Skip to main content
NCBI home page
Medicine logoLink to Medicine
. 2023 Aug 25;102(34):e34953. doi: 10.1097/MD.0000000000034953

Prognostic value of platelet combined with serum procalcitonin in patients with sepsis

Jianhui Chen a, Xiaoyan Tu b, Minghuan Huang c, Ying Xie d, Yanya Lin a, Jianxiong Hu e,*
PMCID: PMC10470786  PMID: 37653816

Abstract

Sepsis, a common and life-threatening condition in critically ill patients, is a leading cause of death in intensive care units. Over the past few decades, there has been significant improvement in the understanding and management of sepsis. However, the mortality rate remains unacceptably high, posing a prominent challenge in modern medicine and a significant global disease burden. A total of 295 patients with sepsis admitted to the hospital from January 2021 to December 2022 were collected and divided into survival group and death group according to their 28-day survival status. The differences in general clinical data and laboratory indicators between the 2 groups were compared. Receiver operating characteristic curve analysis was used to evaluate the predictive value of platelet (PLT) and procalcitonin (PCT) for the prognosis of sepsis patients within 28 days. A total of 295 patients were diagnosed with sepsis, and 79 died, with a mortality rate of 26.78%. The PLT level in the death group was lower than that in the survival group; the PCT level in the death group was higher than that in the survival group. The receiver operating characteristic curve showed that the area under the curve of PCT and PLT for evaluating the prognosis of sepsis patients were 0.808 and 0.804, respectively. Kaplan–Meier survival analysis showed that the 28-day survival rate of the low PLT level group was 19.0% and that of the high PLT level group was 93.1% at the node of 214.97 × 109/L, and the difference between the 2 groups was statistically significant (χ2 = 216.538, P < .001). The 28-day survival rate of the low PCT level group was 93.4% and that of the high PCT level group was 51.7% at the node of 2.85 ng/mL, and the difference between the 2 groups was statistically significant (χ2 = 63.437, P < .001). There was a negative correlation between PCT level and PLT level (r = −0.412, P < .001). Platelet combined with serum procalcitonin detection has high predictive value for judging the 28-day prognosis of sepsis, and it can be used as an index for evaluating the patient’s condition and prognosis, and is worthy of clinical promotion and application.

Keywords: platelet, procalcitonin, sepsis

1. Introduction

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, characterized by hypotension, elevated lactate, or oliguria. It is a common disease in critically ill patients and a major cause of death in intensive care units (ICUs).[1] Despite improved understanding and management of sepsis over the past few decades, the mortality rate remains high, ranging from 20% to 45%,[2,3] and it is a prominent challenge facing modern medicine and a significant global disease burden.[4,5]

Sepsis presents with a diverse range of clinical manifestations, and there is a lack of specific indicators for diagnosis and prognosis evaluation, and the disease progresses rapidly. As the condition worsens, there can be dysfunction of cellular metabolic processes, resulting in sepsis, multiple organ dysfunction syndrome, poor patient outcomes, and even death.[6,7] Therefore, finding laboratory indicators that can quickly assist in diagnosing sepsis is one of the urgent problems to be solved in critical care medicine.[8,9]

Under inflammatory conditions, platelets (PLTs) have a role in promoting coagulation factor activation and cell aggregation, which can lead to host response dysregulation.[10] When sepsis occurs, the inflammatory response of bacteria and platelets, endotoxin-mediated platelet activation, and the effects of circulating immune complexes can all lead to platelet reduction.[11] Platelet reduction is one of the most common complications in sepsis patients, and it is negatively correlated with the severity of sepsis and mortality rates.[12,13] Procalcitonin (PCT) is a nonhormonal glycoprotein whose levels are positively correlated with the severity of bacterial infections. It has important clinical significance in predicting the prognosis of infectious diseases and is a marker of disease course and treatment success.[14,15] A multicenter randomized controlled trial involving 266 sepsis patients showed that using PCT to guide patient antibiotic use can significantly reduce infection-related adverse events, 28-day mortality, and hospitalization costs.[16]

This study aims to explore the value of changes in PLT and PCT levels in evaluating the prognosis of sepsis patients, provide a basis for early prediction of the risk of death in sepsis patients, and better provide a reference for early prevention, early identification, early treatment, and improvement of prognosis.

