Thrombocytosis in patients with biopsy-proven giant cell arteritis

doi:10.1016/S0161-6420(02)01076-X

Ophthalmology

Volume 109, Issue 7, July 2002, Pages 1267-1271

https://doi.org/10.1016/S0161-6420(02)01076-X Get rights and content

Abstract

Objective

To compare the platelet counts, complete blood counts, and Westergren sedimentation rates (WESR) of patients with a biopsy positive for giant cell arteritis (GCA) with those of patients with negative biopsies.

Design

Retrospective, case-control series.

Method

The medical records of 91 consecutive patients who underwent temporal artery biopsy for possible GCA, over an 8-year period, were reviewed.

Main outcome measures

Values obtained for the complete blood counts, including platelet counts, WESR, and biopsy results of 91 consecutive patients undergoing temporal artery biopsy were analyzed.

Results

The mean platelet count of 47 patients with positive temporal artery biopsies (433 × 10³/μl) was significantly higher than that of 44 patients with negative temporal artery biopsies (277 × 10³/μl), P < 0.0001. There was no statistically significant difference in the mean WESR between the biopsy-positive (82 mm/hour) and biopsy-negative (70 mm/hour) groups, P = 0.12. The sensitivity of an elevated WESR for biopsy-positive patients was greater (79%; 95% confidence interval [CI], 64%–89%) than that of an elevated platelet count (57%; 95% CI, 42%–72%). However, the specificity (91% [95% CI, 78%–97%] versus 27% [95% CI, 15%–43%]), positive predictive value (87% [95% CI, 70%–96%] versus 54% [95% CI, 41%–66%]), and negative predictive value (67% [95% CI, 53%–78%] versus 55% [95% CI, 32%–76%]) favored an elevated platelet count compared with WESR, or to the combination of platelets and WESR, as a better test for diagnosing GCA in the 91 patients studied. The area under the receiver operating characteristic function for platelets (0.72) was greater than that for WESR (0.59) or the combination of platelets and WESR (0.65).

Conclusions

In patients suspected of having GCA, an elevated platelet count greater than 400 × 10³/μl is a useful marker of a positive temporal artery biopsy.

Section snippets

Patients and methods

The clinical records of patients suspected of having GCA and examined in the Neuro-Ophthalmology Service at Wills Eye Hospital between January 1, 1992 and December 31, 1999 were reviewed. Patients were included if they had a complete blood count, platelet count, Westergren ESR (WESR), and a temporal artery biopsy performed and interpreted at Wills Eye Hospital. Standard protocol at Wills Eye Hospital requires that all patients undergoing a temporal artery biopsy have a complete blood count,

Results

Table 1 details the complete blood counts, platelet counts, and WESR values for patients with both positive and negative temporal artery biopsies. Forty-seven (52%) of the 91 patients (9 [39%] of 23 men and 38 [56%] of 68 women) had positive biopsies. The mean age of the biopsy-positive group was 78 years (range, 68–88; standard deviation, 6.2) and 76 years (range, 57–88; standard deviation, 6.7) for the biopsy-negative group. There was no statistically significant difference between men and

Discussion

In our 91 patients undergoing temporal artery biopsy for suspected GCA, patients with positive biopsies had a statistically significant (P < 0.0001) higher platelet count than patients whose biopsies were negative. This is in agreement with the findings of other authors who have noted that thrombocytosis occurs in GCA. Bergström and coworkers5 found a mean platelet count of 486 × 10³/μl in eight patients with biopsy-proven GCA. In another group of 10 patients with biopsy-proven arteritic AION,

