Original article
Mean platelet volume as an indicator of disease severity in patients with acute pancreatitis

https://doi.org/10.1016/j.clinre.2011.10.003Get rights and content

Summary

Aim

Acute pancreatitis (AP) constitutes a systemic inflammatory process which is often accompanied by thrombosis and bleeding disorders. The role of platelets in the pathophysiology of the disease has not been elucidated yet. Mean platelet volume (MPV) is an index of platelet activation and reported to be influenced by inflammation. The objective of the present study is to assess whether platelet volume would be useful in predicting disease severity in AP. Additionally possible relationship of MPV with clinical and radiologic parameters in conjunction with other inflammatory markers during AP was also investigated.

Patients and methods

A total of 144 AP patients (male/female: 87/57), and 40 healthy subjects (male/female: 23/17) were enrolled in this study. Mean platelet volume and inflammatory parameters were measured for all study participants. Modified Glasgow Prognostic Score (mGPS) and the computerized tomography severity index (CTSI) were used as to predict the disease severity in AP patients.

Results

A statistically significant decrease in MPV levels was observed in AP patients (8.06 ± 0.71 fL) compared with healthy controls (8.63 ± 0.62 fL) (P < 0.001). According to the mGPS, overall accuracy of MPV in determining severe AP was 72.7% with a sensitivity, specificity, NPV and PPV of 70.6%, 73.9%, 81.9%, and 60 respectively (AUC: 0.762). Overall accuracy of MPV in predicting disease severity according to CTSI was not superior compared with other inflammation markers.

Conclusion

The present study demonstrated that MPV is decreased in AP. Assessment of MPV with other inflammatory markers may provide additional information about disease severity in AP.

Introduction

Acute pancreatitis (AP) refers to inflammation of the pancreas, which is accompanied by oxidative stress and free radical production within the gland causing sudden and severe abdominal pain with a mild or severe course [1], [2]. Subsequent tissue damage and release of inflammatory mediators triggers platelet activation and give rise to a more generalized event [3]. Abdominal pain together with elevation of plasma levels of pancreatic enzymes, namely amylase and lipase, which is released by pancreatic acinar cells are the cornerstone of diagnosis [4]. However, both enzymes can be elevated in other disease states like perforated ulcer, intestinal obstruction, and mesenteric infarction. Serum lipase is a more sensitive and specific indicator than amylase, both of these markers does not correlate with severity of AP. Although there are more specific tests apart from amylase and lipase in detection of AP, such as urinary trypsinogen activation peptide (TAP) and serum and urinary trypsinogen [5], [6], [7], [8], but these are less widely available. Although the early detection of disease severity significantly reduces mortality in patients with AP, the major challenge is to identify mechanisms that induce the switch from mild to severe AP and at what point it occurs. For this reason, the adjunctive use of additional markers may add significant benefit for predicting disease severity and achieving diagnostic accuracy.

Mean platelet volume (MPV) is a measure of platelet size, generated by full blood count analyzers as part of the routine complete blood count (CBC) test cycle which is commonly overlooked by clinicians [9]. MPV is one of the most widely used surrogate markers of platelet function and has been shown to reflect inflammatory burden and disease activity in several diseases including pre-eclampsia, unstable angina, myocardial infarction and systemic inflammation, such as ulcerative colitis and Crohn's disease [10], [11], [12], [13], [14], [15], [16], [17], [18]. Decreased MPV and PDW in AP were reported only in one study [7]. However, it had very limited number of patients and did not compare the accuricity of test with other inflammatory markers and also with clinical and radiologic indexes. With this respect, the present study was undertaken in order to investigate MPV as an index of platelet activation, as well as their possible relationship with clinical and radiologic parameters in conjunction with other inflammatory markers during AP.

Section snippets

Patients and methods

A retrospective review of the available medical records of AP patients admitted to the Turkiye Yuksek Ihtisas Training and Research hospital from January 2007 to February 2011 and with a discharge diagnosis of AP were included in this study. Diagnosis of AP was based on the presence of severe abdominal pain, usually with vomiting, tenderness in the mid-epigastrium, and a serum amylase level three times higher than normal. The following data were extracted from the hospital medical records,

Results

One hundred and forty-four patients with AP and 40 control subjects were enrolled in the present study. There were 87 (60.4%) men and 57 (39.6%) women in AP group and 23 (57.5%) men and 17 (42.5%) women in control group. The mean age of AP and control patients was 57.8 ± 16.7 years and 52.6 ± 15.0 respectively. There were no statistically significant differences between the ages of the study participants. Clinical characteristics and laboratory values of study participants summarized in Table 1.

Discussion

In this study, it was revealed that MPV levels decrease in AP compared with controls. Furthermore, MPV levels were found to be increased after treatment. There was a negative correlation between MPV and mGPS. Although the overall accuracy of MPV for disease activity in AP, as reflected by mGPS, was superior then WBC, hsCRP and ESR, overall accuracy of MPV according to CTSI was found to be lower compared with other inflammation markers.

AP is an inflammatory disease of the pancreas most

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

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