2. Materials and Methods

2.1. Study population

This study was conducted in accordance with the Helsinki Declaration, and written informed consent was obtained from patients who voluntarily agreed to participate in the study, which was approved by ethics committee of Affiliated Hospital of Putian University (approved number 202035). A total of 349 patients diagnosed with sepsis in the ICU of the hospital from January 2021 to December 2022 were selected and included in this study based on the inclusion and exclusion criteria. The inclusion criteria were: All patients met the diagnostic criteria for sepsis according to the 2016 International Sepsis Guidelines (Sepsis 3.0)[17,18]; Age > 18 years; Hospital stay > 72 hours; SOFA score ≥ 2 points; Complete clinical data, voluntary participation in the study, and signing of relevant agreements and informed consent forms. The exclusion criteria were: Discharge or death within 72 hours of admission; Age < 18 years; Patients with malignant tumors or hematological malignancies; Patients with severe liver disease or severe bleeding; Patients who received platelet transfusion therapy within 48 hours before diagnosis.

2.2. Data collection and grouping

Clinical data and laboratory indicators, including gender, age, vital signs, past medical history such as hypertension and diabetes, SOFA score, APACHE II score, PLT, and PCT, were recorded within 24 hours of admission. Sepsis patients were observed and followed up for 28 days, with follow-up conducted during hospitalization, outpatient visits, and telephone consultations. Patient survival and death were recorded, and patients were divided into survival and death groups based on their prognosis.

2.3. Laboratory detection methods

PCT detection: PCT detection was performed using a Roche COBAS601 fully automated electrochemiluminescence immunoassay analyzer. Three milliliters of venous blood were collected from the patient and placed in a vacuum collection tube, which was centrifuged at 3000 r/minutes for 5 minutes to separate the upper serum. The serum was treated with an immunoassay analyzer and corresponding reagents to detect PCT levels. All procedures were strictly followed according to the instructions.

PLT detection: Three milliliters of venous blood were collected from the patient and mixed in an EDTA anticoagulation tube. PLT levels were detected using a SYSMEX XE-5000 hematology analyzer and corresponding reagents from Japan by the impedance method.

2.4. Statistical methods

Statistical analysis was performed using SPSS 20.0 (IBM SPSS Version 22.0). Count data were expressed as the mean (percentage) and analyzed for differences using the chi-square test. Quantitative data were expressed as the mean ± standard deviation and analyzed for differences using the 2-independent sample t test. Receiver operating characteristic (ROC) curves were drawn, and sensitivity, specificity, area under the curve (AUC), and cutoff values were calculated to evaluate the predictive value of PCT and PLT for the prognosis of sepsis patients within 28 days. Kaplan–Meier analysis and log-rank tests were used for survival analysis, and survival curves were drawn. The correlation between PCT values and corresponding patient PLT values was analyzed using Pearson correlation coefficient. Final significance was defined as P < .05, and all tests were 2-tailed.

3. Results

3.1. Comparison of clinical characteristics between survivors and non-survivors of sepsis

A total of 295 patients with sepsis were included in this study. After a 28-day follow-up, 216 patients survived (73.22%) and 79 patients died (26.78%). As shown in Table 1, the death group consisted of 43 males (54.43%) and 36 females (45.57%), with an average age of (63.17 ± 8.04) years and a BMI of (22.37 ± 1.96) kg/m2. The differences between the 2 groups in terms of these indicators were not statistically significant (P > .05). In terms of clinical symptoms, sepsis patients may experience varying degrees of fever, cough, chest tightness, and gastrointestinal symptoms, with no statistically significant differences observed between the 2 groups. Regarding underlying diseases, there were 29 patients (36.71%) with diabetes in the death group, which was significantly higher than that in the survival group (P = .031). The comparison between the 2 groups in terms of hypertension was not statistically significant (P > .05). There was a higher mortality in Sepsis patients with blood infection (P=<.001).

