Mean platelet volume as a marker for differentiating disease flare from infection in Behçet's disease

Mean platelet volume as a predictor in the differentiation of Behçet's disease from recurrent aphthous stomatitis - A single centre, prospective, case-control study

INTRODUCTION

Recurrent oral ulcers (ROUs) are the most common disorder of the oral cavity in the community. The most challenging issue for the clinician to deal with in the diagnosis is to distinguish whether ROUs are associated with primarily Behçet's disease (BD). We aimed to investigate whether hemogram parameters contribute to reinforce BD suspicion in the differential diagnosis of recurrent aphthous stomatitis (RAS) and BD.

METHODS

A total of 260 participants were recruited from the dermatology department in this single-centre, prospective, case-control study. Participants meeting eligibility criteria were divided into three groups as healthy control (n = 90), RAS (n = 97) and mucocutaneous BD (n = 73). The mean platelet volume (MPV), red cell distribution width (RDW), haemoglobin, neutrophils, monocyte, lymphocytes and platelet counts were evaluated with the complete blood count. Furthermore, the neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio and platelet/lymphocyte ratio were calculated. Erythrocyte sedimentation rate (ESR) and C-reactive protein were recorded. The contribution of hemogram parameters to the differentiation of BD from RAS was analysed.

RESULTS

The healthy control, RAS and BD groups were matched in terms of mean age (29.3 ± 5.8, 28.7 ± 5.6 and 29.9 ± 6.8 years; respectively) and sex distribution (women/men rate: 1.4, 1.6 and 1.7; respectively). ESR, neutrophil count and NLR were significantly higher in BD patients. (P = .032, P = .010, P = .019; respectively). MPV is significantly decreased in BD patients than in healthy control and RAS patients (P < .001). Decreased MPV (≤10 fL) and increased RDW (≥13.0%) were useful in predicting BD in patients evaluated with complaints of ROUs (OR = 9.98, 95% CI: [4.65-21.42], P < .001 and OR = 2.23, 95% CI: [1.14-3.36], P = .019, respectively).

CONCLUSIONS

Decreased MPV may be predictive for BD in selected patients with ROUs. We consider that more attention is required in terms of BD especially if MPV ≤10.0 fL.

Platelet activation in ocular Behçet's patients with posterior segment involvement

PURPOSE:

The aim of the present study was to assess platelet activation by analyzing three platelet activation parameters in ocular Behçet's disease (BD): mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT).

METHODS:

Twenty-nine patients with active ocular BD (Group 1), 40 patients with inactive ocular BD (Group 2), and 40 healthy adult individuals serving as controls (Group 3) were evaluated. All of the individuals had been performed the complete ophthalmologic evaluation. The levels of MPV, PDW, and PCT were measured in each group.

RESULTS:

The mean MPV level was 8.40 ± 0.97 in Group 1, 8.32 ± 1.04 in Group 2, and 7.77 ± 0.72 in Group 3. The mean PDW level was 15.12 ± 1.09 in Group 1, 14.97 ± 1.02 in Group 2, and 14.52 ± 0.82 in Group 3. The mean PCT level was 0.23 ± 0.07 in Group 1, 0.21 ± 0.04 in Group 2, and 0.18 ± 0.03 in Group 3. MPV, PDW, and PCT levels were significantly higher in ocular BD patients than controls (P < 0.05).

CONCLUSION:

Platelet activation may affect vascular occlusion in ocular Behçet's patients with posterior segment involvement. This result may be important in evaluating ocular BD patients.

Accuracy of neutrophil CD64 expression in diagnosing infection in patients with autoimmune diseases: a meta-analysis

We aimed to systematically evaluate the accuracy of nCD64 in diagnosing infection in patients with autoimmune diseases. Studies were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases up to October 2018. There was no restriction for language and age. Prospective studies examining the accuracy of nCD64 in diagnosing infection in patients with autoimmune diseases were included. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the quality of eligible studies. Stata 15.1 and Meta-DiSc 1.4 software were used for data analysis. Eleven studies fulfilled the inclusion criteria (677 patients, 229 patients with bacterial infection, and 448 without infection). The pooled sensitivity and specificity of nCD64 were 89% (95% confidence interval (CI) 82-93) and 94% (95% CI 91-96), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 14.9 (95% CI 9.3-23.8) and 0.12 (95% CI 0.07-0.20), respectively. The diagnostic odds ratio and area under the summary receiver operating characteristic curve were 123 (95% CI 53-283) and 0.97 (95% CI 0.95-0.98), respectively. The univariate meta-regression analysis showed that region, type of disease, antibiotic therapy, and presentation of nCD64 measurement results were responsible for the heterogeneity. The Deeks' funnel plot asymmetry test showed that there was no publication bias (p = 0.15). nCD64 has a good overall diagnostic performance for differentiating infection from disease flare in patients with autoimmune diseases. Further studies are needed to confirm the optimized cutoff value.