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

Altered platelet phenotype in patients with type II endoleaks following abdominal aortic aneurysm repair

BACKGROUND

Endovascular abdominal aortic aneurysm repair (EVAR) is a preferred surgery to prevent aneurysm sac enlargement and minimize the risk of life-threatening rupture in patients with AAA. Serious complications of type II endoleaks following EVAR can cause sac expansion and increase rupture risk. This study focused on evaluating clinical and blood characteristics in patients with type II endoleaks to refine our understanding of systemic fluctuations associated with unsuccessful EVAR.

METHODS

This retrospective study included 146 patients with AAA who underwent primary elective endovascular procedures (EVAR/fEVAR) between 2013 and 2021. Clinical characteristics, complete blood count (CBC) and imaging data were analyzed from patients who did and did not develop type II endoleaks.

RESULTS

Mean platelet volume (MPV) was significantly increased in patients who developed type II endoleaks after EVAR. Receiver operating characteristic analysis showed that MPV has a satisfactory discriminatory performance in distinguishing post-EVAR patients who developed type II endoleaks, yielding an area under the curve (AUC) value of 0.64. A risk stratification panel incorporating MPV, type II diabetes history, and administration of dual antiplatelet therapies yielded an AUC of 0.70 and predicted an endoleak-free survival rate with a hazard ratio of 2.94. A nomogram revealed that MPV had the highest scoring weight among all significant variables.

CONCLUSION

Patients with type II endoleaks following EVAR have elevated MPV indicative of different phenotypes of circulating platelets. MPV presents an attractive predictive criteria for assessing the occurrence of type II endoleaks in patients with AAA.

Integrating electronic health records and GWAS summary statistics to predict the progression of autoimmune diseases from preclinical stages

Autoimmune diseases often exhibit a preclinical stage before diagnosis. Electronic health record (EHR) based-biobanks contain genetic data and diagnostic information, which can identify preclinical individuals at risk for progression. Biobanks typically have small numbers of cases, which are not sufficient to construct accurate polygenic risk scores (PRS). Importantly, progression and case-control phenotypes may have shared genetic basis, which we can exploit to improve prediction accuracy. We propose a novel method Genetic Progression Score (GPS) that integrates biobank and case-control study to predict the disease progression risk. Via penalized regression, GPS incorporates PRS weights for case-control studies as prior and forces model parameters to be similar to the prior if the prior improves prediction accuracy. In simulations, GPS consistently yields better prediction accuracy than alternative strategies relying on biobank or case-control samples only and those combining biobank and case-control samples. The improvement is particularly evident when biobank sample is smaller or the genetic correlation is lower. We derive PRS for the progression from preclinical rheumatoid arthritis and systemic lupus erythematosus in the BioVU biobank and validate them in All of Us. For both diseases, GPS achieves the highest predictionR 2 and the resulting PRS yields the strongest correlation with progression prevalence.

Evaluation of hematological markers as prognostic tools in rheumatoid arthritis

BACKGROUND

Reducing inflammation is central to the management of RA. However, commonly used markers such as CRP and ESR, along with the DAS-28 score, have shown limitations. Hematologic indices, such as platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR), show potential as reliable indicators of inflammation in RA. This study evaluates these markers across different RA activity levels to identify effective biomarkers for distinguishing active RA from remission.

MATERIALS AND METHODS

305 RA patients were enrolled in our study, diagnosed by ACR/EULAR 2010 criteria, and divided into four groups according to the DAS28-ESR score. 8 ml of blood were taken for a CBC test and serological tests such as rheumatoid factor (RF), anticyclic citrullinated peptide antibodies (anti-CCP), anti-nuclear antibodies (ANA), and C-reactive protein (CRP). Platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR) were assessed as potential markers of inflammation.

RESULTS

The mean age of RA patients was 51.7 years and a disease duration of 56.7 months. Significant differences in tender and swollen joints were observed between RA groups. Laboratory findings revealed higher CRP and ESR in active RA patients, while hemoglobin, hematocrit, and lymphocyte counts were higher in remission group. ROC analysis showed ESR, CRP, NLR, and PLR as potential markers for distinguishing active from remission RA, with ESR demonstrating the highest diagnostic accuracy. LMR could not differentiate between active and inactive forms of RA disease.

CONCLUSION

The NLR and PLR markers were significantly correlated with traditional inflammatory markers like CRP and ESR. These novel markers could be useful tools for evaluating RA activity, offering a cost-effective alternative to imaging techniques. Further research is needed to confirm their clinical utility.

Evaluating the Role of CBC-Derived Indices in Children with Hashimoto's Thyroiditis

Background/Objectives: Hashimoto's thyroiditis (HT) is an autoimmune disorder characterized by chronic inflammation of the thyroid gland. Recent evidence indicates that the inflammation may extend beyond the thyroid. The study aims to explore the potential of complete blood count (CBC)-derived indices as markers of systemic inflammation in HT. Materials and Methods: This cross-sectional retrospective study from 1 January 2015, to 31 December 2023 included 147 pediatric HT patients and 144 apparently healthy controls. Thyroid profiles, antibodies, CBC, and protein electrophoresis data were collected from patient records. CBC-derived indices were calculated and compared between the HT and control groups, as well as among HT subgroups. Results: The median age of HT patients was 13.6 years (range: 11.2-15.5 years), with 66% being girls. The control group had a similar age and gender distribution, with a median age of 13.7 years (range: 11-15.8 years) and 70.8% girls. Of the HT patients, 50% had subclinical HT, 15% were euthyroid, and 34% had overt thyroid dysfunction. HT patients showed significantly higher neutrophil and lymphocyte counts, as well as all evaluated CBC-derived indices than controls (p < 0.001)). These differences were not significant among HT subgroups. Logistic regression indicated a strong association between an elevated neutrophil-to-lymphocyte ratio (NLR) and HT diagnosis (p < 0.001), while ROC analysis confirmed NLR as the most accurate CBC-derived marker for distinguishing HT from controls. Conclusions: Elevated NLR levels in pediatric HT patients provide additional evidence that inflammation may extend beyond the thyroid gland. These results support the potential of NLR as a reliable and accessible biomarker for evaluating inflammation in Hashimoto's thyroiditis.

The effect of anesthesia methods on the neutrophil-lymphocyte ratio in patients undergoing forearm surgery: A monocentric and retrospective study

Surgical trauma can induce systemic inflammation. The selected anesthesia method may modulate the inflammatory response and surgical results in the inflammatory process that occurs during surgical trauma. In this retrospective study, we aimed to compare the anti-inflammatory effects of general anesthesia and peripheral nerve block (infraclavicular block). Demographic, clinical, and laboratory records (hemogram, total leukocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume) were obtained from the archival data. The patients were divided into 2 groups: Group G, who received general anesthesia, and Group P, who received a peripheral nerve block (infraclavicular block) for forearm surgery. The amount of opioid consumed postoperatively was significantly lower in Group P. Infraclavicular block as an alternative to general anesthesia was found to be associated with a significant decrease in the neutrophil-to-lymphocyte ratio, total leukocyte count, and platelet-to-lymphocyte ratio levels compared to those observed after general anesthesia. Peripheral nerve blocks may play a role in reducing inflammation and alleviating stress.

Congential nasolacrimal duct obstruction: investigating the role of systemic inflammation through novel biomakers

OBJECTIVE

Congenital nasolacrimal duct obstruction (CNLDO) is a common lacrimal system anomaly in newborns and infants. We aimed to evaluate the role of inflammation in the pathogenesis of persistent CNLDO and its potential use in diagnosis and follow up, focusing on novel inflammatory biomarkers: Systemic Immune-Inflammation Index (SII), Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), Red cell distribution width (RDW), and Mean platelet volume (MPV).

METHODS

A retrospective case-control study involving 76 CNLDO patients and 47 age-matched healthy controls was conducted. Complete blood count parameters were analyzed to calculate SII, NLR, PLR, RDW, and MPV. Receiver Operating Characteristic (ROC) analysis determined the diagnostic efficacy of these markers.

RESULTS

SII, RDW, and neutrophil count were significantly elevated in the CNLDO group (p < 0.05). An elevated SII (cutoff > 200.9) demonstrated a sensitivity of 63.2% and a specificity of 63.8%. ROC analysis (AUC = 61.7%, p = 0.029) indicated that SII is a more significant marker for diagnosing CNLDO compared to NLR and PLR.

CONCLUSION

Elevated SII, indicative of systemic inflammation may serve as a significant biomarker in the diagnosis of CNLDO that does not resolve spontaneously and requires probing. SII > 200.9 acts as a threshold that aids in the diagnosis of persistent CNLDO. Being a valuable biomarker, SII can be used in monitoring patients with CNLDO and in identifying those who will require advanced treatment like probing. Prospective studies are essential to validate these findings.

