Hemorajik İnmede Platelet Kitle İndeksinin Prognoz ile İlişkisi

Yıl 2024, Cilt: 7 Sayı: 1, 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

Öz

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.

Anahtar Kelimeler

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

Platelet Mass Index as a Predictor of Prognosis in Hemorrhagic Stroke

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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