Hemorajik İnmede Platelet Kitle İndeksinin Prognoz ile İlişkisi

Year 2024, , 21 - 26, 31.03.2024

Seda Dağar , Emine Emektar , Osman Korucu , Hüseyin Uzunosmanoğlu , Şeref Kerem Çorbacıoğlu , Yunsur Çevik

https://doi.org/10.54996/anatolianjem.1316096

Abstract

Amaç: Platelet kitle indeksi (PKİ), tam kan sayımından kolayca hesaplanabilen ucuz bir parametredir. Son zamanlarda trombosit fonksiyonu ile yakından ilişkili olan iyi bir enflamasyon parametresi olduğu ve aynı zamanda trombositlerin agregasyon kapasitesini gösterdiği iddia edilmiştir. Bu çalışmada PKİ parametresinin akut hemorajik inmeli hastalarda prognostik değerinin araştırılması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmamıza 2014-2018 yılları arasında subaraknoid ya da intraserebral hemoraji tanısı alan 18 yaş ve üzeri tüm hastalar dâhil edildi. PKİ, platelet sayısı ve ortalama platelet hacminin çarpımı formülü ile elde edildi. Yaşayan ve ölen hastalar arasında hemorajik inmenin tipi ve lokalizasyonu, sekonder beyin hasarı varlığı, laboratuar değerleri, cerrahi girişim gerekliliği, hastane kalış süreleri ve 30 günlük mortalite oranları karşılaştırıldı. 30. Günde yaşayan hastaların ayrımında PKİ’nin etkinliği için Receiver Operating Characteristic (ROC) analizi yapıldı.

Bulgular: Çalışmaya toplam 103 hasta dâhil edildi. Yaşayan hastalarda PMI (1912 [IQR 25‒75%: 1544.20-2468.28]) ölen hastalara göre (1722.10 [IQR 25‒75%: 1332.26-2114]) istatiksel olarak anlamlı düzeyde yüksekti (p=0.039). Sekonder beyin hasarı veya cerrahi girişim olan ve olmayan hastalar karşılaştırıldığında, PKİ dâhil trombosit fonksiyonu ve inflamasyonu gösteren parametreler açısından anlamlı bir fark bulunmadı (p <0.05). ROC analizinde 30. günde yaşayan hastaları ayırt etmede PMI için eğri altı alan (AUC) değeri 0.628 (% 95 CI: 0.517-0.738) saptandı.

Sonuç: Çalışmamızda hemorajik inme sonrası ilk 30 günde mortal seyreden hastalarda PKİ düzeylerinin daha düşük olduğunu belirledik. Ancak, PKİ’nin 30 günlük yaşam tahmininde performası zayıftı. Bu nedenle, PKİ’nin hemorajik inmede prognoz öngörüsünde tek başına kullanılamayacağını ancak diğer platelet fonksiyon ve inflamatuvar belirteçlerle birlikte klinisyenlerin hasta risk değerlendirmesine katkı sunabileceğini düşünmekteyiz.

Keywords

Hemorajik inme, subaraknoid kanama, intraserebral hemoraji, platelet kitle indeksi

Platelet Mass Index as a Predictor of Prognosis in Hemorrhagic Stroke

Abstract

Aim: Platelet mass index (PMI) is an inexpensive parameter which can be easily calculated from complete blood count. It has been recently claimed as a good inflammation parameter that is closely related to platelet function and is also believed to indicate the aggregation capacity of platelets. The present study aimed to investigate the prognostic value of PMI in patients with acute hemorrhagic stroke.

Material and Methods: All patients aged 18 years or over who were diagnosed with subarachnoid or intracerebral hemorrhage between 2014 and 2018 were included in the study. Platelet mass index was calculated with the formula “PMI = platelet count x MPV”. The type and localization of hemorrhagic stroke, presence of secondary brain injury, laboratory parameters, need for surgical intervention, length of hospital stay, and 30-day mortality were compared between survivor and non-survivor patients. Receiver Operating Characteristic (ROC) analysis was performed in order to discriminate surviving patients on the 30th day.

Results: A total of 103 patients were included. PMI was significantly higher in the surviving patients (1912 [IQR 25‒75%: 1544.2-2468.2]) compared to the non-surviving ones (1722.1 [IQR 25‒75%: 1332.2-2114])(p=0.039). There was no significant difference in the parameters showing platelet function and inflammation, including PMI levels in patients with and without secondary injuries or surgical intervention (p> 0.05 for all). AUC value was found to be 0.628 (95% CI: 0.517-0.738) for PMI in discriminating surviving patients on the 30th day.

Conclusion: This study revealed that the patients who died by 30th day after hemorrhagic stroke had lower PMI levels. However, the predictive accuracy of PMI for 30-day survival was poor. Therefore, we believe that PMI cannot be used alone in predicting prognosis of hemorrhagic stroke, but in combination with other markers of platelet function and inflammation, it may contribute to clinicians in patient risk assessment.