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We examined 42 consecutive patients who had undergone unilateral TABs at a single hospital in 2015. Clinical data, laboratory data, and histopathologic features of TABs were recorded. Inclusion criteria were clinical diagnosis of giant cell arteritis (GCA) with TAB performed at the same center. CD68 immunohistochemistry was used to label macrophages in the TABs. Primary outcome was multiple logistic regression and bivariate comparisons to measure the association between CD68+ cells per histologic section with placement on immunomodulatory therapy (IMT).
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Citation Excerpt :
The ESR cutoff was >50 mm/hr, selected based on the American College of Rheumatology criteria for the classification of GCA.17 The cutoff value for an elevated CRP was defined as >24.5 mg/L based on a study by Hayreh et al.11 The >400 000/µL cutoff for elevated platelet count was selected based on the regional laboratory cutoff level for a normal platelet level, as well as to maintain consistency with previous studies investigating the relationship between thrombocytosis and GCA.10,18–20 Patients were divided into 3 groups based on TAB diagnoses: (i) active GCA, (ii) HH arterial injury, and (iii) normal/nonspecific changes.
Temporal artery biopsy (TAB) is the gold standard for confirming the diagnosis of giant cell arteritis (GCA) when positive. However, the clinical significance of healed/healing (HH) arterial injury on TAB is not well understood. The purpose of this study was to evaluate the clinical significance of this finding on TAB by determining its association with seromarkers typically predictive of GCA.
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A total of 385 consecutive TABs for clinical suspicion of GCA between January 2009 and January 2016.
Elevations in erythrocyte sedimentation rate, C-reactive protein, and platelet count were compared between patients with negative TAB, GCA-positive TAB, and HH arterial injury using statistical trend testing. Odds ratios of seromarker elevations for HH arterial injury versus GCA were calculated.
Seventy-six GCA-positive, 69 HH, and 240 negative TABs were identified. Mantel-Haenszel tests of trend indicated that platelets >400 000/µL (p < 0.01), erythrocyte sedimentation rate ≥50 mm/hr (p < 0.01), and C-reactive protein ≥24.5 mg/L (p < 0.01) occurred with intermediate frequency in the HH TAB group. The odds of HH TAB were 3.6 times greater (95% CI 1.5–8.5) with platelets >400 000/µL.
HH arterial injury is a heterogenous group that requires treatment in the appropriate clinical setting. From our study, we found that the HH group is intermediate between GCA-positive and GCA-negative biopsy with respect to serology markers only. Thrombocytosis is an independent predictor of HH TAB. With further studies, this marker may be considered when making treatment decisions. Further studies are required to better understand this entity.
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Soixante-seize cas de BAT positive pour l’ACG, 69 cas de lésions artérielles C/VC et 240 cas de BAT négative ont été identifiés. Le test de Mantel-Haenszel a permis de constater qu’une numération plaquettaire > 4 400 000/µL (p < 0,01), une vitesse de sédimentation des érythrocytes ≥ 50 mm/h (p < 0,01) et un taux de protéine C-réactive ≥ 24,5 mg/L (p < 0,01) apparaissaient à une fréquence intermédiaire dans le groupe lésions artérielles C/VC. Le rapport de cotes d’une BAT faisant état d’une lésion artérielle C/VC était 3,6 fois plus élevé (IC à 95 %: 1,5–8,5) lorsque la numération plaquettaire était > 4 400 000/µL.
Les patients qui présentent une lésion artérielle C/VC forment un groupe hétérogène de patients qui doivent être traités dans un contexte clinique approprié. D’après les résultats de notre étude, les lésions artérielles C/VC se situent dans une zone intermédiaire entre les biopsies positives et négatives pour l’ACG en ce qui a trait aux marqueurs sériques seulement. La thrombocytose est un facteur de prédiction indépendant de lésions artérielles C/VC. Il pourrait être intéressant de tenir compte de ce marqueur lorsque vient le temps de choisir le traitement. D’autres études seront nécessaires pour mieux comprendre la question.
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Thrombocytosis in patients with biopsy-proven giant cell arteritis

Abstract

Objective

Design

Method

Main outcome measures

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Surv Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Lancet

Psychiatry Res

Am J Med

J Am Coll Cardiol

The ESR in the diagnosis and management of polymyalgia rheumatica/giant cell arteritis syndrome

Ann Rheum Dis

Erythrocyte sedimentation rate and its relationship to hematocrit in giant cell arteritis

Arch Ophthalmol