Evaluation of hemostatic biomarker abnormalities that precede platelet count decline in critically ill patients with sepsis

Abstract Purpose The hemostatic biomarkers for early diagnosis of sepsis-associated coagulopathy have not been identified. The purpose of this study was to evaluate hemostatic biomarker abnormalities preceding a decrease in platelet count, which is a surrogate indicator of overt coagulopathy in sepsis. Materials and Methods Seventy-five septic patients with a platelet count more than 80 × 10 3 / μ L were retrospectively analyzed. Hemostatic biomarkers at intensive care unit admission were compared between patients with and patients without a subsequent decrease in platelet count (≥ 30% within 5 days), and the ability of biomarkers to predict a decrease in platelet count was evaluated. Results Forty-two patients (56.0%) developed a subsequent decrease in platelet count. Severity of illness, incidence of organ dysfunction, and 28-day mortality rate were higher in patients with a subsequent decrease in platelet count. There were significant differences between patients with and patients without a subsequent decrease in platelet count in prothrombin time–international normalized ratio, fibrinogen, thrombin-antithrombin complex, antithrombin, protein C (PC), plasminogen, and α 2 -plasmin inhibitor ( α 2 -PI). Receiver operating characteristic curve analysis showed that PC (area under the curve, 0.869; 95% confidence interval, 0.699-0.951) and α 2 -PI (area under the curve, 0.885; 95% confidence interval, 0.714-0.959) were strong predictors of a subsequent decrease in platelet count. Conclusions Decreased PC and α 2 -PI activity preceded a decrease in platelet count in intensive care unit patients with sepsis.