IN the clinical landscape of biliary tract infections, accurately predicting which patients are at risk of severe bloodstream infections (BSIs) can be lifesaving. A new study offers compelling evidence that certain platelet count-related ratios may be powerful early indicators of severity in Escherichia coli and Klebsiella pneumoniae-associated bloodstream infections, common culprits in cholangitis and cholecystitis cases.
Researchers analyzed data from 169 patients with biliary BSIs, classifying cases into severe and non-severe groups. They assessed three key biomarkers: the neutrophil-to-lymphocyte to platelet count ratio (NLR/PC), the mean platelet volume to platelet count ratio (MPV/PC), and the red blood cell distribution width to platelet count ratio (RDW/PC). All three ratios were significantly elevated in patients with severe infections (p < 0.05), while platelet counts alone were notably lower. Multivariate logistic regression revealed all three ratios as independent risk factors for poor outcomes. MPV/PC stood out, with an odds ratio (OR) of 1.744 (95% CI: 1.388–2.191, p < 0.001), closely followed by RDW/PC (OR: 1.655, 95% CI: 1.367–2.004, p < 0.001) and NLR/PC (OR: 1.038, 95% CI: 1.014–1.063, p = 0.002). However, predictive power rose significantly when these ratios were combined with the Sequential Organ Failure Assessment (SOFA) score. The area under the ROC curve (AUC) reached 0.958 for MPV/PC + SOFA and 0.959 for RDW/PC + SOFA—both near-perfect predictive models. This study positions platelet-related biomarkers as practical, cost-effective tools for early risk stratification in biliary sepsis. For hospitalists, infectious disease specialists, and critical care teams, integrating these ratios into routine assessments could sharpen prognosis accuracy and inform timely interventions. For now, MPV/PC and RDW/PC ratios may offer a simple yet powerful way to spot danger early. Reference: Zhou P et al. Predictive value of platelet count-related ratios for severity in biliary Escherichia coli and Klebsiella pneumonia bloodstream infections. Eur J Clin Microbiol Infect Dis. 2025. doi: 10.1007/s10096-025-05120-w. [Epub ahead of print].
