M. Gawaz et al., PLATELET ACTIVATION AND INTERACTION WITH LEUKOCYTES IN PATIENTS WITH SEPSIS OR MULTIPLE ORGAN FAILURE, European journal of clinical investigation, 25(11), 1995, pp. 843-851
Citations number
36
Categorie Soggetti
Medicine, Research & Experimental","Medicine, General & Internal
This study focuses on the role of platelet membrane glycoproteins and
platelet-leucocyte adhesion in patients with sepsis and multiple organ
failure (MOF). Specifically, the study raises the following issues: (
1) the influence of sepsis and MOF on platelet activation as assessed
by surface expression of platelet membrane glycoproteins GPIIb-IIIa an
d thrombospondin; and (2) the effect of sepsis and MOF on platelet adh
esion to circulating leucocytes. In addition, platelet activation and
platelet-leucocyte adhesion are evaluated according to clinical outcom
e. Forty-five patients with suspected sepsis or MOF were evaluated by
intensive care scoring systems (APACHE II and Elebute) to assess sever
ity of disease. Flow cytometric techniques were used to examine platel
et membrane expression of various adhesion molecules on circulating pl
atelets and the appearance of platelet specific antigen (CD41) on leuc
ocytes as an index of platelet-leucocyte adhesion. The results were co
mpared with severity of disease and according to outcome in patients.
Twenty-eight patients of the total study population were septic and 17
were non-septic. Twenty-two of the 28 septic patients suffered from s
evere MOF (APACHE II greater than or equal to 20) whereas in six septi
c patients MOF was absent. Eleven of the non-septic group suffered fro
m moderate MOF whereas in six, severe MOF was present. In septic patie
nts fibrinogen receptor activity on platelets was significantly above
normal values (P < 0.001). When MOF was present, thrombospondin surfac
e expression on circulating platelets also increased significantly (P
< 0.05). Concomitantly, platelet-leucocyte adhesion was increased in s
epsis (P < 0.05) and decreased in patients with MOF (P < 0.05). Signif
icant lower levels of circulating platelet-leucocyte aggregates occurr
ed in non-survivors (P < 0.05). We conclude that sepsis is associated
with increased surface expression of platelet adhesion molecules and a
n increased occurrence of circulating platelet-leucocyte aggregates. T
he decrease in circulating platelet-leucocyte aggregates in MOF might
result from enhanced peripheral sequestration. An increased platelet-l
eucocyte adhesion and sequestration might account for development of M
OF in the course of sepsis.