Mean platelet volume is a marker of inflammation but not a marker of disease activity in children with juvenile SLE

Aim of the workTo study the mean platelet volume (MPV) in children with juvenile-onset SLE (Jo-SLE), and whether MPV can be used as a biologic marker for disease activity or flare.Patients and methodsTwenty-nine patients from the rheumatology outpatient clinic, Pediatric Cairo University Hospitals and age 36 and gender matched healthy controls were included in the study. The MPV was determined within 4 h of blood sampling in all study populations. Recent routine laboratory investigations for Jo-SLE patients were obtained. Disease activity was estimated using SLE disease activity index (SLEDAI).Results29 Jo-SLE patients had a mean age of 12.8 ± 2.9 years and disease duration of 3.5 ± 3 year. The most frequent clinical manifestations were photosensitivity, malar rash, followed by arthritis and serositis. The MPV in Jo-SLE patients was 8.2 ± 2.1 femtoliters (fL) compared with 5.6 ± 0.9 fL in healthy controls (p < 0.001). There was no significant difference between MPV in 18 active patients (8.3 ± 2.1 fL) compared to 11 patients with inactive disease (8.1 ± 2.5 fL). Furthermore, there were no significant correlations between the MPV and SLEDAI score (r = −0.19, p = 0.33), or between MPV and other disease parameters routinely used to estimate disease activity or flare.ConclusionResults of the present study confirm the association between MPV and inflammation, but do not support the use of MPV as an indicator for monitoring disease activity or flare in juvenile SLE. Further longitudinal studies with larger numbers of patients are warranted to unveil the possibility of using MPV as a biologic marker of disease activity.     

Mean platelet volume as an inflammatory marker in patients with severe periodontitis

Periodontitis has become the leading cause of tooth loss in adults, and the host’s immunologic and inflammatory response to the bacteria can lead to periodontal destruction. In patients with periodontitis, platelets possess an increased activation status compared with platelets from healthy controls. Mean platelet volume (MPV) has been considered an important index of platelet activity and an inflammatory marker in many infectious diseases. The present study investigated the relationship between MPV and disease activity in subjects with severe periodontitis. Forty-five patients with periodontitis and 45 age and sex-matched healthy subjects were enrolled into the study. All subjects received periodontal and hematological examinations. The periodontitis patients were administered active periodontal treatment (APT). At baseline, a statistically significant decrease in MPV was noted in patients with periodontitis (9.73?±?1.06 fL) compared with healthy controls (10.24?±?1.07 fL). At 1 month post-APT, MPV was substantially increased (10.11?±?1.04 fL). Positive correlation was found between increase of MPV and decrease of periodontal probing depth after treatment(r?=?0.377; p?=?0.014). In conclusion, the decrease of MPV was related to the severe periodontal inflammation, and the value inversed shift after APT. MPV might reflect the disease activity of periodontitis.     

Red cell distribution width: a novel marker of activity in inflammatory bowel disease

Background/Aims

Studies concerning red cell distribution width (RDW) for use in the assessment of inflammatory bowel disease (IBD) activity are limited. We investigated whether RDW is a marker of active disease in patients with IBD.

Methods

In total, 61 patients with ulcerative colitis (UC) and 56 patients with Crohn''s disease (CD) were enrolled in the study group, and 44 age- and-sex-matched healthy volunteers were included as the control group. A CD activity index >150 in patients with CD indicated active disease. Patients with moderate and severe disease based on the Truelove-Witts criteria were considered to have active UC. In addition to RDW, serum C-reactive protein levels, erythrocyte sedimentation rates, and platelet counts were measured.

Results

Twenty-nine (51.7%) patients with CD and 35 (57.4%) patients with UC had active disease. The RDW was significantly higher in patients with CD and UC than in controls (p<0.001 and p<0.001, respectively). A subgroup analysis indicated that for a RDW cut-off of 14%, the sensitivity for detecting active CD was 79%, and the specicity was 93% (area under curve [AUC], 0.935; p<0.001). RDW was the most sensitive and specific marker for active CD. However, it was not valid for UC, as the ESR at a cutoff of 15.5 mm/hr showed a sensitivity of 83% and a specicity of 76% (AUC, 0.817; p<0.001), whereas the RDW at a cutoff of 14% showed 17% sensitivity and 84% specicity for detecting active UC.

