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Immature Platelet Fraction in Septic Patients: Clinical Relevance of Immature Platelet Fraction is Limited to the Sensitive and Accurate Discrimination of Septic Patients From Non-Septic Patients, Not to the Discrimination of Sepsis Severity

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Background: The immature platelet fraction (IPF) reflects the degree of reticulated platelets. We evaluated performances of IPF as a biomarker for the discrimination of septic patients from non-septic patients and sepsis severity. Methods: Total 312 patients admitted between March and July 2013 were enrolled and samples were obtained at admission. Lactate (LA), procalcitonin (PCT), C-reactive protein (CRP), immature granulocyte fraction (IG), immature reticulocyte fraction (IRF), and IPF were analyzed as sepsis biomarkers and their performances were compared. Results: The performance of IPF (area under the curve [AUC]=0.868) in the discrimination of septic patients from non-septic patients was comparable to PCT/CRP/LA/IG (AUC=0.923/0.940/0.781/0.812, P=0.233/0.106/0.186/0.353, respectively), and was significantly better than the IRF (AUC=0.658, P=0.007). Sensitivity (89.8%, 95% confidence interval [CI] 84.9-99.8%) and accuracy (83.2%, 95% CI 78.8-90.0%) of IPF were the best among all biomarkers. The performance of IPF in discriminating septic patients from non-septic patients with local infection showed similar results. However, the IPF could not efficiently discriminate sepsis severity (AUC=0.599), similar to other biomarkers (AUC=0.519-0.752). Conclusions: The IPF possessed high sensitivity/accuracy in discriminating septic patients from non-septic patients, regardless of local infection status. However, the IPF did not efficiently discriminate sepsis severity. The clinical relevance of IPF as a sepsis biomarker is, therefore, limited to sensitive and accurate discrimination of septic patients from non-septic patients, not discrimination of sepsis severity.

Abstract

Background: The immature platelet fraction (IPF) reflects the degree of reticulated platelets. We evaluated performances of IPF as a biomarker for the discrimination of septic patients from non-septic patients and sepsis severity. Methods: Total 312 patients admitted between March and July 2013 were enrolled and samples were obtained at admission. Lactate (LA), procalcitonin (PCT), C-reactive protein (CRP), immature granulocyte fraction (IG), immature reticulocyte fraction (IRF), and IPF were analyzed as sepsis biomarkers and their performances were compared. Results: The performance of IPF (area under the curve [AUC]=0.868) in the discrimination of septic patients from non-septic patients was comparable to PCT/CRP/LA/IG (AUC=0.923/0.940/0.781/0.812, P=0.233/0.106/0.186/0.353, respectively), and was significantly better than the IRF (AUC=0.658, P=0.007). Sensitivity (89.8%, 95% confidence interval [CI] 84.9-99.8%) and accuracy (83.2%, 95% CI 78.8-90.0%) of IPF were the best among all biomarkers. The performance of IPF in discriminating septic patients from non-septic patients with local infection showed similar results. However, the IPF could not efficiently discriminate sepsis severity (AUC=0.599), similar to other biomarkers (AUC=0.519-0.752). Conclusions: The IPF possessed high sensitivity/accuracy in discriminating septic patients from non-septic patients, regardless of local infection status. However, the IPF did not efficiently discriminate sepsis severity. The clinical relevance of IPF as a sepsis biomarker is, therefore, limited to sensitive and accurate discrimination of septic patients from non-septic patients, not discrimination of sepsis severity.

참고문헌 (35)

