Mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus: a case-control study / Volume plaquetário médio e relação neutrófilos/linfócitos em pacientes com zumbido: estudo de caso-controle

Abstract Introduction: Different theories have been proposed on the etiology of tinnitus, including metabolic and audiologic causes. We suggest that mean platelet volume and neutrophil to lymphocyte ratio levels change in tinnitus, indicating microcirculatory disturbance and inflammatory process in the etiopathogenesis of tinnitus. Objectives: We aimed to evaluate the mean platelet volume and neutrophil to lymphocyte ratio in patients with tinnitus in comparison to healthy controls. Methods: Retrospective case-control study. Two-hundred and eighty-seven patients aged 18-59 years and diagnosed with tinnitus in the Ear, Nose, and Throat Clinic between December 2014 and May 2017 (patient group) and 275 healthy individuals who applied for a hearing screening within the same time period (control group). Demographics, concomitant diseases, laboratory results, and audiometric data were recorded. Mean platelet volume and neutrophil to lymphocyte ratio were the outcome measures. Patients with hearing loss due to presbycusis or another reasons, and patients with anatomical disorders in the external and middle ear were excluded from the study by using physical examinations, pure audio audiometry results and radiological imaging. The upper age limit was set at 59 to exclude presbycusis patients. Results: The ratio of female patients was higher in patient group than control group (58.5%, n = 168 vs. 49.4%, n= 127; respectively; p = 0.033). The mean age of patient group was significantly higher than those of control group (44.89 ± 10.96 years and 38.37 ± 10.65 years, respectively; p = 0.001). The percentage of subjects with high mean platelet volume level was significantly higher in patient group than control group (9.4%, n = 27, and 3.1%, n = 8 respectively; p = 0.008). The mean neutrophil to lymphocyte ratio was higher in patients with tinnitus than control group (1.95 ± 1.02 and 1.67 ±0.57, p = 0.012). A neutrophil to lymphocyte ratio level of 2.17 and above is associated with 1.991 times higher risk of tinnitus (odds ratio = 1.99, 95% confidence interval 1.31-3.02). Conclusion: High mean platelet volume and neutrophil to lymphocyte ratio values are associated with idiopathic tinnitus, suggesting the role of vascular pathologies in etiology of tinnitus. Tinnitus may be a sign of underlying systemic or local disorders. Therefore, patients with tinnitus should undergo detailed evaluation including hematological indices.

Resumo Introdução: Diferentes teorias já foram propostas sobre a etiologia do zumbido, inclusive causas metabólicas e audiológicas. Acreditamos que os níveis do volume plaquetário médio e da relação neutrófilos/linfócitos se alteram no zumbido, sugerem distúrbio microcirculatório e processo inflamatório na etiopatogenia do zumbido. Objetivo: Avaliar o volume plaquetário médio e a relação neutrófilos/linfócitos em pacientes com zumbido em comparação com controles saudáveis. Método: Estudo de caso-controle retrospectivo, com 287 pacientes entre 18 e 59 anos e diagnosticados com zumbido na Clínica de Otorrinolaringologia entre dezembro de 2014 e maio de 2017 (grupo pacientes) e 275 indivíduos saudáveis que solicitaram uma triagem auditiva no mesmo período (grupo controle). Foram registrados dados demográficos, doenças concomitantes, resultados laboratoriais e dados audiométricos. O volume plaquetário médio e a relação neutrófilos/linfócitos foram as medidas de desfecho. Pacientes com perda auditiva por presbiacusia ou por outros motivos e pacientes com distúrbios anatômicos na orelha externa e média foram excluídos do estudo por meio de exame físico, resultados de audiometria tonal pura e imagens radiológicas. O limite de idade superior foi fixado em 59 anos para excluir pacientes com presbiacusia. Resultados: A proporção de pacientes do sexo feminino foi maior no grupo de pacientes do que no grupo controle (58,5%, n = 168 vs. 49,4%, n = 127; respectivamente; p = 0,033). A média de idade do grupo de pacientes era significantemente maior do que a do grupo controle (44,89 ± 10,96 anos e 38,37 ± 10,65 anos, respectivamente; p = 0,001). A porcentagem de indivíduos com nível alto de volume plaquetário médio foi significantemente maior no grupo de pacientes do que no grupo controle (9,4%, n = 27 e 3,1%, n = 8, respectivamente; p = 0,008). A relação neutrófilos/linfócitos média foi maior nos pacientes com zumbido do que no grupo controle (1,95 ± 1,02 e 1,67 ±0,57, p = 0,012). Um nível de relação neutrófilos/linfócitos de 2,17 e acima está associado a um risco 1,991 vez maior de zumbido (odds ratio = 1,99, Intervalo de Confiança de 95% 1,31 a 3,02). Conclusão: Altos valores de volume plaquetário médio e relação neutrófilos/linfócitos estão associados ao zumbido idiopático, sugerem o papel de doenças vasculares na etiologia do zumbido. O zumbido pode ser um sinal de distúrbios sistêmicos ou locais subjacentes. Portanto, pacientes com zumbido devem ser submetidos a uma avaliação detalhada, inclusive índices hematológicos.

