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Submitted: 22 Apr 2019
Accepted: 24 Jan 2020
ePublished: 12 Feb 2020
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J Cardiovasc Thorac Res. 2020;12(1): 56-62.
doi: 10.34172/jcvtr.2020.09
PMID: 32211139
PMCID: PMC7080337
  Abstract View: 253
  PDF Download: 134

Original Article

Prognostic value of platelet indices in patients with acute pulmonary thromboembolism

Samad Ghaffari 1 ORCID logo, Nashmil Parvizian 1, Leili Pourafkari 1,2 ORCID logo, Ahmad Separham 1, Reza Hajizadeh 3, Nader D Nader 2 * ORCID logo, Elnaz Javanshir 1, Nariman Sepehrvand 4, Arezou Tajlil 1, Babak Nasiri 1

1 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY, USA
3 Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran
4 Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
*Corresponding Author: Nader D. Nader, Email: nnader@buffalo.edu

Abstract

Introduction: Given the role of platelets in thrombus formation, markers of platelet activation may be able to predict outcomes in patients with acute pulmonary thromboembolism (PTE).

Methods: In a prospective cohort study, 492 patients with acute PTE were enrolled. Patients were evaluated for platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet-lymphocyte-ratio (PLR), as well as for the simplified Pulmonary Embolism Severity Index (PESI) risk score. The primary endpoint was in-hospital all-cause mortality. Major adverse cardiopulmonary events (MACPE, composite of mortality, thrombolysis, mechanical ventilation and surgical embolectomy during index hospitalization) and all-cause death during follow-up were secondary endpoints.
Results:
MPV, PDW and PLR were 9.9±1.0 fl, 13.5±6.1%, and 14.7±14.5, respectively, in the total cohort. Whilst MPV was higher in those with adverse events (10.1±1.0 vs 9.9±1.0 fl; P = 0.019), PDW and PLR were not different between two groups. MPV with a cut-off point of 9.85 fl had a sensitivity of 81% and a specificity of 50% in predicting in-hospital mortality, but it had lower performance in predicting MACPE (Area under the curve: AUC 0.58; 95%CI 0.52-0.63) or long-term mortality (AUC 0.54; 95% CI 0.47-0.61). The AUC for all these three markers were lower than the AUC calculated for the simplified PESI score (0.80; 0.71-0.88).
Conclusion: Platelet indices had only fair-to-good predictive performance in predicting in-hospital all-cause death. Established PTE risk scoring models such as simplified PESI outperform these indices in predicting adverse outcomes.

Keywords: Pulmonary Thromboembolism, Platelet, Mean Platelet Volume, Platelet Distribution Width, Mortaity
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