Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis

Platelet indices in patients with chronic inflammatory arthritis: a systematic review and meta-analysis

Correlation between platelet indices and chronic inflammatory arthritis (CIA) remains a moot point today. This meta-analysis aimed to evaluate whether platelet (PLT) count, mean platelet volume (MPV) and platelet distribution width (PDW) associated with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). A systematic literature search was performed in PubMed, EMBASE, and Web of Science up to August 2019. Pooled standardized mean differences (SMD) and 95% confidence interval (CI) were calculated using a random-effect model. As a result, 34 studies were included, encompassing 17 on RA, 12 on AS, 3 on PsA and 2 on both RA and AS. In these studies, PLT count was significantly higher in RA (SMD = 0.55, 95% CI = 0.36-0.73, P < .001), AS (SMD = 0.53, 95% CI = 0.36-0.70, P < .001) and PsA patients (SMD = 1.29, 95% CI = 0.82-1.77, P < .001) than that in healthy subjects, while MPV and PDW presented nonsignificant differences in these intergroup comparisons (P > .05), and similar results were observed in subgroup analyses. The meta-regression analysis demonstrated that there were strong positive correlations between erythrocyte sedimentation rate and PLT count, and weak correlation trend between the disease activity score and PLT count in both RA and AS subjects without statistically significant difference. The sensitivity analysis indicated that these results were not unduly influenced by any single study. In conclusion, this meta-analysis demonstrated that PLT count was elevated in CIA patients and could be suitable for evaluating the disease activity, whereas MPV and PDW were independent of CIA.

Value of Platelet Distribution Width and Mean Platelet Volume in Disease Activity Score of Rheumatoid Arthritis

Background and Objective

Disease activity score 28 (DAS28) for rheumatoid arthritis (RA) is the commonly used DAS; it relies on clinical parameters that could be subjective. This work aimed to create a more accurate DAS for RA and assess its validity.

Patients and Methods

The study included 98 RA patients and 53 matched controls; they were interviewed, clinically examined, their visual analogue scales (VAS) were reported, and then blood samples were withdrawn for erythrocyte sedimentation rate (ESR), complete blood count (CBC), and C-reactive protein (CRP). Platelet indices (PIs) were obtained from the CBC including Plt (platelet count), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT). DAS28 was calculated for each patient using RheumaHelper mobile software. Minitab Statistical Package^® and SPSS v20 software were used for data analysis.

Results and Conclusions

Results revealed perfect matching between patients and controls as regarding age and gender. ESR, CRP and PDW were significantly higher in patients than controls; also positive correlations were detected among these variables. A new DAS for RA was developed; ESR, CRP, PDW and MPV were the components for this index. Further analyses showed that this new score was significantly higher in patients than controls and correlated with DAS28 of the patients. Furthermore the new score could identify RA patients from healthy subjects (cut off value < -0.79) and stratified RA patients according to their disease activity into low, intermediate, high, or in remission. Conclusively, we developed a more precise, easily obtained new DAS for RA. This new DAS has both diagnostic/prognostic values in patients with RA.

The Association of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios and Hematological Parameters with Diagnosis, Stages, Extrapulmonary Involvement, Pulmonary Hypertension, Response to Treatment, and Prognosis in Patients with Sarcoidosis

Sarcoidosis is a rare disease characterized by granulomatous inflammation in affected organs, primarily in lungs. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are easy and practical methods providing valuable information in diagnosis, severity, and prognosis of various diseases. Here, we aimed to investigate the association between NLR, PLR, and hematological parameters in sarcoidosis. The study was performed with 75 sarcoidosis patients and 92 controls. Patients' NLR, PLR, and hematological parameters were compared with those of controls. Additionally, while differences between NLR and PLR were investigated in sarcoidosis patients, differences of extrapulmonary involvement, pulmonary hypertension (PH), and spontaneous remission between those with and without responses to treatment concerning stages were also assessed. NLR and PLR were significantly higher in sarcoidosis patients than controls. For NLR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found as 68, 61, 58, and 70% respectively, while sensitivity, specificity, PPV, and NPV for PLR were found as 72, 67, 63, and 74%, respectively. In sarcoidosis patients, NLR and PLR were significantly higher at stage-2 and -3 than at stage -1 and -4. There was a significant weak positive correlation between C-reactive protein (CRP) and NLR and PLR. Mean platelet volume (MPV), hemoglobin (Hgb), and mean corpuscular volume (MCV) were lower among patients than controls. A positive moderate correlation was detected between NLR and CD4/CD8 in blood, while there was a strong positive correlation between CD4/CD8 in bronchoalveolar lavage (BAL) and positive moderate correlation between PLR and CD4/CD8 in BAL. High NLR and PLR values were not significantly associated with pulmonary PH, spontaneous remission, response to treatment, and prognosis. The increase in PLR and NLR may be a guide for diagnoses of both sarcoidosis and lung parenchymal involvement. To use these entities as markers, our findings should be supported with prospective studies with larger samples.

Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: A case-control study

INTRODUCTION

Subclinical inflammation markers play a significant role in hyperemesis gravidarum (HEG). Simple hematological markers such as mean platelet volume (MPV), platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), and platelet-to-lymphocyte ratio (PLR) have been shown to reflect inflammatory burden and disease activity in several disorders. Ketonuria is a parameter used in the diagnosis of severe HEG, but its correlation with disease severity remains controversial. The relationship of subclinical inflammation markers with degree of ketonuria has not been examined previously. In this study, we aimed to determine the diagnostic value of these subclinical inflammation markers and the relationship between these markers and grade of ketonuria in patients with HEG.

MATERIALS AND METHODS

A total of 94 pregnant women with a diagnosis of HEG and 100 gestational age-matched healthy pregnant women were enrolled in this retrospective study. MPV, PDW, NLR, PLR, PCT, and ketonuria were calculated and analyzed from complete blood cell counts and total urine analyses.

RESULTS

Lymphocyte count was significantly higher in the control group (P < 0,001); NLR and PLR values were significantly higher in the HEG group (P < 0,001). Among inflammation markers, RDW increased significantly (P = 0,008) with an increase in ketonuria in patients with HEG. A statistically significant correlation was found between white blood cell (WBC) and NLR, PLR, PCT. A moderate uphill relationship was observed between NLR and WBC and a weak uphill linear relationship was observed between WBC and PLR and between WBC and PCT.

CONCLUSIONS

PLR and NLR can be considered effective markers to aid in the diagnosis of HEG. No marker was found to correlate with ketonuria grade except RDW, although the relationship of the severity of ketonuria with severity of disease is controversial. RDW increases as the degree of ketonuria increases.