El volumen medioplaquetario: su importancia en la práctica clínica / Mean platelet volume: its importance in clinical practice

Las plaquetas son fragmentos citoplasmáticos anucleados derivados de los megacariocitos que presentan función central, tanto en procesos fisiológicos como la hemostasia, así como también en procesos patológicos como la inflamación, la ateroesclerosis. El tamaño de las plaquetas, medido como volumen medio de plaquetas, es un marcador de reactividad plaquetaria, que proporciona información importante sobre el curso y pronóstico de una variedad de afecciones inflamatorias. El estudio de este marcador se ha utilizado como pronóstico en enfermedades cardiovasculares, preeclampsia y en la púrpura trombocitopénica. El objetivo de este trabajo es revisar los conceptos actuales basados en la evidencia científica relacionados con el volumen plaquetario medio e insistir en su evaluación y significado en la práctica clínica cotidiana(AU)

Platelets are enucleated cytoplasmic fragments derived from megakaryocytes, which have a central function, both in physiological processes such as hemostasis, as well as in pathological processes such as inflammation, atherosclerosis. Platelet size, measured as mean volume of platelets, is a marker of platelet reactivity, providing important information on the course and prognosis of a variety of inflammatory conditions. The study of this marker has been used as a prognostic in cardiovascular diseases, preeclampsia and in thrombocytopenic purpura. The objective of this paper is to review the current concepts based on scientific evidence related to the mean platelet volume and to insist on its evaluation and meaning in daily clinical practice(AU)

The effect and correlation of smoking with platelet indices, neutrophil lymphocyte ratio and platelet lymphocyte ratio

ABSTRACT Introduction: Smoking is associated with the occurrence and progression of cardiovascular diseases, inflammatory disorders and malignancies. Objective: To study the platelet indices, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in smokers and their correlation with smoking pack-years. Method: A total of 110 smokers and 110 non-smokers were included. The smokers were grouped into three groups: mild (<5 pack-years), moderate (5-10 pack-years) and heavy (>10 pack-years). The platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) were noted. The NLR and PLR were calculated and the statistical analysis was made using the Student's T-test, Analysis of Variance (ANOVA) and Spearman's correlation coefficient. Results: The platelet count, PCT and PDW were significantly higher with mean values: 218.56 ± 121.31 vs 203.23 ± 80.35 (p-value = 0.038), 0.27 ± 0.10 vs 0.26 ± 0.10 (p-value = 0.041) and 12.54 ± 1.45 vs 11.99 ± 1.70 (p-value = 0.001) in smokers and non-smokers, respectively. The PLR differed significantly with mean values: 119.40 ± 84.81 in smokers and 181.99 ± 313.09 in non-smokers, with a p-value of 0.045. A significant positive correlation was found between pack-years of smoking and platelet count and PLR with the Pearson correlation coefficient of 0.250 and 0.198 and p-values, 0.008 and 0.037, respectively. The Platelet Count, PCT, MPV and PDW varied significantly between mild, moderate and heavy smoker groups, with p-values of 0.045, 0.010, 0.015 and 0.017, respectively. Conclusion: The platelet indices and inflammatory markers NLR and PLR are derived from routine blood investigations, which are easily available and inexpensive. The monitoring of platelet indices, along with the PLR, can be used as early predictors of morbidity in smokers.

Role of mean platelet volume in differential diagnosis of adult-onset Still's disease and sepsis

SUMMARY 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.

Reabilitação Cardíaca Baseada em Exercícios Fortemente Relacionada com Redução do Volume Plaquetário Médio / Exercise-Based Cardiac Rehabilitation Has a Strong Relationship with Mean Platelet Volume Reduction

