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Chronic antiplatelet therapy is not associated with alterations in the presentation, outcome, or host response biomarkers during sepsis: a propensity-matched analysis

PURPOSE: Sepsis is a major health burden worldwide. Preclinical investigations in animals and retrospective studies in patients have suggested that inhibition of platelets may improve the outcome of sepsis. In this study we investigated whether chronic antiplatelet therapy impacts on the presentatio...

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Autores principales: Wiewel, Maryse A., de Stoppelaar, Sacha F., van Vught, Lonneke A., Frencken, Jos F., Hoogendijk, Arie J., Klein Klouwenberg, Peter M. C., Horn, Janneke, Bonten, Marc J., Zwinderman, Aeilko H., Cremer, Olaf L., Schultz, Marcus J., van der Poll, Tom
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747987/
https://www.ncbi.nlm.nih.gov/pubmed/26768440
http://dx.doi.org/10.1007/s00134-015-4171-9
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author Wiewel, Maryse A.
de Stoppelaar, Sacha F.
van Vught, Lonneke A.
Frencken, Jos F.
Hoogendijk, Arie J.
Klein Klouwenberg, Peter M. C.
Horn, Janneke
Bonten, Marc J.
Zwinderman, Aeilko H.
Cremer, Olaf L.
Schultz, Marcus J.
van der Poll, Tom
author_facet Wiewel, Maryse A.
de Stoppelaar, Sacha F.
van Vught, Lonneke A.
Frencken, Jos F.
Hoogendijk, Arie J.
Klein Klouwenberg, Peter M. C.
Horn, Janneke
Bonten, Marc J.
Zwinderman, Aeilko H.
Cremer, Olaf L.
Schultz, Marcus J.
van der Poll, Tom
author_sort Wiewel, Maryse A.
collection PubMed
description PURPOSE: Sepsis is a major health burden worldwide. Preclinical investigations in animals and retrospective studies in patients have suggested that inhibition of platelets may improve the outcome of sepsis. In this study we investigated whether chronic antiplatelet therapy impacts on the presentation and outcome of sepsis, and the host response. METHODS: We performed a prospective observational study in 972 patients admitted with sepsis to the mixed intensive care units (ICUs) of two hospitals in the Netherlands between January 2011 and July 2013. Of them, 267 patients (27.5 %) were on antiplatelet therapy (95.9 % acetylsalicylic acid) before admission. To account for differential likelihoods of receiving antiplatelet therapy, a propensity score was constructed, including variables associated with use of antiplatelet therapy. Cox proportional hazards regression was used to estimate the association of antiplatelet therapy with mortality. RESULTS: Antiplatelet therapy was not associated with sepsis severity at presentation, the primary source of infection, causative pathogens, the development of organ failure or shock during ICU stay, or mortality up to 90 days after admission, in either unmatched or propensity-matched analyses. Antiplatelet therapy did not modify the values of 19 biomarkers providing insight into hallmark host responses to sepsis, including activation of the coagulation system, the vascular endothelium, the cytokine network, and renal function, during the first 4 days after ICU admission. CONCLUSIONS: Pre-existing antiplatelet therapy is not associated with alterations in the presentation or outcome of sepsis, or the host response. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00134-015-4171-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-47479872016-02-19 Chronic antiplatelet therapy is not associated with alterations in the presentation, outcome, or host response biomarkers during sepsis: a propensity-matched analysis Wiewel, Maryse A. de Stoppelaar, Sacha F. van Vught, Lonneke A. Frencken, Jos F. Hoogendijk, Arie J. Klein Klouwenberg, Peter M. C. Horn, Janneke Bonten, Marc J. Zwinderman, Aeilko H. Cremer, Olaf L. Schultz, Marcus J. van der Poll, Tom Intensive Care Med Original PURPOSE: Sepsis is a major health burden worldwide. Preclinical investigations in animals and retrospective studies in patients have suggested that inhibition of platelets may improve the outcome of sepsis. In this study we investigated whether chronic antiplatelet therapy impacts on the presentation and outcome of sepsis, and the host response. METHODS: We performed a prospective observational study in 972 patients admitted with sepsis to the mixed intensive care units (ICUs) of two hospitals in the Netherlands between January 2011 and July 2013. Of them, 267 patients (27.5 %) were on antiplatelet therapy (95.9 % acetylsalicylic acid) before admission. To account for differential likelihoods of receiving antiplatelet therapy, a propensity score was constructed, including variables associated with use of antiplatelet therapy. Cox proportional hazards regression was used to estimate the association of antiplatelet therapy with mortality. RESULTS: Antiplatelet therapy was not associated with sepsis severity at presentation, the primary source of infection, causative pathogens, the development of organ failure or shock during ICU stay, or mortality up to 90 days after admission, in either unmatched or propensity-matched analyses. Antiplatelet therapy did not modify the values of 19 biomarkers providing insight into hallmark host responses to sepsis, including activation of the coagulation system, the vascular endothelium, the cytokine network, and renal function, during the first 4 days after ICU admission. CONCLUSIONS: Pre-existing antiplatelet therapy is not associated with alterations in the presentation or outcome of sepsis, or the host response. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00134-015-4171-9) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2016-03-01 2016 /pmc/articles/PMC4747987/ /pubmed/26768440 http://dx.doi.org/10.1007/s00134-015-4171-9 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original
Wiewel, Maryse A.
de Stoppelaar, Sacha F.
van Vught, Lonneke A.
Frencken, Jos F.
Hoogendijk, Arie J.
Klein Klouwenberg, Peter M. C.
Horn, Janneke
Bonten, Marc J.
Zwinderman, Aeilko H.
Cremer, Olaf L.
Schultz, Marcus J.
van der Poll, Tom
Chronic antiplatelet therapy is not associated with alterations in the presentation, outcome, or host response biomarkers during sepsis: a propensity-matched analysis
title Chronic antiplatelet therapy is not associated with alterations in the presentation, outcome, or host response biomarkers during sepsis: a propensity-matched analysis
title_full Chronic antiplatelet therapy is not associated with alterations in the presentation, outcome, or host response biomarkers during sepsis: a propensity-matched analysis
title_fullStr Chronic antiplatelet therapy is not associated with alterations in the presentation, outcome, or host response biomarkers during sepsis: a propensity-matched analysis
title_full_unstemmed Chronic antiplatelet therapy is not associated with alterations in the presentation, outcome, or host response biomarkers during sepsis: a propensity-matched analysis
title_short Chronic antiplatelet therapy is not associated with alterations in the presentation, outcome, or host response biomarkers during sepsis: a propensity-matched analysis
title_sort chronic antiplatelet therapy is not associated with alterations in the presentation, outcome, or host response biomarkers during sepsis: a propensity-matched analysis
topic Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747987/
https://www.ncbi.nlm.nih.gov/pubmed/26768440
http://dx.doi.org/10.1007/s00134-015-4171-9
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