Quantitative changes in platelet count in response to different pathogens: an analysis of patients with sepsis in both retrospective and prospective cohorts

Thrombocytopenia is commonly observed in patients with sepsis and is an independent risk factor for poor prognosis. However, the changes of platelet count caused by different pathogens can vary significantly. Our study aims to evaluate the quantitative changes in platelet count in response to various pathogens. We retrospectively analysed data of 3044 patients with sepsis from Medical Information Mart for Intensive Care (MIMIC, 2008–2019) database and prospectively collected data of 364 patients with sepsis from our local cohort of the Shandong Bloodstream Infection and Sepsis Collaboration Study (SBISC, 2020–2022). Propensity score matching (PSM) was employed to control for baseline differences in variables, except for the causative pathogen. Multivariate logistic analyses of both original and PSM populations identified <i>Candida</i>, <i>Escherichia</i>, <i>Klebsiella</i>, and <i>Serratia</i> species posing a higher risk for thrombocytopenia compared to others. Restricted cubic spline (RCS) curves showed L- or U-shaped associations between platelet count and 28-mortality with various cut-off values among different pathogens: ranging from 96 × 10⁹/L in <i>Candida</i> species − 190 × 10⁹/L in <i>Klebsiella</i> species. Our present findings indicate a pathogen-specific effect on platelet count, highlighting the importance of monitoring thrombocytopenia in patients infected with above microorganisms. Clinicians need to consider pathogen-specific thresholds when intervene on platelet count. This study validated the differential incidence of thrombocytopenia among various pathogens within two distinct populations. <i>Candida</i>, <i>Escherichia</i>, <i>Klebsiella</i>, and <i>Serratia</i> species were identified as having a notably higher risk of causing thrombocytopenia compared to other pathogens. We observed L- or U-shaped relationships between platelet counts and 28-day mortality in <i>Candida</i> species<i>, Enterococcus</i> species<i>, Escherichia</i> species<i>, Enterobacter</i> species<i>, Staphylococcus</i> species, and <i>Klebsiella</i> species with platelet count cutoff values of 96 × 10⁹/L, 100 × 10⁹/L, 100 × 10⁹/L, 146 × 10⁹/L, 152 × 10⁹/L, and 190 × 10⁹/L, respectively.