Bakowski Wojciech, Smiechowicz Jakub, Dragan Barbara, Goździk Waldemar, Adamik Barbara
Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
Pathogens. 2024 Sep 10;13(9):778. doi: 10.3390/pathogens13090778.
Severe viral infections often result in abnormal platelet function, affecting various stages of hemostasis. Activated platelets are often considered prothrombotic and more susceptible to further stimulation. However, emerging evidence suggests that initial hyperactivation is followed by platelet exhaustion and hypo-responsiveness, affecting platelet degranulation, activation, and aggregation. We examined early alterations in platelet aggregation among patients (N = 28) with acute respiratory distress syndrome and SARS-CoV-2 infection who were receiving mechanical ventilation and venovenous extracorporeal membrane oxygenation support. Blood samples were stimulated with four different activators: arachidonic acid, adenosine diphosphate, thrombin receptor-activating protein 6, and ristocetin. Our observations revealed that platelet aggregation was reduced in most patients upon admission (ranging from 61 to 89%, depending on the agonist used), and this trend intensified during the 5-day observation period. Concurrently, other coagulation parameters remained within normal ranges, except for elevated d-dimer and fibrinogen levels. Importantly, we found a significant association between platelet aggregation and patient mortality. Impaired platelet aggregation was more severe in patients who ultimately died, and reduced aggregation was associated with a significantly lower probability of survival, as confirmed by Kaplan-Meier analysis ( = 0.028). These findings underscore the potential of aggregometry as an early detection tool for identifying patients at higher risk of mortality within this specific cohort.
严重的病毒感染常导致血小板功能异常，影响止血的各个阶段。活化的血小板通常被认为具有促血栓形成作用，且更容易受到进一步刺激。然而，新出现的证据表明，最初的过度活化之后会出现血小板耗竭和反应性降低，影响血小板脱颗粒、活化和聚集。我们研究了接受机械通气和静脉-静脉体外膜肺氧合支持的急性呼吸窘迫综合征和SARS-CoV-2感染患者（N = 28）血小板聚集的早期变化。用四种不同的激活剂刺激血样：花生四烯酸、二磷酸腺苷、凝血酶受体激活蛋白6和瑞斯托菌素。我们的观察结果显示，大多数患者入院时血小板聚集减少（根据所用激动剂不同，范围为61%至89%），且在5天观察期内这一趋势加剧。同时，除了D-二聚体和纤维蛋白原水平升高外，其他凝血参数仍在正常范围内。重要的是，我们发现血小板聚集与患者死亡率之间存在显著关联。最终死亡的患者血小板聚集受损更严重，聚集减少与生存概率显著降低相关，Kaplan-Meier分析证实了这一点（P = 0.028）。这些发现强调了血小板聚集测定法作为一种早期检测工具，用于识别该特定队列中死亡风险较高患者的潜力。
