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.

Comparison of platelet indices in dengue fever patients based on platelet transfusion: A prospective observational study in a tertiary care center

CONTEXT

Dengue fever is the most prevalent mosquito-borne viral disease in humans. Platelet indices (PIs) are given by the cell counters but are often not reported which is possibly due to under-recognition of the utility of these parameters.

AIMS

This study aimed to compare PIs in patients with dengue fever to assess their role in the outcome such as hospital stay and platelet transfusion requirements.

SETTINGS AND DESIGN

Prospective observational study in a tertiary care center, Thrissur, Kerala.

SUBJECTS AND METHODS

A group of 250 dengue patients was studied over a period of 18 months. The platelet parameters (platelet count, mean platelet volume [MPV], platelet distribution width [PDW], platelet large cell ratio [PLCR], plateletcrit [PCT] and immature platelet fraction [IPF]) were measured with Sysmex XN-1000 and followed up every 24 h. The clinical features, duration of hospital stay and platelet transfusion requirements details were collected.

STATISTICAL ANALYSIS USED

Independent t-test, Chi-square test, Karl Pearson correlation coefficient.

RESULTS

A total of sample size was 250. The study showed normal PDW and MPV, low platelet count and PCT, and high PLCR and IPF in dengue patients. There were significant differences in PIs (lower platelet count and PCT, higher MPV, PDW, PLCR, and IPF) in comparison between dengue patients based on platelet transfusion.

CONCLUSIONS

PIs may act as a predictive tool in the diagnosis and predicting outcomes in dengue fever. Low platelet count and PCT, high PDW, MPV, PLCR, and IPF in transfused dengue patients were found to be statistically significant. Clinicians need to be sensitized about the utility and limitations of these indices and rationalize the need for red cell and platelet transfusions in dengue.

Are platelet volume indices of clinical use in COVID-19? A systematic review

Background

The incidence of thrombotic complications is high in COVID-19 patients with severe disease. As key regulators of thrombus formation, platelets likely play a crucial role as mediators of severe acute respiratory syndrome coronavirus 2 associated pathogenesis. Studies have reported that parameters reflecting platelet size, known as platelet volume indices (PVI), are raised in patients with thrombosis and can predict poor outcomes. This systematic review evaluates the potential for PVI to be used as a predictor of COVID-19 morbidity and mortality.

Methods

English and Chinese databases were searched electronically to identify studies reporting data on mean platelet volume, platelet distribution width or platelet-large cell ratio in COVID-19 patients. Included articles underwent a quality rating and descriptive narrative analysis.

Results

Thirty-two studies were included in the systematic review. The results show a general trend for PVI to be raised in severe COVID-19 patients and non-survivors, with 14 studies reporting significant differences of baseline PVI between severe and mild disease. Nonetheless, longitudinal studies showed varying PVI trends over the course of the disease and evidence for PVI to be associated with disease progression was limited. The quality rating of 12 studies was poor, 16 were rated fair and four were good. Most studies were retrospective in design, used small study populations and did not consider confounding factors that influence platelet volume. Studies also contained technical flaws in PVI measurement, limiting the reliability of the results.

Conclusion

The evidence on the clinical usefulness of PVI is greatly limited by the lack of prospective evaluation, together with technical problems in measuring PVI. Carefully designed prospective studies are warranted.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304305, identifier CRD42022304305.

A Single-Center Retrospective Observational Study Evaluating the Favorable Predictive Factors for the Disease Control Time of Treatment with Tocilizumab in Patients of Rheumatoid Arthritis

Background

Tocilizumab (TCZ) is humanized monoclonal antibody against the interleukin-6 (IL-6) and receptor that has prominent efficacy for the treatment of rheumatoid arthritis (RA). We conducted a retrospective observational study to determine how long TCZ controls RA.

Patients and Methods

We retrospectively reviewed the medical records of RA patients treated with TCZ. The aim of this study was to evaluate the contribution of clinical parameters to disease control time (DCT) in RA patients.

Results

Overall, 144 patients were enrolled in the study. The median age of patients was 66 years (range: 34–85 years). In univariate analysis, DCT was significantly increased in patients who had never received previous biologic disease-modifying anti-rheumatic drugs treatment (P = 0.0064). We also analyzed the contribution of the base line value of C-reactive protein (CRP) to DCT. We divided the patients with RA into two groups according to a cutoff value of 1.000 mg/dl. The median control times were 77.5 months (95% confidence interval [CI]: 44.8–not reached to median) and 34.5 months (95% CI: 17.0–79.3) for patients with high and low CRP value, respectively. In univariate analysis, DCT was significantly increased in patients with a high CRP value (P = 0.0283). Multivariate analysis clearly revealed that a high baseline CRP value was an independent favorable predictive factor for longer DCT (hazard ratio, 0.608, 95% CI: 0.378–0.981, P = 0.0416).

Conclusion

These data clearly demonstrate that the baseline value of CRP was closely associated with long time DCT in patients of RA treated with TCZ.

Mean Platelet Volume and Platelet Distribution Width Correlate with Microvascular Complications in Egyptian People with Type 2 Diabetes Mellitus

BACKGROUND

Type 2 diabetes is a part of metabolic syndrome associated with a higher risk of vascular complications. Diabetes is characterized by changes in platelet morphology, function, and platelet hyperactivity so, it's considered a prothrombotic condition. Morbidity and mortality in people with type 2 diabetes-related to micro and macrovascular complications. Novel biomarkers are needed to identify and treat people at higher risk.

OBJECTIVE

The main objective of this controlled cross-sectional study was to evaluate Platelet volume indices (PVI) in subjects with type 2 diabetes with and without complications in comparison to subjects without diabetes.

METHODS

Hundred and thirty-five subjects aged from 35 to 60 years were subdivided into 3 groups. Group A includes 55 subjects with type 2 diabetes with complications. Group B includes 45 subjects with type 2 diabetes without complications. Group C includes 35 normal healthy subjects. Detailed clinical history was taken. Also, PVI, fasting blood glucose (FBG), hemoglobin A1c, and creatinine were obtained.

RESULTS

Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), and Platelet large cell ratio (P-LCR) were significantly higher among subjects with retinopathy, nephropathy, and neuropathy than other subjects with diabetes who didn't develop complications (P<0.001). At cutoff value > 11.9 fL, MPV have diagnostic sensitivity 80% and specificity 97.8%. Whereas PDW >16.9fL has a sensitivity of 74.5% and specificity of 100% for diabetic microvascular complications (retinopathy, nephropathy, and neuropathy).

CONCLUSION

MPV and PDW may be considered as possible biomarkers for the early detection of diabetic microvascular complications.