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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 1  |  Page : 60-63

Value of mean platelet volume as a predictor of functional outcome in different types of ischemic stroke


1 Department of Neurology, Ain Shams University, Cairo, Egypt
2 Department of Clinical Pathology, Ain Shams University, Cairo, Egypt
3 Department of Neurology, Helwan University, Cairo, Egypt

Date of Submission21-May-2015
Date of Acceptance20-Aug-2015
Date of Web Publication15-Feb-2016

Correspondence Address:
Magdy A Mostafa
Department of Neurology, Ain Shams University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1083.176375

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  Abstract 

Background
Platelets play an important role in the pathogenesis of ischemic stroke. Mean platelet volume (MPV) values in association with both thrombosis and inflammation have become a point of interest in the last few decades, and some studies have reported MPV values significantly higher in patients with stroke compared to controls.
Objective
The aim of this study was to investigate the association between MPV and the functional outcome of different types of acute ischemic brain stroke.
Patients and methods
Ninety patients with the diagnosis of first-ever acute ischemic stroke were included. Those patients were divided into three equal groups. The first includes patients with lacunar stroke, the second includes patients with large vessel disease, and the third includes cardioembolic stroke patients. They were 35 female (39%) and 55 males (61%). Their age ranged from 29 to 87 years with median value 60 years. MPV was measured on admission. All patients were followed for 3 months then functional outcome was measured using the modified Barthel index.
Results
There was a significant inverse relation between MPV and modified Barthel index score (P < 0.01) only in patients with lacunar stroke. Regarding the other two groups, such correlation is not present.
Conclusion
MPV may be used as early predictor of outcome only in patients with small vessels disease.

Keywords: Ischemic stroke, mean platelet volume, outcome


How to cite this article:
Mostafa MA, Mohamed NA, Abdulghani KO. Value of mean platelet volume as a predictor of functional outcome in different types of ischemic stroke. Egypt J Neurol Psychiatry Neurosurg 2016;53:60-3

How to cite this URL:
Mostafa MA, Mohamed NA, Abdulghani KO. Value of mean platelet volume as a predictor of functional outcome in different types of ischemic stroke. Egypt J Neurol Psychiatry Neurosurg [serial online] 2016 [cited 2021 Apr 20];53:60-3. Available from: http://www.ejnpn.eg.net/text.asp?2016/53/1/60/176375


  Introduction Top


Platelets are small non-nucleated structures, arising from the fragmentation of megakaryocytes. Platelets, besides being acute phase reactants, are also influenced by the patient health and nutritional status. They play a major role in maintaining vessel integrity through homeostasis. The haemostatic efficiency of these circulating cells is directly dependent on some vasoactive factors and prothrombotic agents including thromboxane A2 and serotonin secreted from platelet granules [1].

Differences in platelet volume correlate with differences in density, dense body content and enzymatic activity of lactate dehydrogenase. In addition, the platelet volume affects the platelet functions including aggregation and serotonin uptake and release [2]. It is clear that the larger platelets contain more granules and therefore produce and secrete greater amounts of vasoactive stimulators. In fact, platelet volume affects the bleeding time, and the mean platelet volume (MPV) has been considered as a determinant for the level of platelet activity. MPV is an important marker of platelet-related activities such as platelet aggregation, thromboxane A2 generation, and platelet factor 4 and thromboglobulin secretion [3].

An increase of MPV has been confirmed after acute ischemic heart diseases. The MPV is directly associated with the risk of acute myocardial infarction, and subsequent life-threatening events [4]. Also in patients with risk factors for stroke, like diabetes mellitus or hypercholesterolemia, the MPV values were found to be higher than the control groups. Patients with severe stroke significantly more often have higher MPV levels on admission to the hospital [5]. Although a relationship between the MPV values and the severity and prognosis of the ischemic stroke has been observed in some reports, other studies did not reveal such an interrelation [1].


  Aim of work Top


The aim of this study was to investigate the association between MPV and the functional outcome of different types of acute ischemic brain stroke.


  Patients and methods Top


A prospective follow-up study including 90 patients admitted with the diagnosis of first-ever acute ischemic stroke. The patients were recruited from Ain Shams Specialized Hospital. The only inclusion criteria were the diagnosis of acute ischemic stroke. Thirty patients representing different main three types of ischemic stroke (small vessel disease, cardioembolic stroke, and large vessel atherosclerosis) were recruited, based on the modified TOAST criteria [6].