Caregiver burden in families of children with juvenile idiopathic arthritis in India

Juvenile Idiopathic Arthritis (JIA) causes caregiver burden on families with children affected with it. Our study aimed to explore this multifaceted burden in the Indian context. In this cross-sectional study, we administered the Hindi translated CAREGIVER questionnaire to adult caregivers in the families of JIA patients ≤ 18 years. The responses to the 28 items were used to calculate the burden scores in various dimensions. The relationship of the global burden scores with demographic and socioeconomic factors were analysed. Non parametric tests were used. Two hundred twenty-one caregivers participated with a median age of 39 years (IQR 32-45). This included 116 fathers, 50 mothers, 32 brothers, 18 uncles, three grandfathers, one sister, and one grandmother. The JIA patients had a median age of 15 (12-17) years, and the male-to-female ratio was 3.2:1. Enthesitis-related arthritis was the predominant subtype (72.4%). Most caregivers (70.6%) expressed sadness at diagnosis, and 29.9% continued to express sadness. Nearly two-thirds (65.6%) had to borrow money from others. More than half (59.3%) of the caregivers neglected their health, and 9.0% became sick. Male gender of the child, systemic JIA subtype, low socioeconomic status, high disease activity, extra-articular damage, high parent-reported disease activity and poor quality of life were associated with higher global caregiver burden. JIA has a significant emotional, social, economic, and labour impact on caregivers. Economic and psychosocial support needs to be given to family caregivers caring for children with JIA.

Role of Platelets in Rheumatic Chronic Autoimmune Inflammatory Diseases

Platelets are essential in maintaining blood homeostasis and regulating several inflammatory processes. They constantly interact with immune cells, have immunoregulatory functions, and can affect, through immunologically active substances, endothelium, leukocytes, and other immune response components. In reverse, inflammatory and immune processes can activate platelets, which might be significant in autoimmune disease progression and arising complications. Thus, considering this interplay, targeting platelet activity may represent a new approach to treatment of autoimmune diseases. This review aims to highlight the role of platelets in the pathogenic mechanisms of the most frequent chronic autoimmune inflammatory diseases to identify gaps in current knowledge and to provide potential new targets for medical interventions.

Association of Hematological and Biochemical Parameters and HLA-DRB1 Alleles With Anti-cyclic Citrullinated Peptide Autoantibodies in Sudanese Rheumatic Patients

Introduction Anti-citrullinated protein/peptide antibodies (ACPA) are crucial for the diagnosis and prognosis of rheumatoid arthritis (RA) and are associated with class II HLA-DRB1 alleles. The study's goal was to determine how DRB1 alleles and hematological and biochemical parameters affect ACPA production in RA patients from Sudan. Methods The study analyzed the hematological and biochemical parameters and the frequency of HLA-DRB1 alleles in 120 RA patients and 100 controls. Automated analyzers, ELISA, the latex agglutination test, and the Westergren method were utilized for hematological and biochemical testing. HLA class II alleles were genotyped using polymerase chain reaction-sequence-specific primers (PCR-SSP). The student's t-test and the chi-square (Χ2) test were employed to identify significant alterations between the examined parameters and allele frequencies. Results A total of 51.7% of 120 RA patients tested positive for ACPA (ACPA+). Among those patients, the DRB1*04 and *10 alleles were significantly more prevalent (22.2% vs. 8.9%, P = 0.048 and 23.8% vs. 8.9%, P = 0.030, respectively). RA patients had significantly higher counts of platelet count test (PLT; P = 0.011), lymphocytes (LY; P = 0.000), neutrophils (NE; P = 0.025), monocytes (MO; P = 0.000), eosinophils (EO; P = 0.000), neutrophil-to-lymphocyte ratio (NLR; P = 0.006), C-reactive protein (CRP; P = 0.000), and erythrocyte sedimentation rate (ESR; P = 0.000) than controls. Patients also showed low counts of red blood cells (RBC; P = 0.003), hemoglobin (Hb; P = 0.024), mean platelet volume (MPV; P = 0.000), and basophils (BA; P = 0.048). ACPA+ RA patients had elevated white blood cells (WBC; P = 0.046), PLT (P = 0.029), and low mean corpuscular hemoglobin concentration (MCHC; P = 0.022). The hematological and biochemical parameters of ACPA+ RA patients with the DRB1*04 or *10 alleles did not differ significantly. Conclusions We found significant differences in hematological and biochemical parameters between RA patients and controls that had nothing to do with ACPA positivity or the frequency of DRB1*04 or *10 alleles.

Chronic stress predisposes to the aggravation of inflammation in autoimmune diseases with focus on rheumatoid arthritis and psoriasis

The global incidence of autoimmune diseases is on the rise, and many healthcare professionals believe that chronic stress plays a prominent role in both the aggravation and remission of these conditions. It is believed that prolonged exposure to stress is associated with neuroimmune axis malfunction, which eventually dysregulates multiple immunological factors as well as deregulates autoimmune responses that play a central role in various autoimmune diseases, including rheumatoid arthritis and psoriasis. Herein, we performed validation of an 8-week long rat model of chronic unpredictable stress (CUS) which consisted of exposing groups of rats to random stressors daily for 8 weeks. Additionally, we developed a novel rat model combining 8-week long random stressor-induced CUS with CIA-triggered arthritis and IMQ-triggered psoriasis and have successfully used both these models to assess the role of chronic stress in the aggravation of arthritis and psoriasis, respectively. Notably, the 8-week CUS protocol extensively aggravated and prolonged both arthritis and psoriasis condition in the rat model by upregulating the release of different pro-inflammatory cytokines, dysregulation of immune cell responses and oxidative stress system, which were all related to severe inflammation. Further, CUS aggravated macroscopic features and the increase in destruction of joint tissue and epidermal thickness induced by CIA and IMQ, respectively, in rats. In conclusion, this study suggests that exposure to an 8-week long CUS paradigm aggravates the distinctive characteristics of rheumatoid arthritis and psoriasis in rats via amplifying the inflammatory circuits and immune cell responses linked to these autoimmune diseases.

The mean platelet volume (MPV) in patients with systemic lupus erythematosus (SLE) and its correlation with disease activity: a cross-sectional/case-control study

Introduction

Systemic lupus erythematosus (SLE) is a systemic disease, with unknown etiology. The authors aimed in this study to determine the connection between mean platelet volume (MPV) and disease activity of SLE. Although it has been studied in other rheumatological conditions like rheumatoid arthritis, its role in adult patients with SLE needs to be defined, especially in Syria.

Materials and methods

The authors have included in a cross-sectional study, 80 patients with SLE and 80 controls.The SLE group was divided into two groups based on their disease activity index: the active disease group and the non-active disease group.In all groups, MPV and erythrocyte sedimentation rate (ESR) were analyzed. Clinical findings and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) were evaluated in all patients.

Results

MPV was significantly lower in SLE patients compared to the control group (8.49±1.2 fl and 10.0±0.5 fl, respectively) (P=0.001). A decrease in MPV below the cut-off value (7.2 fl) increased the risk of active disease by an odds ratio of 9.79 (95% CI: 3.4-27.9) (P<0.001).

Conclusion

MPV may be a disease activity indicator in patients with SLE. MPV is reduced in patients with active SLE and presents an inverse correlation with SLEDAI.

Assistive diagnostic indicators for infections related to lumbar posterior interbody fusion internal fixation: platelet count and mean platelet volume

BACKGROUND

The most severe complication after posterior single-segment lumbar interbody fusion and internal fixation (PIFIF) surgery for degenerative lumbar diseases is deep surgical site infection (DSSI). Preoperatively diagnosing such complications proves to be challenging. Platelets, as acute-phase reactants, undergo changes in response to infections and inflammation. This study aims to assess whether platelet indices can further aid in the diagnosis of DSSI.

METHODS

A single-center retrospective study was conducted from January 2016 to February 2021 at Xi'an Jiaotong University-Affiliated Honghui Hospital, involving 83 patients who underwent revision surgery after PIFIF due to lumbar degenerative diseases. Among them, 24 patients were diagnosed with DSSI based on combined bacterial culture and imaging data. Preoperative complete serological indicators including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet count and mean platelet volume ratio (P/M ratio) were analyzed using receiver operating characteristic (ROC) curve analysis to determine cutoff values, sensitivity, and specificity. This was done to further assess the ability of these serological indicators to identify the occurrence of DSSI after PIFIF.

RESULTS

There were no significant differences in baseline demographic characteristics between the two patient groups (P > 0.05). The P/M ratio was 13.54 ± 5.05 in the aseptic revision group, while it was 19.21 ± 6.30 in the DSSI revision patients, showing a significant difference (P < 0.001). ROC curve analysis revealed that the optimal cutoff value for the P/M ratio was 17.50, with a sensitivity of 58.3% and a specificity of 78.6%. The areas under the curve (AUC) for ESR, CRP, and P/M ratio were 0.797, 0.845, and 0.756, respectively. The negative predictive value (NPV) was 87.04%, 89.47%, and 82.45%, respectively; the positive predictive value (PPV) was 58.62%, 69.23%, and 53.84%, respectively, for ESR, CRP, and P/M ratio, respectively. When P/M ratio is used in combination with ESR and CRP, the AUC is 0.887, with a sensitivity of 95.4%, specificity of 67.8%, NPV of 97.56%, PPV of 54.76%. The diagnostic performance of the model for evaluating DSSI is significantly improved compared to using ESR and CRP alone (P < 0.05).

