May mean platelet volume levels be a predictor in the diagnosis of pelvic inflammatory disease?

Investigation of neutrophil/lymphocyte ratio and mean platelet volume in patients diagnosed with preterm labor

BACKGROUND

To investigate the level of neutrophil/lymphocyte ratio (NLO) and mean platelet volume (MPV) in preterm birth in patients who gave birth before 37 weeks.

METHOD

This study was conducted by a retrospective examination of the patients who gave birth with preterm labor diagnosis from January 2017 to May 2018 at Ankara Keçiören Training and Research Hospital, Obstetrics and Gynecology Clinic. The study included 138 patients. Patients were divided into three groups: Early Preterm (delivery before 34 weeks, Group I = 39), Late Preterm (delivery between 34 and 37 weeks, Group II = 59) and the Control Group (delivery after 37 weeks, Group III = 40). All three groups were compared with respect to demographic, obstetric and laboratory results, MPV and NLO parameters.

RESULTS

The difference between the groups was not significant when the patients were compared in terms of age, gravida, parity, fetal sex and smoking. When the three groups were compared in terms of leukocyte, neutrophil, lymphocyte, hemoglobin, MPV and NLO, NLO was higher and MPV rate was lower in the preterm birth group, which was significant (p < 0.05). When the preterm delivery group was further divided as early preterm (<34 weeks) and late (34-37 weeks) preterm delivery group, the NLO rate was higher in the former group, while MPV was lower and the difference was significant (p < 0.05). When the patients were compared in terms of caesarean and vaginal delivery, 58.6% (81) of the total patients were delivered vaginally and 41.4% (57) were delivered by caesarean section. The most common cesarean indication was a previous caesarean section history. Subsequent indications included breech presentation, fetal distress, oligohydramnios, cephalo-pelvic disproportion (CPD), and placenta previa, respectively. The C-section rate was higher in the preterm group when the groups were compared in terms of the mode of delivery, and the difference between them was significant (p < 0.05).

CONCLUSION

NLO and MPV may be decisive as a proinflammatory process marker in patients who give birth before 37 weeks. Preterm births and fetuses of pregnant women with high NLO and low MPV may be considered to be likely to go to the neonatal care unit.

Pelvic inflammatory disease in the adolescent and young adult: An update

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).

Diagnostic and prognostic role of mean platelet volume and mean platelet volume/platelet ratio in the most common soft tissue sarcomas

Objectives

This study aims to investigate the diagnostic and prognostic role of mean platelet volume (MPV) and MPV/platelet (PLT) ratio in the most common soft tissue sarcomas.

Patients and methods

We retrospectively investigated 131 patients (76 males, 55 females; mean age: 51.8±17.1; range, 18 to 87 years) with soft-tissue sarcomas between January 2011 and January 2019. Demographic features, MPV, PLT counts, mortality, and recurrence records of the patients were obtained from archives. A total of 165 healthy volunteers (101 males, 64 females; mean age 52.9±4.1; range, 18 to 60 years) who applied to the outpatient clinic in 2019 and had routine blood control without any additional disease formed the control group.

Results

A total of 55 patients were diagnosed with liposarcoma and 76 with pleomorphic sarcoma. Of the tumors, 77.1% were located in the lower limbs. Lesions were mostly localized on the thigh 48.8% (n=64). Recurrence occurred in 28.2% of the patients. A total of 25 (19.1%) patients were exitus. The mean follow-up period of the patients was 34.4±19.1 (range, 9 to 112) months. The mean PLT value of the patient group was significantly higher than the control group. The median MPV and MPV/PLT ratio were statistically significantly lower in the patient group than in the control group. The MPV and MPV/PLT ratio were not associated with mortality and recurrence.

Conclusion

As a result, MPV and MPV/PLT ratio can be used as a diagnostic support parameter in soft tissue sarcomas, but have no prognostic value.

