Abstract
BackgroundPlatelets have a vital role in antimicrobial host defenses. The objective of this study was to evaluate if increased mean platelet volume to platelet count (MPV/PC) ratio in acute ischemic stroke patients complicated with pneumonia was associated with increased mortality risk.MethodsThe current study was conducted at Zagazig University Hospitals. It included 500 acute ischemic stroke patients classified as group 1 that included 51 patients complicated with pneumonia after admission and group 2 that included the remaining 449 patients. Clinical assessment was carried out to exclude comorbid medical illnesses likely to interfere with platelet function or morphology. Laboratory investigations including MPV/PC ratio and brain imaging were carried out for all patients.ResultsThere was a significant difference between both groups regarding age, National Institutes of Health Stroke Scale (NIHSS) score, and mortality within 30 days (p = 0.02, 0.03, 0.01). There was a significant difference between survivors and non-survivors of group 1 regarding to pneumonia severity index (PSI) classes IV and V (p = 0.01 and 0.02, respectively). Also, there was a significant difference regarding confusion, urea ≥ 7 mmol/L, respiratory rater ≥ 30 breaths/min, systolic blood pressure ≤ 90 mmHg or diastolic blood pressure ≤ 60 mmHg, and age ≥ 65 years at pneumonia occurrence (CURB-65) scores 3, 4, and 5 (p = 0.03, 0.02, and 0.01, respectively). Moreover, there was a significant difference regarding decreased GCS score at pneumonia occurrence, higher NIHSS scores, PSI, and higher MPV/PC ratio (p = 0.01, 0.01, 0.028, and 0.01, respectively). Age > 65 years, need for mechanical ventilation, GCS score of > 9, PSI class ≥ IV, CURB-65 scores ≥ 3, and increased MPV/PC ratio were all significantly associated with 30-day mortality in group 1 (p = 0.03, 0.01, 0.001, 0.04, 0.01, and 0.03, respectively). The predictors of 30-day mortality risk factors were GCS less than 9, increased MPV/PC ratio, and CURB-65 scores ≥ 3 (p = 0.001, 0.05, and 0.01, respectively).ConclusionsOnce pneumonia develops, MPV/PC ratio could be considered a significant laboratory indicator of 30-day mortality.
Highlights
Platelets have a vital role in antimicrobial host defenses
There was a significant difference between group 1 and group 2 regarding age (p = 0.02), National Institutes of Health Stroke Scale score, and number of cases that died within 30 days of admission (p = 0.03 and 0.01, respectively) (Table 1)
The aim of the present study was to investigate the association of increased mean platelet volume to platelet count (MPV/PC) ratio with increased 30-day mortality in hospitalized acute ischemic stroke patients complicated with pneumonia
Summary
Platelets have a vital role in antimicrobial host defenses. The objective of this study was to evaluate if increased mean platelet volume to platelet count (MPV/PC) ratio in acute ischemic stroke patients complicated with pneumonia was associated with increased mortality risk. Pneumonia causes the highest attributable mortality of all medical complications following stroke (Alberti et al 2011). Stroke causes neurogenic dysphagia that besides limiting food intake, it carries a greater risk of malnutrition and tracheal aspiration and triples the incidence of aspiration pneumonia (Baroni et al 2012). This higher risk is due to the possibility of silent aspiration (without cough reflex), micro aspiration, impairment of the laryngeal closure mechanism, delayed swallow initiation, motor dysfunction of the pharynx, presence of pharyngeal residues at epiglottic valleculae, pyriform sinuses, and posterior wall of the pharynx (Nunes et al 2012).
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