Generic placeholder image

Current Neurovascular Research


ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

Inverted U-shaped Relationship Between Mean Platelet Volume/Platelet Count Ratio and Post-thrombolytic Early Neurological Deterioration in Patients with Mild and Moderate Stroke

Author(s): Wei Xu, Hongquan Guo, Huiping Li, Kangping Song, Fangyi Li, Zhen Wang* and Xinfeng Liu*

Volume 19, Issue 5, 2022

Published on: 21 November, 2022

Page: [495 - 504] Pages: 10

DOI: 10.2174/1567202620666221027093103

Price: $65


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.

Keywords: Intravenous thrombolysis (IVT), early neurological deterioration (END), platelet, neurological deficit, atherogenesis, prothrombotic activity, cubic spline analysis.

Seners P, Turc G, Oppenheim C, Baron JC. Incidence, causes and predictors of neurological deterioration occurring within 24h following acute ischaemic stroke: A systematic review with pathophysiological implications. J Neurol Neurosurg Psychiatry 2015; 86(1): 87-94.
[] [PMID: 24970907]
Seners P, Turc G, Tisserand M, et al. Unexplained early neurological deterioration after intravenous thrombolysis: Incidence, predictors, and associated factors. Stroke 2014; 45(7): 2004-9.
[] [PMID: 24876087]
Guo H, Xu W, Zhang X, et al. A nomogram to predict symptomatic intracranial hemorrhage after intravenous thrombolysis in Chinese patients. Neuropsychiatr Dis Treat 2021; 17: 2183-90.
[] [PMID: 34262278]
Bath PMW, Butterworth RJ. Platelet size. Blood Coagul Fibrinolysis 1996; 7(2): 157-61.
[] [PMID: 8735807]
Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: A systematic review and meta-analysis. J Thromb Haemost 2010; 8(1): 148-56.
[] [PMID: 19691485]
Oji S, Tomohisa D, Hara W, et al. Mean platelet volume is associated with early neurological deterioration in patients with branch atheromatous disease: Involvement of platelet activation. J Stroke Cerebrovasc Dis 2018; 27(6): 1624-31.
[] [PMID: 29428328]
Staszewski J, Pogoda A, Data K, et al. The mean platelet volume on admission predicts unfavorable stroke outcomes in patients treated with IV thrombolysis. Clin Interv Aging 2019; 14: 493-503.
[] [PMID: 30880930]
Quan W, Chen Z, Yang X, et al. Mean platelet volume/platelet count ratio as a predictor of 90-day outcome in large artery atherosclerosis stroke patients. Int J Neurosci 2017; 127(11): 1019-27.
[] [PMID: 28270030]
Azab B, Torbey E, Singh J, et al. Mean platelet volume/platelet count ratio as a predictor of long-term mortality after non-ST-elevation myocardial infarction. Platelets 2011; 22(8): 557-66.
[] [PMID: 21714700]
Oh GH, Chung SP, Park YS, et al. Mean platelet volume to platelet count ratio as a promising predictor of early mortality in severe sepsis. Shock 2017; 47(3): 323-30.
[] [PMID: 27504801]
Wu C, Sun C, Wang L, et al. Low-dose tirofiban treatment improves neurological deterioration outcome after intravenous thrombolysis. Stroke 2019; 50(12): 3481-7.
[] [PMID: 31570084]
David Bessman J, Williams LJ, Ridgway Gilmer P Jr. Mean platelet volume. The inverse relation of platelet size and count in normal subjects, and an artifact of other particles. Am J Clin Pathol 1981; 76(3): 289-93.
[] [PMID: 7282629]
Lamparelli RD, Baynes RD, Atkinson P, Bezwoda WR, Mendelow BV. Platelet parameters. Part I. Platelet counts and mean platelet volume in normal and pregnant subjects. S Afr Med J 1988; 73(1): 36-9.
[PMID: 3340899]
Lozano M, Narváez J, Faúndez A, et al. Platelet count and mean platelet volume in the Spanish population. Med Clin 1998; 110(20): 774-7.
[PMID: 9666418]
