Title:Inverted U-shaped Relationship Between Mean Platelet Volume/Platelet
Count Ratio and Post-thrombolytic Early Neurological Deterioration in
Patients with Mild and Moderate Stroke
Volume: 19
Issue: 5
Author(s): Wei Xu, Hongquan Guo, Huiping Li, Kangping Song, Fangyi Li, Zhen Wang*Xinfeng Liu*
Affiliation:
- Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical
School, University of South China, Changsha, Hunan, 410004, China
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing,
Jiangsu, 210002, China
Keywords:
Intravenous thrombolysis (IVT), early neurological deterioration (END), platelet, neurological deficit, atherogenesis, prothrombotic activity, cubic spline analysis.
Abstract:
Objective: The objective of this study is to investigate the relationship between mean
platelet volume (MPV)/platelet count (PC) ratio and post-thrombolytic early neurological deterioration
(END) in patients with mild and moderate stroke.
Methods: Mild and moderate stroke patients treated with intravenous thrombolysis (IVT) at the
Affiliated Changsha Central Hospital of the University of South China between January 2016 and
March 2022 were prospectively and consecutively enrolled. END was defined as an increase in the
total National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points or an increase in the
motor items of ≥1 point within 24 hours after IVT treatment. Logistic regression and restricted cubic
spline models were used to estimate the relationship between the MPV/PC ratio and postthrombolytic
END.
Results: Among the 406 patients recruited, 64 (15.8%) patients developed END. Patients in the first
quintile of MPV/PC ratio (adjusted OR = 0.27, 95% CI = 0.11-0.66, p = 0.004) and the fifth quintile
(adjusted OR = 0.26, 95% CI = 0.10-0.69, p = 0.007) had a significantly lower risk of END compared
with those in the third quintile. Restricted cubic spline analysis revealed an inverted U-shaped
relationship between the MPV/PC ratio and END (p for nonlinearity = 0.016). MPV/PC ratio cut-off
value associated with the highest END risk was 51.0. An MPV/PC ratio ≤ 51.0 was shown to be
positively associated with END (adjusted OR = 1.07, 95% CI = 1.02-1.14, p = 0.012), while an
MPV/PC ratio >51.0 was negatively associated with END (adjusted OR = 0.94, 95% CI = 0.88-1.00,
p = 0.040). A significant interaction existed between the MPV/PC ratio and age in the low MPV/PC
ratio group (p = 0.012). MPV/PC ratio was positively associated with END only in patients ≥ 60
years, whereas this association was insignificant in patients < 60 years.
Conclusion: An inverted U-shaped relationship between the MPV/PC ratio on admission and postthrombolytic
END was identified in patients with mild and moderate stroke, with a threshold
MPV/PC ratio of 51.0. The MPV/PC ratio closer to the threshold was associated with a higher risk
of post-thrombolytic END.