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An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients.

Zampieri FG, Ranzani OT, Sabatoski V, de Souza HP, Barbeiro H, da Neto LM, Park M, Pinheiro da Silva F - Ann Intensive Care (2014)

Bottom Line: Patients in whom MPV increased and platelet count decreased had higher mortality rates (46%).No strong associations between inflammatory mediators and changes in MPV and platelet count were found.An increase in MPV after admission to an ICU is independently associated with higher hospital mortality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil ; Laboratory of Medical Investigation 51 (LIM 51), Faculty of Medicine, University of São Paulo, São Paulo, Brazil ; Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.

ABSTRACT

Background: Platelet activation and consumption are common in critically ill patients and are associated with poorer prognosis. Mean platelet volume is a simple surrogate for platelet activation, with higher MPV being associated with worse clinical condition on a large array of clinical diagnoses. We therefore aimed to investigate associations between changes in platelet count and mean platelet volume (MPV) with prognosis and inflammatory cytokine values in critically ill patients.

Methods: This study prospectively included 84 critically ill patients. Patients were stratified into four groups according to proportional changes in MPV (ΔMPV24h) and platelet count (ΔPlat24h) in the first 24 hours after admission. Mortality between groups was compared using the χ (2) test. Logistic regression was performed using hospital mortality as outcome and Simplified Acute Physiology Score (SAPS 3), ΔPlat24h and ΔMPV24h as covariates. Concentrations of the following inflammatory mediators were measured using Miliplex® technology: IL1β, IL6, IL8, IL10, epidermal growth factor, vascular endothelial growth factor, TNFα and IFNα. Cytokine concentrations were compared between groups using the Kruskal-Wallis test with Bonferroni correction.

Results: Patients in whom MPV increased and platelet count decreased had higher mortality rates (46%). According to logistic regression, ΔMPV24h was independently associated with increased mortality (OR 1.28 per 1% increase; 95% CI 1.08 to 1.48). No strong associations between inflammatory mediators and changes in MPV and platelet count were found.

Conclusion: An increase in MPV after admission to an ICU is independently associated with higher hospital mortality.

No MeSH data available.


Related in: MedlinePlus

Density plots of mean platelet volume (MPV) values in survivors and non-survivors.
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Figure 2: Density plots of mean platelet volume (MPV) values in survivors and non-survivors.

Mentions: According to logistic regression analysis after stepwise selection, only SAPS 3 (odds ratio (OR) 1.05 per each point increase; 95% CI 1.01 to 1.09) and ΔMPV24h (OR 1.28 per 1% increase; 95% CI 1.08 to 1.48) were associated with higher hospital mortality. Neither ΔPlat24h nor the interaction between ΔMPV24h and ΔPlat24h were associated with increased hospital mortality. Confidence intervals after bootstrap analysis were 1.01 to 1.10 for SAPS 3 and 1.04 to 1.56 for ΔMPV24h. VIF between SAPS 3 and ΔMPV24h was low (1.06). Density plots for ΔMPV24h in survivors and non-survivors are shown in Figure 2. A plot for hospital death probability constructed from logistic regression and ΔMPV24h values is shown in Figure 3. A three-dimensional plot of the regression plane of hospital mortality and SAPS 3 and MPV24h values is shown in Figure 4. The model obtained had a non-statistically significant higher AUC when compared to SAPS 3 alone (0.79; 95% CI 0.67 to 0.91 versus 0.70, 95% CI 0.58 to 0.83) (Figure 5). Both the model and SAPS 3 were calibrated according to Hosmer-Lemeshow test (P = 0.60 for the model and P = 0.32 for SAPS 3). However, calibration plot shows that the addition of MPV to SAPS 3 score reduces systematic errors in prognostication in the whole range of probabilities (Figure 6, panels A and B). The secondary logistic regression analysis included 77 patients and SAPS 3 score, ΔMPVday5, and ΔPlatday5. According to this analysis, only ΔMPVday5 (OR 1.12 per 1% increase; 95% CI 1.02 to 1.22) was associated with increased hospital mortality.