Resumo Fundamento O volume plaquetário médio (VPM), uma medida simples de ativação plaquetária, tornou-se recentemente um tópico interessante no campo da pesquisa cardiovascular. A reabilitação cardíaca (RC) baseada em exercícios é uma intervenção abrangente que diminui a morbidade-mortalidade em pacientes com doença arterial coronariana (DAC). Estudos sobre os efeitos do exercício físico na ativação plaquetária têm produzido resultados conflitantes. Objetivo O objetivo deste estudo foi determinar o efeito de um programa de RC baseado em exercícios sobre o VPM em pacientes com DAC estável. Métodos A amostra foi composta por 300 pacientes consecutivos com DAC estável. Os pacientes foram divididos em dois grupos: grupo RC (n = 97) e grupo não RC (n = 203). Foi feito um hemograma. As medidas de correlação ponto-bisserial foram tiradas para mostrar a correlação entre a alteração do VPM e a RC. Valor de p<0,05 foi considerado estatisticamente significativo. Resultados A diminuição do VPM foi maior no grupo CR do que no grupo não CR [(-1,10 (-1,40-(-0,90)) vs. (-0,10 (-2,00-0,00)); p<0,001]. ΔVPM teve correlação positiva com Δ neutrófilos (r = 0,326, p<0,001), ΔTG (r = 0,439, p<0,001), ΔLDL-c (r = 0,478, p<0,001), ΔGB (r = 0,412, p<0,001) e ΔPCR (r = 0,572, p <0,001). Foi encontrada uma correlação significativa entre ΔVPM% e CR (r = 0,750, p <0,001). Conclusões Pudemos mostrar que a RC baseada em exercícios tem forte relação com a redução do VPM em pacientes com DAC. Consideramos que a diminuição da ativação plaquetária com RC baseada em exercícios pode desempenhar um papel importante na redução do risco trombótico em pacientes com DAC estável. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Mean platelet volume (MPV), which is a simple measure of platelet activation, has recently become an interesting topic in cardiovascular research. Exercise-based cardiac rehabilitation (CR) is a comprehensive intervention that decreases mortality-morbidity in patients with coronary artery disease (CAD). Studies on the effects of exercise on platelet activation have yielded conflicting results. Objective The purpose of this study was to determine the effect of an exercise-based CR programs on MPV in patients with stable CAD. Methods The sample was composed of 300 consecutive stable CAD patients. The patients were divided into two groups: CR group (n = 97) and non-CR group (n = 203). Blood analysis was performed. Point-Biserial correlation measures were performed to show correlation between MPV change and CR. A p value of <0.05 was considered statistically significant. Results The decrease in MPV was greater in the CR group than in the non-CR group [(-1.10(-1.40-(-0.90)) vs. (-0.10 (-2.00-0.00)); p< 0.001]. ΔMPV had a positive correlation with Δ neutrophil (r = 0.326, p < 0.001), ΔTG (r = 0.439, p < 0.001), ΔLDL-c (r = 0.478, p < 0.001), ΔWBC (r = 0.412, p < 0.001), and ΔCRP (r = 0.572, p < 0.001). A significant correlation was found between ΔMPV% and CR (r=0.750, p<0.001). Conclusions We were able to show that exercise-based CR has a strong relationship with MPV reduction in patients with CAD. We consider that decreased platelet activation with exercise-based CR might play an important role in reducing thrombotic risk in patients with stable CAD. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Interação Letal entre Síndrome Hemofagocítica e Insuficiência Cardíaca Recentemente Desenvolvida / Mortal Interaction Between Hemophagocytic Syndrome and Newly Developed Heart Failure

Resumo Fundamento: A síndrome hemofagocítica (SHF) é uma síndrome hiperinflamatória debilitante. O status da insuficiência cardíaca (IC) com fração de ejeção preservada (ICFEP) está intimamente relacionado ao aumento da inflamação sistêmica e intramiocárdica. Objetivos: este estudo pretende determinar os preditores de mortalidade e os parâmetros de monitoramento confiáveis nos casos de SHF que desenvolveram a ICFEP durante seu curso clínico. Métodos: Trinta e nove pacientes, diagnosticados com SHF de acordo com os critérios diagnósticos do estudo HLH 2004 com Hscore ≥169, e com aspiração ou biópsia de medula óssea comprovada, foram recrutados retrospectivamente. Foram investigados retrospectivamente os fatores de risco tradicionais, como proteína C reativa sérica, níveis de albumina e ferritina com contagens de linfócitos e plaquetas, e fatores não tradicionais, como relação neutrófilolinfócito (NLR), relação linfócito-monócito (MLR), volume plaquetário médio (MPV) e pró-peptídeo natriurético cerebral N-terminal (NTproBNP). Analisou-se a relação entre os valores laboratoriais alterados ao longo do tempo entre si e com a mortalidade. O nível de significância geral foi de 5%. Resultados: Foi demonstrado que a alteração temporal dos níveis de índice cardiotorácico (ICT), NTproBNP sérico, ferritina, PCR e albumina foram detectados como sendo preditores de mortalidade (p<0,05, para todos) em análise univariada. As contagens de linfócitos e plaquetas com valores de NLR e MPV também foram significativos (p<0,05). A relação entre NT-proBNP e o aumento dos marcadores inflamatórios sistêmicos também foi considerada significativa. Além de fatores de risco tradicionais, os níveis de ferritina sérica, e os níveis de NLR, MLR e MPV foram considerados significativamente correlacionados entre si. Conclusão: Acompanhado de parâmetros de monitoramento confiáveis, o diagnóstico rápido e o tratamento antiinflamatório agressivo com controle rígido de volume podem salvar vidas de pacientes com SHF que sofrem de complicações por ICFEP. O monitoramento rígido da inflamação pode prever o resultado do paciente que sofre de ICFEP.

