Association between mean platelet volume levels and inflammation in SLE patients presented with arthritis

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.

Mean Platelet Volume Is Related to Cumulative Disease Damage in Patients with Systemic Lupus Erythematosus

Mean platelet volume (MPV), which represents the average platelet size in femtoliters, has emerged as a reliable biomarker in several systemic and chronic disorders. However, its relationship with disease characteristics in large series of patients with systemic lupus erythematosus (SLE) has not been exhaustively studied to date. In the present work, we aimed to analyze how disease characteristics, including disease activity and cumulative damage, relate to MPV in a well-characterized series of SLE patients. In total, 179 patients with SLE and 181 age- and sex-matched healthy controls were recruited. Complete blood counts including MPV were assessed. Linear multivariable analysis was performed to evaluate the relationship between MPV and SLE disease characteristics, including composite scores of disease activity and damage. MPV was significantly lower in patients with SLE compared to controls after multivariable analysis (beta coefficient, -0.7 [95% confidence interval, -1.1 to -0.3)] fL, p < 0.001). Although the SLEDAI disease activity index was not related to MPV, the SLICC score measuring cumulative disease damage was significantly associated with lower MPV values after adjustment for covariates. Elements of the SLICC score that were associated with lower MPV levels were those pertaining to the kidney, peripheral vascular, and musculoskeletal manifestations of the disease. In conclusion, MPV is lower in patients with SLE compared to matched controls. This MPV downregulation is primarily due to the renal, peripheral vascular and musculoskeletal manifestations of the disease. MPV may represent a biomarker of accrual disease damage in SLE.

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.

Prognostic Potential of Thrombocyte Indices, Acute Phase Proteins, Electrolytes and Acid-Base Markers in Canine Parvovirus Infected Dogs With Systemic Inflammatory Response Syndrome

Dogs with canine parvovirus enteritis (CPVE) that develop systemic inflammatory response syndrome (SIRS) frequently have a poor prognosis. The aim of the study was to assess the prognostic potential of thrombocyte indices, acute phase proteins, electrolytes, and acid-base markers in CPVE puppies with SIRS (CPVE-SIRS+) at admission. A case-controlled, prospective, and observational study was performed on 36 CPVE puppies. Mean concentrations of C-reactive protein (CRP), albumin, thrombocyte count, mean platelet volume (MPV), platelet distribution width (PDW), sodium (Na+), potassium (K+), chloride (Cl-) and ionized calcium (iCa) were measured and strong ion difference 3 (SID3), ATOT-albumin and ATOT-total protein were determined in CPVE-SIRS+ survivors and nonsurvivors. A prognostic cut-off value for predicting the disease outcome was determined by receiver operating characteristic (ROC) curve analysis. The mean values of MPV, PDW and CRP were significantly higher and the mean values of albumin, Cl- and ATOT-albumin were significantly lower in CPVE-SIRS+ nonsurvivor than CPVE-SIRS+ survivor puppies on the day of admission, but the thrombocyte count, Na+, K+, iCa, SID3 and ATOT- total protein values did not differ significantly. The positive predictive values (PPVs) for survival using cut-off value of MPV (≤15.08 fL), PDW (≤14.85%), CRP (≤180.7 mg/L), albumin (≥1.795 g/dL), Cl- (≥96.00 mmol/L), and ATOT-albumin (≥7.539) were determined as 100%, 100%, 100%, 80%, 100%, and 80%, respectively with better area under ROC curve and sensitivity. Based on sensitivity, specificity, and PPVs from ROC analysis, it is concluded that the determination of Cl- concentration and MPV at admission followed by CRP will serve as the most appropriate biomarkers in predicting the disease outcome of CPVE puppies that develop SIRS.

Haematological Parameters in People with Atherosclerotic Cardiovascular Disease versus Those Who are Only at Risk for Cardiovascular Disease: A Comparative Cross-Sectional Study

Introduction

Cardiovascular disease (CVD) is the foremost killer disease worldwide. ASCVD is one of the most common types of CVD. It is mainly associated with a condition called atherosclerosis. Its occurrence is linked to several risk factors. Hypertension, diabetes, dyslipidemia, smoking, genetic factors, and so on are examples. The presence of ASCVD, as well as its risk factors, causes a variety of disruptions in the body's physiological and biological functions. The presence of abnormal physiological and biological functions, for example, tends to disrupt hematological parameters.

Purpose

The study's aim was to assess and compare the pattern of hematological parameters in people with established atherosclerotic cardiovascular disease (ASVD) versus people with ASCVD risks alone who attended TASH Addis Ababa, Ethiopia, as well as to correlate hematological parameters with the novel inflammatory marker hs-CRP.

Methods

A prospective cross-sectional comparative study with 100 study participants was conducted during where October 2019-March 2020 proposal development, sample collection, and lab analysis period, and from March 2020-June to 2021 data entry, analysis, and writing period. A serum sample was collected from each study participant for the lipid and hsCRP analyses and whole blood for hematological parameter determination. The socio-demographic characteristics of the study participants were obtained through a well-structured questionnaire.

