Relationships Between Mean Platelet Volume,Platelet Distribution Width And Early Prognosis Of Cerebral Infarction And Hemorrhagic Transformation After Thrombolytic Therapy

Objective: Thrombolytic therapy is the main therapy to restore blood flow in the time window of acute cerebral infarction.As the main participant in the process of thrombosis and thrombotic events,platelets have always been an important parameter to evaluate the indications and contraindications of thrombolytic therapy.Mean platelet volume(MPV),platelet distribution width(PDW)are the two parameters of platelet activation,but their relationships with early prognosis of cerebral infarction and hemorrhagic transformation after thrombolytic therapy are still unclear.We aimed to investigate the relationships between MPV,PDW and early prognosis of cerebral infarction and hemorrhagic transformation after thrombolytic therapy.Methods: We retrospectively collected data from cerebral infarction patients treated by recombinant human tissue type plasminogen activator(rtPA),including those who received thrombectomy,but excluding those who were transferred to our hospital after thrombolytic therapy.Demographic data,MPV,PDW,other laboratory parameters and cranial imaging data were collected.Early prognosis: Good early prognosis was defined as early neurological improvement(ENI)if patients had an improvement in the National Institute of Health Stroke Scale(NIHSS)scores of ≥2 points or decrease to 0 or 1 point after 1 week of thrombolytic therapy compared with the baseline.Hemorrhagic transformation was defined as one or more bleeding lesions at the criminal sites corresponding to the symptoms and signs of cerebral infarction found in cranial imaging after 1 week of thrombolytic therapy.Software SPSS 25.0 was used to perform univariate analysis.Variables that were statistically significant or had an impact on outcomes were selected for multivariate binary logistic regression analysis.Meanwhile,the cut-off value was calculated through ROC curve to evaluate the clinical value of MPV,PDW in predicting early prognosis and hemorrhagic transformation after thrombolytic therapy.Results:(1)A total of 125 patients were included in our study,including 90 males(72%).The median age was 68 [62,74] years.63 patients(50.4%)were in ENI group.21 patients(16.8%)were in hemorrhagic transformation group.The change of NIHSS scores was-1 [-4,0],and the ENI and non-ENI group were-4 [-7,-3],0 [0,1 respectively.(2)In ENI group and non-ENI group,the mean of PDW was 14.18±2.47 and 12.84±2.57,respectively.And the mean of MPV was 9.74±1.78 f L and 9.19±1.8f L,respectively.Univariate analysis and multivariate binary logistic regression analysis showed that PDW(P=0.034,OR=1.191)was an independent predictor of early neurological changes.MPV(P=0.091)had no difference between two groups.(3)Pearson correlation analysis showed a moderate positive correlation between PDW and MPV(r=0.458,P < 0.001).(4)ROC curve indicated that the cut-off value of PDW in predicting ENI was 13.27,and the corresponding sensitivity and specificity was 71.4% and 62.9%,respectively.(5)Our study showed that both PDW(P=0.891) and MPV(P=0.319)had no difference between hemorrhagic transformation group and non-hemorrhagic transformation group.Conclusion: PDW is a clinical predictor of early neurological changes after rtPA thrombolytic therapy in cerebral infarction.The higher PDW,the higher possibility of ENI.When PDW was over 13.27,the sensitivity and specificity of predicting ENI was 71.4% and 62.9% respectively.