Association of platelet dynamics for Klebsiella pneumoniae bloodstream infection patients with severe sepsis and/or septic shock.

OBJECTIVE

To investigate the predictive value of reduced platelet count for progression to severe sepsis and/or septic shock in patients with Klebsiella pneumoniae bloodstream infection.

METHODS

The clinical data of 205 patients with K. pneumoniae bloodstream infection admitted to Taizhou Hospital, Zhejiang Province, from January 2023 to December 2024 were retrospectively analyzed. Independent risk factors for severe sepsis and/or septic shock were screened by multivariate logistic regression analysis, and platelet count variations were monitored dynamically for 9 days following the onset of the bloodstream infection.

RESULTS

There was no significant difference in baseline characteristics between the severe sepsis and/or septic shock group (n = 135) and the non-severe sepsis and/or septic shock group (n = 70); however, the incidence of urinary tract infections was significantly higher in the severe group (17.8 % vs. 7.1 %, p = 0.038). Laboratory indicators revealed that PCT, CRP, LAC, Cr, BUN and D-Dimer were markedly elevated, while PLT and ALB were dramatically diminished in the severe group (p < 0.05). Dynamic monitoring indicated that PLT attained its nadir on days 3-5 post-infection in both cohorts; however, the mean PLT value in the severe group was below 150 × 109/L during this period. Multivariate analysis indicated that a platelet (PLT) value of 50-99 × 109/L on the day of blood culture collection (OR = 2.766, 95 % CI 1.060-7.218, p = 0.038) and the trajectory of PLT decline in the stable group (OR = 2.431, 95 % CI 1.073-5.510, p = 0.033) and descending group (OR = 2.036, 95 % CI 1.113-3.724, p = 0.021) on day 5 were independent predictors of severe sepsis and/or septic shock.

CONCLUSION

An early decrease of platelet count, especially the dynamic decrease of KP-BSI patients on day 3-5, was significantly related to the risk of severe sepsis and/or septic shock.