Elevated mean platelet volume is associated with silent cerebral infarction

Do Mean Platelet Volume and Platelet Distribution Width Have An Association with White Matter Hyperintensities in Migraine Patients?

Objective

Increased prevalence of white matter hyperintensities (WMH) is reported in migraine patients; however, the pathophysiology and the progression of these lesions are not definitely clear. Mean platelet volume (MPV) and platelet distribution width (PDW) are easily obtained markers for platelet activity. The aim of this study is to evaluate the relationship between the presence of WMH and MPV and PDW in patients with migraine in order to determine the role of platelet activity in the pathophysiology of WMH.

Methods

Patients who were admitted to the neurology outpatient clinics of Baskent University Hospital from January 2011 to December 2015 with migraine and between 18 and 55 years of age were evaluated retrospectively. The blood samples were taken and total blood count parameters including MPV and PDW were analyzed. Brain magnetic resonance images were evaluated.

Results

Totally, 218 patients were evaluated in this study. Forty-eight (22.0%) patients had WMH in the brain magnetic resonance imaging. In patients with WMH, the median of age was higher than the patients without WMH and the difference was statistically significant (P < 0.05). There was no statistically significant difference between MPV, PDW values, and the presence of WMH.

Conclusions

There are multiple theories suggested for the mechanism of WMH, but the major cause and pathophysiology are still undetermined. Our data suggested that increased platelet activity is insufficient by itself to explain the pathophysiology of WMH in migraine patients and to improve the knowledge on this issue further large longitudinal studies should be performed.

Mean platelet volume and its genetic variants relate to stroke severity and 1-year mortality

OBJECTIVE

To determine whether mean platelet volume (MPV) and selected single nucleotide polymorphisms (SNPs) that have been associated with MPV in genome-wide association studies relate to stroke severity, functional outcome on discharge, and 1-year mortality in patients with ischemic stroke, we retrospectively analyzed 577 patients with first-ever ischemic stroke.

METHODS

Genotyping of 3 SNPs (rs342293, rs1354034, rs7961894) was performed using a real-time PCR allelic discrimination assay. Multivariable regression was used to determine the association of MPV and MPV-associated SNPs with the NIH Stroke Scale (NIHSS) score on admission, modified Rankin Scale score on discharge, and data on 1-year mortality.

RESULTS

Rs7961894, but not rs342293 or rs1354034 SNP, was independently associated with an MPV in the highest quartile (MPV Q4). MPV Q4 was associated with significantly greater admission NIHSS (p = 0.006), poor discharge outcome (p = 0.034), and worse 1-year mortality (p = 0.033). After adjustment for pertinent covariates, MPV Q4 remained independently associated with a greater admission NIHSS score (p = 0.025). The T>C variant of rs7961894 SNP was an independent marker of a lower 1-year mortality (hazard ratio, 0.30; 95% confidence interval, 0.13-0.70; p = 0.006) in the studied population.

CONCLUSION

MPV is a marker of stroke severity and T>C variant of rs7961894 is independently associated with greater MPV in acute phase of ischemic stroke and relates to decreased 1-year mortality after stroke.

Mean platelet volume: a new predictor of ischaemic stroke risk in patients with nonvalvular atrial fibrillation

Background

Mean platelet volume (MPV) has been identified as an individual risk factor for stroke and thrombosis. Concurrently, ischaemic stroke caused by nonvalvular atrial fibrillation (AF) has attracted increasing attention. The aim of this study was to investigate the association between MPV and the risk of ischaemic stroke in AF patients not receiving anticoagulant therapy.

Methods

A total of 370 patients with nonvalvular AF were enrolled. Patients were divided into a control group and a stroke group according to the presence of ischaemic stroke.

