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ORIGINAL ARTICLE   Free accessfree

Minerva Anestesiologica 2019 June;85(6):625-34

DOI: 10.23736/S0375-9393.18.12782-9


language: English

Levels of circulating microparticles in septic shock and sepsis-related complications: a case-control study

Annalisa BOSCOLO 1, Elena CAMPELLO 2, Diana BERTINI 1, Luca SPIEZIA 2, Vittorio LUCCHETTA 1, Eleonora PIASENTINI 1, Claudia M. RADU 2, Leonardo MANESSO 1, Carlo ORI 1, Paolo SIMIONI 2

1 Unit of Anesthesia and Intensive Care, Department of Medicine (DIMED), University of Padua, Padua, Italy; 2 Unit of Thrombotic and Hemorrhagic Diseases, Department of Medicine (DIMED), University of Padua, Padua, Italy

BACKGROUND: Microparticles (MP) have been largely studied as potential biomarkers in septic shock (SS) though their biological and clinical relevance is still unclear. This case-control study describes the trend of various MP subtypes during SS to evaluate their possible association with severity of illness and sepsis-related complications (disseminated intravascular coagulation [DIC] and acute kidney injury [AKI]).
METHODS: Forty patients admitted to the Intensive Care Unit with SS and 40 matched healthy volunteers were recruited. AnnexinV+, E-selectin+, thrombomodulin (TM+), leukocyte-derived (CD45+, CD36+) and platelet-derived MP (PMP-expressed as PMP/platelets ratio) were measured by flow-cytometry at baseline, on day 1, 3 and 7 after diagnosis. Severity of illness was assessed by Sequential Organ Failure Assessment Score, duration of vasoactive support and mechanical ventilation. Sepsis-related complications were considered.
RESULTS: Overall, septic patients showed higher levels of all MP considered compared to controls. TM+MP were significantly lower in more severe sepsis, while CD36+MP and PMP/platelets ratio were significantly increased in patients requiring longer vasoactive support and mechanical ventilation. As for sepsis-related complications, a higher PMP/platelets ratio in patients who developed DIC and increased E-selectin+MP in subjects who developed AKI were observed. PMP/platelets ratio at baseline was significantly associated with longer vasoactive support (OR=1.59 [1.05-2.42]), longer mechanical ventilation (OR=1.6 [1.06-2.42]) and DIC occurrence (OR=1.45 [1.08-1.96]).
CONCLUSIONS: A global response through extra-vesiculation of endothelial cells, leukocytes and platelets during the early stages of SS was confirmed. The cellular activation was detected until day 3 after diagnosis. PMP/platelets ratio at diagnosis may be useful to evaluate SS severity and DIC occurrence.

KEY WORDS: Blood coagulation disorders; Disseminated intravascular coagulation; Cell-derived microparticles; Septic shock

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