Diagnostic Value of Mean Platelet Volume and Platelet Distrubition Width for Massive Pulmonary Embolism in Emergency Care

Abstract

Objectives: Massive pulmonary embolism is a life-threatening condition mostly seen in the emergency setting. Early diagnosis and treatment decrease the risk of mortality. Apart from imaging tests, increased blood levels of several parameters were shown to be helpful to identify these patients. We aimed to determine the diagnostic value of mean platelet volume and platelet distribution width for the diagnosis of acute massive pulmonary embolism. Materials and Methods: We retrospectively reviewed the medical records of patients who were admitted to the emergency department from January 2012 to January 2016. Patients who had a diagnosis of massive pulmonary embolism confirmed by computed tomography pulmonary angiography were included. Blood samples were drawn at admission. Transthoracic echocardiography was performed to evaluate right ventricular size and function. Age and sex matched patients who were admitted to the emergency department with any diagnosis other than pulmonary embolism were enrolled as a control group. Results: Eighty patients met the inclusion criteria and age and sex matched 80 patients were enrolled as a control group. The mean platelet volume and platelet distribution width were significantly higher in patients with massive pulmonary embolism compared to control group [10.1±0.1 fL vs 7.9±0.1 fL p<0.001, 17 (15.5-18.8) vs 13.6 (12.3-15.9) p<0.001 respectively]. Platelet distribution width had the most powerful diagnostic value among other parameters including the mean platelet volume, D dimer and pro-BNP (area under the curve=0.998, p<0.001). Conclusion: Massive pulmonary embolism is a thromboembolic disease associated with high mortality. Platelet distribution width and mean platelet volume are simple parameters of complete blood count that can be used to increase predictive value of previously validated tests when used concomitantly. They may also help to select patients who will undergo imaging.

Keywords

• Massive Pulmonary Embolism
• Platelet Distribution Width
• Mean Platelet Volume

Ethical Statement

The Başkent University Medicine and Health Sciences Research Board approved this retrospective study protocol (Approval no: KA16/80, Date: 01.03.2016).

Acil Serviste Masif Pulmoner Emboli Tanısı için Trombosit Dağılım Genişliği ve Ortalama Trombosit Hacminin Tanısal Değeri

Abstract

Amaç: Masif pulmoner emboli çoğunlukla acil serviste karşılaşılan hayatı tehdit eden bir durumdur. Erken tanı ve tedavi ölüm riskini azaltır. Görüntüleme tetkikleri dışında artmış kan seviyesindeki bazı birkaç parametrenin bu hastaları ayırt etmede yardımcı olduğu gösterilmiştir. Biz çalışmamızda, masif pulmoner emboli tanısında trombosit dağılım genişliği ve ortalama trombosit hacminin tanısal değerini tespit etmeyi amaçladık. Gereç ve Yöntem: Ocak 2012 ile Ocak 2016 yılları arasında acil servise başvuran hastaların kayıtları geriye dönük olarak incelendi. Bilgisayarlı tomografi pulmoner anjiyografi ile tanısı doğrulanmış masif pulmoner emboli hastaları çalışmaya dahil edildi. Tam kan sayımı, D-dimer, pro-BNP ve troponin I testleri için kan örnekleri ilk başvuruda alındı. Sağ ventrikül boyutu ve fonksiyonunun değerlendirilmesi için hastalara ekokardiyografi yapıldı. Yaş ve cinsiyet eşleşmesi yöntemi ile kontrol grubu çalışmaya alındı. Bulgular: Toplam 80 hasta çalışma kriterlerine uydu ve bu hastalarla yaş ve cinsiyet olarak eşleşmiş 80 kontrol hastası ayrıca çalışmaya dahil edildi. Ortalama trombosit hacmi ve trombosit dağılım genişliği anlamlı olarak masif pulmoner emboli tanısı almış hastalarda kontrol grubuna göre yüksek bulundu [10,1±0,1 fL, 7,9±0,1 fL p<0,001, 17 (15,5-18,8) 13,6 (12,3-15,9) p<0,001 sırasıyla]. Trombosit dağılım genişliğinin ortalama trombosit hacmi, D-dimer, pro-BNP dahil parametreler içerisinde en güçlü tanısal değere sahip olduğu tespit edildi (eğri altında kalan alan=0,998, p<0,001). Sonuç: Masif pulmoner emboli, yüksek ölüm riski ile ilişkili bir tromboembolik hastalıktır. Trombosit dağılım genişliği ve ortalama trombosit hacmi, tam kan sayımının basit bir parçası olup daha önceden geçerliliği kabul edilmiş testlerle beraber kullanıldığında onların tanı koydurucu gücünü artırır. Görüntüleme testine gidecek hastaları tespit etmeye yardımcı olabilir.