CONCLUSION

Platelets and their related serum biomarkers are closely associated with DSSI. The P/M ratio can serve as a reliable test for screening DSSI and is worth considering for inclusion in the assessment of patients at risk of developing DSSI after potential PIFIF surgery.

Artificial intelligence-based preventive, personalized and precision medicine for cardiovascular disease/stroke risk assessment in rheumatoid arthritis patients: a narrative review

The challenges associated with diagnosing and treating cardiovascular disease (CVD)/Stroke in Rheumatoid arthritis (RA) arise from the delayed onset of symptoms. Existing clinical risk scores are inadequate in predicting cardiac events, and conventional risk factors alone do not accurately classify many individuals at risk. Several CVD biomarkers consider the multiple pathways involved in the development of atherosclerosis, which is the primary cause of CVD/Stroke in RA. To enhance the accuracy of CVD/Stroke risk assessment in the RA framework, a proposed approach involves combining genomic-based biomarkers (GBBM) derived from plasma and/or serum samples with innovative non-invasive radiomic-based biomarkers (RBBM), such as measurements of synovial fluid, plaque area, and plaque burden. This review presents two hypotheses: (i) RBBM and GBBM biomarkers exhibit a significant correlation and can precisely detect the severity of CVD/Stroke in RA patients. (ii) Artificial Intelligence (AI)-based preventive, precision, and personalized (aiP3) CVD/Stroke risk AtheroEdge™ model (AtheroPoint™, CA, USA) that utilizes deep learning (DL) to accurately classify the risk of CVD/stroke in RA framework. The authors conducted a comprehensive search using the PRISMA technique, identifying 153 studies that assessed the features/biomarkers of RBBM and GBBM for CVD/Stroke. The study demonstrates how DL models can be integrated into the AtheroEdge™-aiP3 framework to determine the risk of CVD/Stroke in RA patients. The findings of this review suggest that the combination of RBBM with GBBM introduces a new dimension to the assessment of CVD/Stroke risk in the RA framework. Synovial fluid levels that are higher than normal lead to an increase in the plaque burden. Additionally, the review provides recommendations for novel, unbiased, and pruned DL algorithms that can predict CVD/Stroke risk within a RA framework that is preventive, precise, and personalized.

Sánchez-Margallo F, Eugenia Candanosa-Aranda I, Poelaert J, Castellanos G, L. N. G. Malbrain M. The pathophysiological impact of intra-abdominal hypertension in pigs

BACKGROUND

Intra-abdominal hypertension and abdominal compartment syndrome are common with clinically significant consequences. We investigated the pathophysiological effects of raised IAP as part of a more extensive exploratory animal study. The study design included both pneumoperitoneum and mechanical intestinal obstruction models.

METHODS

Forty-nine female swine were divided into six groups: a control group (Cr; n = 5), three pneumoperitoneum groups with IAPs of 20mmHg (Pn20; n = 10), 30mmHg (Pn30; n = 10), 40mmHg (Pn40; n = 10), and two mechanical intestinal occlusion groups with IAPs of 20mmHg (MIO20; n = 9) and 30mmHg (MIO30; n = 5).

RESULTS

There were significant changes (p<0.05) noted in all organ systems, most notably systolic blood pressure (SBP) (p<0.001), cardiac index (CI) (p = 0.003), stroke volume index (SVI) (p<0.001), mean pulmonary airway pressure (MPP) (p<0.001), compliance (p<0.001), pO2 (p = 0.003), bicarbonate (p = 0.041), hemoglobin (p = 0.012), lipase (p = 0.041), total bilirubin (p = 0.041), gastric pH (p<0.001), calculated glomerular filtration rate (GFR) (p<0.001), and urine output (p<0.001). SVV increased progressively as the IAP increased with no obvious changes in intravascular volume status. There were no significant differences between the models regarding their impact on cardiovascular, respiratory, renal and gastrointestinal systems. However, significant differences were noted between the two models at 30mmHg, with MIO30 showing worse metabolic and hematological parameters, and Pn30 and Pn40 showing a more rapid rise in creatinine.

CONCLUSIONS

This study identified and quantified the impact of intra-abdominal hypertension at different pressures on several organ systems and highlighted the significance of even short-lived elevations. Two models of intra-abdominal pressure were used, with a mechanical obstruction model showing more rapid changes in metabolic and haematological changes. These may represent different underlying cellular and vascular pathophysiological processes, but this remains unclear.

Effect of thyroid hormone status on complete blood cell count-derived inflammatory biomarkers in patients with moderate-to-severe Graves' ophthalmopathy

PURPOSE

To evaluate the systemic inflammation in moderate-to-severe Graves' ophthalmopathy patients with abnormal thyroid function by using complete blood cell count-derived inflammatory biomarkers and compare to moderate-to-severe GO patients with regulated thyroid function and healthy controls. The second aim is to evaluate the relationship of complete blood cell count-derived inflammatory biomarkers with clinical findings in moderate-to-severe GO.

METHODS

In this retrospective study, 90 GO patients with abnormal thyroid function composed Group 1, 58 patients who had normal thyroid function for at least 3 months composed Group 2, and 50 healthy individuals composed Group 3. Demographic data, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and systemic immune-inflammatory index (SII) were evaluated.

RESULTS

There was no statistically significant difference between groups in terms of age, sex, and smoking habits (p > 0.05). There was a statistically significant difference in NLR (p = 0.011), MLR (p = 0.013), MPV (p < 0.001), and SII (p < 0.001) values among 3 groups. For NLR, MLR, and SII the highest values were detected in Group 1. MPV levels were higher in Group 3 than Groups 1 and 2 (p < 0.001). None of the hematological parameters were found to be a risk factor for any clinical severity findings of GO.

CONCLUSION

The higher levels of NLR, MLR, and SII levels may show systemic inflammation in GO patients with abnormal thyroid function, and this may have an impact on the clinical course of ophthalmopathy. These findings may suggest that cautious control of thyroid hormone levels is important in the management of GO.

Can the prognosis of individual patients with nasopharyngeal carcinoma be predicted using a routine blood test at admission?

BACKGROUND AND PURPOSE

We sought to determine the prognostic value of a pre-treatment peripheral blood signature and the peripheral blood signature-based nomogram for patients with non-metastatic nasopharyngeal carcinoma (NPC).

MATERIALS AND METHODS

We retrospectively collected 21 peripheral blood indicators from patients with NPC between 2004 and 2015. Data were randomly divided into a training and a validation set (ratio: 6:4). The peripheral blood signature was constructed based on candidate biomarkers using the least absolute shrinkage and selection operator Cox regression model. Multivariable logistic regression was applied to identify the independent risk factors of overall survival to build the nomogram. The predictive value of the peripheral blood nomogram was evaluated using time-dependent area under the curve, decision curve analysis, and calibration curve.

RESULTS

In total, 6668 patients were enrolled with 4000 and 2668 in the training and validation cohorts, respectively. Four peripheral blood indicators, (white blood cell count, lymphocyte percentage, haemoglobin, and mean platelet volume), were included to construct the peripheral blood signature. Patients were divided into low- and high-risk groups using an optimal cut-off value of - 1.71142. Patients in the high-risk group had significantly lower overall, distant metastasis-free, and progression-free survival than patients in the low-risk group in both cohorts (P < 0.05). We constructed and validated a peripheral blood signature-based nomogram in combination with five vital clinical characteristics, (age, sex, tumour stage, nodal stage, and pre-treatment Epstein-Barr virus DNA), which showed favourable performance.

CONCLUSION

Patients with NPC with different outcomes could be distinguished based on their peripheral blood signature score; the proposed peripheral blood signature-based nomogram offers individualised risk estimation.

Increased serum IL-41 is associated with disease activity in rheumatoid arthritis

BACKGROUND

Interleukin (IL)-41 is upregulated in the synovial tissue of rheumatoid arthritis (RA) patients, but its serum level has not been reported. The present study aimed to determine IL-41 expression in serum from RA patients and to clarify the relationships between IL-41 and disease-related parameters in RA patients.

METHODS

The study included 46 RA patients and 32 healthy controls (HC). Baseline data were obtained by routine physical examinations and immune-related parameters were measured by an automated chemiluminescent immunoassay analyzer. The correlations between IL-41 and disease activity score in 28 joints (DAS28) and serum clinical data were analyzed using the Pearson correlation test.

RESULTS

Serum IL-41 concentrations were higher in RA patients than in HC. Serum IL-41 was positively correlated with DAS28 based on C-reactive protein (DAS28-CRP), CRP, erythrocyte sedimentation rate (ESR), mean platelet volume (MPV), and CRP-to-albumin ratio (CAR) and negatively correlated with platelet count, while rheumatoid factor was significantly correlated with ESR, CRP, and CAR. Receiver operating characteristic curve analysis showed that IL-41 had diagnostic value for RA, especially when combined with MPV.

CONCLUSIONS

The present findings suggest that IL-41 is increased in the serum of RA patients and may be a potential new diagnostic biomarker for RA.

Potential inflammatory biomarkers for tinnitus in platelets and leukocytes: a critical scoping review and meta-analysis

OBJECTIVE

To explore the association between platelets or leukocytes and tinnitus.