Results

The ASCVD-risk group had significantly higher mean platelet volume (MPV), which was associated with the presence of the risk. Furthermore, hs-CRPs show a significant correlation with MPV in a correlation analysis of highly sensitive C-reactive protein (hs-CRP) with hematological parameters. Thus, using these affordable, routinely tested, and easily available tests may help to infer future ASCVD risk as well as the presence of ASCVD morbidity while hsCRP level in comparison group vs cases requires further study.

Association of mean platelet volume/lymphocyte ratio with inflammation in non-dialysis patients with chronic kidney disease stages 1-4: A retrospective study

OBJECTIVE

The mean platelet volume/ratio (MPVLR) is recognized as a novel marker of inflammation. We evaluated whether the MPVLR is associated with inflammation in non-dialysis patients with chronic kidney disease (CKD) stages 1-4.

METHODS

A total of 402 non-dialysis patients with CKD stages 1-4 were included. The indicators of hematological, renal function (urea, serum creatinine [Scr], estimated glomerular filtration rate [eGFR], and urine albumin to creatinine ratio [ACR]) and the markers of inflammation (high-sensitivity C-reactive protein [hsCRP] and fibrinogen [FIB]) were recorded. The MPVLR values at different CKD stages were analyzed. Next, based on the absence (hsCRP level < 5 mg/L) and presence (hsCRP level > 5 mg/L) of inflammation, the patients were categorized, and the differences in indices between the two groups were observed. The patients were divided into two groups based on the median MPVLR value (6.39) at admission. The laboratory indices of patients with CKD were compared. Simultaneously, a correlation analysis was performed to identify the association between the MPVLR and each parameter. A binary logistic regression analysis was performed to test whether the MPVLR was associated independently with the presence of inflammation in non-dialysis patients with CKD. The receiver operating characteristic (ROC) curve was used to analyzed diagnostic performance of the MPVLR in evaluating the inflammation of non-dialysis patients with CKD stages 1-4.

RESULTS

The MPVLR was higher in patients with CKD stages 3-4 than in those with CKD stages 1 and 2. Significant differences in urea, Scr, eGFR, ACR, lymphocyte (LYM), red blood cell (RBC), hemoglobin (HGB), RBC distribution width (RDW-CV), MPVLR, and FIB values were observed between the groups with and without inflammation. The patients with a higher MPVLR had higher urea, Scr, ACR, WBC, neutrophils (NEU), RDW-CV, platelet distribution width (PDW), mean platelet volume (MPV), and hsCRP values and lower eGFR, LYM, RBC, HGB, and platelet (PLT) values. The MPVLR showed a positive correlation with age, urea, Scr, WBC, NEU, RDW-CV, PDW, MPV, and hsCRP values and a negative correlation with the eGFR, LYM, RBC, HGB, and PLT values. A logistic analysis revealed that the MPVLR was associated independently with the presence of inflammation in non-dialysis patients with CKD, after adjustment for the confounding factors (odds ratio = 1.020; P = 0.024). Furthermore, MPVLR exhibited a modest diagnostic performance for the assessment of inflammation in non-dialysis patients with CKD stages 1-4, with an area under the curve (AUC) of 0.706, and the sensitivity, specificity being 46.2% and 83.2%, respectively.

CONCLUSIONS

The MPVLR was associated independently with the presence of inflammation in non-dialysis patients with CKD and may be useful for monitoring inflammation.

Effect of Mean Platelet Volume to Platelet Count Ratio on Mortality in Peritoneal Dialysis

Background and Aims

Mean platelet volume to platelet count ratio (MPV/PC) has been found to be an independent risk factor for mortality in various diseases, including cardiovascular disease, cancer, and hemodialysis. We aimed to evaluate the association between MPV/PC and all-cause and cardiovascular (CV) mortality in peritoneal dialysis (PD) patients.

Methods and Results

We conducted a retrospective cohort study at a single center and enrolled 1473 PD patients who were catheterized at our PD center from January 1, 2006, to December 31, 2013. All patients were divided into four groups according to the quartiles of baseline MPV/PC levels and followed up until December 31, 2018. A total of 453 patients died, and 221 deaths were caused by cardiovascular disease during a median follow-up time of 48.0 (21.9-82.2) months. There was a significant interaction by age of association between MPV/PC level and all-cause mortality (P = 0.009), and multivariate Cox regression analysis showed that higher MPV/PC level was related to a decreased risk of all-cause and CV mortality in PD patients aged < 60 years (HR = 0.62, 95%CI = 0.40 − 0.96, P = 0.032; HR = 0.49, 95%CI = 0.26 − 0.93, P = 0.029, respectively), rather than in patients aged ≥ 60 years (HR = 1.37, 95%CI = 0.84 − 2.22, P = 0.208; HR = 1.50, 95%CI = 0.77 − 2.92, P = 0.237, respectively).

Conclusion

Our results indicated that low MPV/PC level was an independent risk factor for all-cause and CV mortality in PD patients aged less than 60 years.