Abstract Background: Hemophagocytic syndrome (HPS) ia s devastating hyperinflammatory syndrome. Heart failure (HF) with preserved ejection fraction (HFpEF) status is closely correlated with increased inflammation, both systemic and intramyocardial. Objectives: This study sought to determine mortality predictors and reliable follow-up parameters in HPS that developed HFpEF during the clinical course. Method: Thirty-nine patients, diagnosed as HPS, according to HLH 2004 diagnostic criteria, with an HScore of ≥169 and proven bone marrow aspiration or biopsy, were recruited retrospectively. Both traditional, serum C-reactive protein, albumin and ferritin levels with lymphocyte, and platelet counts, as well as non-traditional risk factors, neutrophil-to-lymphocyte count (NLR), monocyte-to-lymphocyte count (MLR), mean platelet volume (MPV), and N-Terminal pro-brain natriuretic peptide (NTproBNP), were investigated retrospectively. The relationship between time-changed laboratory values both among themselves and with mortality. The overall significance level was set at 5%. Results: This study showed that temporal change of cardiothoracic ratio (CTR), serum NTproBNP, ferritin, CRP, and albumin levels were detected as mortality predictors (p<0.05, for all) in the univariate analysis. Lymphocyte and platelet counts with NLR and MPV values were also significant (p<0.05). The relationship between NT-proBNP and increased systemic inflammatory markers proved to be significant. In addition to traditional risk factors, serum ferritin levels, NLR, MLR, and MPV levels also proved to be significantly correlated with each other. Conclusion: Accompanied by reliable follow-up parameters, rapid diagnosis and aggressive anti-inflammatory treatment with tight volume control can be life-saving in HPS patients who suffer from HFpEF. Close monitoring of inflammation may predict the outcome of patients suffering from HFpEF.

COVID-19 in Pregnancy: Implication on Platelets and Blood Indices / COVID-19 na gravidez: implicações nas plaquetas e índices sanguíneos

Abstract Objective To describe the hematological changes, the platelet indices in particular, in pregnant women with coronavirus disease 2019 (COVID-19) compared to healthy pregnant women. Methods A retrospective case-control study conducted at the Al Yarmouk Teaching Hospital, in Baghdad, Iraq, involving 100 pregnant women, 50 with positive viral DNA for COVID-19 (case group), and 50 with negative results (control group); both groups were subjected to a thorough hematological evaluation. Results Among the main hematological variables analyzed, the platelet indices, namely the mean platelet volume (MPV) and the platelet distribution width (PDW), showed statistically significant differences (MPV: 10.87±66.92 fL for the case group versus 9.84±1.2 fL for the control group; PDW: 14.82±3.18 fL for the case group versus 13.3±2.16 fL for the controls). The criterionvalue of the receiver operating characteristic (ROC) curve forPDWat a cutoffpoint of>11.8 fL showed a weak diagnostic marker, while the MPV at a cutoff value of>10.17 fL showed a good diagnostic marker. Conclusion The MPV and PDW are significantly affected by the this viral infection, even in asymptomatic confirmed cases, and we recommend that both parameters be included in the diagnostic panel of this infection.

Resumo Objetivo Descrever as alterações hematológicas, em particular os índices plaquetários em gestantes com doença coronavírus 2019 (COVID-19) em comparação com gestantes saudáveis. Métodos Estudo caso-controle retrospectivo realizado no Hospital Universitário Al Yarmouk, em Bagdá, Iraque envolvendo 100 gestantes, 50 com DNA viral positivo para COVID-19 (grupo caso) e 50 com resultados negativos (grupo controle); ambos os grupos foram submetidos a uma avaliação hematológica completa. Resultados Entre as principais variáveis hematológicas analisadas, os índices plaquetários, nomeadamente o volume plaquetário médio (VPM) e a largura de distribuição plaquetária (PDW), apresentaram diferenças estatisticamente significativas (VPM: 10,87±66,92 fL para o grupo caso versus 9,84±1.2 fL para o o grupo controle; PDW: 14,82±3,18 fL para o grupo caso versus 13,3±2,16 fL para os controles). O valor de critério da curva de característica de operação do receptor (ROC) para PDW em um ponto de corte de> 11,8 fL mostrou um marcador diagnóstico fraco, enquanto o do VPM emumvalor de corte de> 10,17 fL mostrou um bom marcador de diagnóstico. Conclusão OMPVe PDWsão significativamente afetados por esta infecção viral, mesmo em casos confirmados assintomáticos, e recomendamos que ambos os parâmetros sejam incluídos no painel de diagnóstico desta infecção.

