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.
Highlights
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)
Risk stratification and prognostication is of great importance in patients who present to emergency department with acute PTE, and follows two main purposes: Identifying low-risk patients that can be treated as an outpatient and finding high-risk cases that may benefit from second-line therapies such as thrombolysis or surgical embolectomy
mean platelet volume (MPV) with a cut-off point of 9.85 fl has a sensitivity and specificity of 81% and 50%, respectively in predicting inhospital mortality in patients with acute PTE, but it had lower performance in predicting composite endpoints (i.e. Major adverse cardiopulmonary events (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)
Summary
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). 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. 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. Established PTE risk scoring models such as simplified PESI outperform these indices in predicting adverse outcomes. Higher MPV (i.e. larger platelets) is shown to be associated with the presence of more granules, higher levels of thromboxane A2, rapid aggregation with collagen, and more glycoprotein Ib and IIb/IIIa receptors.[5,6]
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