Conclusions

RDW was elevated in IBD in comparison with healthy controls and increased markedly in active disease. RDW may be a sensitive and specific marker for determining active CD, whereas ESR is an important marker of active UC.     

Urinary excretion of N-methylhistamine as a marker of disease activity in inflammatory bowel disease

OBJECTIVE: Mast cells are thought to participate in the pathogenesis of inflammatory bowel disease (IBD). In this study, urinary excretion of N-methylhistamine (UMH), a stable metabolite of the mast cell mediator histamine, was evaluated as an indicator of disease activity in patients with IBD. METHODS: Urinary excretion of UMH (microg/mmol creatinine x m2 body surface area) was measured by radioimmunoassay in 55 controls, 56 patients with Crohn's disease, and in 36 patients with ulcerative colitis. Excretion rates were correlated with clinical, serological, and endoscopic disease activity, disease extent, and location. RESULTS: Urinary excretion of UMH was found to be significantly elevated in IBD. Patients with active Crohn's disease (7.1 +/- 4.2, p = 0.002 vs controls) and active ulcerative colitis (8.1 +/- 4.8, p = 0.02 vs controls) had higher rates of UMH excretion than patients in remission (6.3 +/- 3.8 and 5.2 +/- 2.3, respectively) or controls (4.6 +/- 1.9). In Crohn's disease and ulcerative colitis, a significant correlation of UMH excretion with clinical disease activity was obtained (Crohn's Disease Activity Index r2 = 0.58, Clinical Activity Index r2 = 0.57, p < 0.0001). Serologically, orosomucoid showed the best positive correlation with disease activity (Crohn's Disease Activity Index r2 0.80, Clinical Activity Index r2 = 0.86, p < 0.0001), but UMH excretion was found to reflect disease activity more accurately than C-reactive protein (Crohn's Disease Activity Index r2 = 0.46, Clinical Activity Index r2 = 0.42, p < 0.0001). No association between UMH excretion and disease type or localization could be found in Crohn's disease. However, UMH excretion correlated strongly with endoscopic severity of inflammation in Crohn's disease (Crohn's Disease Endoscopic Index of Severity r2 = 0.70, p < 0.0001) or disease extent in ulcerative colitis. CONCLUSIONS: Urinary excretion of the histamine metabolite UMH is enhanced in IBD. It appears to represent an integrative parameter to monitor clinical and endoscopic disease activity in IBD, which appears to be influenced most likely by mediators released from histamine-containing cells, such as intestinal mast cell subtypes.     

The platelet indices in patients with rheumatoid arthritis: Mean platelet volume reflects disease activity

The present study was designed to investigate the interaction between platelet indices, inflammatory markers and disease activity in rheumatoid arthritis (RA) subjects. The effects of anti-TNF-α therapy and conventional treatment on platelet indices were also compared. We studied 97 patients with RA (19 men, 78 women: mean age 51 years) and 33 age and sex-matched healthy subjects as a control group. All RA patients were administered conventional therapy. After 3 months of therapy, 35 subjects who had high disease activity score (DAS28 > 5.1) were grouped as non-responders and were administered infliximab as a TNF-α blocker at the standard intravenous dose. Responders to the conventional therapy and non-responders were also compared. At baseline white blood cell (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet count and mean platelet volume (MPV) were significantly higher in patients with RA. Mean platelet volume was positively correlated with DAS28 score (r = 0.27; p = 0.007). These markers of inflammation and platelet indices were substantially decreased after therapy. The reductions were similar in responders to conventional therapy and non-responders (TNF alpha group). In conclusion, we found that MPV was correlated with inflammatory markers and disease activity in patients with RA. Both anti-TNF-alpha and conventional therapy decreases markers of inflammation and platelet indices. MPV can reflect both disease activity and response to treatment.     