Du J, Wang Q, He B, et al. Association of mean platelet volume and platelet count with the development and prognosis of ischemic and hemorrhagic stroke. Int J Lab Hematol 2016; 38(3): 233-9.
[] [PMID: 26992440]
Park J, Cha MJ, Choi Y, et al. Prognostic efficacy of platelet count in patients with nonvalvular atrial fibrillation. Heart Rhythm 2019; 16(2): 197-203.
[] [PMID: 30170225]
Hsu CY, Cheng CY, Tsai YH, et al. Perfusion-diffusion mismatch predicts early neurological deterioration in anterior circulation infarction without thrombolysis. Curr Neurovasc Res 2015; 12(3): 277-82.
[] [PMID: 26044806]
Morita N, Harada M, Uno M, Matsubara S, Nagahiro S, Nishitani H. Evaluation of initial diffusion-weighted image findings in acute stroke patients using a semiquantitative score. Magn Reson Med Sci 2009; 8(2): 47-53.
[] [PMID: 19571496]
Haeusler KG, Gerischer LM, Vatankhah B, Audebert HJ, Nolte CH. Impact of hospital admission during nonworking hours on patient outcomes after thrombolysis for stroke. Stroke 2011; 42(9): 2521-5.
[] [PMID: 21799159]
Mori M, Naganuma M, Okada Y, et al. Early neurological deterioration within 24 hours after intravenous rt-PA therapy for stroke patients: the Stroke Acute Management with Urgent Risk Factor Assessment and Improvement rt-PA Registry. Cerebrovasc Dis 2012; 34(2): 140-6.
[] [PMID: 22854333]
Aiyagari V, Gujjar A, Zazulia AR, Diringer MN. Hourly blood pressure monitoring after intravenous tissue plasminogen activator for ischemic stroke: Does everyone need it? Stroke 2004; 35(10): 2326-30.
[] [PMID: 15331797]
Martin AJ, Price CI. A systematic review and meta-analysis of molecular biomarkers associated with early neurological deterioration following acute stroke. Cerebrovasc Dis 2018; 46(5-6): 230-41.
[] [PMID: 30517919]
Yu WM, Abdul-Rahim AH, Cameron AC, et al. The incidence and associated factors of early neurological deterioration after thrombolysis: Results from SITS registry. Stroke 2020; 51(9): 2705-14.
[] [PMID: 32811373]
Lin CH, Kuo YW, Kuo CY, et al. Shortened activated partial thromboplastin time is associated with acute ischemic stroke, stroke severity, and neurological worsening. J Stroke Cerebrovasc Dis 2015; 24(10): 2270-6.
[] [PMID: 26169548]
Chen SY, Lin YS, Cheng YF, Wang H, Niu XT, Zhang WL. Mean platelet volume-to-lymphocyte ratio predicts poor functional outcomes among ischemic stroke patients treated with intravenous thrombolysis. Front Neurol 2019; 10: 1274.
[] [PMID: 31920909]
Nageeb RS, Abozaid MMN, Nageeb GS, Omran AA. Mean platelet volume to platelet count ratio as a laboratory indicator of mortality in pneumonia following ischemic stroke. Egypt J Neurol Psychiat Neurosurg 2018; 54(1): 27.
[] [PMID: 30363799]
Biino G, Santimone I, Minelli C, et al. Age and sex-related variations in platelet count in Italy: A proposal of reference ranges based on 40987 subjects’ data. PLoS One 2013; 8(1): e54289.
[] [PMID: 23382888]
Verdoia M, Schaffer A, Barbieri L, et al. Impact of age on mean platelet volume and its relationship with coronary artery disease: A single-centre cohort study. Exp Gerontol 2015; 62: 32-6.
[] [PMID: 25562813]
Birschel P, Ellul J, Barer D. Progressing stroke: Towards an internationally agreed definition. Cerebrovasc Dis 2004; 17(2-3): 242-52.
[] [PMID: 14718754]
Nakase T, Yamamoto Y, Takagi M, et al. The impact of diagnosing branch atheromatous disease for predicting prognosis. J Stroke Cerebrovasc Dis 2015; 24(10): 2423-8.
[] [PMID: 26236003]
Takahashi Y, Yamashita T, Morihara R, et al. Different characteristics of anterior and posterior branch atheromatous diseases with or without early neurologic deterioration. J Stroke Cerebrovasc Dis 2017; 26(6): 1314-20.
[] [PMID: 28365073]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy