Trends of Platelet Volume Index Predicts Delayed Cerebral Ischemia after Subarachnoid Hemorrhage.

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Trends of Platelet Volume Index Predicts Delayed Cerebral Ischemia after Subarachnoid Hemorrhage.

World Neurosurg. 2017 Dec 29;:

Authors: Ray B, Tinsley L, Ford L, Thompson DM, Sidorov EV, Bohnstedt BN

Abstract
BACKGROUND: Delayed cerebral ischemia (DCI) is a major cause of disability after aneurysmal subarachnoid hemorrhage (aSAH). Activated platelets are surrogate markers for DCI occurrence and are reliably represented by mean platelet volume (MPV) to platelet count (PLT) ratio. If validated, as a predictor of DCI, the ratio will allow clinicians to use it as a readily available tool in patient management.
METHODS: Retrospective analysis of aSAH patient database at a tertiary care hospital. MPV:PLT ratio was defined as (MPVvalue(fL)PLTper1000∗100). Non-linear regression estimated differences in the ratio's pattern of change over time between those with or without DCI. Receiver operating characteristic (ROC) curve determined optimal threshold of rise in MPV:PLT ratio to predict DCI.
RESULTS: Average age of the cohort (n=169) was 53.0±13.0 years and 38 patients (22.5%) developed DCI. Non-linear regression analysis detected a transition of rising and declining MPV:PLT ratio at 3 days after aSAH. Rate of rise in MPV:PLT ratio was 0.5 units/day (95% CI, 0.3, 0.7) in patients developing DCI as compared to 0.2 units/day (95% CI, 0.1, 0.3) in those without DCI (p=0.0004). ROC analysis determined a threshold of 0.33 units/day rise in MPV:PLT predicted DCI with 89.5% sensitivity and 90.8% specificity. Patients who expired demonstrated a steeper rise during the first 3 days (0.29 units/day) than those who were discharged home (0.21 units/day) [p=0.004].
CONCLUSION: Trend of MPV:PLT ratio after aSAH predicts DCI. This association alludes to significant early rise in reactive platelet population after aSAH in patients developing DCI.

PMID: 29292187 [PubMed - as supplied by publisher]

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