An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients.

Zampieri FG, Ranzani OT, Sabatoski V, de Souza HP, Barbeiro H, da Neto LM, Park M, Pinheiro da Silva F - Ann Intensive Care (2014)

Density plots of mean platelet volume (MPV) values in survivors and non-survivors.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4265891&req=5

Figure 2: Density plots of mean platelet volume (MPV) values in survivors and non-survivors.
Mentions: According to logistic regression analysis after stepwise selection, only SAPS 3 (odds ratio (OR) 1.05 per each point increase; 95% CI 1.01 to 1.09) and ΔMPV24h (OR 1.28 per 1% increase; 95% CI 1.08 to 1.48) were associated with higher hospital mortality. Neither ΔPlat24h nor the interaction between ΔMPV24h and ΔPlat24h were associated with increased hospital mortality. Confidence intervals after bootstrap analysis were 1.01 to 1.10 for SAPS 3 and 1.04 to 1.56 for ΔMPV24h. VIF between SAPS 3 and ΔMPV24h was low (1.06). Density plots for ΔMPV24h in survivors and non-survivors are shown in Figure 2. A plot for hospital death probability constructed from logistic regression and ΔMPV24h values is shown in Figure 3. A three-dimensional plot of the regression plane of hospital mortality and SAPS 3 and MPV24h values is shown in Figure 4. The model obtained had a non-statistically significant higher AUC when compared to SAPS 3 alone (0.79; 95% CI 0.67 to 0.91 versus 0.70, 95% CI 0.58 to 0.83) (Figure 5). Both the model and SAPS 3 were calibrated according to Hosmer-Lemeshow test (P = 0.60 for the model and P = 0.32 for SAPS 3). However, calibration plot shows that the addition of MPV to SAPS 3 score reduces systematic errors in prognostication in the whole range of probabilities (Figure 6, panels A and B). The secondary logistic regression analysis included 77 patients and SAPS 3 score, ΔMPVday5, and ΔPlatday5. According to this analysis, only ΔMPVday5 (OR 1.12 per 1% increase; 95% CI 1.02 to 1.22) was associated with increased hospital mortality.

Bottom Line: Patients in whom MPV increased and platelet count decreased had higher mortality rates (46%).No strong associations between inflammatory mediators and changes in MPV and platelet count were found.An increase in MPV after admission to an ICU is independently associated with higher hospital mortality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil ; Laboratory of Medical Investigation 51 (LIM 51), Faculty of Medicine, University of São Paulo, São Paulo, Brazil ; Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.

ABSTRACT

Background: Platelet activation and consumption are common in critically ill patients and are associated with poorer prognosis. Mean platelet volume is a simple surrogate for platelet activation, with higher MPV being associated with worse clinical condition on a large array of clinical diagnoses. We therefore aimed to investigate associations between changes in platelet count and mean platelet volume (MPV) with prognosis and inflammatory cytokine values in critically ill patients.

Methods: This study prospectively included 84 critically ill patients. Patients were stratified into four groups according to proportional changes in MPV (ΔMPV24h) and platelet count (ΔPlat24h) in the first 24 hours after admission. Mortality between groups was compared using the χ (2) test. Logistic regression was performed using hospital mortality as outcome and Simplified Acute Physiology Score (SAPS 3), ΔPlat24h and ΔMPV24h as covariates. Concentrations of the following inflammatory mediators were measured using Miliplex® technology: IL1β, IL6, IL8, IL10, epidermal growth factor, vascular endothelial growth factor, TNFα and IFNα. Cytokine concentrations were compared between groups using the Kruskal-Wallis test with Bonferroni correction.

Results: Patients in whom MPV increased and platelet count decreased had higher mortality rates (46%). According to logistic regression, ΔMPV24h was independently associated with increased mortality (OR 1.28 per 1% increase; 95% CI 1.08 to 1.48). No strong associations between inflammatory mediators and changes in MPV and platelet count were found.

Conclusion: An increase in MPV after admission to an ICU is independently associated with higher hospital mortality.

No MeSH data available.


Related in: MedlinePlus