An Adjunct Indicator for the Diagnosis of Fracture-Related Infections: Platelet Count to Mean Platelet Volume Ratio

Introduction: Fracture-related infection (FRI) is a common complication associated with orthopaedic fracture care. Diagnosing these complications in the preoperative setting is difficult. Platelets are a known acute phase reactant with indices that change in accordance with infection and inflammation. The purpose of our study was to assess the diagnostic utility of platelet indices at assessing FRI. Methods: A retrospective review performed for all patients who underwent revision surgery for fracture nonunion between 2013 and 2018. Radiographs were employed to define nonunion. Intraoperative cultures were used to define FRI. Receiver operator characteristic (ROC) curve analysis was used to assess the diagnostic ability of preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and the platelet count/mean platelet volume ratio (P/V) at recognizing FRI. Results: Of the 53 revision surgeries that were performed for fracture nonunion, 17 (32.1%) were identified as FRI. There were no significant demographic differences between the two cohorts. Patients with FRIs exhibited higher values for ESR (54.82 vs. 19.16, p<0.001), CRP (0.90 vs. 0.35, p=0.003), and P/V (37.4 vs. 22.8, p<0.001) as compared to those within the aseptic nonunion cohort. ROC curve analysis for P/V demonstrated that at an optimal ratio of 23, area under the curve (AUC) is 0.814, specificity is 55.6%, and sensitivity is 100.0%. There was no significant difference in the diagnostic performance of the serum biomarkers but only ESR and P/V had an AUC greater than 0.80. The negative predictive value (NPV) for P/V, ESR, and CRP was 100.0%, 84.6%, and 78.6%, respectively. Conclusion: The P/V ratio may serve as a reliable screening test for FRI.

Menstrual problems in adolescence: relationship to serum vitamins A and E, and systemic inflammation

BACKGROUND

Vitamin status and inflammatory mechanisms may be related to menstrual cycle abnormalities. We investigated the associations between serum fat soluble vitamin (vitamins A and E) concentrations and biomarkers of inflammation and antioxidant status with menstrual characteristics, primary dysmenorrhea (PD) and premenstrual syndrome (PMS) in healthy adolescents.

METHODS

A total of 897 adolescent girls either suffering from PMS (n = 134), PD (n = 322), PMS and PD (n = 293) or healthy adolescents (n = 148) were recruited. Serum vitamin A and E, high-sensitivity C-reactive protein (hs-CRP), antibody titers to Hsp27 (anti-Hsp27), serum prooxidant-antioxidant balance (PAB), WBC, mean platelet volume (MPV), and platelet distribution width (PDW) and RBC distribution width (RDW) were measured. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and RDW-to-platelet ratio (RPR) were calculated.

RESULTS

Girls with long bleeding periods had lower concentrations of serum vitamin E compared to those who reported a normal period duration. There were significantly differences between the groups reporting oligomenorrhea, regular menses and polymenorrhea with respect to NLR, RPR, MPV and PDW. Logistic regression demonstrated that the presence of both PMS and PD was positively related to higher serum hs-CRP, PAB and NLR, while serum vitamin A level was inversely related to the presence of PMS.

CONCLUSIONS

We found that serum vitamin A, hs-CRP, PAB and NLR are significantly associated with the presence of PMS and PD. Inflammatory processes may contribute to the etiology, symptoms and severity of menstrual disorders. Prospective studies are needed to elucidate the possibility of targeting oxidative stress and inflammatory process for the amelioration of menstrual symptoms.

The predictive role of CA-125 in the management of tubo-ovarian abscess. A retrospective study

OBJECTIVE

Tubo-ovarian abscess (TOA) is a well-established sequel of acute pelvic inflammatory disease (PID). While as up to 25% of women will experience conservative treatment failure, the factors associated with treatment failure are not clearly-established, and the role of Cancer antigen 125 (CA-125) is under-studied. We aim to evaluate the role of CA-125 in the conservative management of TOA.

STUDY DESIGN

A retrospective cohort study conducted at tertiary university-affiliated hospital during 2007-2018. Ninety one patients were diagnosed with a TOA and underwent a trial of conservative management with intravenous antibiotics. Patients who eventually underwent surgical intervention were compared with patients managed conservatively.

