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Levels of circulating microparticles in septic shock and sepsis-related complications: a case-control study
Annalisa Boscolo1, Elena Campello2, Diana Bertini1
1Unit of Anesthesia and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy.
Background:
Microparticles (MP) have been largely studied as potential biomarkers in septic shock (SS) though their biological and clinical relevance is still unclear. This case-control study describes the trend of various MP subtypes during SS to evaluate their possible association with severity of illness and sepsis-related complications (disseminated intravascular coagulation [DIC] and acute kidney injury [AKI]).
Methods:
Forty patients admitted to the Intensive Care Unit with SS and 40 matched healthy volunteers were recruited. AnnexinV+, E-selectin+, thrombomodulin (TM+), leukocyte-derived (CD45+, CD36+) and platelet-derived MP (PMP-expressed as PMP/platelets ratio) were measured by flow-cytometry at baseline, on day 1, 3 and 7 after diagnosis. Severity of illness was assessed by Sequential Organ Failure Assessment Score, duration of vasoactive support and mechanical ventilation. Sepsis-related complications were considered.
Results:
Overall, septic patients showed higher levels of all MP considered compared to controls. TM+MP were significantly lower in more severe sepsis, while CD36+MP and PMP/platelets ratio were significantly increased in patients requiring longer vasoactive support and mechanical ventilation. As for sepsis-related complications, a higher PMP/platelets ratio in patients who developed DIC and increased E-selectin+MP in subjects who developed AKI were observed. PMP/platelets ratio at baseline was significantly associated with longer vasoactive support (OR=1.59 [1.05-2.42]), longer mechanical ventilation (OR=1.6 [1.06-2.42]) and DIC occurrence (OR=1.45 [1.08-1.96]).
Conclusions:
A global response through extra-vesiculation of endothelial cells, leukocytes and platelets during the early stages of SS was confirmed. The cellular activation was detected until day 3 after diagnosis. PMP/platelets ratio at diagnosis may be useful to evaluate SS severity and DIC occurrence.
Insights
Microparticle levels increase in septic shock patients, with platelet-derived microparticles indicating severity and disseminated intravascular coagulation risk. Cellular activation persists for three days post-diagnosis.
Area of Science:
- Critical Care Medicine
- Biomarker Discovery
- Hematology
Background:
- Microparticles (MP) are studied as biomarkers in septic shock (SS), but their clinical relevance remains unclear.
- This study investigates MP subtype trends in SS to assess associations with illness severity and complications like disseminated intravascular coagulation (DIC) and acute kidney injury (AKI).
Purpose of the Study:
- To evaluate the trend of various microparticle subtypes in septic shock patients.
- To determine the association of microparticle levels with disease severity and sepsis-related complications (DIC, AKI).
Main Methods:
- A case-control study involving 40 septic shock patients and 40 healthy volunteers.
- Flow cytometry was used to measure AnnexinV+, E-selectin+, thrombomodulin (TM+), leukocyte-derived (CD45+, CD36+), and platelet-derived MPs (PMP/platelets ratio) at multiple time points.
- Illness severity was assessed using Sequential Organ Failure Assessment Score, vasoactive support duration, and mechanical ventilation duration.
Main Results:
- Septic patients exhibited higher levels of all measured MPs compared to controls.
- CD36+ MPs and the PMP/platelets ratio correlated with longer vasoactive support and mechanical ventilation.
- Increased E-selectin+ MPs were linked to AKI development, while a higher PMP/platelets ratio was associated with DIC.
- Baseline PMP/platelets ratio predicted longer vasoactive support, mechanical ventilation, and DIC occurrence.
Conclusions:
- A systemic response involving endothelial cells, leukocytes, and platelets via microparticle release occurs in early septic shock.
- Cellular activation, indicated by MPs, was detectable up to day 3 post-diagnosis.
- The PMP/platelets ratio at diagnosis is a potential indicator for assessing septic shock severity and predicting DIC.
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