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Circulating histones may predict thrombocytopenia severity in ICU patients
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The level of circulating histones may predict the severity of thrombocytopenia in patients admitted to the ICU, according to a single-center case–control study.
Histone levels appeared 2.5- to 5.5-fold higher in individuals with thrombocytopenia than controls, results showed. High histone levels upon admission to the ICU correlated with risk for moderate to severe thrombocytopenia, as well as development of clinically important thrombocytopenia.
Prior research revealed 30% to 40% of patients in the ICU have thrombocytopenia, a blood disease characterized by low numbers of platelets in the blood. The condition is associated with poor outcomes.
Animal studies showed histones — proteins associated with DNA — induce profound thrombocytopenia, and they are associated with organ injury when released after extensive cell damage in critically ill individuals, according to study background.
Yasir Alhamdi, MBChB, PhD, of Institute of Infection and Global Health at University of Liverpool, and colleagues investigated the association between circulating histones and thrombocytopenia in 112 patients in the ICU. Half had thrombocytopenia and the other half served as controls. Researchers matched study participants for age, sex, APACHE II scores and admission diagnosis.
Researchers determined 51 (91%) patients with thrombocytopenia and 31 (55.3%) controls had detectable circulating histones (P < .001), with daily histone levels higher among the thrombocytopenia group.
Among those with thrombocytopenia, those with high histone levels upon admission (n = 32) had significantly lower platelet counts and significantly greater percentage decreases in platelet counts at 24 and 48 hours after admission than those with low histone levels upon admission (n = 24).
Admission histone levels also appeared significantly associated with development of moderate to severe thrombocytopenia (area under the curve, 0.893; 95% CI, 0.84-0.94).
The researchers acknowledged the study may be limited by the small number of patients from a single center, as well as their inability to establish a causal relationship between circulating histones and thrombocytopenia without interventional studies.
“Circulating histones are potential markers of disease severity, and the association with thrombocytopenia may reflect this,” Alhamdi and colleagues wrote. “Nevertheless, the novel associations reported in this study extend previous reports demonstrating profound thrombocytopenia following histone infusion into mice and suggest that, if confirmed, circulating histones may be valuable in predicting or monitoring thrombocytopenia in patients who are critically ill.” – by Kristie L. Kahl
Disclosure: The researchers report no relevant financial disclosures.
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