Results

The MPV level and CHA2DS2-VASc scores of the stroke group were higher than those of the control group (all p < 0.001). The ischaemic stroke event rates were significantly increased in the highest MPV tertile when compared to the lowest MPV tertile (56.9% vs. 30.3%, p < 0.001). Multivariate logistic regression analysis showed that CHA2DS2-VASc, MPV and D-dimer (D2) were predictors of ischaemic stroke [all p < 0.05]. The receiver operating characteristic (ROC) curve analysis indicated that an MPV value of 11.65 fL could predict ischaemic stroke with a sensitivity of 67.3% and specificity of 58.5%, while a CHA2DS2-VASc score cutoff value 3.5 had a sensitivity of 52.1% and specificity of 87.3%. The predictive value of the combined model of CHA2DS2-VASc+MPV was higher than others (comparison calculated by using MedCalc software). The sensitivity of the CHA2DS2-VASc score combined with MPV for predicting ischaemic stroke was 72.1%, and the specificity was 81.5%.

Conclusions

MPV could be a new predictor of ischaemic stroke risk in patients with AF. Moreover, the CHA2D2S2-VASc combined with MPV can improve predictive value with higher sensitivity and it could be a powerful tool for stratifying patients in terms of ischaemic stroke risk.

Platelet count and mean volume in acute stroke: a systematic review and meta-analysis

Changes of mean platelet volume (MPV) and platelet count (PC) could be a marker or a predictor of acute stroke (AS). We conducted a systematic review and meta-analysis of the published literature on the reporting of MPV and PC in AS. Studies were included in accordance with Patient Population or Problem, Intervention, Comparison, Outcomes, and Setting framework. The PRISMA strategy was used to report findings. Risk of bias was assessed with the Newcastle-Ottawa Scale. We included 34 eligible articles retrieved from the literature. PC was significantly lower in AS patients [standardized mean difference (SMD) = - 0.30, (95% CI: - 0.49 to - 0.11), N = 2492, P = .002] compared with controls (N = 3615). The MPV was significantly higher [SMD = 0.52 (95% CI: 0.28-0.76), N = 2739, P < .001] compared with controls (N = 3810). Subgroup analyses showed significantly lower PC in both ischemic stroke (Difference SMD = -0.18, 95% CI: -0.35-0.01) and hemorrhagic stroke (-0.94, -1.62 to -0.25), but only samples by citrate anticoagulant showed significantly lower result for patients compared to controls (-0.36, -0.68 to -0.04). Ischemic stroke patients had higher MPV (0.57, 0.31-0.83), and samples by Ethylenediaminetetraacetic acid (EDTA) anticoagulant showed significantly higher result for patients compared to controls (0.86, 0.55-1.17). PC and MPV appeared to be significantly different between patients with AS and control populations. MPV was significantly higher in ischemic stroke and PC was significantly lower in both ischemic and hemorrhagic strokes. These characteristics might be related to AS and associated with it. It is advisable to pay attention to elapsed time between phlebotomy and hematology analysis, anticoagulant and hemocytometer types in AS.

SYSTEMATIC REVIEW REGISTRATION

This meta-analysis is registered on the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42017067864 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=67864).

The association between platelet indices, cognitive screening tests and functional dependence screening questionnaires in hospitalized older people

PURPOSE

Activated platelets have been suggested to play an important role in the pathogenesis of dementia. Recent studies have shown contradictory results concerning the relationship between blood platelet indices and cognitive performance.

METHODS

This cross-sectional study evaluates the relationship between basic platelet indices and cognitive and functional performance of 754 men and women, aged 60-105 years old, admitted to the geriatric hospital unit. Assessment of global cognitive function and functional ability were performed using Mini-Mental State Examination, the seven-point Clock Drawing Test, the Katz Activities of Daily Living, the Lawton Instrumental Activities of Daily Living Scale and the Vulnerable Elders Survey Questionnaire. As platelet indices, platelet count, mean platelet volume, plateletcrit and platelet distribution width were measured.

