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Platelet function during sepsis-related disseminated intravascular coagulation (DIC) is only sparsely investigated. We aimed to determine 1) platelet aggregation, independently of platelet count, and platelet activation among septic shock patients and 2) whether platelet aggregation or platelet activation differed among patients with and without DIC. We included 38 septic shock patients at the Intensive Care Unit, Aarhus University Hospital, Denmark. Blood samples were obtained within 24 h of admission and the two consecutive days. Platelet aggregation was measured by impedance aggregometry including a model defining expected platelet aggregation relative to platelet count. Platelet activation was measured employing flow cytometry. Platelet aggregation was significantly lower in septic shock patients than in healthy controls (p <.0001) and was lower in patients with DIC than in patients without DIC (p <.05). However, patients with septic shock, regardless of DIC-status, had platelet aggregation as expected for their platelet counts and were within the 95% prediction interval calculated from healthy controls. Platelet activation was significantly higher in septic shock patients than in healthy controls indicated by higher platelet surface-bound fibrinogen and CD63 (p <.05). Surface-bound P-selectin was significantly lower among septic shock patients than in healthy controls (p <.001), but plasma soluble P-selectin was significantly higher among septic shock patients than in healthy controls (p <.0001). Patients with septic shock displayed no impairment of platelet aggregation when interpreted relative to platelet count. Platelet activation, measured with flow cytometry, was increased among septic shock patients compared with healthy controls. [ABSTRACT FROM AUTHOR]

Retrospective studies suggest that there is an increased postoperative morbidity among alcohol misusers. We have prospectively studied the risk of alcohol intake among patients undergoing surgery. We investigated 15 symptom-free subjects who required colorectal surgery and who were drinking at least 60 g of alcohol per day. These patients were matched for sex, nutrition, age, weight, cardiovascular and pulmonary disease, diagnosis, anaesthesia, and surgery to 15 control subjects who were consuming below 25 g of alcohol daily. Those drinking at least 60 g of alcohol per day developed more postoperative complications than controls (67% vs 20%, p less than 0.05) and hospital stay was prolonged (20 vs 12 days, p less than 0.05). Preoperatively, alcohol misusers had reduced left ventricular ejection fraction (median, 54% vs 68%, p less than 0.01). Delayed hypersensitivity responses were smaller in the alcohol group before (53 mm2 vs 78 mm2, p less than 0.05) and after (18 mm2 vs 55 mm2, p less than 0.01) surgery. Alcohol misusers had longer bleeding times during the first postoperative week (p less than 0.01). Surgical stress responses, as assessed by changes in plasma cortisol and catecholamines, were higher among alcoholics (p less than 0.05). Postoperative morbidity is increased in symptom-free alcohol misusers. The mechanism is probably subclinical cardiac insufficiency, immunosuppression, and decreased haemostatic function. Preoperative alcohol consumption may be a more important risk factor than previously thought. [ABSTRACT FROM AUTHOR]