DESIGN

A meta-analysis and scoping review examining the association between tinnitus and platelets and leukocytes. All 11 studies included were critically appraised using the Joanna Briggs Institute (JBI) checklist (2017a). A random effects model was used to pool the results of the studies examining mean platelet volume (MPV) and tinnitus.

STUDY SAMPLE

1935 studies were identified in the initial search, 11 of which were included in the scoping review. 6 of the 11 studies had their MPV values pooled in the meta-analysis.

RESULTS

Pooled results of 818 subjects from 6 studies indicated that MPV was significantly higher in those with tinnitus compared to a comparison group without tinnitus. The overall mean difference was 0.43 fL with a 95% confidence interval (CI) from 0.31 to 0.55 and a p value of < 0.0001 which was statistically significant. MPV is the only haematological parameter which is reliably associated with tinnitus.

CONCLUSIONS

MPV could be a useful biomarker for tinnitus. Further studies should aim to standardise methodology with more rigorous exclusion criteria to reproduce and define this association. NLR, PLR, WBC count, RDW and PDW do not show a reliable association with tinnitus.

Platelet and Red Blood Cell Volume Indices in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Alterations in the volume of platelets (mean platelet volume, MPV; platelet distribution width, PDW) and erythrocytes (red blood cell distribution width, RDW) have been reported in rheumatoid arthritis (RA) and might serve as diagnostic biomarkers. We conducted a systematic review and meta-analysis of the MPV, PDW, and RDW in RA patients and healthy controls. Relevant articles were searched in PubMed, Web of Science, Scopus, and Google Scholar from inception to June 2022. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and certainty of evidence was assessed using GRADE. In 23 studies (2194 RA patients and 1565 healthy controls), the RDW, but not MPV or PDW, was significantly higher in RA patients (standardized mean difference, SMD = 0.96, 95% CI 0.78 to 1.15, p < 0.001; moderate certainty of evidence). The substantial heterogeneity observed (I2 = 75.1%, p < 0.001) was virtually removed in a subgroup of prospective studies. In sensitivity analysis, the magnitude of the effect size was not substantially modified by sequentially removing individual studies. There was no significant publication bias. No significant associations were observed between the effect size and pre-defined study or patient characteristics. The results of our study suggest that the RDW might be a useful biomarker for the diagnosis of RA, and complement the clinical information provided by other patient characteristics and laboratory parameters (PROSPERO registration number: CRD42022349432).

Correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) with gout activity: A monocentric and retrospective study

To evaluate the correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) with parameters related to gout activity. The general data of the patients and healthy controls (HCs), including complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum uric acid (SUA), and the presence of tophi were retrospectively analyzed. NLR, MPV, and PLR were calculated in patients with intercritical gout and gout flares. Correlation of the 3 markers with clinical features, like ESR, CRP, SUA, and the presence of tophi, were analyzed. The results revealed that NLR and PLR were elevated and MPV was markedly decreased in patients with gout compared with HCs (all P < .05). In patients with gout flares, NLR, and PLR were higher and MPV was lower than in intercritical gout patients (all P < .05). NLR and PLR were positively correlated with ESR and CRP, whereas MPV was negatively correlated with ESR. NLR, PLR, and MPV showed no obvious correlation with SUA and the presence of tophi. The receiver operating characteristic curve showed that NLR was more valuable in assessing gout disease activity. NLR, PLR, and MPV were correlated with inflammatory parameters in gout; they may be used as complementary tools to evaluate gout activity.

Development and Validation of a Machine Learning-Based Nomogram for Prediction of Ankylosing Spondylitis

Introduction

Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the spine and its affiliated tissues. AS mainly affects the axial bone, sacroiliac joint, hip joint, spinal facet, and adjacent ligaments. We used machine learning (ML) methods to construct diagnostic models based on blood routine examination, liver function test, and kidney function test of patients with AS. This method will help clinicians enhance diagnostic efficiency and allow patients to receive systematic treatment as soon as possible.

Methods

We consecutively screened 348 patients with AS through complete blood routine examination, liver function test, and kidney function test at the First Affiliated Hospital of Guangxi Medical University according to the modified New York criteria (diagnostic criteria for AS). By using random sampling, the patients were randomly divided into training and validation cohorts. The training cohort included 258 patients with AS and 247 patients without AS, and the validation cohort included 90 patients with AS and 113 patients without AS. We used three ML methods (LASSO, random forest, and support vector machine recursive feature elimination) to screen feature variables and then took the intersection to obtain the prediction model. In addition, we used the prediction model on the validation cohort.

Results

Seven factors—erythrocyte sedimentation rate (ESR), red blood cell count (RBC), mean platelet volume (MPV), albumin (ALB), aspartate aminotransferase (AST), and creatinine (Cr)—were selected to construct a nomogram diagnostic model through ML. In the training cohort, the C value and area under the curve (AUC) value of this nomogram was 0.878 and 0.8779462, respectively. The C value and AUC value of the nomogram in the validation cohort was 0.823 and 0.8232055, respectively. Calibration curves in the training and validation cohorts showed satisfactory agreement between nomogram predictions and actual probabilities. The decision curve analysis showed that the nonadherence nomogram was clinically useful when intervention was decided at the nonadherence possibility threshold of 1%.

Conclusion

Our ML model can satisfactorily predict patients with AS. This nomogram can help orthopedic surgeons devise more personalized and rational clinical strategies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40744-022-00481-6.

AS is a chronic progressive inflammatory disease of the spine and its affiliated tissues. AS starts gradually, and its early symptoms are mild. Some hospitals lack HLA-B27 and related imaging instruments to assist in the diagnosis of AS. There are relatively few studies on liver function and kidney function of patients with AS. We used ML methods to construct diagnostic models. Our model can satisfactorily predict patients with AS. This diagnostic model can help orthopedic surgeons devise more personalized and rational clinical strategies.

Clinical Features of Dermatomyositis/Polymyositis with Anti-MDA5 Antibody Positivity

This paper aims to investigate the clinical and laboratory test characteristics of patients with anti-MDA5 antibody-positive PM/DM by analyzing the clinical characteristics, laboratory test results, and 1-year survival rate of patients with anti-MDA5 antibody-positive PM/DM in polymyositis (PM) and dermatomyositis (DM). To further investigate the impact of positive anti-MDA5 antibodies on the prognosis of PM/DM patients. According to the anti-MDA5 antibody test results, 18 cases with positive anti-MDA5 antibodies were in the positive group and 46 cases with negative anti-MDA5 antibodies were in the negative group. The clinical manifestations, laboratory tests, treatment protocols, and prognostic risk factors were collected for both groups. The chi-square test, Mann–Whitney method, Fisher test, t-test, Kaplan–Meier method, and Log-rank test were used for statistical analysis. Anti-MDA5 antibody positivity was more common in patients with DM/CADM. With no statistically significant differences in age and sex ratio between the two groups, The differences in erythrocyte sedimentation rate (ESR), ferritin (Fer), and creatine kinase (CK) levels in the positive group were statistically significant compared with the negative group. Clinically, the positive group was more prone to arthralgia, skin rash, and interstitial pneumonia.

Mean platelet volume to lymphocyte ratio and platelet distribution width to lymphocyte ratio in Iraqi patients diagnosed with systemic lupus erythematosus

Introduction

The mean platelet volume to lymphocyte ratio (MPVLR) and platelet distribution width to lymphocyte ratio (PDWLR) have the potential to serve as markers of inflammation which may indicate disease activity. The mean platelet volume to lymphocyte ratio and PDWLR were assessed in patients with systemic lupus erythematosus (SLE) in this study.

Material and methods

Sixty-two patients with systemic lupus erythematosus and 79 controls who were age and gender matched were included. Their sociodemographic information, as well as disease activity scores based on the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), disease duration, current medications, lymphocytes, platelets, platelet distribution width (PDW), and mean platelet volume (MPV), anti-nuclear antibody (ANA), anti-double stranded deoxyribonucleic acid (anti-dsDNA), and complement components (C3, C4) were recorded. The correlations of MPVLR and PDWLR with disease activity and some laboratory parameters were analyzed.

Results

Lupus patients had significantly higher median (interquartile range) values for MPVLR and PDWLR than controls (5.69 [1.16-23.67] vs. 4.40 [2.78-11.93], p = 0.009) and 10.51 (2.87-79.37) vs. 5.21 (2.88-14.66), p < 0.001] respectively. According to the ROC curve, > 7.53 was the best PDWLR cut-off value for predicting SLE with a sensitivity of 71%, a specificity of 87% and an accuracy of 82.6%, whereas the optimum MPVLR cut-off value was > 6.46 with a sensitivity of 45.2%, a specificity of 88.9% and an accuracy of 76.8%. In addition, MPVLR had a significant positive correlation with SLEDAI (r = 0.34, p = 0.008). However, there was no significant correlation between PDWLR and SLEDAI (r = 0.23, p = 0.067). Furthermore, PDWLR had a significant positive correlation with PDW (r = 0.482, p < 0.001), while MPVLR had a significant negative correlation with C3 level (r = -0.260, p = 0.042). Both PDWLR and MPVLR were positively correlated with nephritis (r = 0.388, p = 0.002; r = 0.246, p = 0.038, respectively).