An overlooked indicator of disease activity in ulcerative colitis: Mean platelet volume

Many non-invasive tests have been studied for diagnosis and determining the activation degree of inflammatory bowel disease (IBD). Nevertheless, an ideal test has not been found yet. Mean platelet volume (MPV) is influenced by the inflammation. In a few study, decreased platelet volume have been reported in IBD. The aim of this study is to determine whether platelet volume would be useful in ulcerative colitis (UC) activity. Additionally we have analyzed overall accuracy of MPV in disease activity and compared with other inflammatory markers. A total of 61 UC patients (male/female : 41/20), and 27 healthy subjects (male/female : 18/9) were enrolled into the study. For all subjects following tests were performed; ESR, CRP, white blood cell count and mean platelet volume. A statistically significant decrease in MPV was noted in patients with UC (8.29 ± 1.02fL) compared with healthy controls (8.65 ± 0.79 fL). MPV of active UC (8.06 ± 1.19 fL) patients were significantly lower than that of inactive UC (8.45 ± 0.87 fL). Overall accuracy of MPV in determination of active UC was 71% (with sensitivity 67%, specificity 73%). A negative correlation was found between MPV and endoscopic activity index (r : -0.358 p : 0.005). In UC, MPV did not correlate with ESR, CRP and white blood cell. Our study showed that MPV reduced in UC, particularly in patients with active UC. Decreased MPV may be an indicator for increased disease activity in patients with UC.     

Mean platelet volume is elevated during paroxysmal atrial fibrillation: a marker of increased platelet activation?

Paroxysmal atrial fibrillation might be a risk factor for stroke such as chronic atrial fibrillation. We examined the relation between mean platelet volume and paroxysmal atrial fibrillation to determine the effect of paroxysmal atrial fibrillation on the thrombotic state via elevated mean platelet volume. Mean platelet volume is a marker of platelet size, function, and activation. Increased mean platelet volume reflects active and large platelets that release more thromboxane A2 than smaller ones. We hypothesized that mean platelet volume is elevated in patients with paroxysmal atrial fibrillation. The study population comprised 103 consecutive patients who were detected to have paroxysmal atrial fibrillation by 24-h Holter monitoring and 87 control individuals with normal Holter monitoring. Mean platelet volume and inflammatory parameters were measured. Comprehensive clinical and echocardiographic data were collected. Patients with aortic and mitral stenosis, hyperthyroidism, hypothyroidism, malignancy, infection, and pregnancy were excluded from the study. Mean age of the patients was 63 +/- 11 vs. 45 +/- 14 years (P < 0.001) in paroxysmal atrial fibrillation and control groups, respectively. Fifty-seven patients (55%) in paroxysmal atrial fibrillation and 19 (21%) (P < 0.001) patients in control group were men. Mean platelet volume was significantly higher in the paroxysmal atrial fibrillation group when compared with control group (10.0 +/- 2.0 vs. 8.3 +/- 1.5 fl, respectively; P < 0.001). C-reactive protein (18.5 +/- 28 vs. 3.8 +/- 2 mg/l, respectively; P = 0.004) and erythrocyte sedimentation rate (21 +/- 21 vs. 12 +/- 7 mm/h, respectively; P = 0.01) were also higher in the paroxysmal atrial fibrillation group. There was no difference in white blood cell and platelet counts between groups. In a multivariate analysis, elevated mean platelet volume was associated with the occurrence of paroxysmal atrial fibrillation before and after adjustment for age and sex. Our results indicate that inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate and the marker of platelet size and activity mean platelet volume are elevated in patients with paroxysmal atrial fibrillation.     

Mean platelet volume as an indicator of disease activity in juvenile SLE

The aim of the study was to assess mean platelet volume (MPV) in children with systemic lupus erythematosus (SLE) at the active and inactive stages. Twenty children with SLE and 30 age- and gender-matched controls were enrolled. Demographic data, SLE disease activity index (SLEDAI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), MPV, complement 3 (C3), complement 4 (C4), urine protein (Up), and urine creatinine (Ucr) values upon reactivation and remission phases were recorded. MPV was statistically higher in patients than in controls and significantly increased in active phase compared to inactive phase (p?=?0.001). A MPV level of 8.4 fL was determined as predictive cutoff value of activation of SLE (sensitivity 75 %, specificity 90 %). MPV was positively correlated with SLEDAI (p?=?0.01, r?=?0.55), ESR (p?=?0.01, r?=?0.45), CRP (p?=?0.04, r?=?0.24), and Up/Ucr (p?=?0.01, r?=?0.45) and negatively correlated with C3 (p?=?0.02, r?=??0.36), albumin (p?=?0.01, r?=??0.63), and Hb (p?=?0.01, r?=??0.48). There was not any significant association between MPV and the histological classification of lupus nephritis (p?=?0.65). MPV might be used as an early indicator of reactivation in children with SLE. MPV seemed to be more accurate than ESR, CRP, and C3 for monitoring the disease activity in SLE.     