Mean Platelet Volume-to-Platelet Count Ratio, Mean Platelet Volume-to-Lymphocyte Ratio, and Red Blood Cell Distribution Width-Platelet Count Ratio as Markers of Inflammation in Patients with Ascending Thoracic Aortic Aneurysm

OBJECTIVE

Ascending thoracic aortic aneurysm (ATAA), seen in adults, is an important cause of morbidity and mortality. In this study, we aimed to evaluate the levels of mean platelet volume (MPV), mean platelet volume-to-platelet count ratio (MPVPCR), mean platelet volume-to-lymphocyte ratio (MPVLR), and red cell distribution width platelet count ratio (RDWPCR) in patients with thoracic aortic aneurysm.

METHODS

105 patients admitted to the emergency department were diagnosed with thoracic aortic aneurysm between January and December 2014, and 100 healthy individuals were involved in this retrospective study. MPV, MPVLR, MPVPCR and RDWPCRs were calculated at the time of admission.

RESULTS

Platelet and lymphocyte levels were found to be significantly lower in the patient group when compared to the healthy group (P<0.001, P<0.001, respectively), while MPV, MPVPCR, MPVLR and RDWPCR were found to be significantly higher (P<0.001, P<0.001, P<0.001, and P=0.013, respectively). In the patient group, the high-sensitivity C-reactive protein was significantly higher (P<0.001), and the neutrophil (P=0.062) was also higher. In ROC analysis, MPVPCR had the highest sensitivity (80%) and RDWPCR had the highest specificity (72%).

CONCLUSION

The results for MPV, MPVPCR, MPVLR and RDWPCR can be evaluated as useful parameters in the emergency clinical approach in the evaluation of inflammatory activity in ATAA patients. More extensive studies are required to address the role of these parameters in determining the severity of the disease.

An Adjunct Indicator for the Diagnosis of Fracture-Related Infections: Platelet Count to Mean Platelet Volume Ratio

Introduction: Fracture-related infection (FRI) is a common complication associated with orthopaedic fracture care. Diagnosing these complications in the preoperative setting is difficult. Platelets are a known acute phase reactant with indices that change in accordance with infection and inflammation. The purpose of our study was to assess the diagnostic utility of platelet indices at assessing FRI. Methods: A retrospective review performed for all patients who underwent revision surgery for fracture nonunion between 2013 and 2018. Radiographs were employed to define nonunion. Intraoperative cultures were used to define FRI. Receiver operator characteristic (ROC) curve analysis was used to assess the diagnostic ability of preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and the platelet count/mean platelet volume ratio (P/V) at recognizing FRI. Results: Of the 53 revision surgeries that were performed for fracture nonunion, 17 (32.1%) were identified as FRI. There were no significant demographic differences between the two cohorts. Patients with FRIs exhibited higher values for ESR (54.82 vs. 19.16, p<0.001), CRP (0.90 vs. 0.35, p=0.003), and P/V (37.4 vs. 22.8, p<0.001) as compared to those within the aseptic nonunion cohort. ROC curve analysis for P/V demonstrated that at an optimal ratio of 23, area under the curve (AUC) is 0.814, specificity is 55.6%, and sensitivity is 100.0%. There was no significant difference in the diagnostic performance of the serum biomarkers but only ESR and P/V had an AUC greater than 0.80. The negative predictive value (NPV) for P/V, ESR, and CRP was 100.0%, 84.6%, and 78.6%, respectively. Conclusion: The P/V ratio may serve as a reliable screening test for FRI.

Platelet/lymphocyte ratio and mean platelet volume in patients with granulomatosis with polyangiitis

Background

Granulomatosis with polyangiitis (GPA) is a granulomatous necrotizing vasculitis with high morbidity and mortality. Anti-neutrophil cytoplasmic antibody is a valuable diagnostic marker, however its titer lacks predictive value for the severity of organ involvement. Platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) has been regarded as a potential marker in assessing systemic inflammation. We aimed to explore the value of PLR and MPV in the assessment of disease activity and manifestations of disease in GPA.

Methods

56 newly diagnosed GPA patients and 53 age-sex matched healthy controls were included in this retrospective and cross-sectional study with comparative group. Complete blood count was performed with Backman Coulter automatic analyzer, erythrocyte sedimentation rate (ESR) with Westergen method and C-reactive protein (CRP) levels with nephelometry. The PLR was calculated as the ratio of platelet and lymphocyte counts.

Result

Compared to control group, ESR, CRP and PLR were significantly higher and MPV significantly lower in GPA patients. In patients group, PLR was positively correlated with ESR and CRP (r = 0.39, p = 0.005 and r = 0.51, p < 0.001, respectively). MPV was negatively correlated with ESR and CRP (r = − 0.31, p = 0.028 and r = − 0.34 p = 0.014, respectively). Patients with renal involvement had significantly higher PLR than patients without renal involvement (median:265.98, IQR:208.79 vs median:180.34 IQR:129.37, p = 0.02). PLR was negatively correlated with glomerular filtration rate (r = − 0.27, p = 0.009). A cut-off level of 204 for PLR had 65.6% sensitivity and 62.5 specificity to predict renal involvement.

Conclusion

PLR exhibit favorable diagnostic performance in predicting renal involvement in patients with GPA.

Feasibility of mean platelet volume as a biomarker for chronic obstructive pulmonary disease: A systematic review and meta-analysis

Objective

To evaluate the feasibility of mean platelet volume (MPV) as a biomarker for chronic obstructive pulmonary disease (COPD).

Methods

A systematic search for studies published up to March 2019 was performed in the PubMed and Web of Science databases. Three independent investigators screened the titles and abstracts of including studies according to eligibility criteria. The Newcastle–Ottawa Scale was used to assess the quality of eligible studies, and statistical analyses were performed using Review Manager version 5.3.

Results

A total of eight studies with 1230 COPD patients and 443 healthy controls were included in our meta-analysis. No significant differences in MPV level were identified in pairwise comparisons of the acute exacerbations of COPD (AECOPD), stable COPD, and control groups. Furthermore, no significant correlation was observed between MPV level and systemic inflammatory biomarkers.

Conclusions

MPV does not appear to represent a suitable biomarker of disease phase or inflammatory burden in COPD. However, future large-scale studies should be performed to further investigate the relationship between MPV and COPD.

Alterations in platelet indices link polycyclic aromatic hydrocarbons toxicity to low-grade inflammation in preschool children

BACKGROUND

Environmental exposure to carcinogenic polycyclic aromatic hydrocarbons (PAHs) can disturb the immune response. However, the effect of PAHs on low-grade inflammation related to platelets in humans is unknown.