RESULTS

Overall, 39/91 (42.8%) underwent an invasive intervention subsequent to failed antibiotic treatment. Patients who experienced conservative treatment failure had higher medians of inflammatory markers as CRP (15.7 vs. 10.8 mg/L, p = 0.02), WBC count (14.2 vs. 12.4 1,000/mm³, p = 0.04) and platelet count (374 vs. 295 10⁹/L, p = 0.04) at admission. Higher levels of CA-125 at admission were found in those who required an invasive intervention (57 vs. 30 U\ml, p = 0.02) as well. The largest diameter of TOA at admission was higher in those who required an invasive intervention as compared to those who were successfully treated conservatively (75 mm vs. 57 mm, p = 0.01). CA-125 level was found to be the only independent factor associated with conservative treatment failure (OR; 95% confidence interval [CI], 1.27, 1.08-1.48, p = 0.03).

CONCLUSION

Elevated CA-125 serum levels were found to be associated with failure of conservative parenteral antibiotic therapy for TOA. This finding should be better evaluated in a prospective manner.

Diagnostic value of neutrophil to lymphocyte ratio in differentiation of ruptured ovarian cysts and adnexal torsion

Objective

Ovarian cyst rupture and adnexal torsion (AT) differential diagnosis is important for early surgical intervention of AT for preserving ovarian function. The aim of this study was to evaluate the diagnostic value of preoperative the neutrophil-to-lymphocyte ratio (NLR) in patients with adnexal torsion and ovarian cyst rupture.

Materials and Methods

Data of 80 patients who underwent surgery between 2012 and 2017 for ovarian cyst rupture, adnexal torsion, and unruptured ovarian cyst were analyzed. Patients were categorized as adnexal torsion (n=35), ovarian cyst rupture (n=20), unruptured ovarian cyst (n=25) groups. Preoperative NLR were compared among the three groups of the patients.

Results

The adnexal torsion group had a median NLR of 8.0 (range, 4.0-14.1), the ovarian cyst rupture group had a median of NLR 7.5 (range, 3.7-11.5), and median NLR of the unruptured ovarian cyst group was 2.2 (range,1.8-2.7). The NLR was found to have a difference that reached statistical significance among the three groups (p<0.001). When the groups were individually compared, there was no significant difference between the ovarian cyst rupture and adnexal torsion groups (p=0.372), but there was a significant difference between the unruptured ovarian cyst and adnexal torsion groups (p<0.001).

Conclusion

NLR may be useful in the differential diagnosis of unruptured ovarian cyst from adnexal torsion, but it has no diagnostic value for the differentiation of ovarian cyst rupture and adnexal torsion.

Value of routine blood test in early diagnosis of gastric cancer and its relationship with Helicobacter pylori infection

AIM

To assess the value of each index of routine blood test in the early diagnosis of gastric cancer (GC), and investigate the effect of Helicobacter pylori (H. pylori) infection on routine blood indexes.

METHODS

A total of 223 inpatients or hospitalized patients who underwent gastroscopy from September 2016 to September 2017 were selected and divided into four groups according to gastroscopic and pathological results, including 58 patients with chronic superficial gastritis (CSG), 59 patients with chronic atrophic gastritis (CAG), 52 patients with high-grade intraepithelial neoplasia (HIN), and 57 patients with GC. Red blood cell distribution width (RDW), platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), white blood cell count (WBC), lymphocyte count (LYMP), neutrophil count (NR), neutrophil count to lymphocyte ratio (NLR), and platelet count to lymphocyte ratio (PLR) were compared in different groups, and the sensitivity and specificity of each index for diagnosis of GC were calculated. The effect of H. pylori infection on routine blood indexes was also analyzed.

RESULTS

LYMP and MPV gradually decreased and RDW, NLR, and PLR gradually increased from CSG to CAG, HIN, and GC. RDW, MPV, LYMP, NLR, and PLR were all significantly different between the CSG group and GC group (P < 0.05). In detecting GC, the sensitivities of RDW, MPV, LYMP, NLR, PLR, and NC were 82.5%, 80.7%, 84.2%, 84.2%, 71.9%, and 45.6%, respectively, and the specificities were 72.4%, 55.2%, 82.8%, 91.0%, 89.7%, and 89.7%, respectively. The positive rates of H. pylori in the CSG group, CAG group, HIN group, and GC group were 63.7%, 62.5%, 63.5%, and 66.7%, respectively. In the CSG group, PLT, WBC, and NR were significantly higher in H. pylori positive patients than in H. pylori negative patients (P < 0.05). There were no significant differences in blood routine indexes between H. pylori positive and H. pylori negative patients in the CAG, HIN, and GC groups (P > 0.05).