Table 1.

Comparison of clinical characteristics between surviving and deceased patients with sepsis (n = 295).

Factor Survival group (n = 216) Death group (n = 79) t/χ2 P value
Sex 0.279 .597
 Male 125 (57.87%) 43 (54.43%)
 Female 91 (42.13%) 36 (45.57%)
Age (yr) 61.92 ± 7.89 63.17 ± 8.04 −1.188 .234
BMI (kg/m2) 22.58 ± 2.14 22.37 ± 1.96 0.794 .426
Clinical symptoms: Fever 151 (69.91%) 47 (59.49%) 2.842 .092
Clinical symptoms: Cough 58 (26.85%) 20 (25.32%) 0.070 .791
Clinical symptoms: Chest tightness 38 (17.59%) 13 (16.46%) 0.052 .819
Clinical symptoms: Gastrointestinal symptoms 32 (14.81%) 17 (21.52%) 1.877 .171
Complications: Diabetes 52 (24.07%) 29 (36.71%) 4.636 .031
Complication: Hypertension 56 (25.93%) 24 (30.38%) 0.581 .446
Site of infection: Respiratory system 69 (31.94%) 33 (41.77%) 2.389 .122
Site of infection: Urinary system 73 (33.8%) 29 (36.71%) 0.217 .641
Site of infection: Digestive system 51 (23.6%) 16 (20.25%) 0.372 .542
Site of infection: Neural system 19 (8.80%) 9 (11.39%) 0.454 .501
Site of infection: Blood system 9 (4.17%) 19 (24.05%) 26.62 <.001
Site of infection: Others 4 (1.8%) 3 (3.80%) 1.177 .278
SOFA score 8.79 ± 4.24 12.53 ± 5.37 −5.586 <.001
APACHE II score 17.86 ± 6.35 24.62 ± 7.16 −7.395 <.001
PLT (×109/L) 267.34 ± 102.22 156.99 ± 86.46 8.539 <.001
PCT (ng/mL) 4.03 ± 1.26 6.25 ± 1.91 −11.546 <.001
Open in a new tab

APACHE = acute physiology and chronic health evaluation, BMI = body mass index, PCT = procalcitonin, PLT = platelet, SOFA = sequential organ failure assessment.

The death group had higher SOF scores than the survival group (12.53 ± 5.37 vs 8.79 ± 4.24, t = −5.586, P < .001); higher APACHE II scores (24.62 ± 7.16 vs 17.86 ± 6.35, t = −7.395, P < .001); lower PLT levels than the survival group (156.99 ± 86.46 vs 267.34 ± 102.22, t = 8.539, P < .001); and higher PCT levels than the survival group (6.25 ± 1.91 vs 4.03 ± 1.26, t = −11.546, P < .001).

3.2. Predictive value of PCT and PLT for 28-day mortality in sepsis patients

To explore the predictive value of PCT and PLT for 28-day mortality in sepsis patients, this study drew ROC curves, calculated the AUC, and determined the cutoff value based on the Youden index to obtain the sensitivity and specificity of each indicator. The results showed that PCT and PLT had high predictive value for 28-day mortality in sepsis patients, with AUC areas of 0.808 (95% CI: 0.733–0.882) and 0.804 (95% CI: 0.746–0.861), respectively, and P values <.001. The optimal cutoff value for PCT was 2.85 ng/mL, with a sensitivity of 81.01% and a specificity of 93.52%; for PLT, the optimal cutoff value was 214.97 × 109/L, with a sensitivity of 68.52% and a specificity of 96.21%. See Table 2, Figures 1 and 2 for details.

Table 2.

Predictive value of PCT and PLT for 28-day mortality in patients with sepsis.