OBJECTIVES

We investigated the association of PAH exposure with low-grade inflammation and platelet parameters in healthy preschoolers.

METHODS

The present study recruited 239 participants, aged 2-7 years, from an electronic-waste (e-waste)-exposed (n = 118) and a reference (n = 121) area. We measured ten urinary PAH metabolites, four types of immune cells and cytokines, and seven platelet parameters, and compared their differences between children from the two groups. Spearman correlation analysis was performed to explore the potential risk factors for PAH exposure and the associations between urinary monohydroxylated PAHs (OH-PAHs) and biological parameters. Associations between urinary PAH metabolites and platelet indices were analyzed using quantile regression models. Mediation analysis was used to understand the relationship between urinary total hydroxynaphthalene (ΣOHNa) and interleukin (IL)-1β through seven platelet indices, as mediator variables.

RESULTS

We found higher urinary monohydroxylated PAH (OH-PAH) concentrations, especially 1-hydroxynaphthalene (1-OHNa) and 2-hydroxynaphthalene (2-OHNa), in children from the e-waste-exposed group than in the reference group. These were closely associated with child personal habits and family environment. A decreased lymphocyte ratio and increased pro-inflammatory cytokines, such as gamma interferon-inducible protein (IP)-10 and IL-1β, were found in the e-waste-exposed children. After adjustment for confounding factors, significantly negative correlations were found between levels of mean platelet volume (MPV), platelet distribution width (PDW), platelet-large cell ratio (P-LCR) and ratio of mean platelet volume to platelet count (MPVP) and OH-PAHs. In addition, ΣOHNa was positively associated with IL-1β mediated through MPV, PDW, P-LCR, and ratio of platelet count to lymphocyte count (PLR).

CONCLUSIONS

Platelet indices were significantly associated with the changes in urinary OH-PAH levels, which may can be regarded as effective biomarkers of low-grade inflammation resulting from low PAH exposure in healthy children.

Red cell distribution width, platelet-to-lymphocyte ratio, and mean platelet volume in ankylosing spondylitis and their correlations with inflammation: A meta-analysis

Objectives: To evaluate the relationship between red cell distribution width (RDW), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) and ankylosing spondylitis (AS) and establish a correlation between these haematological indices and AS inflammation.Methods: We searched the Medline, Embase, and Cochrane databases, performed a meta-analysis comparing RDW, PLR, and MPV in patients with AS to controls, and examined correlation coefficients between RDW, PLR, and MPV and C-reactive protein (CRP).Results: Eleven studies were included in this meta-analysis, which revealed that RDW was significantly higher in the AS group than in the control group (standardized mean difference (SMD) = 0.687, 95% confidence interval (CI) = 0.110-1.265, p = .020). However, PLR was not significantly higher in the AS group than in the control group (SMD = 0.197, 95% CI = -0.045-0.439, p = .111). No evidence of elevated MPV in the AS group was found (SMD = -0.005, 95% CI = -0.411-0.400, p = .979). Meta-analysis of correlation coefficients revealed that RDW was positively associated with CRP (correlation coefficient = 0.327, 95% CI = 0.214-0.431, p < .001). PLR was positively associated with CRP (correlation coefficient = 0.444, 95% CI = 0.283-0.581, p < .001). In addition, the meta-analysis showed a correlation between MPV and CRP (correlation coefficient = 0.217, 95% CI = 0.080-0.346, p = .002).Conclusion: This meta-analysis demonstrated that RDW is higher in patients with AS, and a significant positive correlation exists between RDW, PLR, and MPV and CRP.

Does Mean Platelet Volume Decrease in the presence of Coronary Artery Fistula?

BACKGROUND

Coronary artery fistula (CAF) is an abnormal connection that links a coronary artery to a cardiac chamber or another major blood vessel. Several studies have shown the association between mean platelet volume (MPV) and cardiovascular diseases. In the literature, there is no previous study about the association between hematologic parameters and congenital CAF. For this reason, we aimed to investigate the association of MPV with CAF.

METHODS

70 patients with normal coronary arteries and 50 with coronary artery fistulas were included. Routine blood and biochemical parameters were measured before the arteriography. Differences between groups for continuous variables were analyzed with t- test or Mann-Whitney test. P values < 0.05 were considered significant. Regression analysis was used to find independent predictors of CAF.

RESULTS

Baseline patient demographics, including age and clinical risk factors, were similar between the groups. Compared to the control group, median (IQR) High-density lipoprotein cholesterol (HDL) levels were significantly higher (p=0.04) and MPV levels were significantly lower in the CAF group (8.84 ± 1.71fL vs. 10.43 ± 1.34, p < 0.001). In the multivariate analysis, only MPV was a significant predictor of CAF (p < 0.001, 95% CI for OR: 0.438 (0.306-0.629). A negative correlation was found between MPV and fistulae in Pearson's correlation test (r: -0.454, p < 0.001). An MPV level of < 9,6 fL showed sensitivity, specificity, positive predictive value and negative predictive value of 80%, 68%, 71% and 78% respectively (AUC = 0.766, 95% CI, 0.678-0.854) for the prediction of CAF.

CONCLUSION

The present study suggests that MPV may decrease in patients with CAF.

Role of Platelet to Lymphocyte Ratio as a Biomedical Marker for the Pre-Operative Diagnosis of Acute Appendicitis

Background: Recently, the possible use of laboratory parameters such as full blood count, neutrophil count, neutrophil to lymphocyte ratio (NLR), thrombocyte count (PLT), and mean thrombocyte volume (MPV) have been investigated in diagnosis of acute appendicitis and the prediction of complications. The aim of this study was to investigate the utility of the platelet to lymphocyte ratio (PLR) value as a biomedical marker in the prediction of acute appendicitis and perforated appendix. Patients and Methods: The data were retrieved from the hospital records related to age, gender, length of stay in hospital, MPV, leukocyte, neutrophil, lymphocyte, and thrombocyte counts measured in the peripheral venous blood sample on presentation, NLR and PLR values, and the pathology results. The patients were grouped according to the pathology results as follows: group 1 (normal appendix, n = 86); group 2 (acute appendicitis, n = 458); group 3 (perforated appendicitis, n = 14). Results: The study included a total of 558 patients (308 males; 250 females) with a mean age of 34.24 ± 14.27 years. The mean length of stay in hospital was 2.12 days. The leukocyte and neutrophil count values of group 1 were lower than group 2 and group 3 values (p < 0.001). The lymphocyte count values of group 1 were higher than those of the other groups (p < 0.001). The NLR and PLR values of group 1 were lower than group 2 and group 3 values (p < 0.001). The length of stay in hospital was shorter in group 1 than in group 2 and group 3 (p = 0.42). The receiver operating characteristic (ROC) curve test results showed that PLR and NLR values were sensitive and specific to differentiate normal appendix, acute appendicitis, and perforated appendicitis. Conclusion: The results of this study demonstrated that PLR value, such as NLR, could be evaluated as a new biomarker that could be valuable in the differentiation of normal appendix from acute appendicitis and in the differentiation of acute appendicitis from perforated appendicitis.