CONCLUSION

RDW, PLT, MPV, LYMP, NLR, and PLR can be used in the early diagnosis of GC. H. pylori infection can lead to systemic inflammatory reactions. Early eradication of H. pylori is beneficial to the prevention of GC.

Single and combined use of red cell distribution width, mean platelet volume, and cancer antigen 125 for differential diagnosis of ovarian cancer and benign ovarian tumors

BACKGROUND

Cancer is widely believed to result from chronic inflammation, and red cell distribution width (RDW) and mean platelet volume (MPV) are considered as inflammatory markers for cancer. We investigated the values of RDW, MPV, and cancer antigen 125 (CA125), alone or in combination, for distinguishing between ovarian cancer and benign ovarian tumors.

METHODS

The study included 326 patients with ovarian cancer, 290 patients with benign ovarian tumors, and 162 control subjects. Hematologic tests were performed at initial diagnosis.

RESULTS

RDW was increased and MPV was decreased in the ovarian cancer group compared with the control and benign ovarian tumor groups. RDW was positively correlated and MPV was negatively correlated with cancer stage. Area under the curve (AUC) analysis for ovarian cancer versus benign ovarian tumors revealed that the specificity and sensitivity were increased for the combination of MPV and CA125 compared with either marker alone, and the specificity was increased for the combination of RDW and CA125, compared with either alone. The AUCs for RDW plus CA125 and MPV plus CA125 were significantly larger than for any of the markers alone.

CONCLUSIONS

In conclusion, combinations of the markers RDW, MPV, and CA125 may improve the differential diagnosis of ovarian cancer and benign ovarian tumors.

Alterations of the hematologic cells in synthetic cannabinoid users

BACKGROUND

Functions, morphology, distributions, and index of the circulating cells are the most useful parameters that indicate various inflammatory and toxic conditions. The aim of this study was to investigate the clinical significance of these parameters in patients diagnosed with (synthetic) cannabis use disorder.

METHODS

This study included a total of 40 patients in the study group (SG) with synthetic cannabis use; and 40 healthy individuals as the control group (CG). Participants, who had hematological disorders and other chronic diseases, were excluded from the study. All hematological parameters of SG were compared with CG. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) values were calculated and compared between groups.

RESULTS

There were statistically significant differences between the groups in terms of WBC, MCH, RDW, MCV, MPV, and NEU, LYM%, MONO% parameters (P<.05). MPW and LYM% were significantly lower in SG compared to CG. WBC, MCH, RDW, MCV, MPV, MONO, and NEU parameters were significantly higher in SG compared to CG (P<.05). UIBC and TIBC levels were significantly higher in SG compared to CG (P<.001). Although there was statistically significant difference between groups in terms of NLR, there was no significant difference for PLR values.

CONCLUSION

Our data suggested that chronic use of cannabinoids can lead to deterioration of hematopoietic cells. Chronic use of cannabinoids was consistent with subthreshold/subclinical megaloblastic anemia with iron deficiency. Inflammatory cells, especially neutrophil and monocyte counts were higher in SG compared to CG. Thus, recovery of subclinical hematological parameters should be considered in cannabis use disorder patients.

Mean Platelet Volume, a Novel Biomarker in Adolescents with Severe Primary Dysmenorrhea

STUDY OBJECTIVE

To evaluate whether mean platelet volume (MPV) would be a profitable marker in predicting disease severity in adolescents with severe primary dysmenorrhea (PD). DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A total of 67 patients diagnosed with PD and 37 healthy adolescents with regular menstrual cycles were included in the study. Hemoglobin, MPV, and white blood cell, platelet, lymphocyte, and neutrophil counts were measured as part of the automated complete blood examination. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were obtained from the absolute neutrophil or platelet count, respectively, divided by the absolute lymphocyte count. The visual analog scale was used to assess the level of pain, as mild (<40 mm), moderate (40-60 mm) and severe (>60 mm) PD.

RESULTS

The MPV level of the combined severity of PD and control groups were similar. However, the MPV was significantly lower in the severe PD group compared with the control group (P = .04). There were no significant differences in the other hematological parameters between the groups. The mean visual analog scale score of the PD and control subjects were 7.35 ± 2.25 and 1.07 ± 1.96, respectively (P < .01). There was a poor negative correlation, which was statistically insignificant, between MPV and white blood cell count.

