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Mean platelet volume in patients with acute


and chronic cholecystitis

Article in Acta Medica Mediterranea · April 2013

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Ahmet Seker Ahmet Kucuk


Harran University Harran University
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Irfan Eser Ali Uzunkoy


Private Lara Anatolia Hospital, Antalya, Turkey Harran University school of medicine Turkey
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Acta Medica Mediterranea, 2013, 29: 515

MEAN PLATELET VOLUME İN PATIENTS WITH ACUTE AND CHRONIC CHOLECYSTITIS

AHMET SEKER1, ADNAN İNCEBIYIK2, AHMET KUCUK3, ALPASLAN TERZI1, YUSUF YUCEL1, RESIT CIFTCI1, IRFAN
ESER4, ABDULLAH OZGONUL1, ALI UZUNKOY1
1
Harran University Medical Faculty, Department of General Surgery, Sanliurfa, Turkey - 2Harran University Medical Faculty,
Department of Obstetrics and Gynecology, Sanliurfa, Turkey - 3Harran University Medical Faculty, Department of Anesthesiology
and Reanimation, Sanliurfa, Turkey - 4Harran University Medical Faculty, Thoracic Surgery, Sanliurfa, Turkey

ABSTRACT

Aim: The aim of present study was to evaluate the diagnostic value of mean platelet volume in the diagnosis of patients either
with acute or chronic cholecystitis.
Material and method: The study included 33 patients with acute cholecystitis and 32 patients with chronic cholecystitis who
were scheduled to surgical intervention at General Surgery Department of Harran University, Medicine School between January,
2010 and November, 2012. Twenty eight healthy individuals without a chronic disease or history of medication who presented to
our clinic for routine controls were employed as control group. Patients with chronic diseases such as peripheral vascular disease,
coronary artery disease, diabetes mellitus or hypertension and those on anticoagulant or non-steroidal anti-inflammatory medica-
tion were excluded as these medications can affect platelet functions. In all patients and controls, white blood cell (WBC) count,
platelet count and mean platelet volume (MPV) in complete blood count as well as C-reactive protein values were assessed.
Results: MPV values were found to be significantly lower in acute cholecystitis group when compared to those in chronic
cholecystitis and control groups (p<0.05). MPV values were negatively correlated to WBC and CRP values, whereas it was posi-
tively correlated to platelet counts. WBC and CRP values were found to be significantly higher in acute cholecystitis group than
those in chronic cholecystitis and control groups (p<0.05).
Conclusion: It is known that early diagnosis decreases morbidity and mortality in patients with acute cholecystitis. Thus, in
patients with acute cholecystitis, use of MPV in addition to available laboratory studies and imaging modalities could be helpful in
making diagnosis. Although there is a slight decrease in MPV values in patients with chronic cholecystitis, this doesn’t provide
additional benefit in making diagnosis.

Key words: Acute cholecystitis, chronic cholecystitis, mean platelet volume.

Received June 24, 2013; Accepted July 12, 2013

Introduction However, there is still need for a novel marker due


to disadvantages of ESR and CRP which are fre-
Acute cholecystitis is an acute inflammatory quently used to identify inflammatory events(4-6).
disease of gallbladder which generally occur sec- Chronic cholecystitis is a chronic inflammato-
ondary to stasis resulted from obstruction of cystic ry disease leading thickening in the wall of gall-
duct by a stone(1). There are strong evidence indicat- bladder. The diagnosis is usually made by US based
ing that early diagnosis and management of acute on clinical suspicion(7). Currently, there is no labora-
cholecystitis decrease morbidity, length of hospital tory finding specific to the disease. A method that is
stay and hospital costs(2). helpful in making diagnosis will have of great
Currently, ultrasonography (US) is the most importance as many complications should occur in
valuable evaluation in the diagnosis of acute chole- untreated cases.
cystitis and ancillary laboratory studies are fre- At the present day, it is suggested that platelets
quently used to support diagnosis, including white doesn’t only play role in hemostasis but also regu-
blood cell (WBC) count, erythrocyte sedimentation lates inflammatory processes(8). An increase occurs
rate (ESR) and C-reactive protein (CRP) (3) . in the platelet activation following tissue injury and
516 Ahmet Seker, Adnan İncebiyik et Al

release of inflammatory mediators(8). Alterations in medical research involving human subjects.