Prognostic Values of Platelet-Associated Indicators in Resectable Lung Cancers

Background:

Lung cancer is the leading cause of cancer death. Platelet-related indictors, including platelet count, plateletcrit, mean platelet volume, and platelet distribution width, not only associate with morphology and functions of platelet but also correlate with tumor development and metastasis. In the present study, we investigated the values of platelet-related indictors in the prognosis evaluation of resectable lung cancers.

Methods:

In total, 101 patients with resectable lung cancer were recruited in this study. Patients were divided into 2 groups according to the median pretreatment values. To evaluate the individual value changes after treatment, we introduced the concept of post-/pretreatment ratio (≤1 indicated value was not increased after treatment, while >1 suggested increased value).

Results:

The high pretreatment platelet count level was correlated with larger tumor size. High pretreatment plateletcrit level was associated with more lymph nodes metastasis. Patients with high pretreatment plateletcrit level had worse overall survival, whereas pretreatment platelet count, mean platelet volume, and platelet distribution width levels were not correlated with outcomes. Surgery had no impact on the values of platelet count, plateletcrit, mean platelet volume, or platelet distribution width. Adjuvant chemotherapy significantly decreased the values of platelet count and plateletcrit, whereas it had no effect on the values of mean platelet volume or platelet distribution width. Whole course of treatment (surgery combined with adjuvant chemotherapy) significantly decreased the values of platelet count and platelet distribution width, whereas it had no effect on the values of plateletcrit or mean platelet volume. Post-/pretreatment platelet count, plateletcrit, mean platelet volume, and platelet distribution width ratios were not correlated with outcomes. Univariate analyses demonstrated that American Joint Committee on Cancer stage and pretreatment plateletcrit level were significant risk factors for prognosis. Cox regression analysis revealed that no factor independently associated with worse survival.

Conclusion:

Pretreatment plateletcrit level could be a potential prognostic factor in resectable lung cancers.

Platelet indices as biomarkers for characterization and determination of severity in canine chronic enteropathy

Human studies have shown an association between certain platelet indices and active inflammatory bowel disease when compared to healthy controls. The objectives of this retrospective study were to determine if any platelet indices differ between dogs with chronic enteropathies and healthy age- and sex-matched control dogs and are predictive of the severity of chronic enteropathy based on canine chronic enteropathy clinical activity index (CCECAI) scores. Medical records for 22 chronic enteropathy-positive dogs and 22 healthy control dogs were reviewed for historical and physical examination findings, platelet indices, and histologic diagnoses of chronic enteropathy. Platelet indices were compared between the groups, and an association between platelet indices and CCECAI scores in dogs with chronic enteropathy was investigated. Chronic diarrhea and weight loss were common clinical signs associated with chronic enteropathy. Lymphoplasmacytic enteritis was the most common histologic diagnosis. Only one platelet index, platelet component distribution width (P =  0.045), was found to be significantly different between the groups. For predicting severity of disease, determined by CCECAI score, statistically significant differences in indices associated with higher scores were platelet count (P = 0.024) and platelet dry mass distribution width (P =  0.036). Only platelet component distribution width showed potential in characterizing dogs with chronic enteropathy compared to normal dogs. Elevated platelet count and decreased platelet dry mass distribution width had a significant effect on total CCECAI scores. These findings suggest further investigation into the utility of platelet indices as predictors of disease presence and severity in dogs with chronic enteropathy is warranted.

Antineutrophil Cytoplasmic Antibody-Associated Vasculitis in Korea: A Narrative Review

Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a group of systemic necrotising vasculitides, which often involve small vessels, and which lead to few or no immune deposits in affected organs. According to clinical manifestations and pathological features, AAV is classified into three variants: microscopic polyangiitis, granulomatosis with polyangiitis (GPA), and eosinophilic GPA. The American College of Rheumatology 1990 criteria contributed to the classification of AAV, although currently the algorithm suggested by the European Medicines Agency in 2007 and the Chapel Hill Consensus Conference Nomenclature of Vasculitides proposed in 2012 have encouraged physicians to classify AAV patients properly. So far, there have been noticeable advancements in studies on the pathophysiology of AAV and the classification criteria for AAV in Western countries. However, studies analysing clinical features of Korean patients with AAV have only been conducted and reported since 2000. One year-, 5 year-, and 10 year-cumulative patient survival rates are reported as 96.1, 94.8, and 92.8%. Furthermore, initial vasculitis activity, prognostic factor score, age and specific organ-involvement have been found to be associated with either all-cause mortality or poor disease course. The rate of serious infection is 28.6%, and 1 year-, 5 year- and 10 year-cumulative hospitalised infection free survival rates range from 85.1% to 72.7%. The overall standardised incidence ratio of cancer in AAV patients was deemed 1.43 compared to the general Korean population.

Effectiveness of complete blood count parameters for predicting intracranial injury in children with minor head trauma

Objective: We aimed to investigate the relationship between trauma severity and platelet indices (PI) and white blood cell (WBC) count to identify traumatic brain injury (TBI) in children with minor head trauma (MHT). Materials and methods: This prospective study included children with acute isolated MHT who underwent head computed tomography (CT) based on Pediatric Emergency Care Research Network (PECARN) criteria. Mean platelet volume (MPV), platelet distribution width (PDW), MPV to platelet ratio (MPV/PL), MPV to white blood cell ratio (MPV/WBC), and MPV to Neutrophil ratio (MPV/Neu) were evaluated. Results: 86 children with MHT and 245 controls were included the study. WBC, Neu count, MPV, MPV/WBC, MPV/Neu and MPV/PI ratios were statistically different among patients with abnormal CT, patients with normal CT and healthy controls (p < 0.05). For predicting abbreviated injury score (AIS) > 1, the AUC values of WBC, neutrophil, MPV/WBC and MPV/Neu were 0.746, 0.739, 0.726 and 0.724, respectively. Conclusion: In children with MHT who underwent CT, WBC, Neu counts, MPV/WBC and MPV/Neu ratios may be helpful for predicting the severity of trauma in pediatric emergency department.