Conclusions

The platelet distribution width to lymphocyte ratio can be considered as an assisting biomarker in the diagnosis of SLE with the other clinical and serological parameters. The mean platelet volume to lymphocyte ratio may be used in the evaluation of disease activity in SLE patients.

B12 vitamin eksikliği olan kişilerin tam kan, ortalama trombosit hacmi (MPV) ve nötrofil-lenfosit oranlarının (NLR) değerlendirilmesi

Giriş: B12 vitamin eksikliğinin; kan tetkiklerine, ortalama trombosit hacmine (MPV) ve inflamasyon markerlarından nötrofil-lenfosit oranına (NLR) etkilerinin araştırılması amaçlanmıştır.Yöntem: Çalışmamız 375 hasta üzerinde yapılmıştır. B12’si düşük (&lt;130 pg/dL) saptanan 170 hasta deney grubu olarak, B12 düzeyleri normal olan 205 kişide kontrol grubu olarak kabul edilmiştir. Bu iki grup arasında beyaz kan hücreleri (WBC), trombosit sayısı (Plt), hemoglobin (Hgb), ortalama eritrosit hacmi (MCV), MPV, nötrofil, lenfosit sayıları ve nötrofil-lenfosit oranları (NLR) incelenmiştir.Bulgular: Yaş ortalaması B12 eksik grupta 48.45 ±17.497 yıl, kontrol grubunda ise 51.93 ±16.175 yıl idi. Eksik grupta B12vitamini ortalaması 101,41 ± 20,50 pg/mL (min-max; 37-130), kontrol grubunda ise 257,24 ± 88,13 pg/mL (min-max; 131-498) idi. WBC, Hgb, Plt, nötrofil, lenfosit, MVC, MPV ve NLR arasında istatiksel açıdan anlamlı bir fark olmadığı gözlendi.Sonuç: Çalışmamızda B12 eksikliği ile kan tetkikleri arasında anlamlı bir ilişki bulamadık. Önceki çalışmalarda B12 eksikliğinde MPV değerlerinin etkilendiğine dair bilgiler bulunmaktadır. Yaptığımız çalışmada da B12 eksikliği ile MPV ve NLR arasında anlamlı bir ilişkinin olmadığını saptadık (p&gt;0,05). B12 eksikliğinin derecesi ve süresi uzadıkça nasıl değişiklikler meydana geleceği ve özellikle de aterojenik olaylara etkisi hakkında yapılacak yeni çalışmalara ihtiyaç vardır. 

Can Complete Blood Count Picture Tell Us More About the Activity of Rheumatological Diseases?

Background:

In clinical practice, distinguishing disease activity in patients with rheumatological illnesses is challenging.

Objectives:

We aimed to investigate clinical associations of hemogram-derived indices, namely: red cell distribution width (RDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) with disease activity in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS).

Methods:

In 250 patients with rheumatological disease and 100 healthy age-matched controls, we investigated disease activity scores and indicators and evaluated their association with hemogram-derived indices values.

Results:

Compared with the control group, RDW, MPV, and PLR significantly increased (P < .001) in the three studied disorders (RA, SLE, and AS), but LMR dramatically decreased. SII was considerably higher in RA and AS patients compared with controls but not in SLE patients. On the other hand, NLR rose dramatically in SLE patients compared with controls (P = .043), but did not change much in RA and AS patients (P > .05). RDW and MPV showed significant changes (P < .001) in the three studied diseases (RA, SLE, and AS) according to disease activity. They significantly increased across worsening activity scores. Only in the SLE group, PLR was significantly increased with disease activity (P < .001), while LMR showed a significant decrease (P = .016).

Conclusions:

Clinicians must pay close attention to complete blood count (CBC) analysis and its various derived ratios to better characterize the activity of rheumatological disorders and anticipate the disease course and prognosis.

Mean platelet volume and platelet to lymphocyte count ratio are associated with hepatitis B-related liver fibrosis

AIM

Chronic hepatitis B is associated with important morbidity and mortality. Inflammation has a pivotal role in hepatic fibrosis of this population. Hemogram-derived inflammatory predictors, such as mean platelet volume (MPV) and platelet to lymphocyte ratio (PLR), are supposed as inflammatory markers in various diseases. We aimed to compare MPV and PLR of the patients with chronic hepatitis B to those of healthy controls and to observe possible correlation between these markers and fibrosis.

METHODS

Chronic hepatitis B patients that visited our outpatient gastroenterology clinics were enrolled in the study. Healthy volunteers were enrolled as controls. MPV, PLR and other parameters of the study groups were compared.

RESULTS

Median MPV of the mild fibrosis, advanced fibrosis control groups were 8.1 (6.6-13) fL, 8.2 (6.3-14.5) fL and 7.2 (4.6-8.9) fL, respectively (P < 0.001). Median PLR of the mild fibrosis, advanced fibrosis control groups were 99.5 (36-259) %, 119 (61-1547) % and 122 (64-197) %, respectively (P = 0.02). PLR was correlated with the ISHAK score (r = 0.32, P = 0.002). A MPV value greater than 7.52 fL have 80% sensitivity and 56% specificity in determining advanced fibrosis (AUC: 0.68, P = 0.002, 95% confidence interval, 0.58-0.77).

CONCLUSION

We think that increased MPV and decreased PLR are characteristics of chronic hepatitis B disease. Moreover, increased MPV could predict advanced fibrosis in this population.

Dynamic platelet function: A novel biomarker in inflammatory arthritis?

Background

Patients with inflammatory arthritis die prematurely of cardiovascular disease. Inflammation activates platelets. Since treatment of inflammatory arthritis is associated with reduced mortality, and decreased platelet reactivity reduces cardiovascular events, we hypothesised that platelet reactivity as measured by dynamic platelet function (DPF) would be increased in patients with inflammatory arthritis and that reactivity could be reduced with therapeutic intervention.

Objectives

To characterise platelet function using a validated physiological assay in patients with inflammatory arthritis before and after disease improvement.

Methods

22 patients were recruited and treated as per local protocol. DPF was measured at baseline and after clinical improvement. Video microscopy was utilised to measure dynamic platelet behaviour in microliters of blood perfused over von Willebrand factor (VWF) at arterial shear rates (1500 s-1). Motion-analysis software measured the number of platelets interacting with VWF, translocating across VWF, the speed and distance platelets travelled across VWF, and stably adhering to the surface. Platelet parameters at baseline and following improvement were compared using Wilcoxon signed rank test and paired student t-test. Changes in platelet function were correlated to inflammatory disease markers by Pearson Correlation.

Results

18 patients completed the study. Platelet adhesion decreased and platelet motion increased following treatment. Tender joint count correlated with platelet adhesion (Pearson r = 0.616, p≤0.01) while CRP correlated with velocity of platelet movement (Pearson r = 0.563, p≤0.01).

Conclusions

Improvement in clinical markers of inflammation is associated with a corresponding change in platelet function. Given the association between reduced mortality and decreased platelet reactivity our results suggest that an appropriate assay of platelet function could guide future therapy of patients with inflammatory arthritis.

Role of mean platelet volume in differential diagnosis of adult-onset Still's disease and sepsis

OBJECTIVES

Mean platelet volume is a simple biomarker for inflammatory disease. The purpose of this study is to evaluate the role of mean platelet volume in distinguishing adult-onset Still's disease from sepsis.

METHODS

We retrospectively selected 68 patients with adult-onset Still's disease and 55 patients with sepsis between January 2015 and December 2019. Related laboratory data were collected and analyzed.

RESULTS

There were no significant differences in white blood cell counts, neutrophils, lymphocytes, and C-reactive protein between adult-onset Still's disease group and sepsis group. However, patients in adult-onset Still's disease group showed higher ferritin and platelets and lower mean platelet volume and platelet distribution width than those in sepsis group (p<0.01 for both). Receiver operating characteristic curve analysis was performed to distinguish adult-onset Still's disease and sepsis. The area under the curve of mean platelet volume was 0.761 (95%CI 0.673-0.849), with a sensitivity of 79.1%, a specificity of 63.3%, and a cutoff value of 10.9 fL. In contrast, the area under the curve of combined ferritin and mean platelet volume was 0.90l (95%CI 0.837-0.965), with higher sensitivity (82.8%) and specificity (96.2%). Therefore, mean platelet volume could be used as a supplementary indicator to distinguish adult-onset Still's disease from sepsis.

CONCLUSION

We suggest that mean platelet volume could be used as a supplementary biomarker for differential diagnosis of adult-onset Still's disease and sepsis in addition to ferritin.

Relationship Between Vitamin D Level and Platelet Parameters in Children With Viral Respiratory Infections

Apart from their classical roles, both platelets and vitamin D play important roles in inflammation and infectious diseases. This study evaluated the platelet response to viral respiratory tract infection in children aged 4-16 years, 32 with influenza, 27 with non-influenza viral infection tested by nasopharyngeal swab and 21 healthy children of the same age. Blood count, including platelet count (PLT), mean platelet volume (MPV) and other platelet indices, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and vitamin D (vit D) levels were compared. The influenza group showed lower PLT and platelet mass (PLT^*MPV), and the non-influenza group showed significantly lower MPV, which was correlated with the vit D levels, but not CRP or ESR, and the value vit D^*MPV was significantly lower in this group. These results revealed that platelet activation in viral respiratory tract infections in children, as measured by MPV, is related to the vit D level, with differences between influenza and non-influenza infection.

