A new study reveals that the degree of platelet reduction, rather than absolute platelet count, is linked to mortality risk in sepsis.

Researchers at Nagoya University (Japan) conducted a retrospective study using the eICU Collaborative Research Database, which is comprised of 335 intensive care units (ICUs) in the United States; in all, 26,176 patients with sepsis and an ICU stay longer than two days were included in the study. Estimated effects of relative platelet reductions and absolute platelet counts on mortality and coagulopathy-related complications were then evaluated.

The results revealed marked in-hospital mortality risk with larger platelet reductions between days one and two, independent of the resultant absolute platelet counts. Adjusted odds ratios (ORs) for in-hospital mortality were 1.28, 1.86, 2.99, and 6.05 for 20–40%, 40–60%, 60–80%, and over 80% reductions, respectively, when compared to a lower than 20% decrease in platelets. A platelet reduction higher than 11%, and a platelet count lower than 100,000/μL on day two were associated with high coagulopathy-related complications, while only platelet reduction was associated with thromboembolic complications. The study was published on July 7, 2021, in Scientific Reports.

“The results showed that the degree of platelet reductions correlates with the mortality risk associated with sepsis, regardless of absolute platelet count, indicating that the mortality risk is higher with a fast decrease in platelet count,” concluded lead author Daisuke Kasugai, MD, of the department of emergency and critical care medicine. “Surprisingly, we also found that if platelet count decreases by 11% or more, the risks of bleeding, as well as thrombosis development, increases.”

Sepsis is a life-threatening condition arising from tissue and organ damage due to an overactive response to an infection. It is commonly characterized by abnormally low levels of platelets as a result of disseminated intravascular coagulation (DIC), miniscule blood clots that form throughout the bloodstream, resulting in platelet depletion. Consequently, absolute platelet count is currently considered the international criterion for the diagnosis of sepsis-associated DIC. 

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