platelet production, activation and function cause
MPV changes. MPV was previously investigated in Exclusion criteria
sepsis, pulmonary embolism, acute respiratory dis-
tress syndrome, ischemic events, rheumatoid arthri- To achieve standardization among groups,
tis, ankylosing spondylitis, pancreatitis, appendici- patients with chronic diseases such as peripheral
tis and ischemic conditions and reported to have vascular disease, coronary artery disease, diabetes
diagnostic value(8-14). However, to best of our knowl- mellitus or hypertension were excluded. In addi-
edge, there isn’t any study investigating MPV tion, patients on anticoagulant or non-steroidal anti-
changes in patients with acute or chronic cholecys- inflammatory medication were excluded as these
titis so far. medications can affect platelet functions.
Given the changes in MPV value in the dis-
eases in which inflammatory and tissue injury are Statistical analysis
present together, we hypothesized that MPV value
will decrease in patients with acute or chronic Statistical analysis was performed using SPSS
cholecystitis. In the present manuscript, we aimed for Windows, version 17 (SPSS, Chicago, IL).
to investigate whether MPV value represented in Distribution of continuous variables was analyzed
CBC routinely evaluated in patients with acute or with one-sample Kolmogorov–Smirnov test and all
chronic cholecystitis will provide additional benefit data were distributed normally. Among groups,
in the diagnosis. comparisons regarding MPV, CRP, platelet and
WBC were performed by using one-way analysis of
Materials and methods variance (ANOVA) with the Bonferroni post hoc
test. The Pearson’s correlation analysis was per-
Thirty three patients who had been followed formed to identify the correlations among MPV and
with a diagnosis of acute cholecystitis (Group 1) in WBC, CRP and Platelet counts. Multivariate linear
General Surgery Department of Harran University, regression analyses were performed to identify the
Medicine School between January, 2010 and independent predictors of MPV. Two-sided p≤0.05
November, 2012 and 32 patients who underwent was interpreted as statistically significant. Gender
surgery with a diagnosis of chronic cholecystitis at was expressed as number and percentage whereas
the same period (Group 2) were retrospectively numerical variables were expressed as mean ± stan-
included in the study. Control group (Group 3) con- dard deviation.
sisted of 28 healthy individuals without a chronic
disease or history of medication who presented to Results
our clinic for routine controls. The diagnosis of
acute cholecystitis was made by physical examina- Table 1 summarizes the demographic charac-
tion findings including tenderness at right subcostal teristics of acute and chronic patient groups as well
region, presence of rebound tenderness as well as as control group. No significant difference was
laboratory evaluations such as US, elevated ESR, detected between groups regarding age and sex.
positive CRP, leukocytosis in patients presented
Acute Chronic Control
with abdominal pain at right upper quadrant, fever, cholecystitis cholecystitis groups p
nausea and vomiting. The diagnosis of chronic (n=33) (n=32) (n=28)
cholecystitis was made by US in patients who had
Age (years) 56.4±15.7 51.4±13.8 54.7±9.61 >0.05
chronic pain at right upper quadrant which radiates
to back and dyspeptic complaints. Male 14 11 14 >0.05
WBC count, platelet count, MPV values in Gender
Female 19 21 14 >0.05
CBC results and CRP results obtained from patient
records in patients with acute and chronic cholecys- Table 1. Demographic variables.
titis and those obtained from blood samples drawn n: number
in controls were evaluated.
The study was approved by Institutional Table 2 presents WBC, PLT, MPV and CRP
Ethics Committee. This study was conducted in results of all groups included. As expected, WBC
accordance to Declaration of Helsinki, 2008 on count and CRP value were found to be significantly
Mean platelet volume in patients with acute and chronic cholecystitis 517

higher in patients in acute cholecystitis group than Platelet count was found to be lower in
those in patients in chronic cholecystitis and control patients in acute and chronic cholecystitis groups
groups (p<0.05). than controls (p<0.05; Table 2).
MPV values were detected as 6.38±0.88 in In our study, a negative correlation was found
acute cholecystitis group; 7.78±0.75 in chronic between MPV value and results of WBC and CRP.
cholecystitis group; and 7.78±0.74 in control group. In other words, it was found that as MPV value
When MPV values were assessed among groups, decreased WBC count and CRP value increased .
MPV value was found to be significantly lower in However, a positive correlation was detected
acute cholecystitis group (p<0.05; Table 2; Figure 1). between MPV and platelet count (Table 3).