Platelet Count and Mean Platelet Volume in Psoriasis Patients

Objectives:

Psoriasis is a chronic inflammatory, immune-mediated disease, and platelets have an important role in the pathomechanisms of psoriasis. Recent studies showed that MPV (mean platelet volume) could be used as a marker of platelet activation. In this study, we aimed to investigate the MPV level and platelet count in psoriasis patients and its association with disease severity.

Methods:

We designed a case-control study with 28 psoriasis patients and age and sex-matched 30 healthy controls. Haematologic parameters and sedimentation rates compared between groups. These parameters also correlated with PASI (Psoriasis Area and Severity Index) score.

Results:

MPV and platelet count were significantly higher in patients with psoriasis than controls (p=0.012, p=0.015). Also, platelet count was showed positive correlation with PASI scores (r=0.424, p=0.025). The sedimentation rate was not statistically different between groups.

Conclusion:

There are many conflicting results about the correlation of haematologic parameters and psoriasis. We found that MPV and platelet counts higher in the psoriasis group, which suggests that platelets play an important role in the pathomechanism of psoriasis and may be helpful in assessing treatment outcomes.

Relationship of hematologic markers with IL-17 and IL-1 beta in patients with rheumatoid arthritis

OBJECTIVES

In this study, we aimed to investigate the relationship of NLR (Neutrophil lymphocyte ratio), MPV (mean platelet volume), PDW (distribution width) rates in rheumatoid arthritis (RA) patients with IL-17 and IL-1 beta which are within the cytokines playing an important role in etiopathogenesis and activity of the disease.

PATIENTS AND METHODS

Fifty-seven RA patients diagnosed according to RA classification criteria of ACR/EULAR 2010 and 37 controls were included into the study. WBC (white blood cell), NEU (neutrophil), PLT (platelet), LYM (lymphocyte) values in complete blood count received from routine blood examination of patients were recorded, and NLR, PLR (platelet lymphocyte ratio) rates were recorded. IL-17 and IL-1 beta were studies in serum samples. Disease activity of RA patients was evaluated with Disease Activity Score (DAS28). Age, gender, disease age, BMI (body mass index), medications used, co-morbid diseases, smoking of the patients were recorded.

RESULTS

Fifty-seven RA patients (46 (80.7%) females, 11 (19.3%) males), and 34 patients (24 (70.6% females and 10 (29.4) males) as a control group were involved. Demographic characteristics were similar between two groups, and statistically significant difference was not detected between patient and control groups in terms of gender, age, and BMI (p> 0.05). We found higher NLR, MPV, PDW, IL-17 values in RA patients compared to control group (p< 0.05). There was a positive correlation of NLR with DAS28, CRP. While erythrocyte sedimentation rate (ESR) had negative correlation with MPV and PDW, it had positive correlation with PLT. We found positive correlation of C-reactive protein (CRP) with NLR and PLT. We could not find correlation of IL-1 beta and IL-17 with hematologic markers.

CONCLUSION

In this study, we investigated the relationship of IL-17 and IL-1 beta which play an important role in pathogenesis of RA patients with the parameters analyzed in routine complete blood count, providing information about disease activity such as DAS 28, CRP, and ESR. We illuminated on an issue which has not discussed before by looking from a different angle. More extensive, follow-up studies are needed to emphasize the importance of these parameters and to reveal the relationship between cytokines during the follow-up of the disease activity.

Evaluation of Immunomodulatory and Hematologic Cell Outcome in Heroin/Opioid Addicts

The long-term use of opioids leads alternations in both innate-adaptive immune systems and other diagnostic hematologic cells. The purpose of this study is to evaluate the alterations of these parameters in patients with heroin/opioid addictions. Adults, meeting the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria of the American Psychiatric Association regarding opioid use disorder (Heroin Group or HG, n = 51) and healthy controls (Control Group or CG, n = 50), were included in the study. All hematological parameters, inflammation indexes (neutrophil-lymphocyte ratio and platelet-lymphocyte ratio), and iron panel were compared with the controls. Mean corpuscular volume, red blood cell distribution width, mean corpuscular hemoglobin content, unsaturated iron-binding capacity, and total iron-binding capacity were significantly higher in HG compared to CG, while red blood cell count, hemoglobin, hematocrit, and serum iron levels were significantly lower. Additionally, platelet and platelet distribution width were significantly high while mean platelet volume was low in HG. Regarding the parameters related to immunity, white blood cell, neutrophil count, and neutrophil percentage were significantly high while lymphocyte percentage and basophils count were significantly low. Besides, inflammatory indexes were significantly higher in HG compared to CG. Intravenous administration of heroin resulted in lower levels of hemoglobin, hematocrit, and mean corpuscular volume than inhalation and intranasal administration. Our data demonstrated that chronic use of opioids is related to all of the hematologic series. The chronic use of opioid alters the immunologic balance in favor of innate immunity cells and changes the hematometric/morphometric characteristics of erythrocytes. What is more, the route of heroin administration should be taken into consideration as well. This study may lead to a better understanding of the hematological effects of heroin/opioid use in patients with relevant addictions.

Determination of Risk Factors in Children Diagnosed With Henoch-Schönlein Purpura

OBJECTIVES

This study aims to evaluate the frequency of skin, gastrointestinal, joint, and renal involvement in children with Henoch-Schönlein purpura and investigate the risk factors for organ/system involvement.

PATIENTS AND METHODS

The data of 186 patients (97 boys, 89 girls; mean age 7.4±2.8 years; range 1.5 to 16.5 years) who were followed-up with the diagnosis of Henoch-Schönlein purpura in our clinic between October 2011 and December 2013 were evaluated retrospectively.

RESULTS

Logistic regression analysis revealed that the risk of gastrointestinal system involvement was significantly higher in patients with skin lesions in the upper extremities (p=0.002, odds ratio [OR]=3.2). The risk of joint involvement was significantly higher in girls (p=0.024, OR=2.18), in patients with soft tissue swelling (p=0.005, OR=2.63), and with low mean platelet volume levels (p=0.008, OR=4.07). The risk of renal involvement was significantly higher in girls (p=0.047, OR=2.7), in patients >10 years (p=0.001, OR=1.4), and in patients with elevated C-reactive protein levels (p=0.007, OR=6.57).

CONCLUSION

Having skin lesions in the upper extremities is a risk factor for gastrointestinal system involvement. Female sex, soft tissue swelling, and low mean platelet volume levels are risk factors for joint involvement. Female sex, >10 years of age, and high C-reactive protein levels are risk factors for renal involvement. Renal involvement in Henoch-Schönlein purpura is independent of gastrointestinal system or joint involvement and very close follow-up is required in the acute period particularly in girls >10 years with high C-reactive protein levels.