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.

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.

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.

Low Intra-Individual Variation in Mean Platelet Volume Over Time in Systemic Lupus Erythematosus

Platelets have recently emerged as important immune modulators in systemic lupus erythematosus (SLE), in addition to their role in thrombosis and cardiovascular disease. However, studies investigating mean platelet volume (MPV) in SLE are often scarce, conflicting and cross-sectional. In this study, MPV was measured in clinical routine throughout a defined time-period to quantify both individual MPV fluctuations and investigate if such variations are associated with disease activity and clinical phenotypes of SLE. Of our 212 patients, 34 patients had only one MPV value reported with the remaining 178 patients having between 2 and 19 visits with recorded MPV values. The intra-individual MPV variation was low, with a median variation of 0.7 fL. This was further supported by the finding that 84% of patients stayed within their reference interval category (i.e., small, normal or large) over time. In our cohort, no correlation between disease activity and MPV neither cross-sectionally nor longitudinally was found. Mean platelet volume values were significantly smaller in SLE patients (mean 10.5 fL) compared to controls (mean 10.8 fL), p < 0.0001. Based on the reference interval, 2.4% (n = 5) of patients had large-sized platelets, 84.4% (n = 179) had normal-sized and 13.2% (n = 28) had small-sized. A larger proportion (85.7%) of patients with small-sized platelets met the anti-dsDNA criterion (ACR10b; p = 0.003) compared to patients with normal and large (57.6%) sized platelets. In conclusion, the intra-individual MPV variation was of low magnitude and fluctuations in disease activity did not have any significant impact on MPV longitudinally. This lack of variability in MPV over time indicates that measuring MPV at any time-point is sufficient. Further studies are warranted to evaluate MPV as a possible biomarker in SLE, as well as to determine the underlying mechanisms influencing platelet size in SLE.

Haematologic indices and disease activity index in primary Sjogren's syndrome

BACKGROUND

The present study was conducted to investigate the association between haematologic indices, neutrophil/lymphocyte ratio (NLR), mean platelet volume (MPV), platelet/lymphocyte ratio (PLR), disease activation, organ involvement, and inflammatory markers in the SS.

METHODS

The study was conducted with newly diagnosed and treatment-naive 41 primary SS patients who met ACR-2012 criteria and 96 healthy volunteers. Blood tests obtained before treatment were evaluated. Lymphocyte, neutrophil and platelet counts, mean corpuscular volume (MCV), platelet distribution width (PDW), plateletcrit (PCT), haematocrit (HCT), MPV, white blood cell count (WBC) values were harvested from CBC of the subjects and NLR, PLR were calculated over these values. The values were compared between groups and correlation with EULAR SS disease activity index (ESSDAI) was evaluated.

RESULTS

The study included a total of 41 patients with a mean age of 40.73 ± 12.0 years and 96 healthy subjects with a mean age of 40.0 ± 9.2 years. In inter-group comparisons, lymphocyte, platelet counts, and MPV values were significantly lower in the SS group compared with the control group (P < .01), and NLR was significantly higher in the SS group (P = .026). The mean ESSDAI scores in SS patients were 5.65 ± 0.86 SE. These scores were significantly higher in patients with neurological involvement. There was a positive correlation between ESSDAI and PLR.

CONCLUSION

NLR, PLR, and MPV may be used as indicators or with activity index in SS. ESSDAI scores were found to be high in patients with neurological involvement, and it was also found to be correlated with PLR.

Diagnostic and prognostic role of mean platelet volume and mean platelet volume/platelet ratio in patients with primary malignant bone tumor

Objectives

This study aims to investigate the diagnostic and prognostic role of mean platelet volume (MPV) and MPV/platelet (PLT) ratio in primary malignant bone tumors.

Patients and methods

We retrospectively investigated patients with primary malignant bone tumors between January 2010 and January 2019 and included 109 patients (69 males, 40 females; mean age: 41.9±17.9 years; range 15 to 86 years) in the study. A total of 107 healthy volunteers (61 males, 46 females; mean age: 47 years; range 19 to 61 years) who donated blood to the blood center of our hospital in 2019 formed the control group. Demographic features, MPV, PLT counts, mortality, and recurrence records of the patients were obtained from archives.

Results

Of the 109 patients, 11 were diagnosed with Ewing’s sarcoma, 52 with chondrosarcoma, and 46 with osteosarcoma. The tumor was located on the right in 56% of patients and on the lower extremity in 59.6% of patients. The recurrence rate was 41.3% in the patient group. Of the 109 patients, 17 (15.6%) resulted in exitus at follow-up. The mean PLT value of the patient group was significantly higher than the control group (289,440 vs. 247,299, p<0.001). The median MPV and MPV/PLT ratios were statistically significantly lower in the patient group than in the control group (8.3 vs. 10.5, p<0.001 and 0.032 vs. 0.043, p<0.001, respectively). The MPV, PLT count, and MPV/PLT ratio were not associated with mortality and recurrence. The cut-off value was determined as >9.25 fL for MPV (sensitivity=74%, specificity=85%, positive likelihood ratio=4.96, positive predictive value=83.4%, and negative predictive value=76.5).