RESULTS

There was no significant correlation between cognitive performance and platelet indices. Out of the functional dependence questionnaires, only the Katz Activities of Daily Living and the Vulnerable Elders Survey Questionnaire were weakly correlated with platelet count (r = - 0.080 and r = 0.096) and plateletcrit (r = - 0.075 and 0.082, respectively), but these associations diminished in sex-specific analyses.

CONCLUSIONS

Cognitive and functional status are not systematically related to platelet indices in multimorbid hospitalized older adults.

Predictive and prognostic role of mean platelet volume in patients with first-ever acute ischemic stroke

Objective:

To investigate any possible effects of mean platelet volume (MPV) on short-term stroke prognosis and functional outcome in patients with first-ever acute ischemic stroke (FEAIS).

Methods:

This retrospective cross-sectional study included 798 FEAIS patients admitted to the emergency department of a tertiary care hospital in Adiyaman, Turkey between January 2013 and June 2015. The data were evaluated according to whether alive or dead, MPV levels, modified Rankin scale (MRS) scores, National Institutes of Health Stroke Scale (NIHSS) scores. The patients were divided into 3 groups based on MPV level as 4.4-7.4 fL, 7.5-10.4 fL, higher than 10.4 fL.

Results:

A total of 250 patients with FEAIS were included in the study. In both those who survived and those who died, the area under the curve related to hospitalization days, time interval of venipuncture (TIV), and MPV measurements was not statistically significant (p>0.05). The 3 MPV groups showed no significant differences in terms of MRS score, median NIHSS score, hospitalization, and TIV. In subgroups based on MRS scores, there were no statistically significant differences according to median latency (p=0.087), median hospitalization (p=0.394), TIV (p=0.201), and MPV levels (p=0.847). Furthermore, there were no differences in MPV levels between the MRS based groups (p=0.527).

Conclusion:

The results showed that MPV was not a significantly associated and reliable marker for the prediction of prognosis or functional outcome of FEAIS attack.

Platelets: Peripheral Biomarkers of Dementia?

Dementia continues to be the most burdening neurocognitive disorder, having a negative impact on the lives of millions. The search for biomarkers to improve the clinical diagnosis of dementia is ongoing, with the focus on effective use of readily accessible peripheral markers. In this review, we concentrate on platelets as biomarkers of dementia and analyze their potential as easily-accessible clinical biomarkers for various subtypes of dementia. Current platelet protein biomarkers that have been investigated for their clinical utility in the diagnosis of dementia, in particular Alzheimer's disease, include amyloid-β protein precursor (AβPP), the AβPP secretases (BACE1 and ADAM10), α-synuclein, tau protein, serotonin, cholesterol, phospholipases, clusterin, IgG, surface receptors, MAO-B, and coated platelets. Few of them, i.e., platelet tau, AβPP (particularly with regards to coated platelets) and secreted ADAM10 and BACE1 show the most promise to be taken forward into clinical setting to diagnose dementia. Aside from protein biomarkers, changes in factors such as mean platelet volume have the potential to play a very specific role in both the dementia diagnosis and prognosis. This review raises a number of research questions for consideration before application of the above biomarkers to routine clinical setting. It is without doubt that there is a need for more clarification on the effects of dementia on platelet morphology and protein content before these changes can be clinically applied as dementia biomarkers and explored further in differentiating distinct dementia subtypes.

Association of human platelet antigen polymorphisms with platelet count and mean platelet volume

OBJECTIVES

Although recent genome-wide association studies have identified a number of single nucleotide polymorphisms associated with platelet count and mean platelet volume (MPV), it is unclear whether polymorphisms in the human platelet antigens (HPA) genes are associated with platelet count and MPV. The aim of this study was to determine the association of the HPA-2, -3, -5 and -15 polymorphisms with platelet count and MPV.

METHODS

The HPA were genotyped by 5'-nuclease assay in 139 healthy Chinese Han individuals, while platelet count and MPV from the same samples were measured using an hematology cell analyzer.