Index Cut off value Sensitivity Specificity AUC Std. Error 95% CI P value
PCT 2.85 81.01% 93.52% 0.808 0.038 0.733–0.882 <.001
PLT 214.97 68.52% 96.21% 0.804 0.029 0.746–0.861 <.001
Open in a new tab

AUC = area under curve, CI = confidence interval, PCT = procalcitonin, PLT = platelet.

Figure 1.

Figure 1.

Open in a new tab

ROC curve of PCT for prognosis of patients with sepsis. PCT = procalcitonin, ROC = receiver operating characteristic.

Figure 2.

Figure 2.

Open in a new tab

ROC curve of PLT for prognosis of patients with sepsis. PLT = platelet, ROC = receiver operating characteristic.

3.3. Survival analysis of patients with sepsis at different levels of PCT and PLT for 28 days

After the follow-up of this study, 216 patients survived, and the 28-day overall survival rate was 73.22%, with a mean survival time of 24.92 days (95% CI: 24.186–125.665). The cutoff values calculated by ROC analysis were divided into 2 groups for survival analysis of patients with sepsis at different levels of PCT and PLT, and survival curves were plotted. Using a PCT value of 2.85 ng/mL as the cutoff, the low-level group had a 28-day survival rate of 93.4% (mean survival time of 26.842 days, 95% CI: 26.092–27.592), while the high-level group had a survival rate of 51.7% (mean survival time of 27.282 days, 95% CI: 21.484–23.873), and the difference between the 2 groups was statistically significant (χ²=63.437, P < .001). Using a PLT value of 214.97 × 109/L as the cutoff, the low-level group had a 28-day survival rate of 19.0% (mean survival time of 18.481 days, 95% CI: 16.629–20.333), while the high-level group had a survival rate of 93.1% (mean survival time of 27.282 days, 95% CI: 26.863–27.729), and the difference between the 2 groups was statistically significant (χ²=216.538, P < .001). See Table 3, Figure 3, and Figure 4 for details.

Table 3.

Survival analysis of patients with sepsis at different levels of PCT and PLT at 28 days.

variable 28-day OS (%) Mean survival, 95% CI (Days) χ2 Log-rank P
PCT (ng/mL)
 <2.85ng/mL 93.4% 26.842 (26.092–27.592) 63.437 <.001
 >2.85ng/ml 51.7% 22.678 (21.484–23.873)
PLT(×109/L)
 >214.97 × 109/L 93.1% 27.282 (26.863–27.729) 216.538 <.001
 <214.97 × 109/L 19.0% 18.481 (16.629–20.333)
Open in a new tab

CI = confidence interval, OS = overall survival, PCT = procalcitonin, PLT = platelet.

Figure 3.

Figure 3.

Open in a new tab

Survival curve of patients with sepsis at different levels of PCT at 28 days. PCT = procalcitonin.

Figure 4.

Figure 4.

Open in a new tab

Survival curve of patients with sepsis at different levels of PLT at 28 days. PLT = platelet.

3.4. Correlation analysis between PCT level and PLT level

A scatter plot was created for the corresponding values of serum PCT level and PLT level of 295 patients with sepsis (see Fig. 5), which showed a negative correlation between PCT level and PLT level (r = −0.412, P < .001). This indicates that there is a certain correlation between PCT, PLT, and the severity of the disease. The higher the severity of the disease, the higher the PCT level and the greater the decrease in PLT count. These parameters can be used together to predict the prognosis of patients with sepsis.

Figure 5.

Figure 5.

Open in a new tab

Scatter plot of PCT and PLT levels. PCT = procalcitonin, PLT = platelet.