We excluded:

  1. Patients with onset of symptoms for more than 2 days before admission,
  2. Presence of undetermined cause of stroke according to modified TOAST criteria [6],
  3. Patients with comorbid medical illnesses likely to interfere with platelet function or morphology like chronic kidney disease, heart bypass surgery, chronic liver diseases and leukemia, and
  4. Patients receiving medication likely to interfere with platelet morphology or function like aspirin and other NSAIDs, antihistamines and some antibiotics.


The patients were subjected to full clinical evaluation including history taking and complete general and neurological examination, routine laboratory investigations including complete blood count, coagulation profile, lipid profile, liver and kidney functions, and serum electrolytes. In addition, during the first day after admission blood samples for the measurement of MPV were collected into EDTA tubes and were analyzed in an automated hematological analysis system (Ruby analyzer; Abbott Diagnostic, USA) that measures platelets using aperture-impedance technology.

MRI brain; stroke protocol (including T 1 , T 2 , T 2 -star, FLAIR and diffusion weighted images and magnetic resonance arteriography) was done to confirm diagnosis, detect the size of the infarction and to determine the state of intracranial cerebral blood vessels through magnetic resonance arteriography. In addition, all patients were subjected to ECG, transthoracic echocardiography, and carotid duplex. According to the results of the previous investigations, patients were divided into three equal groups. The first group included patients with small vessels disease, the second group included patients with cardioembolic stroke, and the last group included those with large vessel atherosclerosis.

After admission, all patients received standard care and proper management. We followed up the patients for 3 months and used modified Barthel index to determine the functional outcome.

Statistical analysis

IBM SPSS statistics (V. 22.0, 2013; IBM Corp., USA) was used for data analysis. Data was expressed as median and percentiles for quantitative nonparametric measures. The ranked Spearman correlation test was used to study the possible association between each two variables for nonparametric data. The probability of error less than 0.05 was considered significant.


  Results Top


Ninety patients diagnosed as ischemic stroke were studied including 35 female (39%) and 55 males (61%). Their age ranged from 29 to 87 years. These patients were divided into three equal groups. Each group represented a different type of ischemic stroke. The first group included patients with lacunar stroke. The second group included patients with large vessel disease. The third group included patients with cardioembolic stroke. MPV was measured for every patient. Modified Barthel index score was calculated for each patient after 3 months from admission. The range, median value, and the 25th and the 75th percentiles for both MPV and Barthel index in all groups were shown in [Table 1] and [Table 2].
Table 1: Range, median value, and percentiles values of mean platelet volume in all groups

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Table 2: Range, median value, and percentiles values of Barthel index in all groups

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On studying the possible association between MPV and the modified Barthel index score in each group, there was a positive significant negative correlation only among patients with small vessels disease (r = −0.455, P < 0.05) [Figure 1]. As regard other groups, no correlation is found between MPV and the modified Barthel index score [Table 3]. Also other laboratory risk factors were not significantly correlated with functional outcome after 3 months in all groups.
Figure 1: Correlation between mean platelet volume (MPV) and Barthel index in patients with small vessels disease .

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Table 3: Correlation between mean platelet volume and Barthel index in all groups

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  Discussion Top


Platelets have a great role in the pathophysiology of atherothrombotic diseases and are involved in the early thromboembolic phase of ischemic stroke. Large platelets are known to be more active. It was hypothesized that thrombomegaly would affect the platelets' functions leading to more release of thrombogenic factors; hence, thrombomegaly may enhance the process of thrombosis and tissue ischemia development [7].

Many studies stated the increase of MPV in patients with acute ischemic stroke. However, its correlation with stroke severity has not been investigated. In addition, studies on the association of MPV with the functional outcome of stroke patients revealed discordant results [8].

This study is a prospective follow-up study comparing the relation between the functional outcome after 3 months and MPV in the three main types of ischemic stroke. Only patients with small vessel disease showed negative correlation between MPV and the 3 months' functional outcome.

This coincides with findings found in older studies which showed that higher MPV was associated with poor outcome; however, these studies included patients with acute ischemic stroke in general so the results were not specified on small vessels disease. In addition, the use of different scales to assess the short-term prognosis of stroke was a major different point [7],[9].

Also, Greisenegger and colleagues found that elevated MPV is associated with a worse outcome for acute ischemic cerebrovascular events. This association remained significant after adjustment for possible confounding factors, so it was worth to say that MPV can affect the prognosis of ischemic stroke independent of other clinical parameters [5].

