × 109/L) | |
Exclusion criteria | |
1. Patients with malignancies or bone marrow stem cell disorders within the last 2 years | |
2. Patients who received chemotherapy or immunosuppressive agents within 6 months | |
3. Patients who had a history of ITP or such autoimmune diseases | |
4. Patients after cardiopulmonary resuscitation (CPR) | |
5. Patients who are less than 18 years or more than 85 years of age | |
6. Pregnant or puerperal patients | |
7. Patients having acute gastrointestinal hemorrhage | |
9. Patients who have a history of bone marrow, lung, liver, kidney, or small bowel transplantation | |
10. Patients with end-stage hepatic or renal failure | |
11. Patients with disseminated intravascular coagulation (DIC) | |
12. Patients with drug (antibiotics or heparin)-associated thrombocytopenia | |
13. Gut failure or strict nil by mouth following surgery |
Study end points
Data collection
Assessment of platelet desialylation
Statistics
Results
Baseline characteristics and clinical features for all of the patients
Comparison of septic patients with or without thrombocytopenia
Variables | Sepsis without thrombocytopenia (n = 134) | Sepsis with thrombocytopenia (n = 127) |
P value |
---|---|---|---|
Age (year) | 69.5 (54.5, 78.3) | 68 (55.0, 77.0) | 0.468 |
Male | 91 (67.9) | 84 (66.1) | 0.793 |
APACHE II | 18.5 (15.3, 23.8) | 20 (10, 24.8) | 0.861 |
Predicted death rate (%) | 31.5 (21, 45.2) | 37.3 (20.4, 53.5) | 0.217 |
SOFA | 5 (3.25, 7) | 10 (5, 12) | <0.001 |
PCT (ng/mL) | 1.55 (0.32, 5.36) | 6.69 (1.0, 38.9) | <0.001 |
SA (mmol/L) | 732.8 ± 156.5 | 669.1 ± 143.9 | 0.089 |
MAP (mmHg) | 86.8 ± 15.5 | 79.6 ± 14.7 | <0.001 |
Heart rate (beat/min) | 93.3 (88.0, 106.3) | 98 (84, 116) | 0.221 |
White blood cell (×109/L) | 12.5 (8.4, 15.4) | 14.1 (7.81, 15.5) | 0.352 |
Platelet count (×109/L) | 196.5 (143.5, 299.75) | 45 (33.25, 64.75) | <0.001 |
BUN (mmol/L) | 7.4 (5.18, 17.3) | 7.51 (4.06, 14.6) | 0.402 |
Creatinine (μmol/L) | 81 (56.0, 119.0) | 88 (63.3, 225.0) | 0.036 |
Total bilirubin (μmol/L) | 14.8 (9.9, 23.1) | 18.8 (11.4, 35.0) | 0.098 |
Albumin (g/L) | 25.5 ± 3.48 | 24.8 ± 5.75 | 0.267 |
Infection pathogens (%) | |||
Escherichia coli
| 12 (8.96) | 25 (19.7) | 0.020 |
Klebsiella pneumoniae
| 22 (16.4) | 11 (8.66) | 0.065 |
Pseudomonas aeruginosa
| 30 (22.4) | 11 (8.66) | 0.030 |
Acinetobacter baumanii
| 13 (9.70) | 7 (5.51) | 0.248 |
Staphylococcus aureus
| 21 (15.7) | 5 (3.93) | 0.020 |
Streptococcus pneumonae
| 1 (0.75) | 2 (1.57) | 0.641 |
Enterococcus faecium
| 5 (3.73) | 4 (3.15) | 0.999 |
Chicken enterococcus
| 1 (0.75) | 2 (1.57) | 0.614 |
Proteus mirabilis
| 0 | 1 (0.78) | 0.487 |
Candida albicans
| 1 (0.75) | 2 (1.57) | 0.614 |
Aspergillus
| 3 (2.24) | 7 (5.51) | 0.207 |
Viruses | 17 (12.7) | 36 (28.3) | 0.002 |
New Bunya virus | 0 | 21 (16.5) | <0.001 |
Influenza A virus subtype H1N1 | 6 (4.48) | 6 (4.72) | 0.999 |
Others | 11 (10.4) | 9 (9.45) | 0.818 |
Infection sites (%) | |||
Lung | 69 (51.5) | 29 (22.8) | <0.001 |
Bloodstream | 8 (5.97) | 33 (23.6) | <0.001 |
Abdominal cavity | 11 (8.21) | 15 (11.1) | 0.409 |
Hepatobiliary system | 8 (5.97) | 9 (6.9) | 0.804 |
Urinary system | 6 (4.48) | 8 (6.9) | 0.589 |
Surgical incision | 3 (2.24) | 3 (6.9) | 0.632 |
Skin and soft tissue | 2 (1.49) | 2 (1.4) | 0.668 |
Central nervous system | 2 (1.49) | 1 (1.4) | 0.520 |
Others | 25 (18.7) | 27 (21.3) | 0.644 |
Platelet desialylation level (%) | |||
RCA-I | 90.14 ± 8.88 | 95.64 ± 4.19 | 0.014 |
ECL | 2.33 ± 1.90 | 5.70 ± 4.37 | <0.001 |
sWGA | 0.15 ± 0.95 | 0.50 ± 0.293 | <0.001 |
Mechanical ventilation | 63 (47.0) | 72 (56.7) | 0.137 |
Renal replacement therapy | 19 (14.2) | 32 (25.2) | 0.029 |
Septic shock | 11 (8.2) | 24 (18.9) | 0.017 |
ARDS | 30 (22.4) | 34 (26.8) | 0.472 |
Bleeding | 32 (23.9) | 29 (22.8) | 0.884 |
28-day mortality | 19 (14.2) | 46 (36.2) | <0.001 |
Comparison of antimicrobial therapy plus oseltamivir with antimicrobial therapy alone in severe sepsis patients with thrombocytopenia
Variables | Control (n = 52) | Oseltamivir (n = 54) |
P value |
---|---|---|---|
Platelet response rate, % (n) | 65.4 (34) | 83.3 (45) | 0.045 |
Platelet recovery time (day) | 7 (5, 10) | 5 (4, 6) | 0.003 |
Platelet transfusion (apheresis unit) | 1.35 ± 1.98 | 0.676 ± 1.36 | 0.044 |
Bleeding (%) | 9 (17.3) | 11 (20.4) | 0.805 |
28-day mortality (%) | 22 (42.3) | 19 (35.2) | 0.550 |
Variables | Hazard ratio | 95% CI |
P value | |
---|---|---|---|---|
Lower | Upper | |||
Age | 1.020 | 0.990 | 1.051 | 0.189 |
Sex | 0.938 | 0.726 | 1.212 | 0.626 |
APACHE II | 1.105 | 0.951 | 1.284 | 0.191 |
SOFA | 0.578 | 0.365 | 0.965 | 0.029 |
Platelet recovery time | 0.798 | 0.636 | 0.990 | 0.042 |
Platelet count | 1.011 | 0.983 | 1.039 | 0.463 |