Mean platelet volume and lymphocyte-to-monocyte ratio are associated with shorter progression-free survival in EGFR-mutant lung adenocarcinoma treated by EGFR tyrosine kinase inhibitor

Background

A growing body of evidence supports the role of platelets in cancer metastasis, escape from immune surveillance, and angiogenesis. Mean platelet volume (MPV), which reflects platelet turnover, is reported routinely as part of automated complete blood count. Accumulating evidence suggests that MPV is a useful biomarker in several diseases including cancer. However, its role in cancer patients receiving molecular targeted therapy has not been described in the literature.

Materials and methods

We retrospectively analysed the prognostic impact of MPV in advanced or recurrent EGFR mutant lung adenocarcinoma treated with EGFR tyrosine kinase inhibitors (EGFR-TKIs). Lymphocyte-to-monocyte ratio (LMR) has been previously reported to be a poor prognostic factor in EGFR mutant non-small cell lung cancer and was also included as a covariate.

Results

Using the previously described Cutoff Finder algorithm, the cut-off points for MPV and LMR that best predicted progression free survival (PFS) of EGFR-TKI were determined as 10.3 and 2.8, respectively. The median PFS was 14.7 and 8.2 months in MPV low and high groups (p = 0.013, log-rank test). The median PFS was 13.5 and 6.2 months in LMR high and low groups (p < 0.001, log-rank test). MPV and LMR were independently distributed (chi square test) and the multivariate analysis using Cox’s proportional hazards regression model revealed that high MPV, low LMR, and pleural effusion were significant predictors for shorter PFS.

Conclusion

MPV and LMR, measured as part of routine complete blood count, can be utilized to predict the outcome of EGFR-TKI therapy with no additional costs. Our results suggest a mechanism of EGFR-TKI resistance which is associated with the functional status of the platelets.

Red blood cell distribution width-to-platelet ratio as a disease activity-associated factor in systemic lupus erythematosus

BACKGROUND

Although different clinical and experimental parameters have been used to estimate disease activity in systemic lupus erythematosus (SLE) patients, the relationship between red blood cell distribution width-to-platelet ratio (RPR) and disease activity in SLE has not been previously illuminated. Therefore, the aim of this study was to investigate the association between RPR levels and disease activity in SLE.

METHODS

This study enrolled 105 SLE patients and 105 healthy subjects. We divided the patients into 2 groups using the SLE Disease Activity Index (SLEDAI) 2000. Group 1 included patients with SLEDAI score ≤9 (mild disease activity group) and group 2 with SLEDAI >9 (severe disease activity group). Correlations between RPR and disease activity were then analyzed. A subgroup follow-up analysis of 93 patients was conducted to explore the effect of SLE-related glucocorticoid therapy.

RESULTS

The PLR and RPR values of SLE patients were significantly higher compared with the controls (both P < .001), whereas mean platelet volume was decreased (P < .05). The RPR level was found to be positively correlated with SLEDAI (r = 0.368, P < .001) and erythrocyte sedimentation rate (r = 0.313, P = .027). According to the receiver-operating characteristic (ROC) curve, the optimal cut-off value for predicting SLE using RPR was 0.073, and the area under ROC curve was 0.817. RPR level was correlated with clinical disease activity in SLE, and its value was normalized after treatment.

CONCLUSION

RPR may be a useful measurement for the assessment of disease activity in SLE patients.

Assessment of Mean Platelet Volume in Patients with Systemic Lupus Erythematosus

INTRODUCTION

The Mean Platelet Volume (MPV) is a platelet activation biomarker that has been recently correlated with disease activity in SLE. We aimed to evaluate the MPV in patients with SLE comparing it with healthy individuals, to study the correlation between MPV and SLE Disease Activity Index (SLEDAI) in SLE patients and to analyze possible correlation between MPV and Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and complement components C3 and C4.

METHODS

This is a cross-sectional study in which 81 patients with SLE according to the American College of Rheumatology (ACR) diagnostic classification criteria and 58 healthy controls were included. Active disease was defined as SLEDAI>0.

RESULTS

Patients with active SLE had decreased MPV when compared to inactive disease group (10.0±0.7fL vs. 10.7±1.0fL, p=0.005, respectively) and when compared to control group (10.9±1.0fL, p<0.001). Our study found a weak negative correlation between the SLEDAI and the MPV (r=-0.29, p=0.009). There was no correlation between MPV and CRP, ESR, C3 and C4. Also, no correlation between SLEDAI and CRP, ESR, C3 and C4 was found.

CONCLUSION

MPV decreases in patients with active SLE and is inversely correlated with SLEDAI.

Assessing the Role of DNA Methylation-Derived Neutrophil-to-Lymphocyte Ratio in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a disease of chronic systemic inflammation (SI). In the present study, we used four datasets to explore whether methylation-derived neutrophil-to-lymphocyte ratio (mdNLR) might be a marker of SI in new onset, untreated, and treated prevalent RA cases and/or a marker of treatment response to the tumour necrosis factor inhibitor (TNFi) etanercept. mdNLR was associated with increased odds of being a new onset RA case (OR = 2.32, 95% CI = 1.95-2.80, P < 2 × 10-16) and performed better in distinguishing new onset RA cases from controls compared to covariates: age, gender, and smoking status. In untreated preclinical RA cases and controls, mdNLR at baseline was associated with diagnosis of RA in later life after adjusting for batch (OR = 4.30, 95% CI = 1.52-21.71, P = 0.029) although no association was observed before batch correction. When prevalent RA cases were treated, there was no association with mdNLR in samples before and after batch correction (OR = 0.34, 95% CI = 0.05-1.82, P = 0.23), and mdNLR was not associated with treatment response to etanercept (OR = 1.10, 95% CI = 0.75-1.68, P = 0.64). Our results indicate that SI measured by DNA methylation data is indicative of the recent onset of RA. Although preclinical RA was associated with mdNLR, there was no difference in the mean mdNLR between preclinical RA cases and controls. mdNLR was not associated with RA case status if treatment for RA has commenced, and it is not associated with treatment response. In the future, mdNLR estimates may be used as a valuable research tool to reliably estimate SI in the absence of freshly collected blood samples.

Platelet distribution width as a novel indicator of disease activity in systemic lupus erythematosus

Background:

Significance of platelet distribution width (PDW) and mean platelet volume (MPV) in assessing disease activity of systemic lupus erythematosus (SLE) remains unclear. This study was aimed to evaluate PDW and MPV as potential disease activity markers in adult SLE patients.