Leucocyte elastase in chronic inflammatory bowel diseases: a marker of inflammatory activity?

Leucocyte elastase is a neutral proteinase which plays an important role in the pathogenesis of inflammatory disorders. Infiltration of bowel mucosa by neutrophil and eosinophilic granulocytes is a characteristic feature of chronic inflammatory bowel diseases. We studied plasma elastase in 44 patients suffering from Crohn's disease or ulcerative colitis. Plasma levels were significantly higher in these patients compared to 7 patients with non-inflammatory bowel diseases or 53 healthy controls. Elevated plasma levels were more often found in patients with active inflammation than in those with inactive disease. Elastase did neither correlate with leucocyte counts, serum albumin, ESR, alpha 1-proteinase inhibitor and orosomucoid nor with clinical indices or the faecal excretion of 111In-labelled granulocytes. In serial studies of 15 patients, elastase did not always run parallel to the disease activity. We conclude that plasma elastase does not reliably indicate the inflammatory activity in chronic inflammatory bowel diseases.     

C-reactive protein as a marker for inflammatory bowel disease

The production of CRP occurs almost exclusively in the liver by the hepatocytes as part of the acute phase response upon stimulation by IL-6, TNF-alphaand IL-1-betaoriginating at the site of inflammation. Its short half-life makes CRP a valuable marker to detect and follow up disease activity in Crohn's disease (CD). In contrast, ulcerative colitis has only a modest to absent CRP response despite active inflammation, and the reason for this is unknown. In CD, serum levels of CRP correlate well with disease activity and with other markers of inflammation as the CDAI, serum amyloid, IL-6 and faecal calprotectin. CRP is a valuable marker for predicting the outcome of certain diseases as coronary heart disease and haematological malignancies. An increased CRP (>45 mg/L) in patients with IBD predicts with a high certainty the need for colectomy and this by reflecting severe ongoing and uncontrollable inflammation in the gut. Finally, trials with anti-TNF and anti-adhesion molecules have shown that a high CRP predicts better response to these drugs. However, whether we need to include CRP as an inclusion criterion for future trials with biologicals is still a matter of debate.     

Mean platelet volume is a useful parameter: a reproducible routine method using a modified Coulter thrombocytometer

The principal physiological function of platelets is to promote haemostasis but they also contribute to thrombosis and atherogenesis. Platelet volume is a marker and possibly a determinant of platelet function in that large platelets are more active than normal sized platelets. Mean platelet volume (MPV), a measure of platelet size, reflects changes in either the level of platelet stimulation or the rate of platelet production. For these reasons, we have developed a sensitive instrument to measure platelet volume, which we believe is more reliable and specific than previously used instruments. It is based on a computer-interfaced Coulter Thrombocytometer and a pulse analyser including a high-speed baseline restorer. We have developed a reproducible method to assay MPV and from the histogram derived the median (MED) and the skewness (SK) values. We have looked at the effects of anticoagulant used and time elapse prior to assay. A normal range has been established for MPV which correlates directly with MED and inversely with SK. The MPV decreases with age but there is no difference between genders. We have demonstrated a negative correlation between whole blood platelet number and MPV and MED, and a direct relationship with the SK of the histogram of the platelet volume.     

Mean platelet volume is a useful parameter: a reproducible routine method using a modified Coulter Thrombocytometer

The principal physiological function of platelets is to promote haemostasis but they also contribute to thrombosis and atherogenesis. Platelet volume is a marker and possibly a determinant of platelet function in that large platelets are more active than normal sized platelets. Mean platelet volume (MPV), a measure of platelet size, reflects changes in either the level of platelet stimulation or the rate of platelet production. For these reasons, we have developed a sensitive instrument to measure platelet volume, which we believe is more reliable and specific than previously used instruments. It is based on a computer - interfaced Coulter Thrombocytometer and a pulse analyser including a high - speed baseline restorer. We have developed a reproducible method to assay MPV and from the histogram derived the median (MED) and the skewness (SK) values. We have looked at the effects of anticoagulant used and time elapse prior to assay. A normal range has been established for MPV which correlates directly with MED and inversely with SK. The MPV decreases with age but there is no difference between genders. We have demonstrated a negative correlation between whole blood platelet number and MPV and MED, and a direct relationship with the SK of the histogram of the platelet volume.