Trombosit Büyük Hücre Oranı (P-LCR) Düzeylerine Göre İnmenin Ayırıcı Tanısı

Year 2021, , 900 - 904, 20.11.2021

Mehmet Nuri Koçak , Mustafa Bayraktar , Muhammet Çelik , Erdal Tekin

https://doi.org/10.16899/jcm.867170

Abstract

Amaç: Trombositler, tromboz ve ateroskleroz patogenezinde önemli bir rol oynamaktadır. Rutin hemogramda bakılan bir parametre olan trombosit büyük hücre oranı (P-LCR), trombotik olaylarla daha yakından ilişkili olan trombositlerin en büyük fraksiyonunun ölçümüdür. Bu çalışmamızda, literatürde ilk kez, iskemik ve hemorajik inme hastalarında P-LCR seviyeleri geçici iskemik atak (TIA) grubundaki seviyelerle karşılaştırıldı.
Yöntem: Retrospektif olarak, Ocak 2016-2019 tarihleri arasındaki hastane kayıtları ICD-10 kodları ile araştırılarak, iskemik inme, hemorajik inme ve geçici iskemik atak tanısı alan 18-70 yaş arası hastalar çalışmaya dâhil edilmiştir. Hastaların hastaneye başvuru anında alınan ilk hemogram testindeki PLCR test sonuçları karşılaştırılmıştır.
Bulgular: Çalışmaya dâhil edilen 4511 hastanın, %92,6’sı (n=4177) iskemik inme hastası, %6’sı (n=271) hemorajik inme hastası ve %1,4’ü (n=63) TIA hastası tespit edildi. İskemik ve hemorajik inme hastalarında P-LCR düzeylerinin TIA grubuna göre anlamlı olarak yüksek olduğu bulunmuştur (sırasıyla p=0,027; p = 0,044). İskemik, hemorajik ve total inme hastaları ile TIA hastaları karşılaştırıldığında, eğri altındaki alan (AUC) değerleri sırasıyla 0,581; 0,568 ve 0,580 idi. İskemik inme ve TIA arasında P-LCR kesme değeri 26,65 ng/L idi.
Sonuç: P-LCR seviyelerindeki artış, iskemik ve hemorajik inmeyi TIA'dan ayırt etmek için kullanılabilir.

Keywords

Trombosit Büyük Hücre Oranı, İnme, İskemik, Hemorajik, Geçici İskemik Atak

Supporting Institution

Yoktur.

Differential Diagnosis of Stroke by Platelet Large Cell Ratio (P-LCR) Levels

Abstract

Aim: Platelets play an important role in the pathogenesis of thrombosis and atherosclerosis. Platelet Large Cell Ratio (P-LCR), a routine hemogram parameter, is the largest fraction of platelets that are more closely related to thrombotic events. In this study, for the first time in the literature, P-LCR levels in ischemic and hemorrhagic stroke patients were compared with the levels in transient ischemic attack (TIA) group.
Method: Retrospectively, hospital records between January 2016 and 2019, were searched by ICD-10 codes, and patients aged between 18-70 years who were diagnosed as ischemic stroke, hemorrhagic stroke and transient ischemic attack were included. The P-LCR test results in the first hemogram test of the patients taken at the time of admission to the hospital were included and compared.
Results: Of the 4511 patients, 92.6% (n=4177) were diagnosed with ischemic stroke, 6% (n=271) with hemorrhagic stroke, and 1.4% (n=63) of patients with TIA. The P-LCR levels of the ischemic and hemorrhagic stroke patients were found to be significantly higher than the TIA group (p=0.027; p=0.044, respectively). The Area Under the Curve (AUC) values for ischemic, hemorrhagic and total stroke versus TIA patients were 0.581, 0.568, and 0.580; respectively. The cut-off value of P-LCR was 26.65 ng/L between the ischemic stroke and TIA.
Conclusion: The increase in P-LCR levels can be used to distinguish ischemic and hemorrhagic stroke from TIA.

Keywords

Platelet Large Cell Ratio, stroke, ischemic, hemorrhagic, Transient ischemic attack

References

• Simon RS, Aminoff AJ, Greenberg DA. Clinical Neurology, 10th edition. . McGraw-Hill Education. 2018
• Choi D-H, Kang S-H, Song H. Mean platelet volume: a potential biomarker of the risk and prognosis of heart disease. Korean J Intern Med. 2016;31(6):1009-17.
• Sadeghi F, Kovács S, Zsóri KS, Csiki Z, Bereczky Z, Shemirani AH. Platelet count and mean volume in acute stroke: a systematic review and meta-analysis. Platelets. 2019:1-9.
• Ranjith MP, DivyaRaj R, Mathew D, George B, Krishnan MN. Mean platelet volume and cardiovascular outcomes in acute myocardial infarction. Heart Asia. 2016;8(1):16-20.
• Park Y, Schoene N, Harris W. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets. 2002;13(5-6):301-6.
• Grotto HZW, Noronha JFA. Platelet larger cell ratio (P-LCR) in patients with dyslipidemia. Clinical & Laboratory Haematology. 2004;26(5):347-9.
• Rechciński AJT, Foryś J, Krzemińska-Pakuła M, et al. Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention. Cardiol J 2013;20(5):491-8.
• Dehghani MR, Taghipour-Sani L, Rezaei Y, Rostami R. Diagnostic importance of admission platelet volume indices in patients with acute chest pain suggesting acute coronary syndrome. Indian Heart J. 2014;66(6):622-8.
• Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008;7(10):915-26.
• Haast RAM, Gustafson DR, Kiliaan AJ. Sex differences in stroke. J Cereb Blood Flow Metab. 2012;32(12):2100-7.
• Girijala RL, Sohrabji F, Bush RL. Sex differences in stroke: Review of current knowledge and evidence. Vascular Medicine. 2016;22(2):135-45.
• Khandekar MM, Khurana AS, Deshmukh SD, Kakrani AL, Katdare AD, Inamdar AK. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. Journal of Clinical Pathology. 2006;59(2):146.
• Cerit L, Cerit Z. Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit. Cardiovasc J Afr. 2017;28(6):385-8.
• De Luca G, Santagostino M, Secco GG, et al. Platelet-Large Cell Ratio and the extent of coronary artery disease: results from a large prospective study. Journal of Thrombosis and Thrombolysis. 2010;30(4):426-33.
• Verdoia M, Barbieri L, Schaffer A, et al. Platelet–larger cell ratio and the risk of periprocedural myocardial infarction after percutaneous coronary revascularization. Heart and Vessels. 2015;30(1):20-7.