Materials and Methods:

A total of 204 study participants, including 91 SLE patients and 113 age- and gender-matched healthy controls, were selected in this cross-sectional study. They were classified into three groups: control group (n = 113), active SLE group (n = 54), and inactive SLE group (n = 37). Demographic, clinical, and laboratory data were analyzed.

Results:

In patient group, PDW was statistically higher than that in control group (13.54 ± 2.67 vs. 12.65 ± 2.34, P = 0.012), and in active group, PDW was significantly increased compared to inactive group (14.31 ± 2.90 vs. 12.25 ± 1.55, P < 0.001). However, MPV was significantly lower in SLE group than in control group (10.74 ± 0.94 vs. 11.09 ± 1.14, P = 0.016). PDW was positively correlated with SLE disease activity index (P < 0.001, r = 0.529) and erythrocyte sedimentation rate (P = 0.002, r = 0.321) and negatively correlated with C3 (P < 0.001, r = −0.419). However, there was no significant association between MPV and these study variables. A PDW level of 11.85% was determined as a predictive cutoff value of SLE diagnosis (sensitivity 76.9%, specificity 42.5%) and 13.65% as cutoff of active stage (sensitivity 52.6%, specificity 85.3%).

Conclusion:

This study first associates a higher PDW level with an increased SLE activity, suggesting PDW as a novel indicator to monitor the activity of SLE.

Mean Platelet Volume in Pemphigus Vulgaris

Pemphigus vulgaris (PV) is an autoimmune blistering disease of the skin and mucous membranes. The mean platelet volume (MPV) is an index of platelet activation reported to be influenced by inflammation. We investigated the MPV in patients with PV relative to controls. This case-control study included 160 patients with PV and 640 age- and sex-matched controls. The MPV, platelet count, and other inflammatory parameters were measured for all study participants. A significantly decreased MPV was observed in patients with PV compared with controls, 9.1 (1.5) fL versus 10.3 (1.4) fL, P < .001. A significant negative association between MPV and PV was demonstrated in multivariate analysis (odds ratio, 0.59; 95% confidence interval, 0.51-0.68, P < .0001). Patients having PV with laryngeal involvement had significantly lower MPVs than those without involvement of the larynx, 8.81 (1.5) fL versus 9.32 (1.4) fL, P = .032. Disease activity (before and after treatment) does not affect the MPV. Patients with PV showed decreased MPV values compared to healthy controls. The MPV may be a feasible diagnostic marker in patients with PV.

Mean platelet volume can estimate the current vasculitis activity of microscopic polyangiitis

Mean platelet volume (MPV) was known to be associated with the inflammatory burdens in various diseases, but not microscopic polyangiitis (MPA) yet. In this study, we investigated the association between MPV and Birmingham vasculitis activity score (BVAS) in 88 patients with MPA. We retrospectively reviewed the medical records of 88 patients with MPA. Clinical and laboratory data at diagnosis and partially at follow-up were collected. Linear regression analyses were used to clarify the association between MPV and BVAS. We also stratified MPA patients into three groups according to tertile of BVAS and define the lower limit of the highest tertile as the cut-off of BVAS for severe MPA. The area under the receiver operator characteristic curve (AUROC) was used to identify the cut-off of MPV for severe MPA (8.85 fL). The mean age was 60.5 years and 25 patients were male (28.4%). In univariable linear regression analysis, MPV was negatively correlated with BVAS (r = - 0.326). In multivariable linear regression analysis, MPA was independently associated with BVAS (β = - 0.260). When we classified MPA patients into two groups based on the cutoff of MPV for severe MPA, patients having MPV ≤ 8.85 fL exhibited the higher frequency of severe MPA than those having MPV > 8.85 fL (RR 5.000). In addition, MPV increased along with improvement of vasculitis activity during the follow-up. In conclusion, MPV is significantly associated with BVAS and it can estimate the current BVAS in patients with MPA.

From blood coagulation to innate and adaptive immunity: the role of platelets in the physiology and pathology of autoimmune disorders

Thrombosis and cardiovascular complications are common manifestations of a variety of pathological conditions, including infections and chronic inflammatory diseases. Hence, there is great interest in determining the hitherto unforeseen immune role of the main blood coagulation executor-the platelet. Platelets store and release a plethora of immunoactive molecules, generate microparticles, and interact with cells classically belonging to the immune system. The observed effects of platelet involvement in immune processes, especially in autoimmune diseases, are conflicting-from inciting inflammation to mediating its resolution. An in-depth understanding of the role of platelets in inflammation and immunity could open new therapeutic pathways for patients with autoimmune disorders. This review aims to summarize the current knowledge on the role of platelets in the patomechanisms of autoimmune disorders and suggests directions for future research.

Association between multimorbidity and mean platelet volume in diabetic patients with acute myocardial infarction

AIMS

Diabetes mellitus (DM) is one of the most frequently detected conditions in multimorbid disease clusters. Platelet activation is one of the key mechanisms underlying atherothrombosis in acute myocardial infarction. Available data link mean platelet volume (MPV) to poor prognosis not only in cardiovascular and non-cardiovascular disease. Given the lack of research data on the association between disease clusters and MPV, we have set out to investigate the link between multimorbidity and MPV in diabetic patients with acute myocardial infarction.

METHODS

A total of 277 patients with DM and STEMI undergoing primary percutaneous coronary intervention were enrolled. Based on the number of comorbidities the study population was divided into two groups: group 1 (N = 58) with ≤ 1 comorbidity and group 2 (N = 219) with ≥ 2 comorbidities. A subanalysis was performed within the multimorbidity group: group 2A with two or three comorbidities (N = 156) and group 2B with at least four comorbidities (N = 63).

RESULTS

In the study population, 15.9% of patients had one comorbidity, and 22.0, 34.3, and 22.7% of patients had two, three, or at least four comorbid conditions, respectively. Both MPV and PDW were elevated in multimorbid patients (9.3 vs 10.8 fl and 9.5 vs 10.3 fl, respectively). The highest platelet volume indices were observed in patients with at least four comorbid conditions. There was a moderate positive correlation between MPV and the total number of comorbidities, the number of CVD comorbidities, and the number of non-CVD comorbidities.

CONCLUSIONS

These findings indicate that multimorbidity is associated with an increase in platelet volume indices. MPV values increased with the increasing number of comorbid conditions. Importantly, MPV values were elevated in some, but not all CVD and non-CVD conditions.

Role of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) in assessing disease control in Asian patients with axial spondyloarthritis

INTRODUCTION

C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) which are used for assessment of axial spondyloarthritis (AxSpA) related disease activity have poor specificity and sensitivity. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) have not been investigated as disease activity markers among Asian AxSpA patients.