The role of platelet to mean platelet volume ratio in the identification of adult-onset still's disease from sepsis

OBJECTIVES: Inflammatory factors exert a significant role in the development of adult-onset Still's disease (AOSD) and sepsis. Although platelet counts and platelet parameters have long served as indicators for inflammatory diseases, their role in the differential diagnosis between adult-onset stilĺs disease and sepsis remains unclear. We designed this retrospective study to explore whether the platelet to mean platelet volume (MPV) ratio (PMR) can help to distinguish AOSD from sepsis. METHODS: A total of 110 AOSD patients and 84 sepsis patients were enrolled in the study. Seventy-three AOSD patients and 56 sepsis patients between January 2010 and June 2017 were enrolled in the test cohort to analyze PMR values, which was then validated in the validation cohort (37 AOSD patients and 28 sepsis patients between June 2017 and December 2019). RESULTS: The values of PMR were significantly higher in AOSD patients than in sepsis patients (test cohort, validation cohort, and entire cohort), In the test cohort, logistic regression analysis showed that PMR was an independent risk factor of AOSD (odds ratios [OR]: 9.22, 95% confidence interval [CI] 2.15-39.46, p=0.003). Further receiver operating characteristic curve (ROC) analysis showed that the area under the ROC curve was 0.735 (95% CI 0.631-0.839, p<0.001) for PMR alone and 0.925 (95% CI 0.869-0.980, p<0.001) for the combination of PMR and serum ferritin. Consistently, the validation cohort exhibited analogous results. CONCLUSIONS: PMR could be used as a single indicator or a complementary indicator to distinguish AOSD from sepsis.

Comparison of neutrophil lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume and PCR test in COVID-19 patients

SUMMARY OBJECTIVE: The polymerase chain reaction test, used in the diagnosis of COVID-19, can be positive with delay, and thorax tomography is used for the diagnosis of the disease. We aimed to compare the relation between thorax tomography findings, PCR test results, and neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume in COVID-19 patients. METHODS: COVID-19 patients were divided into three groups, according to baseline laboratory and thorax tomography findings: Group A: thorax tomography finding positive - polymerase chain reaction test positive; Group B: thorax tomography finding negative - polymerase chain reaction test positive; and Group C: thorax tomography finding positive - polymerase chain reaction test negative. Neutrophil lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume values were compared between these three groups. RESULTS: Group C neutrophil lymphocyte ratio level and polymerase chain reaction level were statistically higher than that of group B (p<0.001 in both). Mean platelet volume was not statistically significant between groups (p>0.005 for all). A positive correlation was detected between neutrophil lymphocyte ratio and C-reactive protein (r=0.421, p<0.001). Similarly, positive correlation was found with polymerase chain reaction and C-reactive protein (r=0.243, p=0.001). CONCLUSIONS: The thorax tomography finding can be detected earlier in the disease before the polymerase chain reaction test. The sensitivity of the polymerase chain reaction test varies according to the tester, the way of performing it, and the quality of the test. Therefore, especially in patients with polymerase chain reaction negative and thorax tomography findings, neutrophil lymphocyte ratio and platelet lymphocyte ratio levels should be evaluated, and patients should be followed up upon suspicion of COVID-19 diagnosis.

Association between Mean Platelet Volume-to-Lymphocyte Ratio and the Presence of Apical Mural Thrombus in Post-Myocardial Infarction Patients

Abstract Background Left ventricular apical thrombus (AT) is generally associated with ischemic and non-ischemic cardiomyopathies. The thrombo-inflammatory process plays an important role in the pathophysiology of acute coronary syndromes and post-myocardial thromboembolic complications. Mean platelet volume (MPV) has been linked to poor prognosis following myocardial infarction. Recently, platelet-to-lymphocyte ratio (PLR) has emerged as a new marker of worse outcomes linking inflammation and thrombosis. Objective We aimed to investigate the prognostic significance of the marker - mean platelet volume to lymphocyte ratio (MPVLR) in patients with AT. Methods Fifty-six patients with left ventricular AT after an anterior myocardial infarction and 51 patients without left ventricular AT after an anterior myocardial infarction were enrolled in this study retrospectively. Admission MPVLR was compared between the two groups. Logistic regression analysis was carried out to identify whether MPVLR is an independent predictor of AT. The receiver operating curve (ROC) analysis was used to show the optimal cut-off for MPVLR to predict AT. P values less than 0.05 were considered statistically significant. Results Age, gender, frequency of diabetes mellitus, hypertension and atrial fibrillation, and ejection fraction values did not differ between the groups. MPVLR was higher in patients with AT than patients without AT (7.91±2.5 vs 5.1±2.1, p<0.001). ROC analysis revealed moderate diagnostic value in predicting the presence of AT with a MPVLR cut-off > 4.75 (82.1% sensivity and 70.2% specifity (area under the curve=0.811, 95% confidence interval [CI]: 0.731-0.891, p<0.001). MPVLR was found to be an independent risk factor for the formation of AT (B:0.441, p.0.001). Conclusion MPVLR is a simple, cheap and easily accessible test that can predict left ventricular AT formation. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Volumen plaquetario medio como predictor de la mortalidad en pacientes con sepsis: revisión sistemática y metanálisis / Mean platelet volume as a predictor of mortality in patients with sepsis: systematic review and meta-analysis

