P-selectin And Platelet Count In Patients With Severe Infection

BackgroundSevere infection is due to pathogenic microorganisms multiplying in the body, causing a particular organ or systemic infection, and characterized by the organ or systemic multiple organ dysfunction that caused by the infection. Despite the comprehensive treatment of anti-infective drugs, multiple organ support and fluid resuscitation have made great progress, severe infection is still an important factor that leads to death in the ICU ward, The incidence trends to raise year by year in the world. In the United States, most people die of serious infection, ranked in the tenth, and about25people have died of severe infection or septic shock per hour. Mortality rates of severe infection is similar in our country demonstrated by a multicenter study, about8.68%. Due to severe infection is lack of specificity of clinical symptoms and signs, it is important to explore auxiliary examinations that estimate the apostasis and prognosis of severe infection patients. Studies suggest that patients with severe infections associated with the change of the platelet count. Hypoxia, pathogenic microorganism and toxins as initiating factor can cause the microvascular endothelial injury, platelet shape changes, platelet components release and platelet aggregation. Patelet activation resulting in abnormal blood viscosity and the formation of microthrombus, that makes the attack deteriorated quickly, eventually lead to multiple organ dysfunction (MODS) and multiple organ function failure (MODF). Platelets and their activation products at the molecular level play an important role in the response and progress of inflammation. Based on P-selectin as a "gold standard" of platelet activation, the research is to observe P-selectin level and platelet count in the severe infected patients and to assess if the changes of P-selectin level and platelet count can be prognostic markers for severe infected patients.ObjectiveTo investigate the P-selectin, platelet count in the evaluation, prediction of severity and prognosis of patients with severe infection and its clinical significance.MethodsA total of80severe infection patients diagnosed in the First Affiliated Hospital of Zhengzhou University from September2010to February2013were enrolled in this study.43cases of male,37cases of female, aged from26to86years old, the average age is56.0±3.4years old. Meanwhile,40healthy individuals were served as controls,20cases of male,20cases of female, age from20to86, the average age is55.0±3.4years old, there is no difference between the two groups in the gender and age (P>0.05). The Infection group are pumped peripheral venous blood in the fasting state within24hours and the7th day in our department (control group on the examination day),respectively, using a double antibody sandwich enzyme-linked immunosorbent assay and fully automatic five categories of blood cell analysis plasma P-selectin levels and platelet count, whether there are the differences between the two groups in the plasma P-selectin levels and platelet count, and analysis the correlation between plasma P-selectin levels and platelet counts,according to different outcomes in2weeks, infection groups divided into groups of improvement and deterioration group, two groups were compared the differences in the plasma P-selectin levels and platelet count in7th day.Results1. Infection group compared with the control group, plasma P-selectin levels (μg/L) was significantly higher (27.60±3.24vs9.41±4.63, P=0.03), platelet count (×109/L) had no significant decrease (198±61vs236±73, P=0.58). 2. Improved group with worsening group, seven days into the plasma P-selectin was significantly higher (32.24±2.87ratio of19.62±3.48, P=0.005), platelet count decreased significantly (103±57vs201±73, P=0.01).3. Infection group into the Division within24hours and7days of plasma P-selectin levels and platelet counts showed a negative correlation (within24hours: r=-0.68, P=0.02,The7th day:r=-0.88, P=0.001).Conclusions1. Severe infection in patients with platelet activation, release one of the adhesion molecule P-selectin can be used as indicators judge severe infection of the patient’s condition changes.2. platelet count was negatively correlated with plasma P-selectin levels and platelet counts decreased indicates severe infections in patients with serious illness and poor prognosis.