Acute Chronic Control


p Discussion
cholecystitis cholecystitis groups
(ANOVA)
(n=33) (n=32) (n=28)
In the present study, we hypothesized that
WBC (x109/L) 11960±3839.32* 8306±1851.91 8053.57±1392.70 <0.05
MPV value, a one of the parameters in CBC,
CRP (mg/L) 4.31±6.15* 1.10±2.27 0.19±0.26 <0.05 will be lower in patients with acute or chronic
cholecystitis in which inflammation and tissue
MPV (fL) 6.38±0.88* 7.78±0.75 7.88±0.74 <0.05
injury occur together than healthy controls. As
PLT (x109/L) 265.39±67.8 279.75±10.04 390.67±11.27+ <0.05 a result of our study, we reached the following
findings: 1) leukocyte count and CRP value
Table 2. Comparison of groups regarding WBC, CRP, MPV ve
were higher in patients with acute or chronic
PLT measurements.
*<0.05 (post hoc Bonferroni) compared with group chronic cholecystitis
cholecystitis; 2) MPV value was significantly
and control lower in patients with acute cholecystitis; 3)
+<0.05 (post hoc Bonferroni) compared with a cute and chronic cholecy- Although MPV value decreased in patients
stitis with chronic cholecystitis, the difference was
n: number, WBC: white blood cell, CRP: C reactive protein, MPV: mean
found to be insignificant; 4) there was a posi-
platelet volume, PLT: platelet.
tive correlation between platelet count and
MPV value; and 5) there was a negative correlation
between MPV value and results of WBC and CRP
studies.
Chronic cholecystitis is a chronic inflammato-
ry process leading thickening in the wall of gall-
bladder, which is generally accompanied by a gall-
bladder stone. The disease presents with pain at
right upper quadrant radiating to back. As there is
no specific laboratory finding, the diagnosis is usu-
ally based on clinical suspicion and US(7). Untreated
Fig. 1. MPV values according to the groups. cases may cause complications including obstruc-
tion in common bile duct, cholangitis, perforation
with pericholecystic abscess formation, cholecysto-
Pearson correlation Beta regression
p p duodenal fistula, bile peritonitis and pancreatitis.
coefficient coefficient
There is an ongoing research attempts to introduce
MPV
a disease-specific laboratory finding because of
WBC -0.419 <0.001 -0,311 0,006 challenges in diagnosis and above-mentioned com-
plications.
CRP -0.369 <0.001 -0,208 0,061
Acute cholecystitis is an acute inflammatory
PLT 0.206 0,047 0,206 0,047 disease of gallbladder which presents as an infec-
tious event accompanying to gallbladder stone(1).
Table 3.Relationship between MPV and WBC, CRP, The disease manifests as severe pain at right upper
PLT. quadrant, nausea, vomiting and fever(15). On physical
WBC: white blood cell, CRP: C reactive protein, MPV: mean
examination, there is tenderness at right subcostal
platelet volume, PLT: platelet.
region, rebound tenderness and muscle rigidity.
518 Ahmet Seker, Adnan İncebiyik et Al

The most valuable evaluation is US in the acute pancreatitis and inflammatory bowel diseases.
diagnosis of acute cholecystitis; however, laborato- It has been suggested that increased interleukin-6
ry parameters such as WBC count, ESR and CRP causes a decrease in MPV value by reducing
are also used to support diagnosis(16,17). However, platelet production(20, 21, 25-27). As it was shown that
there is still need for a novel marker due to disad- interleukin-6 levels increased in the studies on
vantages of ESR and CRP which are frequently patients with cholecystitis(28), we also think that the
used to identify inflammatory events(4-6). decrease in MPV value is mediated by inflammato-
ESR and CRP level measurements are the ry cytokines.
most commonly used laboratory studies to identify There are some limitations in our study,
inflammatory events. However, ESR is limited as it including small sample size and being a single-cen-
is affected from age, sex and presence of non- ter study.
inflammatory events such as anemia or renal fail- In conclusion, we think that MPV is a helpful
ure. CRP use is also limited as it begins to increase acute phase reactant that can aid to diagnosis in
48 hours after onset of symptoms and has disadvan- patients with cholecystitis. MPV and other serologi-
tages similar to ESR. These problems related to use cal markers could be just of interest to address
of both markers result in growing need to a novel physicians toward the need of execute higher level
marker that can reflect inflammatory conditions(4-6). diagnostic tools. Moreover, MPV can be a benefi-
In recent years, MPV can gain value for this end. cial, time-saving, readily available marker without
MPV is the measure of platelet volume which additional cost as it is one of the parameters already
is one of the parameters of complete blood count(18). studied during routine CBC.
It has been proposed that MPV is an indicator of
platelet function and activation(19). It was shown that
MPV value decreased in active rheumatoid arthritis,
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