  1. Patel GP, "New treatment strategies for severe sepsis and septic shock", Curr Opin Crit Care, 9, pp.390~396 (2003)
  2. Harbarth S, "Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis", Am J Respir Crit Care Med, 164, pp.396~402 (2001)
  3. Müller B, "Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit", Crit Care Med, 28, pp.977~983 (2000)
  4. Reinhart K, "New approaches to sepsis: molecular diagnostics and biomarkers", Clin Microbiol Rev, 25, pp.609~634 (2012)
  5. Dhainaut JF, "Dynamic evolution of coagulopathy in the first day of severe sepsis: relationship with mortality and organ failure", Crit Care Med, 33, pp.341~348 (2005)
  6. Levi M, "Bidirectional relation between inflammation and coagulation", Circulation, 109, pp.2698~2704 (2004)
  7. Briggs C, "Assessment of an immature platelet fraction (IPF%) in peripheral thrombocytopenia", Br J Haematol, 126, pp.93~99 (2004)
  8. Kickler TS, "A clinical evaluation of high fluorescent platelet fraction percentage in thrombocytopenia", Am J Clin Pathol, 125, pp.282~287 (2006)
  9. 정혜영, "Immature Platelet Fraction: Establishment of a Reference Interval and Diagnostic Measure for Thrombocytopenia", Annals of Laboratory Medicine, 30(5), pp.451~459 (2010), 대한진단검사의학회
  10. Cremer M, "Immature platelet fraction as novel laboratory parameter predicting the course of neonatal thrombocytopenia", Br J Haematol, 144, pp.619~621 (2009)
  11. Zucker ML, "Mechanism of thrombocytopenia in chronic hepatitis C as evaluated by the immature platelet fraction", Int J Lab Hematol, 34, pp.525~532 (2012)
  12. De Blasi RA, "Immature platelet fraction in predicting sepsis in critically ill patients", Intensive Care Med, 39, pp.636~643 (2013)
  13. Di Mario A, "Immature platelet fraction (IPF) in hospitalized patients with neutrophilia and suspected bacterial infection", J Infect, 59, pp.201~206 (2009)
  14. Enz Hubert RM, "Association of the immature platelet fraction with sepsis diagnosis and severity", Sci Rep, 5, pp.8019~ (2015)
  15. Vincent JL, "Clinical sepsis and septic shock--definition, diagnosis and management principles", Langenbecks Arch Surg, 393, pp.817~824 (2008)
  16. Levy MM, "SCCM", ESICM, ATS, pp.SIS International Sepsis Definitions Conference, Crit Care Med[DOI]
  17. Levi M, "Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology", Br J Haematol, 145, pp.24~33 (2009)
  18. Zakariah AN, "Combination of biphasic transmittance waveform with blood procalcitonin levels for diagnosis of sepsis in acutely ill patients", Crit Care Med, 36, pp.1507~1512 (2008)
  19. Kofoed K, "Use of plasma C-reactive protein, procalcitonin, neutrophils, macrophage migration inhibitory factor, soluble urokinase-type plasminogen activator receptor, and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: a prospective study", Crit Care, 11, pp.R38~ (2007)
  20. Gibot S, "Combination biomarkers to diagnose sepsis in the critically ill patient", Am J Respir Crit Care Med, 186, pp.65~71 (2012)
  21. Tsalik EL, "Discriminative value of inflammatory biomarkers for suspected sepsis", J Emerg Med, 43, pp.97~106 (2012)
  22. Mikkelsen ME, "Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock", Crit Care Med, 37, pp.1670~1677 (2009)
  23. Shapiro NI, "Serum lactate as a predictor of mortality in emergency department patients with infection", Ann Emerg Med, 45, pp.524~528 (2005)
  24. Howell MD, "Occult hypoperfusion and mortality in patients with suspected infection", Intensive Care Med, 33, pp.1892~1899 (2007)
  25. Tschaikowsky K, "Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis", J Crit Care, 26, pp.54~64 (2011)
  26. Tschaikowsky K, "Lipopolysaccharide-binding protein for monitoring of postoperative sepsis: complemental to C-reactive protein or redundant?", PLoS One, 6, pp.e23615~ (2011)
  27. Al-Subaie N, "C-reactive protein as a predictor of outcome after discharge from the intensive care: a prospective observational study", Br J Anaesth, 105, pp.318~325 (2010)
  28. Ho KM, "C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study", Intensive Care Med, 34, pp.481~487 (2008)
  29. Litton E, "C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a nested case-control study", Crit Care Resusc, 9, pp.19~25 (2007)
  30. Ranzani OT, "Failure to reduce C-reactive protein levels more than 25% in the last 24 hours before intensive care unit discharge predicts higher in-hospital mortality: a cohort study", J Crit Care, 27, pp.525~ (2012)
  31. Silvestre J, "Should C-reactive protein concentration at ICU discharge be used as a prognostic marker?", BMC Anesthesiol, 27, pp.17~ (2010)
  32. Hermans MA, "The value of the Mortality in Emergency Department Sepsis (MEDS) score, C reactive protein and lactate in predicting 28-day mortality of sepsis in a Dutch emergency department", Emerg Med J, 29, pp.295~300 (2012)
  33. Ruzicka K, "The new hematology analyzer Sysmex XE-2100: performance evaluation of a novel white blood cell differential technology", Arch Pathol Lab Med, 125, pp.391~396 (2001)
  34. Briggs C, "New quantitative parameters on a recently introduced automated blood cell counter--the XE 2100", Clin Lab Haematol, 22, pp.345~350 (2000)
  35. Hong KH, "Prognostic value of immature platelet fraction and plasma thrombopoietin in disseminated intravascular coagulation", Blood Coagul Fibrinolysis, 20, pp.409~414 (2009)

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