RESULTS

The platelet count was significantly lower in the individuals with the HPA-2aa genotype compared to those with HPA-2ab (P = 0.020), and significantly higher in individuals with HPA-5aa and HPA-15aa genotypes compared to those with HPA-5ab (P = 0.045) and HPA-15ab/bb (P = 0.032), respectively. On the other hand, platelet count of individuals with the HPA-3aa and HPA-3ab/bb genotypes did not differ significantly (P = 0.084). The MPV was significantly lower in individuals with HPA-5aa genotype compared to those with HPA-5ab (P = 0.001) but did not differ among the HPA-2, -3 and -15 genotypes. Furthermore, HPA-2, -5 and -15 polymorphisms were identified as independent factors for the platelet count and HPA-5 polymorphism was shown as an independent factor for MPV.

CONCLUSIONS

This study demonstrates that HPA-2, -5 and -15 polymorphisms are associated with the platelet count while HPA-5 polymorphism is associated with MPV. This finding will further our understanding of the association of HPA polymorphisms with platelet-related diseases.

Increased platelet count and reticulated platelets in recently symptomatic versus asymptomatic carotid artery stenosis and in cerebral microembolic signal-negative patient subgroups: results from the HaEmostasis In carotid STenosis (HEIST) study

BACKGROUND

The pathophysiological mechanisms responsible for the disparity in stroke risk between asymptomatic and symptomatic carotid stenosis patients are not fully understood. The functionally important reticulated platelet fraction and reticulocytes could play a role.

OBJECTIVES

We performed a prospective, multi-centre, observational analytical study comparing full blood count parameters and platelet production/turnover/activation markers in patients with asymptomatic versus recently symptomatic moderate (≥ 50-69%) or severe (≥ 70-99%) carotid stenosis.

PATIENTS/METHODS

Data from 34 asymptomatic patients were compared with 43 symptomatic patients in the 'early phase' (≤ 4 weeks) and 37 of these patients in the 'late phase' (≥ 3 months) after TIA/ischaemic stroke. Reticulated platelets were quantified by whole blood flow cytometry and reticulated platelets and red cell reticulocytes by 'automated assays' (Sysmex XE-2100™). Bilateral simultaneous transcranial Doppler ultrasound monitoring classified patients as micro-embolic signal (MES)+ve or MES-ve.

RESULTS

Mean platelet count was higher in early (216 × 10⁹/L; P = 0.04) and late symptomatic (219 × 10⁹/L; P = 0.044) than asymptomatic patients (194 × 10⁹/L). Mean platelet volume was higher in early symptomatic than asymptomatic patients (10.8 vs. 10.45 fl; P = 0.045). Automated assays revealed higher % reticulated platelet fractions in early (5.78%; P < 0.001) and late symptomatic (5.11%; P = 0.01) than asymptomatic patients (3.48%). Red cell reticulocyte counts were lower in early (0.92%; P = 0.035) and late symptomatic (0.93%; P = 0.036) than asymptomatic patients (1.07%). The automated % reticulated platelet fraction was also higher in early symptomatic than asymptomatic MES-ve patients (5.7 vs. 3.55%; P = 0.001).

DISCUSSION

The combination of increased platelet counts and a shift towards production of an increased population of larger, young, reticulated platelets could contribute to a higher risk of first or recurrent cerebrovascular events in recently symptomatic versus asymptomatic carotid stenosis, including those who are MES-ve.

Baseline platelet parameters for predicting early platelet response and clinical outcomes in patients with non-cardioembolic ischemic stroke treated with clopidogrel

Purpose

The present study investigated whether routine baseline platelet parameters(BPPs) detected before clopidogrel therapy in acute non-cardioembolic ischemic stroke(NCIS) could predict early platelet response and future clinical outcomes.

