The Association Between Platelet Mass Index and Mechanical Ventilation in Pediatric Surgery Cases

Platelet mass index (PMI) is an indicator of platelet functionality. This study aimed to examine the relationship between PMI and mechanical ventilation need in infants less than 1 year of age who underwent gastrointestinal system surgery. We retrospectively reviewed the medical records of cases that underwent gastrointestinal surgery in the last 10 years (2010-2020) at Baskent University Konya Hospital. Demographic data, indications for surgery, age at surgery, preoperative blood tests, hospitalization times, discharge status, mechanical ventilation need and duration, sepsis, accompanying anomalies, recurrent surgery requirements were collected from patient records. The study group (n: 143) was divided into 2 groups as the need for mechanical ventilation (MV; n: 73) and the group that did not need mechanical ventilation (n-MV; n: 70). Data were analyzed with SPSS version 25. PMI was significantly lower in the MV group (1999 Vs 2798, p< .001). 65% of the cases were newborns. Mean gestational age was 34.5 ±4 weeks, and birth weight was 2100 ± 820 g. Most of the cases that need surgical intervention consist of small bowel atresia, esophageal atresia, surgeries due to necrotizing enterocolitis, and anal atresia. Ileus was present in 54% of the patients. The recurrent surgery requirement was 34%. The frequency of accompanying cardiac anomalies was 30.6%, and the rate of proven sepsis was 38.3%. Preoperative 2163 PMI value can discriminate not needing MV with 72% sensitivity and 69% specificity (AUC: .699, p<.001). When the basic characteristics of the groups were evaluated, 83% of the patients who underwent MV were in the newborn group. The birth weight, gestational age, hospital duration, oxygen exposure, culture-positive sepsis rates, total parenteral nutrition (TPN) rates, and duration were found to be significantly higher in patients who underwent MV. While there was no difference in the number of white blood cells in the preoperative blood analysis, the neutrophil-lymphocyte (N-L) ratio, platelet number, albumin values were significantly lower and CRP values were significantly higher in the MV group. There was no difference in the platelet –lymphocyte (PL) ratio. High PMI values can be used as a parameter to discriminate the need for mechanical ventilation

The Diagnostic Power of the Platelet Mass Index for Testicular Tumours: A Simple Blood Test

Introduction: The relationship between inflammation and cancer has long been the focus of researchers' interest. There are many inflammatory markers studied for this purpose in the literature. In this context, we focused on the effects of platelet counts and platelet mass index (PMI) as inflammatory markers in the diagnosis of low-volume localized testicular cancer. Materials and methods: Thirty-eight patients with localized testicular cancer with a mean age of 30.84 ± 5.79 years and 38 patients with varicocele as a control group with a mean age of 32.8 ± 9.7 years were enrolled in the study. Number of platelets, mean platelet volume and value of PMI were calculated from peripheral blood samples obtained. Results: Number of platelets and PMI values were statistically significantly higher in patients with testicular cancer compared with the control group (p<.05). Conclusions: Both platelet counts and PMI values can be used as a simple test in the diagnosis of testicular cancer besides the well-known accurate serum tumor markers as AFP (alpha fetoprotein), hCG (human chorionic gonadotropin) and LDH (lactate dehydrogenase).

Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children

Platelet mass index (PMI) as a prognostic indicator in pediatric sepsis is not reported. In this retrospective observational study, we evaluated PMI's performance as a prognostic indicator in children aged younger than 18 years with sepsis and septic shock in relationship with survival. Over 5 years, we collected data of 122 children admitted to our pediatric intensive care unit (PICU). PMI accuracy was assessed with sensitivity and specificity and its discrimination was assessed using the area under the receiver operating characteristic curve (AUC). The median PMI values on days 1 and 3 of PICU admission were lower among nonsurvivors. On day 1 of PICU admission, a cutoff PMI value of 1,450 fL/nL resulted in a sensitivity of 72% and a specificity of 69%, and the AUC was 0.70 (95% confidence interval [CI]: 0.55–0.86). Similarly, on day 3, a cutoff of 900 fL/nL resulted in a sensitivity of 71% and a specificity of 70%, and the AUC was 0.76 (95% CI: 0.59–0.92). Our exploratory study suggests that low PMI in children with septic shock is associated with increased mortality. Considering the PMI's fair performance, further studies have to assess its clinical value.

