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Prognostic role of platelet parameters in ischemic stroke : systematic review and meta-analysis
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Contextualização: Vários factores estão associados ao prognóstico de doentes com Acidente Vascular Cerebral (AVC) isquémico, nomeadamente a gravidade e subtipo de AVC, a idade, sexo e terapêutica realizada. Com base no papel das plaquetas na hemostase e na regulação das respostas inflamatórias, os parâmetros plaquetários, tais como a contagem de plaquetas (CP), volume plaquetário médio (VPM), plaquetócrito (PCT) e amplitude de distribuição das plaquetas (PDW), têm potencial como predictores de prognóstico. Contudo, os resultados de vários estudos sobre esta temática foram inconclusivos. Objectivos: Realizar uma revisão sistemática para avaliar o papel prognóstico dos parâmetros plaquetários em adultos com AVC isquémico. Métodos: Pesquisa de estudos potencialmente elegíveis na PubMed, ClinicalTrials.gov e Cochrane Library. Extracção de dados relevantes e meta-análise dos mesmos. Resultados: Incluíram-se 22 estudos na síntese qualitativa. A qualidade geral dos estudos foi baixa, com elevada heterogeneidade. O VPM foi avaliado em 14 estudos, a CP em sete e o rácio plaquetário (VPM/CP) em um. Seis estudos tinham dados adequados para a síntese quantitativa para avaliar a associação entre o VPM e prognóstico (Escala de Rankin modificada). A meta-análise incluiu 2201 doentes e demonstrou que níveis mais elevados de VPM na admissão estão associados a prognóstico desfavorável (OR (95% CI) = 1.47 (1.22-1.79)). A heterogeneidade foi substancial (I2=69.9%), mas diminuiu na análise de sub-grupos incluindo estudos com análise multivariada (OR = 2.11, 95% CI, 1.59-2.80; I2=26.1%). Apesar da síntese qualitativa sugerir que CP menores estão associadas a pior prognóstico, a síntese quantitativa não foi realizada por falta de dados. Conclusão: VPM mais alto na admissão está associado a pior prognóstico. É necessário realizar mais estudos para avaliar o valor de outros parâmetros plaquetários na predição de prognóstico e determinar como esta evidência pode ser transposta para a prática clínica.
Background: Several factors are associated with the prognosis of patients with ischemic stroke, including stroke severity and subtype, age, sex and treatment. Based on the platelets’ role in hemostasis and in regulation of inflammatory responses, platelet parameters, such as platelet count (PC), mean platelet volume (MPV), plateletcrit (PCT), and platelet volume distribution width (PDW), were suggested to be used as prognostic predictors. However, the results of several studies were not conclusive. Objectives: Evaluate the prognostic role of platelet parameters in adult patients with acute ischemic stroke through a systematic review. Methods: PubMed, ClinicalTrials.gov and Cochrane Library were searched for potential eligible literature. Relevant data was extracted and a systematic review and meta-analysis was conducted. Results: 22 studies were included for qualitative synthesis. Overall studies’ quality was very low, with large heterogeneity. MPV was evaluated in 14 studies, PC in seven, and platelet ratio (MPV/PC) in one. Six studies had suitable data for quantitative synthesis assessing the association between MPV and prognosis (modified Rankin scale). The meta-analysis included 2201 patients, and showed that higher levels of MPV at admission were associated with an unfavorable prognosis (pooled OR (95% CI) = 1.47 (1.22-1.79)). The heterogeneity was substantial (I2=69.9%), but decreased when only studies with multivariate analysis were analyzed (OR = 2.11, 95% CI, 1.59-2.80; I2=26.1%). Although the qualitative synthesis suggested that lower PC was associated with poor prognosis, quantitative synthesis was not carried out due to lack of data. Conclusion: Higher MPV at admission is associated with a poorer prognosis. More studies are required to assess the value of other platelet parameters in prognosis prediction, and to ascertain how this evidence could be translated into clinical practice.
Background: Several factors are associated with the prognosis of patients with ischemic stroke, including stroke severity and subtype, age, sex and treatment. Based on the platelets’ role in hemostasis and in regulation of inflammatory responses, platelet parameters, such as platelet count (PC), mean platelet volume (MPV), plateletcrit (PCT), and platelet volume distribution width (PDW), were suggested to be used as prognostic predictors. However, the results of several studies were not conclusive. Objectives: Evaluate the prognostic role of platelet parameters in adult patients with acute ischemic stroke through a systematic review. Methods: PubMed, ClinicalTrials.gov and Cochrane Library were searched for potential eligible literature. Relevant data was extracted and a systematic review and meta-analysis was conducted. Results: 22 studies were included for qualitative synthesis. Overall studies’ quality was very low, with large heterogeneity. MPV was evaluated in 14 studies, PC in seven, and platelet ratio (MPV/PC) in one. Six studies had suitable data for quantitative synthesis assessing the association between MPV and prognosis (modified Rankin scale). The meta-analysis included 2201 patients, and showed that higher levels of MPV at admission were associated with an unfavorable prognosis (pooled OR (95% CI) = 1.47 (1.22-1.79)). The heterogeneity was substantial (I2=69.9%), but decreased when only studies with multivariate analysis were analyzed (OR = 2.11, 95% CI, 1.59-2.80; I2=26.1%). Although the qualitative synthesis suggested that lower PC was associated with poor prognosis, quantitative synthesis was not carried out due to lack of data. Conclusion: Higher MPV at admission is associated with a poorer prognosis. More studies are required to assess the value of other platelet parameters in prognosis prediction, and to ascertain how this evidence could be translated into clinical practice.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Acidente vascular cerebral isquémico Parâmetros plaquetários Volume plaquetário médio Meta-análise Revisão sistemática Prognóstico Neurologia