4. Discussion

Sepsis is an uncontrolled systemic response to a multifactorial infectious disease, including immune and coagulation system dysregulation, thrombosis, endothelial barrier dysfunction, increased vascular permeability, microvascular isolation, tissue damage, and others.[19] It can lead to multiple organ failure and cognitive impairment. It is estimated that there are 480,000 sepsis and related diseases worldwide, and 9.19% of all deaths worldwide are related to sepsis.[20] After the follow-up of this study, 79 deaths occurred, with a mortality rate of 26.78%, and 216 survived, with a 28-day overall survival rate of 73.22% and an average survival time of 24.92 days (95% CI: 24.186–125.665). Sepsis is considered a significant global health problem with a significant economic impact.[21,22] An analysis of 10 studies conducted by Johnston et al revealed that participants who received antimicrobials within 1 hour had a 33% lower risk of mortality.[23] Therefore, early diagnosis and treatment intervention of sepsis are crucial to improving survival outcomes, avoiding adverse outcomes, and reducing mortality by starting treatment before irreversible damage occurs.[24]

The early diagnosis of sepsis is usually complicated, and patients have varying clinical presentations. Early diagnosis and treatment are critical to reducing in-hospital mortality rates in sepsis patients.[25] Due to the convenience of PCT and PLT detection and reliable repeated test data, studying the trends of serum PCT and mean platelet levels is of great value in assessing the severity and prognosis of sepsis.[13]

PCT is the main biomarker used for diagnosing sepsis. In healthy individuals, the concentration of PCT in the blood is low, <0.05 ng/mL.[26] Under inflammatory conditions, particularly bacterial infections or sepsis, various tissues and cell types in the body can produce PCT and release it into the bloodstream.[27] Research by Lipińska-Gediga M[28] and others has shown that the PCT levels of survivors in blood culture-negative patients are higher than those of non-survivors. The present study shows that the PCT levels of the non-survivors were higher than those of the survivors (6.25 ± 1.91 vs 4.03 ± 1.26, t = −11.546, P < .001), consistent with the results of the aforementioned study.

Platelet count changes frequently occur in ICU patients, with 20% to 30% of ICU patients having thrombocytopenia. Thrombocytopenia is associated with a higher mortality rate in sepsis patients [20]. Research by Vieira Corrêa PCM[29] and others has confirmed a significant correlation between low platelet counts and the severity and mortality rate of sepsis, and persistent thrombocytopenia is considered an independent risk factor for sepsis-related death.[19] The present study also shows that the platelet count of the non-survivors was lower than that of the survivors (156.99 ± 86.46 vs 267.34 ± 102.22, t = 8.539, P < .001).

Zeng et al[30] conducted a study on the diagnosis of sepsis using multiple biomarkers, which showed that combining any 2 biomarkers can improve the sensitivity and specificity of sepsis diagnosis. The ROC curve analysis in this study showed that the AUC for PCT and PLT in predicting patient prognosis was 0.808 (95% CI: 0.733–0.882) and 0.804 (95% CI: 0.746–0.861), respectively, with both P values <.001. This indicates that PCT and PLT have good diagnostic value in assessing patient prognosis. Previous studies have shown[31] that PCT is an important predictor of sepsis prognosis, with an AUC of 0.88 in ROC curve analysis, indicating high predictive value.

This study demonstrated through Kaplan–Meier survival analysis that the 28-day survival rate for the low PLT group (214.97 × 109/L as the cutoff value) was 19.0%, while that for the high PLT group was 93.1%, with a significant difference between the 2 groups (χ^2 = 216.538, P < .001). This suggests that a lower platelet count is associated with higher mortality. The cutoff value for PCT was 2.85ng/mL, and the 28-day survival rate for the low PCT group was 93.4%, while that for the high PCT group was 51.7%, with a significant difference between the 2 groups (χ^2 = 63.437, P < .001). This indicates that higher levels of procalcitonin are associated with higher mortality. Previous studies[32,33] have shown that there is a correlation between PCT and PLT levels and the severity of the disease, with higher levels of PCT and lower PLT counts indicating more severe disease and increased mortality. This study also found a negative correlation between PCT and PLT levels (r = −0.412, P < .001). Therefore, effective anti-infection treatment combined with correction of platelet reduction may be more beneficial for the prognosis of sepsis patients.