Conclusion

Consequently, MPV and MPV/PLT ratios can be used as a diagnostic support parameter in primary malignant bone tumors, but have no prognostic value.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Combined Use of Mean Platelet Volume/Platelet Count Ratio and Platelet Distribution Width to Distinguish Between Patients with Nasopharyngeal Carcinoma, Those with Benign Tumors of the Nasopharynx, and Healthy Subjects

Purpose

For the diagnosis of nasopharyngeal carcinoma (NPC), reliable early indicators with sensitivity and specificity should be sought. This study evaluated the effect of the combined use of mean platelet volume/platelet count ratio (MPV/PC ratio) and platelet distribution width (PDW) for differential diagnosis of NPC. In this study, MPV/PC ratio was used for the first time to diagnostically evaluate NPC.

Patients and methods

We retrospectively analyzed various hematological indices of three subject groups (208, 185, and 162 patients with NPC, benign tumors of the nasopharynx, and healthy subjects, respectively) and evaluated the value of combined use of MPV/PC ratio and PDW for differential diagnosis of the three groups using the one-way analysis of variance.

Results

Comparison of laboratory variables between the three groups showed a significant difference in MPV/PC ratio and PDW (P<0.001, all). The MPV/PC ratio in the NPC group was significantly lower than the other two groups (P<0.001); MPV/PC ratio also showed a statistically significant difference in different stages (P=0.034) and serosal invasions (P<0.001) of the NPC group. Receiver operating characteristic curve (ROC) analysis showed that areas under the curve (AUC) of either patients with benign tumors of the nasopharynx (AUC_{MPV/PCratio+PDW}: 0.708) or healthy subjects (AUC_{MPV/PCratio+PDW}: 0.909) were larger than those of MPV/PC ratio (AUC_MPV/PCratio: 0.665, 0.869, respectively) and PDW (AUC_PDW:0.614, 0.716, respectively) use alone (P<0.05, all).

Conclusion

MPV/PC ratio and PDW may be used as indexes of NPC. MPV/PC ratio combined with PDW could be considered as meaningful laboratory indexes for differential diagnosis of NPC, benign tumors of the nasopharynx, and healthy subjects. This finding could enhance the detection of NPC.

Mean Platelet Volume (MPV): New Perspectives for an Old Marker in the Course and Prognosis of Inflammatory Conditions

Platelet size has been demonstrated to reflect platelet activity and seems to be a useful predictive and prognostic biomarker of cardiovascular events. It is associated with a variety of prothrombotic and proinflammatory diseases. The aim is a review of literature reports concerning changes in the mean platelet volume (MPV) and its possible role as a biomarker in inflammatory processes and neoplastic diseases. PubMed database was searched for sources using the following keywords: platelet activation, platelet count, mean platelet volume and: inflammation, cancer/tumor, cardiovascular diseases, myocardial infarction, diabetes, lupus disease, rheumatoid arthritis, tuberculosis, ulcerative colitis, renal disease, pulmonary disease, influencing factors, age, gender, genetic factors, oral contraceptives, smoking, lifestyle, methods, standardization, and hematological analyzer. Preference was given to the sources which were published within the past 20 years. Increased MPV was observed in cardiovascular diseases, cerebral stroke, respiratory diseases, chronic renal failure, intestine diseases, rheumatoid diseases, diabetes, and various cancers. Decreased MPV was noted in tuberculosis during disease exacerbation, ulcerative colitis, SLE in adult, and different neoplastic diseases. The study of MPV can provide important information on the course and prognosis in many inflammatory conditions. Therefore, from the clinical point of view, it would be interesting to establish an MPV cut-off value indicating the intensity of inflammatory process, presence of the disease, increased risk of disease development, increased risk of thrombotic complications, increased risk of death, and patient's response on applied treatment. Nevertheless, this aspect of MPV evaluation allowing its use in clinical practice is limited and requires further studies.

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

OBJECTIVES

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

PATIENTS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Assessment of Mean Platelet Volume in Patients with Systemic Lupus Erythematosus

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Neutrophil to lymphocyte and platelet to lymphocyte ratios in systemic lupus erythematosus: Relation with disease activity and lupus nephritis

OBJECTIVES

To investigate the role of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as activity markers in systemic lupus erythematosus (SLE) without nephritis and lupus nephritis (LN) patients.

PATIENTS AND METHODS

This study included 60 SLE patients with LN, 60 SLE patients without renal involvement and 30 healthy controls. We analyzed correlations between NLR and PLR and both disease activity and renal affection.