Introducción: El volumen medio plaquetario (VMP) es un biomarcador utilizado en el abordaje integral de la sepsis. Objetivo: Evaluar la asociación entre VMP con la mortalidad en pacientes con sepsis. Métodos: Se realizó una revisión sistemática de estudios observacionales en cinco bases de datos. Se analizó la mortalidad asociada con la sepsis; las intervenciones consideradas fueron VMP, APACHE y lactato sérico. Resultados: Respecto a la mortalidad asociada a sepsis, se encontró un valor significativo en la VMP a las 72 horas (200 fallecidos versus 654 no fallecidos; MD 0.83 IC95% 0.53-1.13, p=< 0.0001, I2 =72.9%); así como el valor de APACHE II (220 muertos frente a 604 no fallecidos; MD 0.81 IC95% 0.62-1.0, p= 0.0001, I2 =32%). No se encontró significancia estadística para las demás variables clínicas. Conclusiones: El aumento de la VMP se asocia con mayor riesgo de mortalidad en pacientes con sepsis, especialmente después de 72 horas de evolución de las características clínicas.

Introduction: Platelet mean volume (MVP) is a biomarker used in the integral approach to sepsis. Objective: To assess the association between MVP and mortality in patients with sepsis. Methods: A systematic review of observational studies in five databases was performed. Mortality associated with sepsis was analysed; interventions considered were MPV, APACHE and serum lactate. Results: Regarding mortality associated with sepsis, a significant value was found in the MVP at 72 hours (200 deceased versus 654 not deceased; MD 0.83 IC95% 0.53-1.13, p=<0.0001, I2 =72.9%); as well as the value of APACHE II (220 dead versus 604 not deceased; MD 0.81 IC95% 0.62-1.0, p= 0.0001, I2 =32%). No statistical significance was found for the other clinical variables. Conclusions: Increased MVP is associated with increased risk of mortality in patients with sepsis, especially after 72 hours of evolution of clinical features.

Effect of COVID-19 on platelet count and its indices

SUMMARY BACKGROUND Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width. METHODS In total, 215 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant. RESULTS The patients' mean age was 64,32 ± 16,07 years. According to oxygen saturation, 81 patients had moderate and 134 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times. CONCLUSION In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

RESUMO OBJETIVO Testes laboratoriais de fácil acesso, baixo custo e amplamente utilizados capazes de demonstrar a gravidade da COVID-19 são importantes. Portanto, neste estudo, o nosso objetivo foi investigar a relação entre a mortalidade na COVID-19 e a contagem de plaquetas, volume plaquetário médio (VMP) e largura de distribuição de plaquetas. MÉTODOS No total, 215 pacientes com COVID-19 foram incluídos no estudo. Os pacientes foram divididos em dois grupos. Pacientes com saturação de oxigênio < 90% em ar ambiente foram considerados casos graves de COVID-19 e pacientes com valores ≥90% foram considerados casos moderados. Os registros médicos dos pacientes e o sistema eletrônico de monitoramento de dados de pacientes foram analisados retrospectivamente. As análises foram realizadas utilizando o software estatístico SPSS. Um valor de p <0,05 foi considerado significativo. RESULTADOS A média de idade dos pacientes foi de 64,32 ± 16,07 anos. Com base na saturação de oxigênio, 81 pacientes eram casos moderados e 134 tinham COVID-19 grave. Nosso estudo revelou que a saturação de oxigênio no momento da internação e a diferença nos valores de VPM entre o primeiro e terceiro dia de internação foram parâmetros significativos para predizer mortalidade de pacientes com COVID-19. A mortalidade foi 8,4 vezes maior nos pacientes com saturação abaixo de 90% no momento da internação, mas um aumento de apenas 1 unidade no valor de VPM aumentou a mortalidade 1,76 vezes. CONCLUSÃO Além da capacidade pulmonar dos pacientes, o volume plaquetário médio pode ser utilizado como um teste auxiliar para prever a mortalidade de pacientes com COVID-19.