CONCLUSIONS

Viral respiratory tract infection in children can diminish the platelet size most likely by suppressing the platelet activation. This response is associated with low levels of vit D. Whether the vit D status is associated with the virus-platelet immune/inflammatory process needs further investigation.

C-Reactive Protein-to-Albumin Ratio: A Novel Inflammatory Marker and Disease Activity Sign in Early Rheumatoid Arthritis

Objective A novel inflammation-based score, C-reactive protein (CRP)-to-albumin ratio (CAR), has been shown to have an association with the inflammatory status in several diseases. We aimed to analyse the association between CAR and disease activity in patients with early rheumatoid arthritis (RA) and to determine the cut-off value of CAR in early and established RA.

Methods A total of 177 patients with RA and 111 age and gender-matched healthy controls were included in this study. Cases with a disease duration of less than 1 year were classified as early RA. Serum albumin, CRP, erythrocyte sedimentation rate (ESR), Disease Activity Score-28 (DAS-28-ESR), Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire (HAQ) scores were recorded.

Results CAR was 2.44 (0.21–30.83) in the RA group and 0.45 (0.21–10.47) in the control group (p<0.001). Eighty-seven (49.15%) of the RA cases were classified as early RA. The analyses indicated that the ESR, CRP and CAR values were higher in patients with early RA than in those with established RA and controls. CAR was correlated with albumin, CRP, ESH, DAS-28 and HAQ scores in both early RA and established RA groups. The receiver operating characteristic curves revealed a CAR cut-off value of 2.67 (80% sensitivity and 85% specificity) and 1.63 (77% sensitivity and 72% specificity) for the prediction of early and established RA, respectively.

Conclusion CAR, a formulated ratio, has been described as a predictor for disease activity in patients with early RA as well as in those with established RA. However, CAR has higher sensitivity and specificity for early RA than for established RA.

The Relationship between Platelet Indices and Ultrasound, Clinical, Laboratory Parameters of Disease Activity in Patients with Rheumatoid Arthritis

(1) Background: A proper assessment of disease activity is crucial for the management of a patient with rheumatoid arthritis (RA). Platelets seem to be involved in joint inflammation pathophysiology. Platelet indices (PIs) are markers of platelet activation, and include platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT). The purpose of the study was to assess the relationship between PIs and disease activity markers, both systemic (clinical, laboratory) and local (ultrasound, US), in patients with RA; (2) Methods: The study group consisted of 131 consecutive RA patients. The following assessments were performed: joint counts, Disease Activity Score (DAS28), complete blood cell counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and US of 24 small joints; (3) Results: Mean values of PIs remained within the normal reference ranges. Values of PC, PCT, PDW were significantly associated with disease activity markers, both clinical (DAS28, joint counts) and laboratory (CRP, ESR). In patients with high disease activity, PC, PCT were significantly higher and PDW lower. PC was positively correlated with Power Doppler US (PDUS) score. In patients with features of RA severity (antibodies positivity, extra-articular manifestations) PC and PCT were positively associated with all US parameters (Grey Scale US, PDUS, Global scores); (4) Conclusions: In patients with RA, PC and PCT may serve as positive disease activity markers and PDW may serve as a negative marker. PIs may be used as reliable, inexpensive markers of RA systemic activity; they may also serve as markers of local inflammation in the joints affected by RA.

Factors relating to bone mineral density in young and middle-aged patients with ankylosing spondylitis

BACKGROUND

Ankylosing spondylitis (AS) is a common chronic progressive rheumatic disease. The aim of this study was to explore factors influencing abnormal bone mineral density (BMD) in young and middle-aged patients with AS.

METHODS

From July 2014 to August 2018, hospitalized patients with AS and health examinees in the health examination center of our clinics, ranging in age from 20 to 50 years, were monitored. The BMD of the lumbar spine and femoral neck of AS patients and those of a healthy control group were measured using dual-energy X-ray absorption. The BMDs of AS patients were compared with respect to age, course of disease, iritis, smoking habits, sex, height, weight, body mass index (BMI), medication use, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet volume, platelet count, uric acid (UA), alkaline phosphatase (AKP), and calcium ion levels. Single-nucleotide polymorphisms (SNPs) related to BMD were screened using genome-wide association analysis.

RESULTS

There was no statistical difference in the proportion of abnormal bone masses between the different body parts. The BMD of all bones in AS patients was lower than that in healthy controls (P < 0.05). Additionally, BMD was correlated with serum calcium and CRP in AS patients (P < 0.05), but not with age, platelet volume, platelet count, ESR, UA, AKP, height, weight, and BMI. The incidence of abnormal bone mass in AS patients was correlated with sex (P < 0.05), but not with medication use, iritis, or smoking. BMD of the lumbar spine in AS patients did not correlate linearly with the course of the disease, but BMD of the femoral neck correlated linearly with the course of the disease (P < 0.05). BMD was correlated with multiple SNPs in patients with AS. Lumbar BMD was correlated with rs7025373 and rs7848078. Femoral head BMD was correlated with 3:102157365, 3:102157417, rs1252202, rs1681355, rs3891857, rs7842614, and rs9870734, suggesting that genetic factors play a role in BMD in patients with AS.

CONCLUSIONS

The proportion of abnormal bone mass in AS patients was higher than that in healthy individuals of the same age. The factors related to BMD in patients with AS are gender, CRP, and blood calcium. The BMD of the femoral neck of AS patients decreases with the course of the disease, but BMD of the lumbar spine is not related to the course of the disease. BMD in AS patients is associated with multiple SNPs.

Red Cell Distribution Width and Mean Platelet Volume in Patients With Ankylosing Spondylitis: A Systematic Review and Meta-analysis

OBJECTIVE

The results of previous studies regarding the relationship between red cell distribution width (RDW) or mean platelet volume (MPV) levels and ankylosing spondylitis (AS) are inconsistent. Therefore, we conducted this meta-analysis to systematically evaluate the associations.

METHODS

The Web of Science, PubMed, and Cochrane Library (as of February 14, 2019) were used to retrieve relevant articles. Pooled standard mean difference (SMD) and its 95% confidence interval (CI) were calculated. All statistical analyses were performed using the "meta" and "metafor" packages of the R 3.5.1 software.

RESULTS

Nine studies on RDW, including 775 AS patients and 972 healthy controls, and 8 studies on MPV, including 743 AS patients and 571 healthy controls, were included. The results showed that RDW levels were significantly higher in AS patients (SMD = 0.67; 95% CI, 0.30 to 1.05; p < 0.001) compared with healthy controls, whereas MPV levels (SMD = 0.01; 95% CI, -0.28 to 0.30; p = 0.929) were not significantly different from healthy controls.

CONCLUSIONS

Our current study shows that the elevated levels of RDW may be associated with AS, whereas MPV levels may be not associated with AS.

Platelet indices parameters in the new disease activity score of rheumatoid arthritis with ankle involvement: A comparative analytic study

BACKGROUND

Platelet indices (PIs) are platelet parameters that are correlated with platelet activity. Despite being widely available, inexpensive, and feasible; their use in clinical settings is limited. Recently, we developed a new score (EgyDAS), which relies on PIs and assesses disease activity in rheumatoid arthritis (RA).

OBJECTIVES

This study explored the practicability and validity of EgyDAS in RA with ankle involvement, considering that ankle is neglected in the commonly used DAS28 score.

METHODS

This comparative case-control study included 2-groups of RA patients, group1 (control): without and group 2: with ankle involvement.

RESULTS

Ankle involvement in RA showed no gender or age differences, however, it was associated with higher platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet distribution width (PDW), visual analogue scale (VAS), tender joint count (TJC), and lower hemoglobin (Hb) and mean platelet volume (MPV). DAS28 categorized a higher proportion of patients to have high disease activity compared with EgyDAS; moreover, it did not detect those in remission in group 2 patients. Highly significant differences in the 2-scores were observed between the two groups. Further analyses revealed superiority of EgyDAS in assessing disease activity in group 2 patients. Finally, both scores were found correlated together in the study groups.

CONCLUSIONS

Over or underestimation of RA disease activity could occur when using DAS28. PIs were found correlated with ankle involvement in RA. PIs and EgyDAS are the best tools to assess disease activity in RA patients with ankle involvement. However, the study recommended the use of both scores together.

The relationship between platelet to albumin ratio and disease activity in axial spondyloarthritis patients

OBJECTIVES

The study aims to investigate the clinical significance of platelet to albumin ratio (PAR), neutrophil to albumin ratio (NAR), and monocyte to albumin ratio (MAR) in axial spondyloarthritis (axSpA).

METHODS

Two hundred and ninety-seven axSpA patients and 71 healthy volunteers were recruited. AxSpA patients were divided into inactive group and active group. Spearman's correlation, receiver operating characteristic (ROC) curves, and binary logistic regression analysis were conducted.

