Low Mean Platelet Volume is Associated with Deep Vein Thrombosis in Older Patients with Hip Fracture

Prognostic Nutritional Index as a Potential Biomarker for the Risk of Lower Extremity Deep Venous Thrombosis: A Large Retrospective Study

BACKGROUND

Prognostic nutritional index (PNI) has recently been identified as a novel marker of nutritional status. However, existing evidences on the association between PNI and the risk of lower extremity deep venous thrombosis (LEDVT) are limited and conflicting.

OBJECTIVE

To determine the association between PNI and the risk of LEDVT, and further evaluate its diagnostic value.

METHODS

Over a 10-year period (2012-2022), a total of 12790 patients who underwent compression ultrasonography examinations were consecutively included, and 1519 (11.9%) LEDVT events occurred. Multivariate logistic regression analysis was used to investigate the association, and receiver operating characteristic (ROC) curve was constructed to evaluate its diagnostic performance.

RESULTS

After full adjustment, patients in third quartile (odds ratio [OR] = 1.486, 95% confidence interval [CI]: 1.205-1.832), second quartile (OR = 2.436, 95% CI: 1.993-2.978) and first quartile (OR = 3.422, 95% CI: 2.791-4.195) of PNI were at higher risk of LEDVT compared with those in fourth quartile, and the test for trend was significant. Consistently, each unit decrease in PNI was associated with a 6.0 % (95% CI: 1.052-1.069) increased risk of LEDVT. Moreover, adding PNI to a base model improved the area under the curve (AUC) from 0.721 (95% CI: 0.709-0.734) to 0.746 (95% CI: 0.734-0.758).

CONCLUSION

PNI is inversely associated with the risk of LEDVT, and provides significant incremental diagnostic value for the identification of LEDVT events. These findings suggest that PNI may be a potential biomarker to help clinicians identify patients at risk of thrombosis and make clinical decisions timely.

Prediction of deep vein thrombosis in pregnant women by platelet indices: A retrospective case-control study

AIMS

This study aimed to investigate the predictive value of the platelet indices for the diagnosis of acute deep vein thrombosis (DVT) in pregnant women.

MATERIALS AND METHODS

Pregnant women aged 20-45 years who presented to the emergency room with leg pain and edema and underwent bilateral lower extremity venous Doppler examination for DVT were included in the study. Platelet large cell ratio (P-LCR), platelet distribution width (PDW) and mean platelet volume (MPV) values, which provide information on current platelet activity in the hemogram parameters recorded at first presentation in the emergency department, were analyzed between the two groups. Pregnant women with a history of venous thromboembolism, anticoagulant medication, heart disease, cancer, essential thrombocytopenia, gestational thrombocytopenia, pulmonary embolism, and multiple pregnancies were excluded.

RESULTS

A total of 125 participants were included in the study. Acute DVT was diagnosed in 37 participants using venous Doppler of the lower extremities. In the remaining 88 patients, the diagnosis of DVT was excluded. There was no significant difference between the groups in terms of age, body mass index, parity, and gestational age at diagnosis. Although platelet counts were similar between groups, P-LCR, PDW, and MPV values, which provide information on platelet shape and volume, were statistically significantly lower in Group DVT (p < 0.05).

CONCLUSION

According to this study, low MPV, PDW and P-LCR values in pregnant women can be evaluated as independent markers in the diagnosis of acute DVT or these markers can be included in the DVT scoring system for pregnant women.

Predictive Value of Systemic Immune Inflammation Index, Aggregate Index of Systemic Inflammation, and Systemic Inflammation Response Index in Lower Extremity Deep Venous Thrombosis Following Severe Trauma

OBJECTIVES

Venous thromboembolism is a highly prevalent condition after polytrauma, and recognized as an important factor contributing to poor prognosis. The aim of this study was to investigate the risk factors for lower extremity deep venous thrombosis (LEDVT) in a severely traumatized population and to evaluate their predictive value for LEDVT.

