Background: Sepsis-associated disseminated intravascular coagulation (SAC) is associated with marked hemostatic changes including transient thrombocytopenia due to their enodogenous activation / consumption. The widespread activation of platelets contribute to vascular occlusions, fibrin deposition, multi-organ dysfunction, contributing to a two-fold increase in mortality.
Aims: The purpose of this study was to measure markers of platelet function in the plasma of patients with clinically established SAC and to determine their association to disease severity and outcome.
Methods: Plasma samples from 103 adult intensive care unit (ICU) patients with sepsis and suspected disseminated intravascular coagulation (DIC) were acquired from the University of Utah Hospital at the time of admission. Samples were shipped to Loyola University Chicago and stored at -80˚C prior to analysis. Plasma levels of CD40L, von Willebrand Factor (vWF), platelet factor-4 (PF-4), and microparticles (MP) were quantified using commercially available ELISAs.
Results: Markers of platelet activation were significantly elevated in patients with sepsis alone and with DIC compared to normal controls on ICU (p< 0.001). PF-4 was significantly decreased in non-survivors compared to survivors (p = 0.0156). Since platelet count is often reduced in patients with DIC, the platelet count and levels of platelet biomarkers were also evaluated. Markers of platelet activation were significantly elevated in patients with SAC compared to healthy volunteers, independent of platelet count, underscoring the importance of activation processes to this disease process. Of the markers studied, PF4 showed a significant difference based on DIC score and mortality, and differentiated the non-survivors compared to survivors. Levels of CD40L, vWF, PF4, and MP showed significant association with platelet count.
Conclusions: These studies suggest that the markers of platelet activation as primarily regulated by the number of circulating platelets and may be independent of the factors leading to their endogenous consumption.
|<50 (k/ul)||50-99 (k/ul)||100-149 (k/ul)||>150 (k/ul)||P (Kruskal-Wallis ANOVA)|
|CD40L (pg/ml)||127.0 ± 46.0||158.0 ± 42.0||274.0 ± 37.0||496.0 ± 94.0||0.0063|
|vWF (%)||218.0 ± 35.0||268.0 ± 18.0||274.0 ± 16.0||232.0 ± 8.6||0.0452|
|PF-4 (ng/ml)||46.0 ± 3.4||52.0 ± 5.6||81.0 ± 8.2||84.0 ± 4.6||<0.0001|
|MP (nM)||20.0 ± 4.8||20.0 ± 5.5||29.0 ± 4.3||47.0 ± 4.0||<0.0001|
[Markers of Platelet Activation on Day 0 vs. Platelet Count.]
To cite this abstract in AMA style:Hoppensteadt D, Wegryzn G, Walborn A, Rondina M, Fareed J. Biomarkers of Platelet Activation and their Prognostic Value in Patients in Sepsis Associated Coagulopathy [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/biomarkers-of-platelet-activation-and-their-prognostic-value-in-patients-in-sepsis-associated-coagulopathy/. Accessed November 26, 2020.
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