The usefulness of systemic inflammatory markers as diagnostic indicators of the pathogenesis of diabetic macular edema / A utilidade de marcadores inflamatórios sistêmicos como indicadores diagnósticos da patogênese do edema macular diabético

ABSTRACT Purpose: To investigate the usefulness of systemic inflammatory markers [i.e., white blood cell and platelet counts, mean platelet volume, and their ratios] as diagnostic markers of the pathogenesis of diabetic macular edema. Methods: The study cohort included 80 diabetic macular edema patients (40 with diabetic retinopathy and 40 without) and 40 healthy age- and sex-matched controls. Neutrophil, lymphocyte, monocyte, and platelet counts, and the mean platelet volume were determined from peripheral blood samples, and the monocyte/lymphocyte, platelet/lymphocyte, and mean platelet volume/lymphocyte, and neutrophil/lymphocyte ratios were calculated and compared among groups. Results: The mean neutrophil/lymphocyte ratio of the diabetic macular edema and non-diabetic macular edema groups was higher than that of the control group, and the value of the diabetic macular edema group was higher than that of the non-diabetic macular edema group (p<0.001 in diabetic macular edema vs. control, p=0.04 in non-diabetic macular edema vs. control, and p=0.03 in diabetic macular edema vs. non-diabetic macular edema). A neutrophil/lymphocyte cutoff value of ≥2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with a sensitivity of 85% and specificity of 74%. The mean platelet volume of the diabetic macular edema group was higher than those of the non-diabetic macular edema and control groups, while those of the non-diabetic macular edema and control groups were similar (diabetic macular edema vs. non-diabetic macular edema, p=0.08; diabetic macular edema vs. control, p=0.02; and non- diabetic macular edema vs. control, p=0.78). All other parameters were similar between groups (all p>0.05). Conclusion: The neutrophil/lymphocyte ratio and mean platelet volume of the diabetic macular edema group were higher than those of the non-diabetic macular edema and control groups. A neutrophil/lymphocyte ratio cutoff value of ≥2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with high sensitivity and specificity. Moreover, the neutrophil/ lymphocyte ratio of the non-diabetic macular edema group was higher than that of the control group.

RESUMO Objetivo: Investigar a utilidade de marcadores inflamatórios sistêmicos (ou seja, contagem de glóbulos brancos e plaquetas, volume médio de plaquetas e suas proporções) como marcadores de diagnóstico da patogênese do edema macular diabético. Métodos: A coorte do estudo incluiu 80 pacientes com edema macular diabético (40 com retinopatia diabética e 40 sem) e 40 controles saudáveis de acordo com a idade e sexo. As contagens de neutrófilos, linfócitos, monócitos, plaquetas e valores do volume plaquetário médio foram determinados a partir de amostras de sangue periféricdo, e as proporções de monócitos/linfócitos, plaquetas/linfócitos, volume plaquetário médio/linfócitos e neutrófilos/linfócitos foram calculadas e comparadas entre os grupos. Resultados: A proporção média de neutrófilos/linfócitos dos grupos com edema macular diabético e não-diabético foi maior que a do grupo controle, e o valor do grupo com edema macular diabético foi maior que o do grupo com edema macular não diabético (p<0,001 no com edema macular diabético vs. controle, p=0,04 no com edema macular não diabético vs. controle e p=0,03 no com edema macular diabético vs. o com edema macular não-diabético). Um valor de corte de neutrófilos/linfócitos ≥2,26 foi identificado como um indicador da patogênese do edema macular diabético com sensibilidade de 85% e especificidade de 74%. O volume plaquetário médio do grupo com edema macular diabético foi maior que o dos grupos com edema macular não-diabético e controle, enquanto os do grupo de edema macular não-diabético e controle foram semelhantes (edema macilar diabético vs. Edema macular não-diabético, p=0,08; com edema macular diabético vs. controle, p=0,02; e com edema macular não-diabético vs. controle, p=0,78). Todos os outros parâmetros foram semelhantes entre os grupos (todos p>0,05). Conclusão: A proporção de neutrófilos/linfócitos e o volume plaquetário médio do grupo com edema macular diabético foram superiores aos do grupo com edema macular não-diabético e controle. Um valor de corte da razão neutrófilos/linfócitos ≥2,26 foi identificado como um indicador da patogênese do edema macular diabético com alta sensibilidade e especificidade. Além disso, a proporção de neutrófilos/linfócitos do grupo com edema macular não-diabético foi superior à do grupo controle.

