Reduced mean platelet volume levels predict shorter survival in patients with resectable pancreatic ductal adenocarcinoma and type 2 diabetes.

BACKGROUND: Type 2 diabetes mellitus (T2DM) increased the risk of developing pancreatic cancer. Pancreatic ductal adenocarcinoma (PDAC) is the most common neoplastic disease originating from the pancreas. Increasing evidence indicates that platelets activation plays a prominent role in tumor and T2DM. Mean platelet volume (MPV) is an indicator of activated platelets and is altered in several cancers. The current study aimed to evaluate the prognostic role of MPV in resectable PDAC patients with T2DM. METHODS: Eight hundred and three patients with PDAC were included in this retrospective study. We determined the optimal cutoff value of MPV for 5-year overall survival (OS) using the receiver operating characteristic (ROC) method. The associations between MPV levels and clinical characteristics were analyzed. Kaplan-Meier survival analysis and Cox's proportional hazard regression model were used to evaluate the prognostic value of MPV for OS. RESULTS: Compared to the PDAC patients without T2DM, MPV levels were significantly higher in the PDAC patients with T2DM. Moreover, MPV was significantly associated with the differentiation between T2DM and non-T2DM. In addition, Kaplan-Meier analysis found that patients with low MPV levels had a poorer 5-year OS than patients with high MPV levels in diabetic patients. Multivariate analyses revealed that MPV was an independent prognostic factor for OS in patients with T2DM. However, the independent prognostic role of MPV was not observed in patients without T2DM. CONCLUSION: MPV independently predicts poor survival in PDAC patients with T2DM. Prospective studies are required to confirm the role of MPV in PDAC.

High-Density Lipoprotein, Mean Platelet Volume, and Uric Acid as Biomarkers for Outcomes in Patients With Sepsis: An Observational Study.

BACKGROUND: We conducted an observational study evaluating the association between uric acid, mean platelet volume (MPV), and high-density lipoprotein (HDL) with complications and outcomes of patients with sepsis in a critical care setting. METHODS: We followed patients with a diagnosis of severe sepsis and septic shock for a maximum of 28 days. Main outcomes assessed included length of stay (LOS), the need for renal replacement therapy (RRT), assisted mechanical ventilation (AMV), and vasopressor support as well as in-unit mortality. RESULTS: The overall average age of the 37 patients enrolled was 48.1 (19.8) years; among them, 37.8% were male. Abdominal related (43.2%) and pulmonary (29.7%) were the main sites of infection. The overall Acute Physiology and Chronic Health Evaluation 2 (APACHE-2) median score was 19 (9-24). Acute kidney injury (AKI) was observed in 46.9% of the sample. In all, 54.1% required vasopressor support, 54.1% AMV, and 35.1% RRT. Patients with bacteremia were significantly more likely to require vasopressor support and those with urinary tract infections were significantly younger. We found increasing ΔMPV levels, higher APACHE-2 scores, lower HDL values, and a reduced age to be associated with a longer LOS. Higher scores on the APACHE-2 scale and lower levels of HDL significantly associated with higher odds for developing AKI. The need for vasopressor support was significantly associated with higher values of 72-hour MPV and with higher levels of baseline uric acid and lower values of initial HCO3. Initial and 72-hour levels of MPV and higher scores in the APACHE-2 were all significantly correlated with the need for AMV. An increased probability of dying during follow-up was significantly correlated with increasing age. CONCLUSION: We were able to establish significant associations between our candidate biomarkers and relevant outcomes for patients with sepsis. Our results support the use of these low-cost biomarkers in the assessment of prognosis of patients with sepsis.

Association Between Hemogram Parameters and Survival of Critically Ill Patients.

AIM: Recently, hemogram parameters, such as mean platelet volume (MPV), had been proposed as novel inflammatory and prognostic factors. In present retrospective analysis, we aimed to determine and compare MPV of survived and dead patients whom admitted to intensive care unit (ICU) of our institution. METHODS: We recorded hemogram parameters and other laboratory data and demographic characteristics of patients treated in ICU. Patients are divided into 2 groups-dead patients and survived patients. Laboratory data of survived patients compared to those of dead patients. RESULTS: Age, gender, and other laboratory variables were not significantly different between dead and survived patients. On the other hand, MPV of survived patients was significantly higher than that of the dead patients ( P = .001). CONCLUSION: We think that elevated MPV levels in an ICU patient should alert clinicians for worse outcome. Physicians should be more careful in the management of these patients.

