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Evaluation of the delta of immature platelet fraction as a predictive biomarker of inflammatory response after cardiac surgery
  1. Claudia Elizabeth Imperiali1,2,
  2. Juan Carlos Lopez-Delgado3,
  3. Macarena Dastis-Arias1,
  4. Lourdes Sanchez-Navarro1
  1. 1 Clinical Laboratory, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
  2. 2 Biochemistry and Molecular Biology Department, Universitat Autonoma de Barcelona, Barcelona, Spain
  3. 3 Intensive Care Unit, Bellvitge University Hospital, L'Hospitalet de Llobregar, Barcelona, Spain
  1. Correspondence to Claudia Elizabeth Imperiali, Clinical Laboratory, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona 08907, Spain; cimperialir{at}


Aims Cardiac surgery (CS) can induce an inflammatory response (IR) that is associated with poorer outcomes. Immature platelets are among the factors that may be associated with IR development. We aimed to evaluate whether immature platelet fraction (IPF) could be a predictive biomarker for IR and whether IPF could improve the prognosis assessment of IR for Acute Physiologic and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) following CS.

Methods Three-hundred and twenty-seven (327) patients who underwent CS were enrolled during the study period. IR was defined according to the need for vasopressor support (>48 hours). Perioperative variables and outcomes were registered in our database. IPF was measured immediately following CS and at 24 hours by Sysmex XN analyzer and the difference between both measurements (ΔIPF) was calculated. To assess the relationship between ΔIPF and IR, univariate and multivariate logistic regression were performed. To analyse the additive value of ΔIPF in APACHE II and SOFA scores in predicting IR, an area under the receiver operating characteristic (AUROC) curve was calculated.

Results Among 327 patients included, 60 patients (18.3%) developed IR. Multivariate analysis showed ΔIPF was significantly associated with IR (OR: 1.26; 95% CI: 1.01 to 1.56; p=0.038). The combination of ΔIPF with scores improved the AUROC for IR prediction: 0.629 vs 0.728 (p=0.010) for APACHE II and 0.676 vs 0.715 (p=0.106) for SOFA.

Conclusion These findings suggested that ΔIPF may be a useful and low-cost biomarker for the early identification of patients at risk of IR development.

  • platelets
  • inflammation
  • surgery

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  • Handling editor Mary Frances McMullin.

  • Contributors CI, JCL-D, MD-A and LS-N conceived and designed the study. CI and JCL-D collected data and performed the laboratory analysis. All authors were involved in the analysis and interpretation of the data. CI wrote the paper. MD-A, JCL-D and LS-N reviewed and edited the manuscript. The final version of the manuscript has been read and approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information