CONCLUSION

The present study showed that MPV is decreased in adolescents with severe PD. Further studies with larger numbers of subjects are necessary to clarify the roles of platelets in the pathogenesis of severe PD and evaluate the changes in MPV value in response to treatment.

Mean Platelet Volume and Platelet Distribution Width as Markers in the Diagnosis of Acute Gangrenous Appendicitis

Introduction. Acute gangrenous appendicitis (AGA) is a common medical condition; however, the grade of appendicitis usually cannot be established preoperatively. We have attempted to identify some indicators, such as the mean platelet volume (MPV) and the platelet distribution width (PDW), to diagnose AGA. Aims. To evaluate whether or not the MPV and PDW are suitable markers to diagnose AGA. Methods. A retrospective study of 160 patients with AGA and 160 healthy patients was undertaken. Disease diagnosis was confirmed based on the pathologic examination of surgical specimens. Patient white blood cell (WBC) count, neutrophil ratio (NR), platelet (PLT) count, MPV, PDW, and hematocrit (HCT) were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of these indices in AGA. Results. There were no significant differences between the AGA and control groups in age and gender. Compared to the control group, the WBC count, NR, and PDW were significantly higher (P < 0.001, resp.) and the MPV and HCT were significantly lower (P < 0.001, resp.) in the AGA group. The diagnostic specificities of the WBC count, NR, PLT count, MPV, PDW, and HCT were 86.3%, 92.5%, 58.1%, 81.7%, 83.9%, and 66.3%, respectively. Therefore, the NR had the highest diagnostic specificity for the diagnosis of AGA. Conclusions. This is the first study to assess the MPV and PDW in patients with AGA. Our present study showed that the MPV is reduced and the PDW is increased in patients with AGA; the sensitivity of PDW was superior to the MPV. A decreased MPV value and an increased PDW could serve as two markers to diagnose AGA. The NR had the highest specificity for the diagnosis of AGA.

Mean Platelet Volume in Early Diagnosis of Adnexal Torsion

BACKGROUND

Adnexal torsion (AT) is among the gynecological emergencies; more common in reproductive age, if diagnosed late, this can cause ovarian failure and infertility, but rarely thrombophlebitis and peritonitis. Despite these severe complications, preoperative diagnostic tests are not enough for early diagnosis. There are certain pieces of literature on the subject that reveal changes in mean platelet volume (MPV) values occur in inflammatory and ischemic diseases and that these changes have diagnostic and prognostic significance. However, there are no studies investigating this relationship with adnexal torsion.

AIMS

The aim of the study is to investigate the diagnostic and prognostic significance of the mean platelet volume value in the early diagnosis of patients with adnexal torsion.

STUDY DESIGN

Case-control study.

METHODS

Pre-operative demographic data, MPV, leukocyte count and neutrophils to lymphocytes (N/L) ratio in the blood samples of 51 patients, who were operated on preliminary adnexal torsion and diagnosed as adnexal torsion with a benign ovarian cyst (AT group) were retrospectively compared with those of 50 patients who were operated upon because of benign ovarian cysts and without torsion (control group) at this hospital between 2006 and 2014.

RESULTS

The mean MPV level was found to be 8.1 (7.1-10.7) fL in the AT group and 7.9 (6.6-10.2) fL in the control group; no statistically significant difference was found between the groups (p>0.05). Leukocyte count and N/L ratio in the AT group were, on average, 12×10(3)/mm(3) and 82% respectively and in control group; they were, on average, 7.2×10(3)/mm(3) and 59%, respectively. A statistically significant increase was found in the leukocyte count and N/L ratio of the AT group compared to the control group (p<0.001). The platelet count in the AT group was, on average, 253×10(3)/mm(3) and in the control group it was, on average, 280×10(3)/mm(3); no statistically significant difference was detected between these two groups (p>0.05). No correlation was detected between the MPV, platelet and leukocyte counts. The sensitivity of the leukocytosis to the AT cases was found to be 66.7%, and selectivity was 94%.

CONCLUSION

The AT diagnostic and prognostic importance of MPV value has not been determined in this study.