Assessment of inflammatory markers in otosclerosis patients / Avaliação de marcadores de inflamação em pacientes com otosclerose

Abstract Introduction Otosclerosis is an idiopathic disease characterized by new bone formation in foci of the human otic capsule. It is more common in Caucasian populations; affecting females twice as often as males. Its etiopathogenesis has not yet been fully elucidated. Objective The aim of this study was to investigate the relationship between otosclerosis and white blood cell and thrombocyte counts, mean platelet volume, neutrophil lymphocyte ratio, and the platelet lymphocyte ratio. Methods This retrospective case-control study was conducted in the outpatient clinic Mustafa Kemal University, in the department of otolaryngology, between 2015 and 2018. A total of 30 patients with an established diagnosis of otosclerosis were compared to a control group of 30 healthy subjects, matched for age, gender and body mass index. The white blood cell, thrombocyte, mean platelet volume, neutrophil lymphocyte ratio and platelet lymphocyte ratio values were calculated for all participants. Results There was no statistically significant difference between the groups with respect to age, gender, or body mass index, or for the mean neutrophil lymphocyte ratio, platelet lymphocyte ratio, white blood cell, or thrombocyte values (p > 0.05). A statistically significant difference was determined between the groups for the mean platelet volume values. The mean platelet volume values were lower in the otosclerotic patients (p = 0.047). Conclusion These results show that neutrophil lymphocyte ratio, platelet lymphocyte ratio, white blood cell and thrombocytes should not be used to predict otosclerosis, but suggest that mean platelet volume may be a negative predictive marker.

Resumo Introdução A otosclerose é uma doença idiopática caracterizada por neoformação óssea em focos da cápsula ótica humana. É mais comum em populações caucasianas, afeta o sexo feminino numa taxa 2 vezes maior do que o masculino. A etiopatogenia ainda não foi totalmente elucidada. Objetivo Investigar a relação entre otosclerose e taxa de glóbulos brancos, plaquetas, volume plaquetário médio, relação neutrófilos-linfócitos e relação plaquetas-linfócitos. Método Estudo retrospectivo de caso-controle feito no ambulatório da Mustafa Kemal University, Departamento de Otorrinolaringologia, entre 2015 e 2018. Foram comparados 30 pacientes com diagnóstico estabelecido de otosclerose com um grupo controle de 30 indivíduos saudáveis, pareados por idade, sexo e índice de massa corpórea. Os valores de glóbulos brancos, plaquetas, volume plaquetário médio, relação neutrófilos-linfócitos e relação plaquetas/linfócitos foram calculados para todos os participantes. Resultados Não houve diferença estatisticamente significante entre os grupos em relação a idade, sexo ou índice de massa corpórea, ou em relação aos valores médios de relação neutrófilos-linfócitos, relação plaquetas/linfócitos, valores de glóbulos brancos e plaquetas (p > 0,05). Uma diferença estatisticamente significante foi observada entre os grupos em termos de valores médios de volume plaquetário médio. Os valores de volume plaquetário médio foram menores nos pacientes com otosclerose (p = 0,047). Conclusão A relação plaquetas/linfócitos, a relação plaquetas/linfócitos, os valores de glóbulos brancos e plaquetas não podem ser usados para predizer a otosclerose, mas sugerem que o volume plaquetário médio possa ser um marcador preditivo negativo.

Performance of a Hematological Scoring System in Predicting All-Cause Mortality in Patients with Acute Myocardial Infarction

Abstract Background: The presence of nucleated red blood cells (NRBCs) and increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) in peripheral circulation are associated with poorer prognosis in patients with acute coronary disease. Objective: We developed a scoring system for in-hospital surveillance of all-cause mortality using hematological laboratory parameters in patients with acute myocardial infarction (AMI). Methods: Patients admitted for AMI were recruited in this prospective study. Exclusion criteria were age younger than 18 years, glucocorticoid therapy, cancer or hematological diseases and readmissions. NRBCs, MPV and NLR were measured during hospitalization. The scoring system was developed in three steps: first, the magnitude of the association of clinical and laboratory parameters with in-hospital mortality was measured by odds ratio (OR), second, a multivariate logistic regression model was conducted with all variables significantly (p < 0.05) associated with the outcome, and third, a β-coefficient was estimated by multivariate logistic regression with hematological parameters with a p < 0.05. Results: A total of 466 patients (mean age were 64.2 ± 12.8 years, 61.6% male) were included in this study. A hematological scoring system ranging from 0 to 49, where higher values were associated with higher risk of in-hospital death. The best performance was registered for a cut-off value of 26 with sensitivity of 89.1% and specificity of 67.2%, positive predictive value of 26.8% (95% CI: 0.204 - 0.332) and negative predictive value of 97.9% (95% CI: 0.962 - 0.996). The area under the curve for the scoring system was 0.868 (95% CI: 0.818 - 0.918). Conclusions: Here we propose a hematological scoring system for surveillance tool during hospitalization of patients with acute myocardial infarction. Based on total blood count parameters, the instrument can evaluate inflammation and hypoxemia due to in-hospital complications and, consequently, predict in-hospital mortality.