RESULTS

Albumin was lower in axSpA group, while neutrophil, platelet, monocyte, NAR, PAR, and MAR were higher (p < .05). Albumin was negatively correlated with BASDAI and BASFI (p < .05). Platelet, NAR, PAR, MAR, ESR, and CRP were all positively correlated with BASDAI and BASFI (p < .05). Albumin was lower in axSpA of active group, while platelet, NAR, PAR, MAR, ESR, and CRP were higher (p < .05). ROC curve indicated that the AUC of PAR for axSpA of active group was higher than that of other variables. The optimal cut-off value of PAR was 6.354, with Youden index of 0.337, specificity of 55.4%, and sensitivity of 78.4%. Logistic regression analysis result suggested that PAR was an independent indicator for axSpA disease activity.

CONCLUSIONS

PAR had a high diagnostic value for axSpA of active group. PAR was a novel and reliable indicator for axSpA disease activity.

Risk factors associated with progression of diabetic retinopathy in eyes treated with panretinal photocoagulation

Uncontrolled diabetes has been associated with progression of diabetic retinopathy (DR) in several studies. Therefore, we aimed to investigate systemic and ophthalmic factors related to worsening of DR even after completion of panretinal photocoagulation (PRP). We retrospectively reviewed DR patients who had completed PRP in at least one eye with a 3-year follow-up. A total of 243 eyes of 243 subjects (mean age 52.6 ± 11.6 years) were enrolled. Among them, 52 patients (21.4%) showed progression of DR after PRP (progression group), and the other 191 (78.6%) patients had stable DR (non-progression group). The progression group had higher proportion of proliferative DR (P = 0.019); lower baseline visual acuity (P < 0.001); and higher platelet count (P = 0.048), hemoglobin (P = 0.044), and hematocrit, (P = 0.042) than the non-progression group. In the multivariate logistic regression analysis for progression of DR, baseline visual acuity (HR: 0.053, P < 0.001) and platelet count (HR: 1.215, P = 0.031) were identified as risk factors for progression. Consequently, we propose that patients with low visual acuity or high platelet count are more likely to have progressive DR despite PRP and require careful observation. Also, the evaluation of hemorheological factors including platelet counts before PRP can be considered useful in predicting the prognosis of DR.

Correlation of clinical signs and symptoms of Behçet's disease with platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR)

Behçet's disease (BD) is a chronic disorder that involves multiple organs and is pathologically considered as a form of vasculitis. The current study aims to assess the metric properties of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in assessing BD disease activity. Three-hundred-nineteen patients with BD were enrolled in this cross-sectional study. Demographic and epidemiological data, including IBDDAM, time since the onset, and medication and manifestation history were recorded. Complete blood counts (CBC), NLR, and PLR were assessed by analyzing blood samples. On the last visit, patients were assessed for active manifestations of disease. IBDDAM and ocular IBDAAM scores were calculated for activity of disease in each patient. Both PLR and NLR were higher in patients with active BD (Mann-Whitney U test, p-value < 0.05). Patients with active ocular manifestation had significantly higher NLR and PLR (Mann-Whitney U test, p-value < 0.05). These ratios, however, were not associated with other active BD manifestations. A value of NLR > 2.58 had 46% sensitivity and 85% specificity for the diagnosis of active ocular manifestations (AUC: 0.690). NLR had a significant, though, weak positive correlation with IBDDAM (Spearman's rho = 0.162; p-value < 0.05) and ocular IBDDAM (Spearman's rho = 0.159; p-value < 0.05). Active Behçet's presented with higher NLR and PLR ratios; however, there was only a modest correlation between NLR and BD activity (IBDDAM score). Also, NLR and PLR have significant relationship with ocular features of BD patients.

Clinical Usefulness of Hematologic Indices as Predictive Parameters for Systemic Lupus Erythematosus

OBJECTIVE

This study assessed the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume, platelet distribution width, and red cell distribution width (RDW) in systemic lupus erythematosus (SLE) patients and their correlation with disease activity.

METHODS

Two hundred eight SLE patients and 205 age- and sex-matched healthy controls were included. Disease activity was assessed using the systemic lupus erythematosus disease activity index 2000, and hematological indices were determined.

RESULTS

Lymphocyte and platelet counts were significantly lower in SLE patients than in the controls, while the NLR, PLR, and RDW were significantly higher (P < .05). In patients with active disease, the neutrophil counts, NLR, and PLR were significantly higher than in those with inactive disease (P < .05), while the lymphocyte count was significantly lower (P < .05). Based on receiver operating characteristic curve analyses, only for lymphocyte count and PLR. The area under curve was significantly higher (P = .001 and P = .053, respectively).

CONCLUSION

PLR can serve as a biomarker for indicating SLE disease activity.

Therapeutic potential of russelioside B as anti-arthritic agent in Freund's adjuvant-induced arthritis in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Caralluma species are traditional edible herbs used in folkloric medicine as antidiabetic, antioxidant, antipyretic, antirheumatic, anti-inflammatory and anthelmintic agents. C. quadrangula was selected in this study to document the traditional use of the genus as anti-rheumatic treatment and the possible mechanisms of action.

AIM OF THE STUDY

The higher mortality rates and shorter survival among the patients suffering from rheumatoid arthritis (RA) led to the increased interest on searching for new treatments for RA. Russelioside B (RB), a major pregnane glycoside found in C. quadrangula, was evaluated as a new anti-rheumatic agent.

MATERIALS AND METHODS

The n-butanol fraction of C. quadrangula was chromatographed on a silica gel column to isolate RB. The adjuvant-induced arthritis (AIA) model was established in rats by intradermal injection of complete Freund's adjuvant (CFA) to evaluate its anti-arthritic effect. Ibuprofen was used as a reference drug. Forty rats were randomly divided into 5 groups (n = 8): normal (NOR); CFA model (CFA); ibuprofen, 5 mg/kg; RB, 25 mg/kg and RB, 50 mg/kg. The treatments were initiated from day 16 when AIA model was established and continued up to day 40. Serum diagnostic rheumatoid markers, inflammatory cytokines, oxidative stress biomarkers, cartilage and bone degeneration enzymes were assessed.

RESULTS

RB at 50 mg/kg b. wt., showed significant decreases in the activities of hyaluronidase and β-glucouronidase enzymes as well significant decreases in the levels of proinflammatory cytokines as nuclear factor-kappa-B (NF-κB), tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-1β (IL-1β) compared to the CFA group; 11.04 ± 0.61 pg/mg protein, 4.35 ± 0.25 pg/mg protein, 3.32 ± 0.13 pg/mg protein & 2.75 ± 0.14 pg/mg protein for RB, 50 mg/kg b. wt. group vs. 25.33 ± 2.13 pg/mg protein, 25.65 ± 2.1 pg/mg protein, 22.20 ± 1.34 pg/mg protein & 13.27 ± 1.40 pg/mg protein for the arthritic group, respectively. The total antioxidant capacity (TAC) was significantly restored to normal values in RB, 50 mg/kg treated rats (4.01 ± 0.09 nmol/mL vs. 3.71 ± 0.27 nmol/mL) and the levels of myeloperoxidase (MPO) reduced by 10-folds of the CFA arthritic group. Bone histomorphometry revealed that RB treatment significantly attenuated the CFA-induced bone loss in a dose-dependent manner.

CONCLUSIONS

These findings suggested that the anti-arthritic effect of RB was mediated through the reduction of the rheumatoid markers, anti-inflammatory and antioxidant action, inhibition of cartilage and bone degenerative enzymes as well as attenuation of bone loss and osteoclastogenesis.

Cancer diagnosis and mortality in patients with ankylosing spondylitis: A Western Australian retrospective cohort study

AIM

Ankylosing spondylitis (AS) has been associated with a modest increase in the risk of cancer. However, little is known as to how AS influences risk of mortality following cancer diagnosis. This study compared the risk of cancer and subsequent mortality in patients with AS compared with a non-AS population group.

METHODS

Patients diagnosed with AS in Western Australia (WA) between 1980 and 2014 were identified from the WA Rheumatic Disease Epidemiological Register (N = 2152; 31 099 patient-years). A non-AS comparison group (N = 10 760; 165 609 patient-years) was selected from hospital records, matched 1:5 on age, Aboriginality, and gender. Data on cancer diagnosis, comorbidities and mortality were extracted from state cancer, hospital, and mortality registers. The relative risk of cancer (overall and by type) and mortality following cancer diagnosis between AS and non-AS comparators was compared using Cox proportional hazard models, adjusting for risk factors and comorbidities.

RESULTS

Ankylosing spondylitis patients had a 15% increase in the crude risk of cancer (hazard ratio [HR]: 1.15, 95% CI: 1.02-1.30). However, this association was attenuated following adjustment for smoking and common comorbidities (adjusted HR: 1.08, 95% CI: 0.95-1.22). Following a cancer diagnosis, patients with AS had an increased risk of 5-year mortality in the unadjusted (HR: 1.24, 95% CI: 1.03-1.49) and the adjusted models (adjusted HR: 1.37, 95% CI: 1.13-1.66).