¿El volumen medio plaquetario es un predictor de mortalidad en pacientes sépticos?: Revisión de la literatura / The mean platelet volume is a predictor of mortality in septic patients?: Review of the literature

La sepsis es una de las causas más frecuentes que motivan el ingreso de pacientes al hospital y a las unidades de cuidados intensivos, tiene alto impacto en la morbilidad y mortalidad. Pese a los avances tecnológicos que han permitido mejorar el soporte de fallos orgánicos, no se ha logrado disminuir de forma importante sus complicaciones. Por ello es importante tener herramientas que sean predictoras de severidad en esta patología; los biomarcadores (procalcitonina, pro adrenomodulina, interleuquina 6), se han convertido en buenos índices de pronostico y evolución, sin embargo, su disponibilidad ya sea por el costo o existencia de reactivos en los distintos laboratorios no es constante; es por ello que buscamos con ésta revisión determinar si el uso del volumen medio plaquetario, un biomarcador reportado en el hemograma común y que se viene usando con relativo éxito en patologías cardiovascular, metabólica e inflamatoria/infecciosa, como un indicador de pronóstico de severidad y mortalidad. (AU)

Sepsis is one of the most common causes of hospital admission to intensive care units and has a high impact on morbidity and mortality. In spite of the technological advances that have allowed to improve the support of organic failures, it has not been possible to diminish of important form its complications. Therefore, it is important to have tools that are predictive of severity in this pathology, the biomarkers (procalcitin, proadrenomodulin, interleukin 6) have become good indicators of prognosis and evolution, however their availability either by cost or existence of reagents in the different laboratories is not constant; this is why we seek with this review to determine if determine if the use of mean platelet volume, a biomarker reported in the common hemogram and has been used with relative success in cardiovascular, metabolic and inflammatory / infectious pathology, as an indicator of prognosis of severity and mortality. (AU)

Mean platelet volume and mortality risk in a national incident hemodialysis cohort.

BACKGROUND: Higher mean platelet volume (MPV) is an indicator of larger, reactive platelets, and has been associated with a higher risk of thrombosis and cardiovascular events in the general population. Hemodialysis patients have a higher risk for cardiovascular death and predisposition to platelet dysfunction (thrombosis and bleeding diathesis), but the relationship between MPV and mortality in this population is unknown. METHODS: Among a 5-year cohort (1/2007-12/2011) of 149,118 incident hemodialysis patients from a large national dialysis organization, we examined the association between MPV and all-cause mortality. In primary analyses, we granularly analyzed MPV across five categories: 7.2-7.5, >7.5-9.5, >9.5-11.5, >11.5-13.5, and >13.5-15.0fL. In secondary analyses, we examined MPV categorized as low, normal, and high based on thresholds in the general population: 7.2-7.5, >7.5-11.5, and >11.5fL, respectively. Associations between baseline and time-dependent MPV with mortality were estimated using traditional and time-dependent Cox models in order to determine long-term and short-term exposure-mortality associations, respectively, using three adjustment levels: unadjusted, case-mix, and case-mix+laboratory models. RESULTS: In primary analyses, higher baseline and time-dependent MPV levels were associated with incrementally higher death risk in case-mix+laboratory analyses (reference: >9.5-11.5fL). In secondary analyses, high baseline and time-dependent MPV levels were associated with higher mortality, whereas low MPV was associated with lower death risk across all multivariable models (reference: normal MPV). CONCLUSIONS: Hemodialysis patients with higher MPV have heightened mortality risk. Further studies are needed to determine the pathophysiologic basis for the higher risk, and if modification of MPV ameliorates mortality in this population.

Platelet indices are novel predictors of hospital mortality in intensive care unit patients.

BACKGROUND AND OBJECTIVE: Platelet volume indices (PVIs) are inexpensive and readily available in intensive care units (ICUs). However, their association with mortality has never been investigated in a critical care setting. Our study aimed to investigate the association of PVI and mortality in unselected ICU patients. METHODS: This was a retrospective study conducted in a mixed 24-bed ICU from September 2010 to December 2012. Platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), platelet count, and plateletcrit were measured on ICU entry. Univariable analyses were performed to screen for variables that were associated with mortality. Variables with P < .1 were incorporated into a regression model to adjust for the odds ratio of platelet indices. RESULTS: A total of 1556 patients were included during the study period, including 1113 survivors and 443 nonsurvivors (mortality rate: 28.47%). Platelet distribution width and MPV were significantly higher in nonsurvivors than in survivors. Platelet distribution width greater than 17% and MPV greater than 11.3 fL were independent risk factors for mortality (adjusted odds ratio: 1.92 and 1.84, respectively) and survival time (hazards ratio: 1.77 and 1.75, respectively). CONCLUSION: Higher MPV and PDW are associated with increased risk of death, whereas the decrease in plateletcrit is associated with increased mortality risk.