METHODS

This was a retrospective, single-center observational study. All subjects were severely traumatized patients who were admitted to the Traumatic Intensive Care Unit from January 2021 to May 2024. Based on Doppler ultrasound findings of both lower extremities from the time of injury to 30 days post-injury, patients who developed LEDVT were enrolled in the LEDVT group, and those who did not develop LEDVT were enrolled in the NLEDVT group. Demographic, clinical, and laboratory data were collected upon admission. Multivariable logistic regression analysis was performed to identify risk factors for LEDVT. Receiver operating characteristic (ROC) curve was used to evaluate the overall fit of the final model.

RESULTS

There were 56 patients enrolled in the LEDVT group and 81 patients in the NLEDVT group.Age, Aggregate Index of Systemic Inflammation (AISI), Systemic Inflammation Response Index (SIRI), ICU length of stay, and albumin were identified as independent risk factors for LEDVT (all P < 0.05). The area under their ROC curves were 0.604, 0.657, 0.694, 0.668, and 0.405, respectively. Combined model for early clinical prediction of LEDVT in severely traumatized patients by age, SIRI, AISI, and albumin resulted in an area under the ROC curve of 0.805 (95%CI: 0.73-0.88, SE = 0.037).

CONCLUSIONS

The combination of age, SIRI, AISI, and albumin has a predictive value for LEDVT in severely traumatized patients.

Factors influencing DVT formation in sepsis

INTRODUCTION

Sepsis is a global public health burden. Deep vein thrombosis (DVT) is the third most common cause of death from cardiovascular disease after heart attacks and strokes. We designed this experiment to investigate the factors influencing DVT formation in patients with sepsis.

METHODS

In this survey, 918 septic patients admitted to Peking Union Medical College Hospital, who underwent DVT screening were enrolled. The data were collected from June 8, 2013 to October 12, 2022. The differences between septic patients with and without DVT were studied from following aspects: basic information, comorbidities, inflammatory cytokines, albumin, source of infection, sequential organ failure assessment (SOFA) score, coagulation and prognosis.

MAIN RESULTS

In this study, the prevalence of DVT in patients with sepsis was 0.23. Elderly patients with sepsis were prone to DVT (p value < 0.001). In terms of comorbidities, septic patients with hypertension and atrial fibrillation were prone to DVT (p value 0.045 and 0.048). Inflammatory cytokines, such as procalcitonin (PCT), C-reactive protein (CRP), interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-α, had no significant correlation with DVT in patients with sepsis (p value 0.364, 0.882, 0.912, 0.789, 0.245, and 0.780). Levels of serum albumin correlated with DVT in patients with sepsis (p value 0.003). The SOFA total score had no relationship with DVT formation (p value 0.254). Coagulation and respiration function were negatively correlated with DVT (p value 0.018). Liver function was positively correlated with DVT (p value 0.020). Patients in the DVT group had longer duration of mechanical ventilation and longer intensive care unit (ICU) stays (p value < 0.001 and 0.006). There was no significant difference in survival in septic patients with and without DVT (p value 0.868).

CONCLUSIONS

The SOFA total score had no relationship with DVT formation. The function of each organ had different effects on DVT formation. Better coagulation and respiration function, easier DVT formation. Poorer liver function, easier DVT formation. DVT was associated with longer duration of mechanical ventilation and longer ICU stays.

Association between systemic immune-inflammation index and risk of lower extremity deep venous thrombosis in hospitalized patients: a 10-year retrospective analysis

Background

The systemic immune-inflammation index (SII), as a novel inflammatory biomarker, has recently attracted attention in cardiovascular disease research. However, the relationship between SII and risk of lower extremity deep venous thrombosis (LEDVT) remains unclear to date. Thus, this study aimed to explore the association in a large sample over a 10-year period (2012-2022).

Methods

All hospitalized patients undergoing lower extremity compression ultrasonography (CUS) examination were consecutively screened by searching our hospital information system database. The receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value for high and low SII group. Multivariate logistic regression analyses were performed to investigate the relationship between SII and LEDVT risk. Propensity score matching (PSM), subgroup and sensitivity analyses were also conducted. Moreover, restricted cubic spline (RCS) regression and two-piecewise linear regression models were used to assess the dose-response relationship between natural log transformed SII [ln(SII)] and risk of LEDVT.