RESULTS

The NLR of SLE patients was much higher than those of the controls. Both ratios showed significantly increased values in SLE patients with active disease. NLR and PLR were positively correlated with SLEDAI, ESR, and CRP and negatively correlated with C4. SLE patients with LN had higher levels of NLR than those without nephritis. NLR showed positive correlations with BUN, serum urea, serum creatinine and 24h urinary protein. We found NLR to be related to anti-ds-DNA level and renal biopsy classes. While PLR was related only to anti ds-DNA. The best NLR to predict SLE active disease was 2.2 and the best PLR cut-off value was 132.9.

CONCLUSION

NLR and PLR are useful inflammatory markers to evaluate disease activity in SLE patients. Also, NLR could reflect renal involvement in SLE patients and is associated with the different classes of its histological staging.

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

Background:

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

Materials and Methods:

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

Results:

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

Conclusion:

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

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

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

The Relationship between Hematological Indices and Autoimmune Rheumatic Diseases (ARDs), a Meta-Analysis

This meta-analysis was undertaken to investigate the relationship between hematological indices and autoimmune rheumatic diseases (ARDs). PubMed, Embase, and Web of Science were searchedfor studies of ARDs and hematological indices. Standardized mean difference (SMD) was calculated with confidence interval (CI) of 95%. 18 studies were included in our meta-analysis. Compared to the healthy control group, neutrophil–lymphocyte ratio (NLR) was increased in patients with ankylosing spongdylitis(AS), Behçet’s disease(BD), andrheumatoid arthritis(RA)(SMD = 0.33; 95% CI: 0.19 to 0.47; SMD = 1.90; 95% CI: 0.13 to 3.67; SMD = 0.75; 95% CI: 0.23 to 1.28). Platelet–lymphocyte ratio (PLR) was found increased in RA and SLE (SMD = 33.91; 95% CI: 20.50 to 47.32; SMD = 59.11; 95% CI: 4.46 to 113.76). Mean platelet volume (MPV)was irrelevant to BD and SLE by comparing with the healthy control group respectively. (SMD = 0.24; 95% CI: −0.49 to 0.97; SMD = −0.15; 95% CI: −1.77 to 1.48). Red cell distribution width (RDW) was not related to AS (SMD = 0.59, 95% CI: −0.37, 1.55). Our findings indicated that NLR had a strong association with AS, BD, and RA. PLR was also related to RA and SLE. NLR and PLR could be recommended as inexpensive diagnostic biomarkers for ARDs.

Mean Platelet Volume and Immature Platelet Fraction in Autoimmune Disorders

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

Decreased platelet size is associated with platelet activation and anti-phospholipid syndrome in systemic lupus erythematosus

Objectives

. SLE is an autoimmune disease with increased cardiovascular morbidity and platelet activation. In the general population, increased platelet size predicts platelet reactivity and cardiovascular disease. The aim of this study was to investigate whether platelet size related to platelet activation and cardiovascular disease in SLE.

Methods

. Fresh blood samples from SLE patients ( n = 148), healthy volunteers ( n = 79) and disease controls ( n = 40) were analysed for platelet size and activation by flow cytometry, ELISA and cell count. Associations to manifest cardiovascular disease, venous thrombosis and APS were adjusted for traditional cardiovascular risk factors using logistic regression analysis.

Results

. SLE patients had decreased platelet size as compared with healthy controls ( P = 0.003). In SLE, decreased platelet size was related to increased platelet activation, in particular microparticle formation ( P < 0.0001, r = -0.46) and release of serotonin from dense granules ( P < 0.001, r = 0.57). SLE patients with aCL had decreased platelet size ( P = 0.02) and aCL decreased platelet size in vitro ( P = 0.007). In contrast to the general population, increased platelet size was not associated with cardiovascular disease. Instead, decreased platelet size was associated with secondary APS, even after adjusting for traditional cardiovascular risk factors ( P = 0.01, odds ratio 3.58).

Conclusion

. Platelet size is decreased in SLE patients and associated with microparticle formation and APS. Future studies are needed to determine the underlying mechanism(s) as well as the potential predictive value of small platelets for disease complications in SLE.

Can Platelet Indices Be New Biomarkers for Subjective Tinnitus?

OBJECTIVES

Mean platelet volume (MPV) is one of the platelet function indices that reflect the platelet production rate and functions. The MPV levels are increased by vascular occlusion, acute or chronic syndromes, and vasculitis, whereas infections, autoimmune diseases, and inflammatory situations reduce these levels. In this study, the authors investigated whether there was a relationship between platelet indices and subjective tinnitus.

METHODS

In this retrospective study, the authors evaluated platelet indices in subjective tinnitus patients. One hundred patients with subjective tinnitus and 100 healthy, age and sex-matched subjects were enrolled to the study. Audiometer and laboratory results were recorded. Comparative multivariate analyses between indicator factors and hearing outcomes were conducted.

RESULTS

Mean platelet volume is significantly lower in subjective tinnitus group (P < 0.001). Platelet count and platelet distribution width are higher in the subjective tinnitus than control group (P < 0.001, P < 0.003, respectively).

CONCLUSION

The authors' findings indicate that subjective tinnitus appears to be characterized by autoimmune and inflammatory events. Considering the decreasing MPV levels, MPV may be used to evaluate subjective tinnitus as an helper indicator.

