Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Mar 9, 2024; 13(1): 88540
Published online Mar 9, 2024. doi: 10.5492/wjccm.v13.i1.88540
Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock
Xia Li, Sheng Wang, Jun Ma, Su-Ge Bai, Su-Zhen Fu
Xia Li, Jun Ma, Su-Ge Bai, Su-Zhen Fu, Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
Sheng Wang, Department of Physiology, Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Co-corresponding authors: Xia Li and Su-Zhen Fu.
Author contributions: Li X, Wang S, and Fu SZ conceived, designed and refined the study protocol; Ma J and Bai SG were involved in the data collection; Li X and Fu SZ analyzed the data; Li X wrote the paper; Wang S polished the language; Li X and Fu SZ contributed equally to this work as co-corresponding authors. Li X proposed, designed and conducted platelets analysis, performed data analysis and wrote the paper. Fu SZ was responsible for patient screening, enrollment, data analysis and paying for language polishing fees, both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-corresponding authors.
Institutional review board statement: According to the ethics committee review process, the paper entitled “The predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock” was submitted for review, We agree that it conform to the principles of the CFDA, GCP, ICH-GCP, declaration of Helsinki and the requirement of the medical ethics and the relevant laws and regulations, not to the safety of the subjects, the research scope of influence or scientific quality, suitable for quick review process. The audit conclusion agreed to conduct clinical research.
Informed consent statement: This article was a retrospective clinical data analysis with no human interventions, our ethical committee agreed to the study and we did not require signed informed consent form(s) or document(s).
Conflict-of-interest statement: We also confirm that all the listed authors have seen and approved the submitted manuscript. The authors do not have any possible conflicts of interest.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at lix0518@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xia Li, MS, Doctor, Department of Critical Care Medicine, Xingtai People Hospital, No. 16 Hongxing Street, Xingtai 054001, Hebei Province, China. lix0518@163.com
Received: October 1, 2023
Peer-review started: October 1, 2023
First decision: November 23, 2023
Revised: December 4, 2023
Accepted: January 2, 2024
Article in press: January 2, 2024
Published online: March 9, 2024
Processing time: 156 Days and 1.2 Hours
Abstract
BACKGROUND

Thrombocytopenia is common in patients with sepsis and septic shock.

AIM

To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit.

METHODS

A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited. Patient population characteristics and laboratory data were collected for analysis.

RESULTS

The study group consisted of 85 (39%) inpatients with bloodstream infection, and the control group consisted of 133 (61%) with negative results or contamination. The percentage decline in platelet counts (PPCs) in patients positive for pathogens [57.1 (41.3-74.6)] was distinctly higher than that in the control group [18.2 (5.1–43.1)] (P < 0.001), whereas the PPCs were not significantly different among those with gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection. Using receiver operating characteristic curves, the area under the curve of the platelet drop rate was 0.839 (95%CI: 0.783-0.895).

CONCLUSION

The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock. However, it cannot identify gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection.

Keywords: Platelet counts; Thrombocytopenia; Bloodstream infection; Sepsis; Shock

Core Tip: Thrombocytopenia is common in sepsis and septic shock, but there are few reports on the diagnostic value of thrombocytopenia in bloodstream infection. Our results found that the rate of platelet drop but not the lowest platelet count has a high predictive ability for bloodstream infection in patients with sepsis or septic shock. However, it cannot identify gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection. Dynamic detection of platelet counts appears to be an early alert for the clinician in identifying the site of infection and evaluating serious infection. This will guide the performance of blood cultures and the use of empirical antibiotics.