Variation of platelet parameters in preterm neonates

Background: Platelets play a crucial role in hemostasis and phagocytosis. These functions of platelets are acquired gradually from foetal life to infant life. Larger, immature platelets are more reactive and hence platelet mass indices may be indicative of the thrombotic potential of platelets.Methods: This study was conducted in Kempegowda institute of medical sciences and research centre attached hospital in Bengaluru, Karnataka, India between January, 2019 and July, 2020. Platelet count, mean platelet volume (MPV), platelet distribution width (PDW) was obtained from automated analyzer reports (SYSMEX XT 1800i). The statistical association between the gestational age, birth weight and gender of preterm and their platelet parameters, was then assessed.Results: In this study, the effect of gestational age, birth weight and gender on platelet parameters was studied. A significant correlation between PDW (platelet distribution width), MPV (mean platelet volume) and gestational age was found. It was found that with increasing gestational age, both PDW and MPV decreased. With respect to birth weight, the mean, median PDW significantly decreased with increasing birth weight. None of the platelet parameters were different between male and female preterm neonates.Conclusions: There still remains a paucity of studies regarding the correlation between platelet mass indices and gestational age and birth weight. While some studies show positive correlation, some studies show no correlation and this study shows negative correlation. Hence, this calls for more studies, with larger sample sizes, to be undertaken.

Platelet Counts and Patent Ductus Arteriosus in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Background: A meta-analysis published in 2015 showed a significant association between low platelet counts in the first day(s) of life and risk of patent ductus arteriosus (PDA). The meta-analysis pooled data from 11 studies cohorts (3,479 preterm infants).Objective: To update the meta-analysis by adding new studies on the topic and including other platelet parameters different from platelet counts.Methods: PubMed/Medline and Embase databases were searched. Random-effects risk ratios (RR) and differences in means (DM) and 95% confidence intervals (CI) were calculated.Results: We included 31 studies (7,638 infants). Meta-analysis showed that the risk of developing any PDA was significantly associated with platelet counts&lt;150 × 109/L (11 studies, RR 1.58, 95% CI 1.28 to 1.95), and &lt;100 x 109/L (7 studies, RR 1.61, 95% CI 1.14 to 2.28), but not &lt;50 x 109/L (4 studies, RR 1.34, 95% CI 0.77 to 2.32). Risk of developing hemodynamically significant PDA (hsPDA) was significantly associated with platelet counts&lt;150 x 109/L (12 studies, RR 1.33, 95% CI 1.09 to 1.63), and &lt;100 x 109/L (7 studies, RR 1.39, 95% CI 1.06 to 1.82), but not &lt;50 x 109/L (6 studies, RR 1.24, 95% CI 0.86 to 1.79). Infants with hsPDA had significantly lower mean platelet counts (19 studies, DM 22.0 x 109, 95% CI 14.9 to 29.1) and platelet mass (11 studies, DM 214.4, 95% CI 131.2 to 297.5) and significantly higher platelet distribution width (PDW, 9 studies, DM −0.53, 95% CI −1.01 to −0.05) than infants without hsPDA. Meta-analysis could not demonstrate significant differences in mean platelet volume (MPV).Conclusion: Compared to the previous analysis, this updated meta-analysis included 21 additional studies that provide stronger evidence of the association between low platelet counts and PDA/hsPDA. Other platelet parameters such as platelet mass and PDW are also associated with hsPDA risk. However, the low number of platelets may be an epiphenomenon associated with the maturity and clinical stability of preterm infants rather than a contributing factor in the pathogenesis of PDA.