Another more recent study found MPV bears an inverse relationship to the immediate outcome from ischemic stroke independent of stroke subtype but this study measured the outcome shortly after ischemic stroke at the end of the first week [2].

On the other hand, Ntaios et al. [8] stated that MPV, assessed within 24 h after ischemic stroke onset, is not associated with stroke severity or functional outcome. The same findings were reached in another two earlier studies [10],[11].

Possible reasons for these divergent results could be small numbers of patients, the use of different outcome measures and variation in the timing of obtaining blood samples and their assessment in these studies. Also it was suggested that increased MPV and higher platelet reactivity simply reflect a marker for a more severe stroke event and a more pronounced acute-phase reaction [5], but in our present study, we included only patients whose MPV was determined within the first day of admission. Also, we included patients within the first 48 h from onset of symptoms. Given the average life span of a platelet of 8 days [12], it is unlikely that the platelet size at the time of measurement was affected by the acute vascular event. Moreover, our results suggested that stroke patients already had an elevated MPV, reflecting higher platelet reactivity even before the stroke occurred.

The strengths of our study included the recruitment of well-phenotyped cases of the three main types of ischemic stroke, review of original imaging allowing accurate classification of stroke patients, and follow-up stroke patients for 3 months to assess the functional outcome. On the other hand, the limitations of this study were the relative small sample size and the presence of confounding factors that may affect the findings. These limitations decrease the possibility of generalization of the results, as the study population somewhat deviates from the stroke population at large.


  Conclusion Top


MPV may be an early and important predictor for the prognosis of ischemic stroke especially the small vessels disease subtype. It may affect the functional outcome of patients with lacunar infarction.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Abd BA. Mean platelet volume and its influence on the severity of acute ischemic stroke. Med J Bab 2014; 11 :500-506.  Back to cited text no. 1
    
2.
Shah PA, Mir RA, Kamili MM, Bardi GH, Masoodi ZA. Role of mean platelet volume in ischemic stroke. JK Sci 2013; 15 :136-139.  Back to cited text no. 2
    
3.
Murat SN, Duran M, Kalay N, Gunebakmaz O, Akpek M, Doger C, et al. Relation between mean platelet volume and severity of atherosclerosis in patients with acute coronary syndromes. Angiology 2013; 64 :131-136.  Back to cited text no. 3
    
4.
Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost 2010; 8 :148-156.  Back to cited text no. 4
    
5.
Greisenegger S, Endler G, Hsieh K, Tentschert S, Mannhalter C, Lalouschek W. Is elevated mean platelet volume associated with a worse outcome in patients with acute ischemic cerebrovascular events? Stroke. 2004; 35 :1688-1691.  Back to cited text no. 5
    
6.
Adams HPJr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtypes of acute ischemic stroke: definitions for use in a multicenter clinical trial. TOAST (Trial of Org 10172 in Acute Stroke Treatment). Stroke 1993; 24 :35-41.  Back to cited text no. 6
    
7.
Butterworth RJ, Bath PM. The relationship between mean platelet volume, stroke subtype and clinical outcome. Platelets 1998; 9 :359-364.  Back to cited text no. 7
    
8.
Ntaios G, Gurer O, Faouzi M, Aubert C, Michel P. Mean platelet volume in the early phase of acute ischemic stroke is not associated with severity or functional outcome. Cerebrovasc Dis 2010; 29 :484-489.  Back to cited text no. 8
    
9.
Mayda-Domaç F, Misirli H, Yilmaz M. Prognostic role of mean platelet volume and platelet count in ischemic and hemorrhagic stroke. J Stroke Cerebrovasc Dis 2010; 19 :66-72.  Back to cited text no. 9
    
10.
D′Erasmo E, Aliberti G, Celi FS, Romagnoli E, Vecci E, Mazzuoli GF. Platelet count, mean platelet volume and their relation to prognosis in cerebral infarction. J Intern Med 1990; 227 :11-14.  Back to cited text no. 10
    
11.
O′Malley T, Langhorne P, Elton RA, Stewart C. Platelet size in stroke patients. Stroke 1995; 26 :995-999.  Back to cited text no. 11
    
12.
Smith NM, Pathansali R, Bath PM. Platelets and stroke. Vasc Med 1999: 4 :165-172.  Back to cited text no. 12
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  In this article
Abstract
Introduction
Aim of work
Patients and methods
Results
Discussion
Conclusion
References
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