Results

The CYP2C19 polymorphisms constituted independent risk factors for LCR. The number of female patients, the incidence of diabetes mellitus (DM), the level of low-density lipoprotein(LDL) cholesterol, and the neutrophil-to-lymphocyte ratio(NLR) were significantly high in the clinical clopidogrel resistance (CCR) group. However, none of the BPPs had a significant association with laboratory clopidogrel resistance (LCR) or discriminated with the cut-off values regarding LCR or CCR. The patients were divided into two groups according to the average mean platelet volume(MPV) or platelet count(PC). We found that the HbA1c level, the number of female patients, and the CCR were higher in the groups with elevated MPV (≥ 10.6fL) and PC (≥ 235 × 10⁹/L); the LCR, the NIHSS score at discharge, and elevated MPV and PC were risk predictors for CCR.

Materials and Methods

This study included 196 patients with acute NCIS who underwent routine blood tests upon admission, were treated with clopidogrel, and were followed up for 6 months. Early platelet response was assessed and the CYP2C19 genetic variants were screened for. All participants were categorized into either laboratory clopidogrel resistance(LCR) or clinical clopidogrel resistance (CCR) groups.

Conclusions

Elevated baseline MPV and PC before clopidogrel therapy, as well as CYP2C19 gene variants, should be included in a risk algorithm for NCIS. Furthermore, other nongenetic clinical risk factors should be assessed for optimal prediction of the risk for thrombotic events because of individual variability in platelet response to clopidogrel.

Usefulness of mean platelet volume as a marker for clinical outcomes after out-of-hospital cardiac arrest: a retrospective cohort study

Essentials It is unknown whether mean platelet volume (MPV) estimates outcomes after cardiac arrest (CA). We investigated whether MPV was associated with 30-day neurologic outcome and mortality after CA. Elevated MPV at admission was associated with poor neurological outcomes and mortality at 30 days. Identifying levels of MPV is helpful for estimating disease severity among resuscitated patients.

SUMMARY

Background Whole-body ischemia followed by reperfusion during cardiac arrest and after return of spontaneous circulation (ROSC) triggers systemic sterile inflammatory responses, inducing a sepsis-like state during post-cardiac arrest syndrome. Activated platelets are enlarged, and contain vasoactive and prothrombic factors that aggravate systemic inflammation and endothelial dysfunction. Objectives To investigate whether mean platelet volume (MPV) is useful as a marker for early mortality and neurologic outcomes in patients who achieve ROSC after out-of-hospital cardiac arrest (OHCA). Methods OHCA records from the Emergency Department Cardiac Arrest Registry were retrospectively analyzed. Patients who survived for > 24 h after ROSC were included. We evaluated mortality and cerebral performance category scores after 30 days. Results We analyzed records from 184 patients with OHCA. Increased 30-day mortality among patients who achieved ROSC after OHCA was associated with MPV at admission (hazard ratio [HR] 1.36; 95% confidence interval [CI] 1.06-1.75). An elevated MPV at admission was also associated with poor neurologic outcomes (HR 1.28; 95% CI 1.06-1.55). Conclusions An elevated MPV was independently associated with increased 30-day mortality, with the highest discriminative value being obtained upon admission after OHCA. An elevated MPV on admission was associated with poor neurologic outcomes. High MPVs are helpful for estimating 30-day mortality and neurologic outcomes among patients who achieve ROSC after OHCA.

Changes in platelet parameters in leukocytosis

INTRODUCTION

In recent years, platelets are known to have a large variety of functions in many pathophysiological processes and their interaction with endothelial cells and leukocytes is known to play an important role in the pathophysiology of vascular inflammation. The aim of this study was to investigate the relationship between white blood cell count in conditions resulting in leukocytosis and platelet count and platelet parameters including mean platelet volume, platelet distribution width, and plateletcrit.

METHODS

White blood cell counts count and all platelet parameters were evaluated in 341 results of normal complete blood count (of which the white blood cell counts were within reference range, group 1) and 327 results of elevated white blood cell counts count (group 2).