Mean Platelet Volume (MPV) as an indicator of disease activity and severity in lupus

Background: Amongst the different clinical and laboratory parameters used to monitor disease activity in systemic lupus erythematosus (SLE), mean platelet volume (MPV) is a novel biomarker. Although MPV has been studied in other rheumatological conditions like rheumatoid arthritis, its role in adult SLE needs to be defined, especially in Pakistan. Methods: The aim of this study was to evaluate the role of MPV as a biomarker of disease activity in SLE. Fifty patients were recruited through a consecutive non-probability sampling technique for this cross-sectional study.  On the basis of their SLE disease activity index (SLEDAI) score of greater or lesser than 5, these 50 participants were divided into two equal groups respectively;25 patients with active SLE, and another 25 participants with stable, inactive lupus. MPV was measured in each group and compared using SPSS version 16. MPV was also correlated with SLEDAI and erythrocyte sedimentation rate (ESR). Independent sample t-test and Spearman’s rho and Pearson’s correlation tests were applied. Sensitivity and specificity of MPV were checked through ROC analysis.    Results: The MPV of patients with active SLE (n=25, mean [M]=7.12, SD=1.01) was numerically lower than those in the inactive-SLE group (n=25, M= 10.12, SD=0.97), and this was statistically significant ( P<0.001). MPV had an inverse relationship with both ESR (r=-0.93, P<0.001) and SLEDAI (r _s= -0.89, P<0.001). However, there was a strong positive correlation between ESR and SLEDAI (r _s=0.90, P<0.001). For MPV, a cutoff value of less than 8.5fl had a sensitivity of 92% and a specificity of 100% ( P< 0.001).  Conclusions: Higher disease activity in SLE is associated with a correspondingly low MPV.

Mean Platelet Volume (MPV) as an indicator of disease activity and severity in lupus

Background: Amongst the different clinical and laboratory parameters used to monitor disease activity in systemic lupus erythematosus (SLE), mean platelet volume (MPV) is a novel biomarker. Although MPV has been studied in other rheumatological conditions like rheumatoid arthritis, its role in adult SLE needs to be defined, especially in Pakistan. Methods: The aim of this study was to evaluate the role of MPV as a biomarker of disease activity in SLE. Fifty patients were recruited through a consecutive non-probability sampling technique for this cross-sectional study.  On the basis of their SLE disease activity index (SLEDAI) score of greater or lesser than 5, these 50 participants were divided into two equal groups respectively;25 patients with active SLE, and another 25 participants with stable, inactive lupus. MPV was measured in each group and compared using SPSS version 16. MPV was also correlated with SLEDAI and erythrocyte sedimentation rate (ESR). Independent sample t-test and Spearman's rho and Pearson's correlation tests were applied. Sensitivity and specificity of MPV were checked through ROC analysis.    Results: The MPV of patients with active SLE (n=25, mean [M]=7.12, SD=1.01) was numerically lower than those in the inactive-SLE group (n=25, M= 10.12, SD=0.97), and this was statistically significant ( P<0.001). MPV had an inverse relationship with both ESR (r=-0.93, P<0.001) and SLEDAI (r _s= -0.89, P<0.001). However, there was a strong positive correlation between ESR and SLEDAI (r _s=0.90, P<0.001). For MPV, a cutoff value of less than 8.5fl had a sensitivity of 92% and a specificity of 100% ( P< 0.001).  Conclusions: Higher disease activity in SLE is associated with a correspondingly low MPV.

Blood mean platelet volume and platelet lymphocyte ratio as new predictors of hip osteoarthritis severity

Osteoarthritis (OA) is a low grade systemic inflammatory disease in which many inflammatory mediators are known to be elevated in the peripheric blood. Blood platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) are accepted as novel markers in many of the systemic inflammatory disorders, but have not been investigated in synovitis-free radiographic OA yet.The aim of this study was to evaluate the levels of blood PLR and MPV in radiographic hip OA. A total of 880 patients were evaluated retrospectively and after certain exclusion criteria, 237 of them who have primary hip OA were included. Age, sex, height, weight, body mass index, neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR), PLR, and MPV levels were recorded, Kellgren-Lawrence (KL) grading of the hip joints were performed. Patients were then divided into 2 groups as KL grades 1 to 2 (mild-moderate) and KL grades 3 to 4 (severe) hip OA.Mean age, mean neutrophil, lymphocyte and platelet counts, mean MPV, mean PLR, and mean ESR were statistically significantly different between mild/moderate hip OA group and severe hip OA group. In univariate analysis, older age and higher MPV, PLR, and ESR were severely associated with severe hip OA. In multiple logistic regression analysis, MPV, PLR, and ESR emerged as independent predictors of severe hip OA.The results of the present study, for the first time in the literature, suggest blood PLR and MPV as novel inflammatory markers predicting the radiographic severity of hip OA in the daily practice.