Keywords

Hemorrhagic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, platelet mass index

References

• 1. Wu X, Luo X, Zhu Q,et al. The roles of thrombospondins in hemorrhagic stroke. Biomed Res Int 2017, Article ID: 8403184 (doi:10.1155/2017/8403184).
• 2. Doğan NÖ, Akıncı E, Gümüş H, Akıllı NB, Aksel G. Predictors of inhospital mortality in geriatric patients presenting to the emergency department with ischemic stroke. Clinical and Applied Thrombosis/Hemostasis 2016;22(3):280-4.
• 3. Gong C, Hoff JT, Keen RF. Acute inflammatory reaction following experimental intracerebral hemorrhage in rat. Brain Res 2000;871(1):57-65.
• 4. Wang J, Rogove AD, Tsirka AE, Tsirka SE. Protective role of tuftsin fragment 1-3 in an animal model of intracerebral hemorrhage. Ann Neurol 2003;54(5):655-64.
• 5. Nording HM, Seizer P, Langer HF. Platelets in inflammation and atherogenesis. Front Immunol 2015;6:98.
• 6. Noris P, Melazzini F, Balduini CL. New roles for mean platelet volume measurement in the clinical practice? Platelets 2016;27(7):607-12.
• 7. Okur N, Buyuktiryaki M, Uras N, et al. Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities? J Matern Fetal Neonatal Med 2016;29(19):3218-22.
• 8. Dagar et al. 8. Ünal M. Platelet mass index is increased in psoriasis. A possible link between psoriasis and atherosclerosis. Arch Med Sci Atheroscler Dis 2016;1:e145–e149.
• 9. Uzunosmanoğlu H, Emektar E, Dağar S, et al. Evaluation of the relationship between bleeding severity and platelet mass index in geriatric patients with upper gastrointestinal bleeding in the emergency department. Anatolian J Emerg Med. 2022;5(4):175-80.
• 10. Girgin R, Cınar O, Bulut E,Onal CF. Does Platelet Mass Index Play a Role in Predicting Biochemical Recurrence in Localized Prostate Cancer? J Urol Surg 2018;5(3):164-9.
• 11. SrinivasanA, AggarwalA, GaudihalliS, et al. Impact of early leukocytosis and elevated high-sensitivity c-reactive protein on delayed cerebral ischemia and neurologic outcome after subarachnoid hemorrhage. World Neurosurg 2016;90:91-5.
• 12. Tao C, Wang J, Hu X, Ma J, Li H, You C. Clinical value of neutrophil to lymphocyte and platelet to lymphocyte ratio after aneurysmal subarachnoid hemorrhage. Neurocrit Care 2017;26(3):393-401.
• 13. Chen L, Zhang Q. Increased mean platelet volume is associated with poor outcome in patients with aneurysmal subarachnoid hemorrhage. World Neurosurg 2020;137:e118-e125.
• 14. Siegler JE, Marcaccio C, Nawalinski K, et al. Elevated Red Cell Distribution Width is Associated with Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2017;26(1):26-33.
• 15. Krečak I, Zekanović I, Morić Perić M, et al. High plateletcrit may be associated with thrombotic risk in polycythemia vera. Int J Lab Hematol 2023;45(5):799-801.
• 16. Gao Y, Jin H. Platelet count and plateletcrit: Potential haematological biomarkers for livedoid vasculopathy? Australas J Dermatol 2022;63(3):e200-e205.
• 17. Ozbalci D, Alanoglu EG, Findos E, Eroglu HN. Low plateletcrit is associated with reduced progression: Free and overall survival in chronic lymphocytic leukemia. J Med Biochem 2023;42(2):274-81.
• 18. WangJ,XiaJ,YanX,etal.Plateletcritasapotentialindexforpredicting liver fibrosis in chronic hepatitis B. J Viral Hepat 2020;27(6):602-9.
• 19. Akpinar I, Sayin MR, Gursoy YC, et al. Plateletcrit and red cell distribution width are independent predictors of the slow coronary flow phenomenon. J Cardiol 2014;63(2):112-8.
• 20. Öztürk E, Yıldırım Karaca S, İnce O, Karaca I. Can prepartum platelet indices be a parameter to predict postpartum hemorrhage? J Matern Fetal Neonatal Med 2022;35(15):2829-35.
• 21. Korkmaz L, Bastug O, Ozdemir A, et al. Can Platelet Mass Index Be a Parameter to Predict Intraventricular Hemorrhage in Very-Low-Birth-Weight Newborns? Am J Perinatol 2019;36(11):1188-97.
• 22. Morotti A, Phuah CL, Anderson CD, et al. Leukocyte Count and Intracerebral Hemorrhage Expansion. Stroke 2016;47(6):1473-8.
• 23. BehrouzR,HafeezS,MillerCM.Admissionleukocytosisinintracerebral hemorrhage: associated factors and prognostic implications. Neurocrit Care 2015;23(3):370–3.
• 24. Ray B, Ross SR, Danala G, et al. Systemic response of coated-platelet and peripheral blood inflammatory cell indices after aneurysmal subarachnoid hemorrhage and long-term clinical outcome. J Crit Car. 2019;52:1-9.
• 25. CelikbilekA,IsmailogullariS,ZararsizG.Neutrophiltolymphocyteratio predicts poor prognosis in ischemic cerebrovascular disease. J Clin Lab Anal 2014;28(1):27-31.
• 26. Tokgoz S, Keskin S, Kayrak M, Seyithanoglu A, Ogmegul A. I sneutrophil/lymphocyte ratio predict to short-term mortality in acute cerebral infarct independently from infarct volume? J Stroke Cerebrovasc Dis 2014;23(8):2163-8.
• 27. Ray B, Tinsley L, Ford L, Thompson DM, Sidorov EV, Bohnsteld BN. Trends of platelet volume index predicts delayed cerebral ischemia after subarachnoid hemorrhage. World Neurosurg 2018;111:e624- e631.
• 28. Miller BA, Turan N, Chau M, Pradilla G. Inflammation, vasospasm, and brain injury after subarachnoid hemorrhage. Biomed Res Int. 2014; Article ID: 384342. doi:10.1155/2014/384342.