In summary, the combination of platelet count and serum procalcitonin detection has high predictive value for assessing the 28-day prognosis of sepsis patients and can be used as an indicator for patient evaluation and prognosis, which is worth promoting in clinical practice. Clinicians can use the cutoff values of each indicator to assess the risk of death in patients and intervene early to prevent disease progression. However, this study has certain limitations, such as a small sample size, and the conclusions need to be confirmed by multicenter and large-scale clinical trials. The severity of sepsis is a continuum, and biomarker monitoring at different stages is required.

Acknowledgments

The research was funded with Fujian provincial health technology project (NO.2020QNA085) and National Natural Science Foundation of China (NO.62276146).

Author contributions

Conceptualization: Jianxiong Hu.

Data curation: Jianhui Chen, Xiaoyan Tu.

Formal analysis: Jianhui Chen, Ying Xie.

Investigation: Minghuan Huang, Xiaoyan Tu.

Methodology: Ying Xie.

Resources: Xiaoyan Tu.

Software: Ying Xie.

Supervision: Yanya Lin.

Writing – original draft: Jianhui Chen.

Writing – review & editing: Jianxiong Hu.

Abbreviations:

AUC
area under the curve
ICU
intensive care unit
PCT
procalcitonin
PLT
platelet
ROC
receiver operating characteristic

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

The authors have no funding and conflicts of interest to disclose.

How to cite this article: Chen J, Tu X, Huang M, Xie Y, Lin Y, Hu J. Prognostic value of platelet combined with serum procalcitonin in patients with sepsis. Medicine 2023;102:34(e34953).

Contributor Information

Jianhui Chen, Email: cjh9077@126.com.

Xiaoyan Tu, Email: 1425224173@qq.com.

Minghuan Huang, Email: 776912889@qq.com.

Ying Xie, Email: xieying@ptu.edu.cn.

Yanya Lin, Email: linyanya556@hotmail.com.

