Key result
Platelet dysfunction on day 1 of ECMO, detected by elevated baseline CD63 expression and reduced activated GPIIb/IIIa, is significantly associated with mortality.
Why the study?
ECMO is associated with severe bleeding and poor outcome, and platelet dysfunction may be a contributing factor.
Is early platelet dysfunction associated with mortality in patients receiving extracorporeal membrane oxygenation?
Observational (n=55)
No
Is early platelet dysfunction associated with mortality in patients receiving extracorporeal membrane oxygenation?
Effect estimate: AUC 0.79
p-value: p=0.007
Early platelet dysfunction, specifically altered CD63 and activated GPIIb/IIIa expression on day 1, is associated with mortality in patients receiving ECMO and may serve as a prognostic biomarker.
Platelet dysfunction characterization in ECMO may identify bleeding mechanisms; leaves open whether targeting it improves outcomes.
Extracorporeal membrane oxygenation (ECMO) is used for patients with cardiopulmonary failure and is associated with severe bleeding and poor outcome. Platelet dysfunction may be a contributing factor. The aim of this prospective observational study was to characterize platelet dysfunction and its relation to outcome in ECMO patients. Blood was sampled from thirty ECMO patients at three timepoints. Expression of CD62P, CD63, activated GPIIb/IIIa, GPVI, GPIbα and formation platelet-leukocyte aggregates (PLA) were analyzed at rest and in response to stimulation. Delta granule storage-pool deficiency and secretion defects were also investigated. Fifteen healthy volunteers and ten patients with coronary artery disease served as controls. Results were also compared between survivors and non-survivors. Compared to controls, expression of platelet surface markers, delta granule secretion and formation of PLA was reduced, particularly in response to stimulation. Baseline CD63 expression was higher and activated GPIIb/IIIa expression in response to stimulation was lower in non-survivors on day 1 of ECMO. Logistic regression analysis revealed that these markers were associated with mortality. In conclusion, platelets from ECMO patients are severely dysfunctional predisposing patients to bleeding complications and poor outcome. Platelet dysfunction on day 1 of ECMO detected by the platelet surface markers CD63 and activated GPIIb/IIIa is associated with mortality. CD63 and activated GPIIb/IIIa may therefore serve as novel prognostic biomarkers, but future studies are required to determine their true potential.
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Siegel et al. (2021) conducted an observational in Cardiopulmonary failure requiring ECMO (n=55). Extracorporeal membrane oxygenation (ECMO) vs. Healthy volunteers and patients with coronary artery disease was evaluated on Mortality prediction by baseline CD63 expression on day 1 (AUC 0.79, p=0.007). Platelet dysfunction on day 1 of ECMO, detected by elevated baseline CD63 expression and reduced activated GPIIb/IIIa, is significantly associated with mortality.
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