Results

A total of 16,725 consecutive hospitalized patients were included, and 1,962 LEDVT events occurred. After adjusting for confounding factors, patients in the high SII group (≥ 574.2 × 10⁹/L) showed a 1.740-fold risk of LEDVT (95% CI: 1.546-1.959, P < 0.001), and elevated ln(SII) was associated with a 36.1% increased risk of LEDVT (95% CI: 1.278-1.449, P < 0.001). PSM, subgroup and sensitivity analyses confirmed the robustness of the association. A non-linear relationship was observed (P _non-linear< 0.001), with a threshold value of 5.6 × 10⁹/L for all LEDVT events. Above the threshold, each unit increase in ln(SII) had a 1.369-fold higher risk of LEDVT (95% CI: 1.271-1.475, P < 0.001). The association also existed in both distal and proximal LEDVT.

Conclusion

Elevated SII is significantly associated with an increased risk of LEDVT in hospitalized patients. Additionally, the association is non-linear and exhibit a threshold effect.

Associations Between Mean Platelet Volume and Risk of Deep Vein Thrombosis: A Mendelian Randomization Study and a Retrospective Study

Objective

In this study, it was intended to explore the causal association between mean platelet volume (MPV) and risk of deep vein thrombosis (DVT) using a two-sample Mendelian randomization (MR) analysis and a retrospective study.

Methods

This study applied two-sample MR analysis to estimate the causal association between MPV and risk of DVT. Twenty-one single nucleotide polymorphisms (SNPs) were selected as genetic variants from two independent consortiums cohorts (p-value <5×10^-8, linkage disequilibrium r²<0.1). Inverse variance weighted (IVW), MR-egger method and weighted median were performed. A retrospective study was also conducted to verify the associations identified from the MR study.

Results

The MR analysis demonstrated that genetically predicted higher MPV was associated with significantly lower risk of DVT (OR 0.982, 95% CI = 0.967-0.998, P = 0.023), with the consistent result in weighted median and MR-Egger. There was no directional horizontal pleiotropy in the method of MR-Egger regression (intercept=2.9e-04, P = 0.194). There was no single SNP was found to strongly drive the combined causal effect in the leave-one-out sensitivity analysis. Additionally, the similar result was observed in the retrospective study.

Conclusion

This study suggested that MPV was negatively associated with the risk of DVT. More basic researches are needed in the future to explore its specific mechanism.

Association Between Platelet Indices and Preoperative Deep Vein Thrombosis in Elderly Patients Undergoing Total Joint Arthroplasty: A Retrospective Study

To investigate the association between platelet (PLT) indices and preoperative deep vein thrombosis (DVT) in elderly patients undergoing total joint arthroplasty (TJA). A total of 1391 patients were enrolled. We created receiver operator characteristic (ROC) curve using the ratio of PLT indices to DVT before TJA, divided the enrolled patients into groups based on the cut-off value, and then analyzed risk factors for DVT before TJA in the multivariate binary logistic regression analysis. Preoperative DVT occurred in 103 cases. Based on the ROC curve, we determined that the cut-off values for PLT, mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR), and plateletcrit (PCT) were 202 × 109/L, 11.4 fL, 13.2 fL, 34.6%, and 0.228%. And the areas under the curve were 0.606, 0.605, 0.617, 0.616, and 0.598. Multivariate binary regression analysis revealed that the risk of preoperative DVT in TJA patients with PLT≥202 × 109/L, MPV≤11.4 fL, PDW≤13.2 fL, P-LCR≤34.6%, and PCT≥0.228% increased by 2.32 (P < .001, 95% confidence interval [CI] [1.50-3.60]), 1.86 (P < .001, 95% CI [1.22-2.83]), 2.17 (P < .001, 95% CI [1.43-3.31]), 2.27 (P < .001, 95% CI [1.50-3.45]), and 1.76 times (P = .013, 95% CI [1.13-2.76]), respectively. Age, P < .001, odds ratio (OR) = 1.08, 95% CI [1.04-1.11]; corticosteroid use, P = .011, OR = 3.66, 95% CI [1.34-9.96]. We found that increased PLT count and PCT, decreased MPV, PDW, and P-LCR, old age, and corticosteroid use were independent risk factors for preoperative DVT in elderly TJA patients.