RESULTS

There was a significant difference between these two groups in PLT counts and PCT values, being higher in Group 2. However, there was no statistically significant difference between two groups in MPV and PDW values. On the other hand, there were statistically significant, but weak, correlations between the WBC and platelet counts in both groups (p<0.01, r=0.235 for group 1, p<0.05, r=0.116 for group 2).

CONCLUSION

As a conclusion PLT count and PCT values increase in infectious conditions. This study and previous studies show that PLTs are employed in infectious conditions but the exact mechanism and the exact clinical importance of this response remains to be cleared by further studies.

Neutrophil/lymphocyte ratio and mean platelet volume in branch retinal vein occlusion

Purpose

To evaluate the mean platelet volume (MPV) and the neutrophil/lymphocyte ratio (NLR) in patients with branch retinal vein occlusion (BRVO).

Methods

Thirty patients with branch retinal vein occlusion (BRVO group) and 27 age and sex matched subjects (control group) were included in the study. MPV and NLR parameters obtained from peripheral blood were recorded.

Results

The mean age was 62.6 ± 12.3 years in BRVO and 63.5 ± 8.2 years in control group. The BRVO group consisted of 13 males and 17 females and the control group included 12 male and 15 female subjects. The mean MPV values were 8.64 ± 2.01 fL in BRVO group and 8.5 ± 1.26 fL in control group. NLR was 2.24 ± 0.79 and 1.89 ± 0.64 in BRVO and control groups respectively. The difference between two groups in terms of MPV and NLR was not statistically significant.

Conclusion

MPV and NLR were found to be not affected in branch retinal vein occlusion patients.

Prognostic value of mean platelet volume on tinnitus

OBJECTIVE

This study aimed to determine whether there was any relationship between tinnitus and mean platelet volume.

METHODS

This retrospective study was conducted between January 2013 and January 2014 in Ankara Atatürk Hospital and Ondokuz Mayıs University Hospital, Turkey, on a study group of 86 patients with tinnitus and a control group of 84 healthy subjects. Mean platelet volume was recorded and comparisons were made between the two groups.

RESULTS

Mean (± standard deviation) platelet volume was 7.67 ± 0.83 μm(3) in the study group and 7.28 ± 0.56 μm(3) in the control group. There was a statistically significant difference in mean platelet volume between the tinnitus patients and the healthy subjects (p < 0.05).

CONCLUSION

The clinical findings indicated that tinnitus patients had a higher mean platelet volume than the healthy control subjects; however, the pathophysiological mechanism remains unclear.

Is Mean Platelet Volume a Reliable Marker to Predict Ischemic Stroke in the Follow-Up of Patients with Carotid Stenosis?

BACKGROUND

The objective of the study is to evaluate the reliability of mean platelet volume (MPV) for predicting ischemic stroke (cerebrovascular event [CVE]) among patients with different degrees of carotid stenosis.

METHODS

Fifty-two patients with CVEs, 136 patients with carotid artery disease (CAD), and 40 healthy volunteers were enrolled in this study. All participants were divided into the following groups according to CAD: absence of stenosis, less than 50% stenosis, 50%-69% stenosis, and 70% or more to total occlusion of the internal carotid artery. For each participant, the parameters of CAD were assessed using ultrasonography. To obtain the values of CRP and MPV and the leukocyte and platelet counts, all samples were processed within 30 minutes after blood collection. Univariate and multivariate analyses were used to evaluate the association between the values of serum C-reactive protein (CRP) and MPV and carotid stenosis.

RESULTS

In terms of age and gender, there was no statistically significant difference between the groups (P = .094 and P = .428, respectively). However, CRP values in patients with CAD and CVEs were significantly higher than those in the controls (P < .001). There was no statistically significant difference between the CRP values in patients with CAD and CVEs (P = .249). Moreover, the MPV values did not show any significant difference between the groups (P = .053) and among the patients with CAD (P = .64). There was no positive correlation between serum CRP and MPV values in patients with CAD regarding the degree of carotid stenosis (r = .061, P = .477).