Temporary changes in neutrophil-to-lymphocyte, platelet-to-lymphocyte ratios, and mean platelet volume reflecting the inflammatory process after radioiodine therapy

OBJECTIVE

Data on the effects of radioiodine (RAI) therapy on systemic inflammation are very limited. The aim of this study is to explore alterations of subclinical systemic inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV), after RAI therapy in patients with differentiated thyroid carcinoma (DTC).

MATERIALS AND METHODS

We evaluated 57 DTC patients treated with RAI (RAI group), 37 DTC patients not treated with RAI (non-RAI control group), and 37 age-matched healthy individuals (healthy control group). NLR, PLR, and MPV levels were compared among the study groups; these were also examined after RAI in the RAI group.

RESULTS

Initially, NLR was significantly higher in the RAI group than in the healthy controls. NLR and PLR increased significantly and MPV decreased significantly 2 months after RAI therapy (P=0.021, 0.001, and 0.008, respectively). Although NLR and PLR levels decreased, they were still high compared with the preoperative values. MPV returned to normal levels at 6 months. These parameters did not change significantly in the non-RAI control group.

CONCLUSION

This is the first study to evaluate changes in NLR, PLR, and MPV after RAI therapy. Our findings suggest that NLR, PLR, and MPV changes indicate systemic inflammation that occurs after RAI therapy because of thyroid remnant tissue ablation.

The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review

Platelet indices (PI) -- plateletcrit, mean platelet volume (MPV) and platelet distribution width (PDW) -- are a group of derived platelet parameters obtained as a part of the automatic complete blood count. Emerging evidence suggests that PIs may have diagnostic and prognostic value in certain diseases. This study aimed to summarize the current scientific knowledge on the potential role of PIs as a diagnostic and prognostic marker in patients having emergency, non-traumatic abdominal surgery. In December 2015, we searched Medline/PubMed, Scopus and Google Scholar to identify all articles on PIs. Overall, considerable evidence suggests that PIs are altered with acute appendicitis. Although the role of PI in the differential diagnosis of acute abdomen remains uncertain, low MPV might be useful in acute appendicitis and acute mesenteric ischemia, with high MPV predicting poor prognosis in acute mesenteric ischemia. The current lack of consistency and technical standards in studies involving PIs should be regarded as a serious limitation to comparing these studies. Further large, multicentre prospective studies concurrently collecting data from different ethnicities and genders are needed before they can be used in routine clinical practice.

The role of mean platelet volume in patients with Takayasu arteritis

Background

Takayasu arteritis is a chronic non-specific inflammatory disease and mean platelet volume can either be decreased or increased during inflammation. However, there are no published data to confirm an association between mean platelet volume and Takayasu arteritis. Our aim was to evaluate the role of mean platelet volume in patients with Takayasu arteritis.

Methods

A total of 119 consecutive patients with Takayasu arteritis and 217 healthy individuals were included in this study. Forty-five Takayasu arteritis patients with active disease were followed with prednisone therapy.

Results

Mean platelet volume of patients was low compared with control groups (10.1 ± 1.47 fL vs. 11.2 ± 0.91 fL; P < 0.001). Mean platelet volume was lower in active Takayasu arteritis than in inactive Takayasu arteritis patients (9.3 ± 1.39 fL vs. 10.6 ± 1.28 fL; P< 0.001). Mean platelet volume values were significantly increased after prednisone treatment (9.3 ± 1.45 fL vs. 10.5 ± 1.29 fL; P < 0.001). Mean platelet volume negatively correlated with C-reactive protein, erythrocyte sedimentation rate, neutrophil count and platelet count (r = − 0.219, P = 0.018; r = − 0.296, P < 0.001; r = − 0.273, P = 0.003; r =−0.486, P< 0.001), and positively correlated with platelet distribution width (r=0.304, P ≤ 0.001) in patients with Takayasu arteritis. An inverse correlation between mean platelet volume and erythrocyte sedimentation rate was observed in active Takayasu arteritis patients (r = −0.406, P = 0.010). In multiple linear regression analysis, mean platelet volume was independently correlated with erythrocyte sedimentation rate in patients with Takayasu arteritis.

Conclusions

Our results suggest that mean platelet volume may identify active disease in patients with Takayasu arteritis, and the values of mean platelet volume may help to establish remission of active disease after treatment in Takayasu arteritis patients.

Can the neutrophil-to-lymphocyte ratio be used to predict recurrence and progression of non-muscle-invasive bladder cancer?

The aim of our study was to evaluate whether neutrophil-to-lymphocyte ratio (NLR) is a predictor of disease progression and recurrence in patients with primary non-muscle-invasive bladder cancer (NMIBC). This was a prospective study of 86 patients with newly diagnosed NMIBC. The patients were classified by the number of points assigned by the European Organization for Research and Treatment of Cancer risk tables. The correlation between progression score, recurrence score, age, mean platelet volume, red blood cell distribution width and NLR was assessed statistically. The same parameters were compared between the risk groups. A significant difference in NLR and age values was observed between recurrence and progression risk score groups. The relationships between NLR and recurrence and progression risk scores were no longer significant after correcting for the statistical effect of age on scores. Age was significantly different between groups after adjusting for NLR. Our study revealed that NLR and age were associated with patient age and bladder tumor progression and recurrence risk scores. After correcting for age, the significant relationship with NLR was lost, in contrast to some previous studies. We recommend that patient age should be corrected to avoid misleading results in NLR studies.