References

  • [1].Andersson P, Frigyesi A. High-sensitivity troponin T is an important independent predictor in addition to the simplified acute physiology score for short-term ICU mortality, particularly in patients with sepsis. J Crit Care. 2019;53:218–22. [DOI] [PubMed] [Google Scholar]
  • [2].Paoli CJ, Reynolds MA, Sinha M, et al. Epidemiology and costs of sepsis in the United States-an analysis based on timing of diagnosis and severity level. Crit Care Med. 2018;46:1889–97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [3].Reinhart K, Daniels R, Kissoon N, et al. Recognizing sepsis as a global health priority - a WHO resolution. N Engl J Med. 2017;377:414–7. [DOI] [PubMed] [Google Scholar]
  • [4].Huang M, Cai S, Su J. The pathogenesis of sepsis and potential therapeutic targets. Int J Mol Sci. 2019;20:5376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [5].de Souza DC, Machado FR. Epidemiology of pediatric septic shock. J Pediatr Intensive Care. 2019;8:3–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [6].Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486–552. [DOI] [PubMed] [Google Scholar]
  • [7].Yealy DM, Mohr NM, Shapiro NI, et al. Early care of adults with suspected sepsis in the emergency department and out-of-hospital environment: a consensus-based task force report. Ann Emerg Med. 2021;78:1–19. [DOI] [PubMed] [Google Scholar]
  • [8].Moons KGM, Wolff RF, Riley RD, et al. PROBAST: a tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration. Ann Intern Med. 2019;170:W1–W33. [DOI] [PubMed] [Google Scholar]
  • [9].Erikson K, Ala-Kokko TI, Koskenkari J, et al. Elevated serum S-100β in patients with septic shock is associated with delirium. Acta Anaesthesiol Scand. 2019;63:69–73. [DOI] [PubMed] [Google Scholar]
  • [10].Rayes J, Bourne JH, Brill A, et al. The dual role of platelet-innate immune cell interactions in thrombo-inflammation. Res Pract Thromb Haemost. 2020;4:23–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [11].Shannon O. The role of platelets in sepsis. Res Pract Thromb Haemost. 2021;5:27–37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [12].Sah V, Giri A, Kc M, et al. Association of thrombocytopenia and mortality in critically ill children admitted to PICU in tertiary hospital in Biratnagar. Birat J Health Sci. 2019;4:649–53. [Google Scholar]
  • [13].Jiang L, Lin SH, Wang J, et al. Prognostic values of procalcitonin and platelet in the patient with urosepsis. Medicine (Baltim). 2021;100:e26555. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [14].Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47:1181–247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [15].Mustafić S, Brkić S, Prnjavorac B, et al. Diagnostic and prognostic value of procalcitonin in patients with sepsis. Med Glas (Zenica). 2018;15:93–100. [DOI] [PubMed] [Google Scholar]
  • [16].Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, et al. Procalcitonin to reduce long-term infection-associated adverse events in sepsis. a randomized trial. Am J Respir Crit Care Med. 2021;203:202–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [17].Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [18].Napolitano LM. Sepsis 2018: definitions and guideline changes. Surg Infect (Larchmt). 2018;19:117–25. [DOI] [PubMed] [Google Scholar]
  • [19].Chaudhary PK, Kim S, Kim S. An insight into recent advances on platelet function in health and disease. Int J Mol Sci. 2022;23:6022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [20].Al Saleh K, AlQahtani RM. Platelet count patterns and patient outcomes in sepsis at a tertiary care center: beyond the APACHE score. Medicine (Baltim). 2021;100:e25013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [21].Agnello L, Giglio RV, Bivona G, et al. The value of a complete blood count (CBC) for sepsis diagnosis and prognosis. Diagnostics (Basel). 2021;11:1881. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [22].Rello J, Valenzuela-Sánchez F, Ruiz-Rodriguez M, et al. A review of advances in management. Adv Ther. 2017;34:2393–411. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [23].Al-Kader DA, Anwar S, Hussaini H, et al. Systematic review on the effects of prompt antibiotic treatment on survival in septic shock and sepsis patients in different hospital settings. Cureus. 2022;14:e32405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [24].Lee S, Song J, Park DW, et al. Diagnostic and prognostic value of presepsin and procalcitonin in non-infectious organ failure, sepsis, and septic shock: a prospective observational study according to the Sepsis-3 definitions. BMC Infect Dis. 2022;22:8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [25].Ruan L, Chen GY, Liu Z, et al. The combination of procalcitonin and C-reactive protein or presepsin alone improves the accuracy of diagnosis of neonatal sepsis: a meta-analysis and systematic review. Crit Care. 2018;22:316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [26].Huang G, Chen H, Wang Q, et al. High platelet-to-lymphocyte ratio are associated with post-stroke depression. J Affect Disord. 2019;246:105–11. [DOI] [PubMed] [Google Scholar]
  • [27].Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106:dju124. [DOI] [PubMed] [Google Scholar]
  • [28].Lipińska-Gediga M, Mierzchała-Pasierb M, Durek G. Procalcitonin kinetics - prognostic and diagnostic significance in septic patients. Arch Med Sci. 2016;12:112–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [29].Vieira Corrêa PCM, Carneiro DM, da Silva Valente LS, et al. Detection of sepsis in platelets using MicroRNAs and membrane antigens. Genes. 2021;12:1877. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [30].Zhang C, Shang X, Yuan Y, et al. Platelet-related parameters as potential biomarkers for the prognosis of sepsis. Exp Ther Med. 2023;25:133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [31].Polilli E, Sozio F, Frattari A, et al. Comparison of monocyte distribution width (MDW) and procalcitonin for early recognition of sepsis. PLoS One. 2020;15:e0227300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [32].Park SY. Procalcitonin to guide antibiotic therapy for critically ill patients in Korea. J Korean Med Sci. 2019;34:e122. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [33].Kelly BJ, Lautenbach E, Nachamkin I, et al. Combined biomarkers predict acute mortality among critically ill patients with suspected sepsis. Crit Care Med. 2018;46:1106–13. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Medicine are provided here courtesy of Wolters Kluwer Health

RESOURCES