CONCLUSION

The findings of this study claim that MPV has no predictive value during follow-up of the patients with CAD for CVEs.

The relationship of fibroblast growth factors 21 and 23 and α-Klotho with platelet activity measured by platelet volume indices

BACKGROUND

Subjects with high fibroblast growth factor 21(FGF21) and 23 (FGF23), endocrine hormones that regulate insulin sensitivity and phosphate metabolism, respectively, are reported to have a higher risk for adverse cardiovascular outcome. Therefore, the relationship of FGF21, FGF23, and α-Klotho (co-receptor for FGF23 signaling) with mean platelet volume (MPV) and platelet distribution width (PDW), two platelet volume indices that reflect platelet activity, was investigated.

METHODS

Data from 156 patients admitted to the cardiology department were analyzed. MPV and PDW were measured by an automatic blood counter, and serum FGF21, FGF23, and α-Klotho concentrations were measured by an enzyme-linked immunoassay.

RESULTS

Log(FGF21) was significantly correlated with serum triglycerides but did not differ according to the use of non-use of antidiabetic or lipid-lowering drugs. MPV and PDW were significantly correlated (R=0.475, p<0.001). MPV was significantly correlated with log(FGF21) (R=-0.167, p<0.05) and log(FGF23) (R=0.351, p<0.001) but not with log(α-Klotho). Linear regression analysis showed a negative and positive association of log(FGF21) and log(FGF23), respectively, with MPV that was independent of possible confounders including sex, age, renal function, and antithrombotic drug use. In addition, log(FGF23) was found to have a significant independent positive association with PDW.

CONCLUSIONS

Among cardiac patients, FGF21 had a negative association with MPV, whereas FGF23 had a positive association. Future studies of serum FGF23/FGF21 concentrations and the incidence of thromboembolic disorders are warranted.

Reduced Serum Level of Interleukin-10 is Associated with Cerebral Infarction: A Case-Control and Meta-Analysis Study

IL-10 expression limits inflammation and restricts the size of CNS damage from stroke. In this study, we examined the correlation between cerebral infarction (CI) and serum levels of interleukin-10 (IL-10) using a combination of case-control study and meta-analysis of published data, with an aim of understanding the relevance of serum IL-10 levels to CI development. This study enrolled a total of 169 CI patients admitted to the Second Hospital of Hebei Medical University between May 2011 and November 2014. During the same period, a group of 145 individuals were recruited at the same hospital as healthy controls after thorough physical examination. Serum IL-10 levels were measured by enzyme-linked immunosorbent assay (ELISA). SPSS 19.0 (IBM, 2010, Chicago, IL, USA) and Comprehensive Meta-Analysis 2.0 (CMA 2.0) software were used for data analysis. Serum levels of IL-10 (pg/mL) were significantly lower in CI patients when compared to healthy controls (15.36 ± 3.21 vs. 21.64 ± 5.17, t = 13.12, P < 0.001). In addition, patients with large artery atherosclerosis (LAAS), cardioembolic infarct (CEI), and lacunar infarct (LAC) displayed drastically reduced serum levels of IL-10 (pg/mL) compared to healthy controls (LAAS 14.77 ± 5.21, CEI 15.25 ± 5.10, LAC 16.58 ± 4.92, all P < 0.001). Interestingly, no significant differences were observed in the serum IL-10 levels when pair-wise comparisons were made between these three clinical subtypes of CI (all P > 0.05). Logistic regression analysis indicated that, with the exception of triglyceride (TG) and uric acid (UA) levels (both P > 0.05), the other seven parameters, including fasting blood glucose (FPG), total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), creatinine (Cr), systolic blood pressure (SBP), and diastolic blood pressure (DBP), strongly correlated with CI development (all P < 0.05). Meta-analysis of pooled data from nine case-control studies revealed an inverse correlation between the serum IL-10 levels and CI (SMD = 1.797, 95% CI 0.785~2.810, P = 0.001). Subgroup analysis based on country showed that low serum levels of IL-10 may be the major risk factor for CI in Croatia (SMD = 2.961, 95% CI 2.480~3.443, P < 0.001) and India (SMD = 1.440, 95% CI 1.129-1.750, P < 0.001). Further, subgroup analysis based on ethnicity showed that IL-10 serum levels and CI displayed negative relationship in Asians (SMD = 2.522, 95% CI 0.468~4.576, P = 0.016) but not in Caucasians (P > 0.05). Our study provided convincing evidence that the patients with CI exhibit consistently reduced serum levels of IL-10, and IL-10 may be a major player in the development and progression of CI.