CONCLUSION

Ankylosing spondylitis was not associated with an increased risk of cancer diagnosis. Following a cancer diagnosis, AS was associated with an increased risk of 5-year mortality.

Clinical relevance of neutrophil-to-lymphocyte ratio and mean platelet volume in pediatric Henoch-Schonlein Purpura: a meta-analysis

The association of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) with the severe gastrointestinal (GI) involvement in pediatric Henoch–Schonlein Purpura (HSP) has been reported in many studies. However, the conclusions from the previous studies were controversial. Therefore, for the first time, we performed a meta-analysis to systematically evaluate the relationship of NLR and MPV to the severe GI involvements. We retrieved PubMed, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) (up to October 2020) thoroughly to acquire eligible studies. The pooled standard mean difference (SMD) with 95% confidence interval (CI) was used to describe the correlation of NLR and MPV with the severe GI involvement. A total of 1² studies comprising 2168 patients with HSP were included in this meta-analysis. Our combined analysis showed that NLR in HSP patients with the severe GI involvement was significantly higher than that in those without the severe GI involvement (SMD = 1.37; 95% CI: 0.70–2.05; p < 0.01). In addition, a lower MPV was observed in children with severe GI involvement (SMD = −0.29; 95% CI: −0.56 – −0.01, p = 0.042). Our sensitivity analysis and publication bias evaluation indicated that our combined results were reliable. Taken together, our study suggested NLR and MPV may be used as biomarkers for predicting or diagnosing the severe GI involvement in children with HSP. Nevertheless, more homogeneous studies with a larger sample size are required to validate these findings.

Associations of Platelet Count with Inflammation and Response to Anti-TNF-α Therapy in Patients with Ankylosing Spondylitis

Background: Increased platelet count has been reported in ankylosing spondylitis (AS) patients, but its clinical significance is still largely elusive. The objective of this study was to evaluate the clinical role of platelet count in AS patients, especially its impact on treatment outcomes.

Methods: A case-control study containing 35 AS patients receiving anti-tumor necrosis factor-α (anti-TNF-α) therapy and 45 healthy controls was performed, and AS patients were followed at least 6 months after anti-TNF-α therapy. A systematic review and meta-analysis of studies containing relevant data on outcomes of interest was also performed.

Results: AS patients had significantly higher platelet count than controls (p = 0.0001), and the significantly increased platelet count in AS patients was confirmed in a meta-analysis of 14 studies involving 1,223 AS patients and 913 controls (mean difference = 39.61, 95% CI 27.89–51.34, p < 0.001). Besides, platelet count was significantly correlated with ESR (p < 0.001) and was moderately correlated with ASDAS-CRP score (p = 0.002). Moreover, anti-TNF-α therapy could reduce platelet count in AS patients at the first month and the effect was maintained through the treatment duration. In the prospective follow-up study of those 35 AS patients, those responders to anti-TNF-α therapy had significantly lower platelet count than nonresponders (p = 0.015). Logistic regression analysis suggested that lower platelet count was associated with higher possibility of achieving good response to anti-TNF-α therapy in AS patients (odds ratio = 2.26; 95% CI = 1.06–4.82; p = 0.035).

Conclusion: This study suggested that platelet count was associated with inflammation severity and treatment outcomes in AS patients, and elevated platelet count was a promising biomarker of poorer response to anti-TNF-α therapy. The findings above need to be validated in more future studies.

Prognostic value of neutrophil/lymphocyte ratio and mean platelet volume/platelet ratio for 1-year mortality in critically ill patients

Several studies have reported that the neutrophil to lymphocyte ratio (NLR) and mean platelet volume (MPV) are associated with poor prognosis. This study investigated whether NLR and/or the MPV/platelet ratio could function as predictive markers of mortality in critically ill patients. We retrospectively reviewed 1,154 patients admitted to the intensive care unit (ICU) between January 2017 and December 2017. Patients were divided into 2 groups according to 1-year mortality. We compared the NLR and MPV/platelet ratio on each day of ICU admission. Patients were classified into tertiles based on their NLR and MPV/platelet ratios, and the incidence of 1-year mortality was compared. Kaplan-Meier survival curves were plotted to evaluate their potential as prognostic factors for 1-year mortality. The NLR and MPV/platelet ratio were higher in the non-survivor group than in the survivor group. The incidence of 1-year mortality was the highest in the third tertile for both the NLR and MPV/platelet ratio. The MPV/platelet ratio was an independent predictor for 1-year mortality based on the Kaplan-Meier survival analysis. Our data showed that the MPV/platelet ratio is a predictive factor for 1-year mortality in critically ill patients.

Platelets count and platelets indices; mean platelet volume and plateletcrit in pediatric chronic lung disease

Background

The lungs contribute in the final maturation of the circulating platelets, and some studies suggested that chronic lung disease (CLD) could impair circulating platelets maturation or count. Our aim was to study the validity of platelet count (PLT), mean platelet volume (MPV), and plateletcrit (PCT) as simple tools to assess chronic lung disease severity or predict its course.

Results

In 39 pediatric patients with CLD, we showed a significant rise in PLTs and PCT and a significant lower MPV when compared to normal controls (P values 0.003, 0.010, 0.004, respectively). Also, a significant positive correlation was detected between the C reactive protein (CRP) level and both the PLTs and PCT (r 0.327, 0.363 respectively) in addition to a significant reduction in MPV level in relation to the age of disease onset (P value 0.031).

Conclusion

This study disagrees with the postulation that chronic lung disease could lead to the reduction of circulating platelets and emphasizes the role of increased platelets count and decreased MPV in reflecting the inflammatory condition underlying the chronic lung disease in the pediatric age group.

Prognostic and clinicopathological significance of pretreatment mean platelet volume in cancer: a meta-analysis

OBJECTIVE

Our study aimed to evaluate the prognostic and clinicopathological significance of pretreatment mean platelet volume (MPV) on cancer by using meta-analysis of published studies.

DESIGN

Meta-analysis.

DATA SOURCES

Relevant studies available before 22 December 2019 were identified by searching MEDLINE, EMBASE.

ELIGIBILITY CRITERIA

All published studies that assessed the prognostic and clinicopathological significance of pretreatment MPV on cancer were included.

DATA EXTRACTION AND SYNTHESIS

Studies were identified and extracted by two reviewers independently. The HR/OR and its 95% CIs of survival outcomes and clinicopathological parameters were calculated.

RESULTS

A total of 38 eligible studies (41 subsets) with 9894 patients with cancer were included in the final meta-analysis. MPV level was not significantly associated with both overall survival (HR 0.98, 95% CI 0.84 to 1.14) and disease-free survival (HR 1.22, 95% CI 0.86 to 1.73) of patients with cancer. Neither advanced nor mixed-stage tumour patients showed significant association between MPV and overall survival (HR 1.36, 95% CI 0.96 to 1.94, HR 0.90, 95% CI 0.74 to 1.09). However, high MPV had the strongest relationship with poor overall survival (HR 2.01; 95% CI 1.08 to 3.41) in gastric cancer, followed by pancreatic cancer (HR 1.54; 95% CI 1.31 to 1.82). Whereas in the subgroup using receiver operating characteristic curve method to define cut-off values, low MPV was significantly related to poor overall survival (HR 0.78, 95% CI 0.64 to 0.95). In addition, MPV had no significant association with age (OR 0.96, 95% CI 0.90 to 1.02), sex (OR 1.04, 95% CI 1.00 to 1.09), depth of cancer invasion (OR 0.90, 95% CI 0.77 to 1.04) and tumour stage (OR 0.91, 95% CI 0.78 to 1.07).

CONCLUSIONS

Pretreatment MPV level is of no clearly prognostic significance in cancers and no significant association with clinicopathological parameters of patients with cancers.

Correlation of clinical signs and symptoms of Behçet's disease with mean platelet volume (MPV) and red cell distribution width (RDW)

Background

A strong correlation was previously found between mean platelet volume (MPV), red blood cell distribution width (RDW), and the severity of signs and symptoms in patients suffering from inflammatory and autoimmune diseases. The current study evaluated these correlations in patients with Behçet’s disease (BD) as well the relationship between MPV and RDW and disease activity score on the Iranian Behçet’s Disease Dynamic Activity Measurement (IBDDAM).

Methods

This cross-sectional study included 319 patients with BD for whom demographic and epidemiological data, IBDDAM scores, and duration of illness was recorded. Blood samples were then obtained and the relationships between their disease status and manifestations and their laboratory parameters were evaluated with statistical models to find possible correlations.

Results

Our analysis showed a significantly higher RDW in patients with BD who had ocular manifestations (p < 0.001) and oral aphthae (p = 0.004). Patients with active BD had higher RDW (p < 0.001) and MPV (p < 0.001) in comparison to those with currently inactive BD. Similarly, patients who had any type of ocular manifestation had higher RDW (p < 0.001) and MPV (p < 0.001). Regression analyses identified a statistically significant model for the effect of RDW and MPV in predicting active BD status (p < 0.001), as well as its significant relationship with active ocular manifestations (p < 0.001).

Conclusion

BD was found to be associated with an increase in MPV and RDW, particularly during active phases. RDW and MPV were also found to have predictive value for screening to detect BD activity and its ocular complications.