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PLoS One. 2014 Sep 30;9(9):e108589. doi: 10.1371/journal.pone.0108589. eCollection 2014.

The role of whole blood impedance aggregometry and its utilisation in the diagnosis and prognosis of patients with systemic inflammatory response syndrome and sepsis in acute critical illness.

Author information

1
Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, Wales, United Kingdom.
2
NISCHR Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, Wales, United Kingdom.
3
NISCHR Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, Wales, United Kingdom; Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, Wales, United Kingdom.
4
NISCHR Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, Wales, United Kingdom; Intensive Therapy Unit, Abertawe Bro Morgannwg University Health Board, Swansea, Wales, United Kingdom.
5
NISCHR Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, Wales, United Kingdom; School of Applied Science, University of Wales Institute Cardiff, Cardiff, Wales, United Kingdom.
6
College of Engineering, Swansea University, Singleton Park, Swansea, Wales, United Kingdom.
7
Department of Haematology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
8
NISCHR Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, Wales, United Kingdom; Cardiac Intensive Care Unit, Abertawe Bro Morgannwg University Health Board, Swansea, Wales, United Kingdom.

Abstract

OBJECTIVE:

To assess the prognostic and diagnostic value of whole blood impedance aggregometry in patients with sepsis and SIRS and to compare with whole blood parameters (platelet count, haemoglobin, haematocrit and white cell count).

METHODS:

We performed an observational, prospective study in the acute setting. Platelet function was determined using whole blood impedance aggregometry (multiplate) on admission to the Emergency Department or Intensive Care Unit and at 6 and 24 hours post admission. Platelet count, haemoglobin, haematocrit and white cell count were also determined.

RESULTS:

106 adult patients that met SIRS and sepsis criteria were included. Platelet aggregation was significantly reduced in patients with severe sepsis/septic shock when compared to SIRS/uncomplicated sepsis (ADP: 90.7±37.6 vs 61.4±40.6; p<0.001, Arachadonic Acid 99.9±48.3 vs 66.3±50.2; p = 0.001, Collagen 102.6±33.0 vs 79.1±38.8; p = 0.001; SD ± mean)). Furthermore platelet aggregation was significantly reduced in the 28 day mortality group when compared with the survival group (Arachadonic Acid 58.8±47.7 vs 91.1±50.9; p<0.05, Collagen 36.6±36.6 vs 98.0±35.1; p = 0.001; SD ± mean)). However haemoglobin, haematocrit and platelet count were more effective at distinguishing between subgroups and were equally effective indicators of prognosis. Significant positive correlations were observed between whole blood impedance aggregometry and platelet count (ADP 0.588 p<0.0001, Arachadonic Acid 0.611 p<0.0001, Collagen 0.599 p<0.0001 (Pearson correlation)).

CONCLUSIONS:

Reduced platelet aggregometry responses were not only significantly associated with morbidity and mortality in sepsis and SIRS patients, but also correlated with the different pathological groups. Whole blood aggregometry significantly correlated with platelet count, however, when we adjust for the different groups we investigated, the effect of platelet count appears to be non-significant.

PMID:
25269018
PMCID:
PMC4182491
DOI:
10.1371/journal.pone.0108589
[Indexed for MEDLINE]
Free PMC Article

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