Altered mean platelet volume in patients with polymyositis and its association with disease severity

Polymyositis (PM) is an autoimmune disease characterized by chronic inflammation in skeletal muscle. Mean platelet volume (MPV), a marker in the assessment of systemic inflammation, is easily measured by automatic blood count equipment. However, to our knowledge, there are no data in the literature with respect to MPV levels in PM patients. Therefore, in this study we aimed to investigate MPV levels in patients with PM. This study included 92 newly diagnosed PM patients and 100 healthy individuals. MPV levels were found to be significantly lower compared with healthy controls (10.3±1.23 vs 11.5±0.74 fL, P<0.001). Interestingly, MPV was found to be positively correlated with manual muscle test (MMT) score and negatively correlated with erythrocyte sedimentation rate (ESR) in patients with PM (r=0.239, P=0.022; r=-0.268, P=0.010, respectively). In addition, MPV was significantly lower in active PM patients compared with inactive PM patients (9.9±1.39 vs 10.6±0.92 fL, P=0.010). MPV was independently associated with PM in multivariate regression analyses, when controlling for hemoglobin and ESR (OR=0.312, P=0.031, 95%CI=0.108 to 0.899). The ROC curve analysis for MPV in estimating PM patients resulted in an area under the curve of 0.800, with sensitivity of 75.0% and specificity of 67.4%. Our results suggest that MPV is inversely correlated with disease activity in patients with PM. MPV might be a useful tool for rapid assessment of disease severity in PM patients.

Relationship between Altered Platelet Morphological Parameters and Retinopathy in Patients with Type 2 Diabetes Mellitus

Purpose. To investigate whether platelet morphology or function is altered in patients with diabetic retinopathy (DR). Methods. This prospective study enrolled 85 healthy controls (HCs) (group 1) and 262 patients with Type 2 diabetes mellitus (T2DM). Patients were subclassified into three groups according to ocular findings: no DR (group 2; n = 88); nonproliferative DR (group 3; n = 88), and proliferative DR (group 4; n = 86). Mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (PLCR), plateletcrit (PCT) values, and platelet count were measured in the studied groups. Results. MPV, PDW, and PLCR levels were significantly altered in groups 2-4 compared with HCs (p < 0.05, p < 0.05, p < 0.05). Compared with group 2, both DR groups had higher MPV and PDW levels, with a significant difference between groups 2 and 4 for both MPV (p = 0.036) and PDW (p = 0.006). PLCR correlated with retinopathy stage, but no significant difference was found between the DR groups. Platelet count and PCT values were not significantly different between the groups (p > 0.05). Conclusion. Our findings suggest an association between mean platelet indices (MPI) (i.e., MPV, PDW, and PLCR) and DR stage. Therefore, MPI could be a beneficial prognostic marker of DR in patients with T2DM.

Hematological Indices May Be Useful in the Diagnosis of Systemic Lupus Erythematosus and in Determining Disease Activity in Behçet's Disease

OBJECTIVES

The aim of this study was to investigate the relationships between clinical features of rheumatic diseases and hematologic indices, including mean platelet volume (MPV), MPV/platelet ratio (MPR), platelet/lymphocyte ratio, and neutrophil/lymphocyte ratio (NLR). Subjects andMethods: Rheumatoid arthritis (RA; n = 91), systemic lupus erythematosus (SLE; n = 51), systemic sclerosis (SSc; n = 39), and Behçet's disease (BD; n = 53) patients, and 55 healthy controls (HC) were enrolled. Hematological indices were calculated and one-way analysis of variance, Mann-Whitney U and χ2 tests, and receiver operating characteristic (ROC) analyses were performed.

RESULTS

The MPV and MPR were higher in the SLE group than the RA group (p < 0.05 and p < 0.01, respectively). ROC analysis indicated that MPV (area under the curve, AUC, 0.68, 95% CI 0.58-0.77) and MPR (AUC 0.69, 95% CI 0.59-0.78) were sensitive and specific markers for SLE against RA. The NLR was higher in the RA, SLE, and SSc groups compared to the HC group (p < 0.05, p < 0.001, and p < 0.01, respectively). The NLR was higher in the active BD patients than those that were inactive (p = 0.008). Besides, NLR was higher in patients with neuro-BD and patients with active genital ulcers compared to patients without neurological involvement (p < 0.01) and active genital ulcers (p < 0.05).

CONCLUSION

The MPV and MPR were significantly higher in the SLE group than in the RA group. They were also higher in the active than in the inactive BD patients. The MPV and MPR are useful diagnostic tools for SLE, and NLR reflects disease activity in BD. However, further research should be performed to standardize these tools.