Keywords

• Masif Pulmoner Emboli
• Trombosit Dağılım Genişliği
• Ortalama Trombosit Hacmi

Ethical Statement

The Başkent University Medicine and Health Sciences Research Board approved this retrospective study protocol (Approval no: KA16/80, Date: 01.03.2016).

References

1. 1. Kucher N, Goldhaber SZ. Management of massive pulmonary embolism. Circulation. 2005;112:e28-32.
2. 2. Lin BW, Schreiber DH, Liu G, et al. Therapy and outcomes in massive pulmonary embolism from the Emergency Medicine Pulmonary Embolism in the Real World Registry. Am J Emerg Med. 2012;30:1774-1781.
3. 3. Busse LW, Vourlekis JS. Submassive pulmonary embolism. Crit Care Clin. 2014;30:447-473.
4. 4. Shujaat A, Shapiro JM, Eden E. Utilization of CT Pulmonary Angiography in Suspected Pulmonary Embolism in a Major Urban Emergency Department. Pulm Med. 2013;2013:915213.
5. 5. Marshall PS, Mathews KS, Siegel MD. Diagnosis and management of lifethreatening pulmonary embolism. J Intensive Care Med. 2011;26:275-294.
6. 6. Levin D, Seo JB, Kiely DG, et al. Triage for suspected acute Pulmonary Embolism: Think before opening Pandora’s Box. Eur J Radiol. 2015;84:1202- 1211.
7. 7. Sunnetcioglu A, Sertogullarindan B, Ozbay B, et al. Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism. Clinics (Sao Paulo). 2015;70:441-445.
8. 8. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2:358-367.

9. 9. Golpe R, Pérez-de-Llano LA, Castro-Añón O, et al. Right ventricle dysfunction and pulmonary hypertension in hemodynamically stable pulmonary embolism. Respir Med. 2010;104:1370-1376.
10. 10. Amorim S, Dias P, Rodrigues RA, et al. Troponin I as a marker of right ventricular dysfunction and severity of pulmonary embolism. Rev Port Cardiol. 2006;25:181-186.
11. 11. Mehta NJ, Jani K, Khan IA. Clinical usefulness and prognostic value of elevated cardiac troponin I levels in acute pulmonary embolism. Am Heart J. 2003;145:821-825.
12. 12. Konstantinides S, Geibel A, Olschewski M, et al. Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation. 2002;106:1263-1268.
13. 13. Coutance G, Le Page O, Lo T, Hamon M. Prognostic value of brain natriuretic peptide in acute pulmonary embolism. Crit Care. 2008;12:R109.
14. 14. Frisbie JH. An animal model for venous thrombosis and spontaneous pulmonary embolism. Spinal Cord. 2005;43:635-639.
15. 15. Koupenova M, Kehrel BE, Corkrey HA, et al. Thrombosis and platelets: an update. Eur Heart J. 2017;38:785-791.
16. 16. Martin JF, Trowbridge EA, Salmon G, et al. The biological significance of platelet volume: its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration. Thromb Res. 1983;32:443-460.
17. 17. Kostrubiec M, Łabyk A, Pedowska-Włoszek J, et al. Mean platelet volume predicts early death in acute pulmonary embolism. Heart. 2010;96:460-465.
18. 18. Park Y, Schoene N, Harris W. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets. 2002;13:301-306.
19. 19. Vagdatli E, Gounari E, Lazaridou E, et al. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14:28-32.
20. 20. Yardan T, Meric M, Kati C, et al. Mean platelet volume and mean platelet volume/platelet count ratio in risk stratification of pulmonary embolism. Medicina (Kaunas). 2016;52:110-115.
21. 21. Huang J, Chen Y, Cai Z, et al. Diagnostic value of platelet indexes for pulmonary embolism. Am J Emerg Med. 2015;33:760-763.
22. 22. Günay E, Sarinc Ulasli S, Kacar E, et al. Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism? Clin Respir J. 2014;8:33-40.