The changes in platelet function in SIRS, sepsis and MODS - a tight connection to the changes in the immune and hemostatic system

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Background

In previous studies platelet dysfunction was described as a part of disseminated intravascular coagulation (DIC). These findings are also important in septic patients. In this present study, the association of the platelet function with the systemic inflammation and the development in different parts of the septic process in patients of an internal intensive care unit were investigated.

Methods

Twenty-five patients fulfilling clinical, hemodynamic and blood chemistry results of a systemic inflammation were included. The investigations were done in a two-day period. The characterization of the immune-state with IL-6, TNF-α and Procalcitonin used standard methods. The platelet activation marker P-selectin (GMP-140) was analyzed by flow cytometric detection ex vivo and after stimulation using 5 μM ADP and 10 μM TRAP-6. DIC was also characterized by standard laboratory results (platelet count, aPTT, AT III, fibrinogen, TAT, D-Dimer). The APACHE II-score evaluated the clinical situation.

Results

The activation status of platelets was significantly associated with the process of inflammation. Pre-activated platelets (ex vivo) were seen in all patients with systemic inflammation (PCT P<0.03). During the measurement over a two-day period (five results for each patient) the pre-activation and the reagibility of TRAP-6-stimulation were significantly correlated to plasma levels of IL-6 (P<0.01) and TNF-α (P<0.04). Furthermore the detection of changes in platelet function started earlier then the measured results of common laboratory tests in DIC.

Conclusion

Platelet function was tightly associated with the process of systemic inflammation. The dysfunction of the cellular part of coagulation could be an important marker of changes in the hemostatic system and the development of the disseminated intravascular coagulation.