Clinics and Research in Hepatology and Gastroenterology
Original articleMean platelet volume as an indicator of disease severity in patients with acute pancreatitis
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.
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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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