The value of serum mean platelet volume in testicular torsion

OBJECTIVE

To compare the serum mean platelet volume (MPV) in patients with testicular torsion and healthy control subjects.

METHODS

This retrospective study compared clinical and demographic data from patients who underwent surgery for testicular torsion and healthy controls. Testicular torsion was diagnosed with a physical examination and Doppler ultrasonography. Age, leukocyte count, platelet count and MPV were recorded for all participants.

RESULTS

A total of 50 patients with testicular torsion and 51 healthy control subjects were enrolled. There was no significant difference in age and platelet count between the two groups. Patients with testicular torsion had a significantly higher leukocyte count and MPV, compared with controls. According to receiver operating characteristic curve analysis performed for the prediction of testicular torsion, the best cut-off point for MPV was 7.7 fl (sensitivity 62%, specificity 96%), and the best cut-off point for leukocyte count was 9.5 × 10(9)/l (sensitivity 58%, specificity 80%).

CONCLUSIONS

The MPV may be useful as an ancillary test for the diagnosis of testicular torsion. Further studies are needed in order to confirm these preliminary results.

Characteristics of platelet indices, neutrophil-to-lymphocyte ratio and erythrocyte sedimentation rate compared with C reactive protein in patients with cerebral infarction: a retrospective analysis of comparing haematological parameters and C reactive protein

OBJECTIVE

Elevation of C reactive protein (CRP) is one of the major acute-phase responses following ischaemic or haemorrhagic stroke. This study aims to investigate the associations between platelet indices, neutrophil-to-lymphocyte ratio (NLR) and erythrocyte sedimentation rate (ESR) compared with CRP in patients with cerebral infarction.

SETTING

The clinical data of patients with cerebral infarction were analysed retrospectively.

PARTICIPANTS

We analysed, unduplicated, 516 patients with cerebral infarction (mean age 66.2±12.7, male/female=291/225).

OUTCOME MEASURES

Mean platelet volume (MPV), MPV to platelet count, NLR and ESR were compared with CRP in patients with cerebral infarction in a single institute through Spearman correlation test.

RESULTS

There were significant correlations between CRP and MPV (ρ=0.088, p=0.045), NLR (ρ=0.4, p<0.001) and ESR (ρ=0.468, p<0.001) in patients with cerebral infarction. In the male group, NLR (ρ=0.398, p<0.001) and ESR (ρ=0.502, p<0.001) showed significant correlations with CRP. In the female group, CRP showed significant correlations with MPV (ρ=0.17, p=0.011), NLR (ρ=0.392, p<0.001) and ESR (ρ=0.475, p<0.001).

CONCLUSIONS

MPV, NLR and ESR showed significant correlation with CRP in patients with cerebral infarction. MPV and NLR are cost-effective and simple parameters that can be attainable by using an automatic haematology analyser. Further well-designed and large-scale prospective studies are warranted to evaluate platelet indices or NLR for monitoring patients with cerebral infarction.