METHODOLOGY

A retrospective, cross-sectional study was conducted in Singapore General Hospital from January 2013 to December 2015 to investigate the role of NLR, PLR and MPV as disease activity markers in AxSpA patients.

RESULTS

The mean age of patients (n = 122) was 37.0 ± 12.5 years old and majority of them were male (n = 93, 76.2%). No significant differences were found between patients with disease with regards to age, gender, ethnicity, HLAB-27 status, age at onset of diagnosis of AxSpA, duration of disease and comorbidities such as cardiac disease (p > 0.05). There were no significant differences in the ESR, NLR, PLR and MPV between the four disease activity groups (p > 0.05). However, patients with very high disease activity had higher ESR and CRP compared to patients with inactive disease and moderate disease activity (p < 0.05).

CONCLUSION

NLR, PLR and MPV were not associated with disease activity in Asian AxSpA patients.

Investigation of mean platelet volume and platelet count in the blood of patients with lumbago and sciatica

Background:

Aim:

Patients and Methods:

Results:

Conclusion:

Platelets are activated in ANCA-associated vasculitis via thrombin-PARs pathway and can activate the alternative complement pathway

BACKGROUND

In this study, we investigated the mechanism of platelet activation in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), as well as the activation of the alternative complement pathway by platelets in AAV.

METHODS

CD62P and platelet-leukocyte aggregates in AAV patients were tested by flow cytometry. Platelets were stimulated by plasma from active AAV patients. The effect of the thrombin-protease-activated receptors (PARs) pathway was evaluated by blocking thrombin or PAR1 antagonists. After platelets were activated by plasma from AAV patients, Ca/Mg-Tyrode's buffer and Mg-EGTA buffer were used to measure complement activation in liquid phase and on the surface of platelets.

RESULTS

The levels of CD62P-expressing platelets and platelet-leukocyte aggregates were significantly higher in active AAV patients than those in remission and normal controls. Platelets were activated by plasma from active AAV patients (percentage of CD62P-expressing platelets, 97.7 ± 3% vs. 1 ± 0.2%, p < 0.0001, compared with those incubated with healthy donor plasma), and this was inhibited by thrombin or PAR1 antagonists (percentage of CD62P-expressing platelets, 97.7 ± 3% vs. 2.7 ± 1%, p < 0.0001, 97.7 ± 3% vs. 5 ± 1.4%, p < 0.0001, respectively). Platelets activated by plasma from AAV patients could trigger complement activation via the alternative pathway, as demonstrated by significant elevation of C3a, C5a, and sC5b-9 and significantly more C3c and C5b-9 deposition on the surface of platelets.

CONCLUSIONS

Platelets were activated in AAV patients, and such activation was at least partially attributed to the thrombin-PARs pathway. Activated platelets triggered the alternative complement pathway in AAV.

The Relationship Between Serum Pentraxine 3 Levels and Hematological Markers in Patients With Rheumatoid Arthritis

Objectives

This study aims to investigate the association of pentraxin 3 (PTX3) with neutrophil/lymphocyte ratio (NLR) rather than the disease activity score 28 using C-reactive protein in rheumatoid arthritis (RA).

Patients and methods

The study included 59 RA patients (11 males, 48 females; mean age 53.79±13.55 years; range 40 to 66 years) and 20 healthy controls (5 males, 15 females; mean age 50.41±6.11 years; range 43 to 56 years). Complete blood count tests were recorded and NLR and platelet/ lymphocyte ratio were calculated. PTX3 and interleukin-6 levels were examined in serum samples. Disease activity of RA patients was assessed by disease activity score 28.

Results

Demographic characteristics were similar between the two groups, with no statistically significant difference in terms of sex, age, and body mass index (p>0.05). NLR, PTX3 and interleukin-6 levels were higher in patients with RA than the control group (p<0.05). While erythrocyte sedimentation rate had a positive correlation with mean platelet volume, we found no correlation between NLR and other parameters of disease activity, PTX3, and interleukin-6.

Conclusion

We found no correlation between PTX3 and disease activity score 28 or NLR, although PTX3 levels were higher in RA patients than the controls. As a result, we were unable to establish a relationship between PTX3 and disease activity, directly or indirectly. To our knowledge, our study was the first to investigate the relationship between PTX3 and NLR.

Mean Platelet Volume and Immature Platelet Fraction in Autoimmune Disorders

Mean platelet volume (MPV), measured using automated blood analysers, has been appraised as a potential biomarker in cardiovascular disease, diabetes mellitus, and cancer. The test, a useful tool in differentiation of thrombocytopenic states, has now been carried out for autoimmune disorders, but data are yet scarce. Controversial results have been obtained in systemic and organ-specific autoimmune disorders. Another test, the immature platelet fraction (IPF) reflects the amount of young, reticulated platelets. IPF is calculated by automated hematology analysis or flow cytometry, and it is usually high in patients with rapid platelet destruction. For both MPV and IPF, standardization of cutoff is a major need. In this review, we focus the current applicability of MPV and IPF as biomarkers in patients with autoimmune diseases.

Association between mean platelet volume and severity of rheumatoid arthritis

Introduction

In recent years, it is suggested that platelet histogram indices, such as mean platelet volume (MPV) may be related to the activity of rheumatoid arthritis (RA). The aim of this study was to assess relationship between MPV and activity of rheumatoid arthritis.

Methods

Sixty consecutive patients fulfilling the American College of Rheumatology (ACR) criteria for RA were recruited from the rheumatology outpatient clinics in Semnan, Iran. Current disease activity score (DAS-28 score) was assessed at baseline, 2 months and 4 months after the admission time and beginning of the treatment schedule. Complete blood count (including MPV), C-reactive protein (CRP) and ESR were measured in each visit. MPV was analyzed by the Cell Dyne 3500 automated blood cell counter.

Results

There was a significant reduction in DAS-28 score within 4 months of total assessment (from 4.47 ± 2.24 versus 3.18 ± 1.55) (p < 0.001). There was no significant difference in MPV levels at the three study time points. No significant correlations were observed between the DAS-28 score and mean MPV levels at the same time points. The rate of positive CRP was decreased within the same period (p = 0.002); however, the trend of the changes in other laboratory parameters including MPV, platelet count and ESR values was not significant. The measurement of MPV value did not correlate with disease activity in RA patients within 4 months of treatment scheduling.

Conclusion

Although therapeutic regimens, which improve RA manifestations, can reduce RA activity, they had no effect on MPV during this time period. It seems MPV may not be able to predict disease activity in RA patients.