Relationship between platelet counts, C-reactive protein and plasma fibrinolytic capacity in critically ill patients

Background

Multiple Organ Failure (MOF) complicating the sepsis remains the first cause of death in the ICU. A recent study showed that vascular endothelial damage was the primary cause of MOF in patients with thrombopenia and that humoral mediators played a major role in the development of this process [1]. Other parameters like C-protein reactive were also probably important via a direct effect on endothelial cells and increasing the secretion of IL-6. In this study, we aimed to evaluate the relation between the platelet counts (PC), the C-reactive protein and plasma fibrinolytic capacity (as a marker of endothelium dysfunction) in ICU patients.

Methods

We studied blood samples of ICU patients with (n = 11) and without (n = 21) sepsis at the first day of admission. Fibrinolytic capacity was evaluated by the Euglobulin Clot Lysis Time (ECLT) determined by a new method [2]. We also collected biological data and the SAPS II score for each patients. The correlations were depicted by Spearman's test.

Results

The ECLT was significantly correlated with CRP (R = 0.64; P < 0.001) and PC (R = -0.4; P = 0.02). The two-way ANOVA showed that the sepsis status increased significantly the ECLT (P = 0.023) and that platelets under 208,500 cells/μl (median of the histogram of PC was used as the cut-off) also increased the ECLT (P = 0.023). However, there was no interaction (P = 0.184).

Conclusion

Platelets can protect the endothelium against several forms of oxidative injuries [3]. With this study we showed that the decrease of the platelets count could favor the endothelium dysfunction and impaired fibrinolytic capacity, and this independently of sepsis. In addition, C-reactive protein is not only an inflammatory marker, but it might be involved in the endothelium damage.

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