Abstract
Mean platelet volume (MPV) was recently published as a possible marker of coronary artery disease in patients at high risk for major adverse cardiac events. Because platelets play an important role in atherosclerosis, we examined the relationship between critical limb ischemia (CLI) and MPV in patients with peripheral arterial occlusive disease (PAOD). Our study comprised 2124 PAOD patients. Univariate logistic regression was performed to analyze potential predictors for CLI. Nagelkerke’s R² is reported. Cross validation was performed using the leave-one-out principle. ROC analyses were performed to identify the best cut off value for MPV predicting CLI; to this end, Youden’s index was calculated. For CLI diabetes (p < 0.001, OR 2.44, 95% CI 1.97–3.02), hsCRP (p < 0.001, OR 1.01, 95% CI 1.01–1.01), age (p < 0.001, OR 1.05, 95% CI 1.04–1.06), thrombocytosis (p = 0.025, OR 1.84, 95%CI 1.08–3.14), and MPV (p = 0.003, OR 0.84, 95% CI 0.75–0.94) were significant independent predictors for CLI. ROC analysis (AUC: 0.55, 95% CI 0.52–0.58, p < 0.001) showed ≤10.2 as the best cut off value for MPV to predict CLI. As there is a significant relationship between low MPV and a high risk for CLI in PAOD patients, MPV can be used to identify patients who are likely to develop CLI.
Highlights
Peripheral arterial occlusive disease (PAOD), a common disorder, must be diagnosed and treated promptly if progression to critical limb ischemia (CLI), with its high mortality and risk of limb amputation, is to be avoided[1,2]
As CLI has not yet been included as a vascular endpoint in published studies, and since platelets seem to be substantially involved in vascular disease, we looked into the association of Mean platelet volume (MPV) with CLI and other vascular endpoints in our peripheral arterial occlusive disease (PAOD) cohort
Multivariate logistic regression analysis (R2 = 0.199) revealed that presence of diabetes (p < 0.001, odds ratio (OR): 2.4 95%CI: 2.0–3.0) and thrombocytosis (p = 0.025, OR: 1.84 95%CI: 1.08–3.14), higher hsCRP (p < 0.001, OR: 1.012 95%CI: 1.008– 1.014) and age (p < 0.001, OR: 1.05 95%CI: 1.04–1.06) and lower MPV (p = 0.003, OR: 0.84 95%CI: 0.75–0.94) were significant variables associated with CLI (Table 2) with highest absolute values of standardized estimates for age (0.31) hsCRP (0.23) and presence of diabetes (0.23)
Summary
Peripheral arterial occlusive disease (PAOD), a common disorder, must be diagnosed and treated promptly if progression to critical limb ischemia (CLI), with its high mortality and risk of limb amputation, is to be avoided[1,2]. Despite new and improved treatment options developed in recent years, CLI still often leads to amputation and/ or death[3,4]. Platelets play a crucial role in the development of CLI, as there is a high risk for vascular endpoints with a high platelet count. In recent years MPV has been discussed as a potential marker to identify atherosclerosis patients at high risk for an unfavorable outcome. Coronary artery disease (CAD) patients with high MPV seem to be at an especially high risk of death compared to those with low MPV9. As CLI has not yet been included as a vascular endpoint in published studies, and since platelets seem to be substantially involved in vascular disease, we looked into the association of MPV with CLI and other vascular endpoints in our PAOD cohort
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