The value of platelet-associated parameters as biomarkers in evaluating the disease activity of inflammatory bowel disease: a systematic review and meta-analysis

BACKGROUND: Developing inflammatory bowel disease (IBD) affects platelet counts (PLT), which are involved in blood coagulation. However, the predictive or diagnostic utility of platelet characteristics in assessing IBD disease activity of inflammatory bowel disease. We conducted thisremains unknown. This meta-analysis was conducted to quantitatively evaluate changes in platelet parameters during the active phase of IBD using a large sample size. METHODS: PubMed, Embase, Wiley Online Library, Web of Science, and Google Scholar databases were searched to identify studies. Platelet parameter data were collected, pooled, examined, and assessed from studies that met the inclusion criteria and were evaluated for risk of bias using the Newcastle Ottawa Scale. The enzyme-linked immunosorbent assay was used to determine the difference in PF4 levels between normal and DSS-induced UC mice. RESULTS: A total of 18 articles were included in this study, with 2,160 patients, including 1,107 patients with Crohn's disease (CD) and 1,053 with ulcerative colitis (UC). There were 410 active and 697 inactive patients with CD, while 443 active and 610 inactive patients with UC. Of the 18 studies, 1 was retrospective, 2 were cross-sectional, and 15 were prospective cohort studies. Data on platelet count (PLT), the primary outcome measure of this study, were given in 15 studies, whereas mean platelet volume (MPV), fibrinogen (FIB), and PF4 were secondary outcomes. The pooling of effect size for CD patients in active and inactive phases was as follows: (PLT, MD = 55.51, 95% confidence interval CI (35.87, 67.16), Z = 6.45, P < 0.0001), (MPV, MD = - 0.42, 95% CI (-0.84, 0.01), Z = - 1.92, P = 0.05), (PF4, MD = 12.27, 95% CI (3.78, 20.76), Z = 2.83, P = 0.0046), (FIB, MD = 104.09, 95% CI (38.43, 169.75), Z = 3.11, P = 0.002). The pooled effect sizes of patients with UC in active and inactive phases were as follows: (PLT, MD = 58.48, 95% CI (38.71, 78.26), Z = 5.80, P < 0.0001), (MPV, MD = - 0.70, 95% CI (-0.93, - 0.47), Z = - 5.99, P < 0.0001), (PF4, MD = 3.03, 95% CI (-4.03, 10.10), Z = 0.84, P = 0.40), (FIB, MD = 109.73, 95% CI (45.64, 173.81), Z = 3.36, P = 0.001). PF4 levels were markedly elevated in DSS-induced UC mice. The heterogeneity sources analysis revealed that "Study type" was a statistically significant source of heterogeneity. Egger's test identified publication bias (t = 0.74, P = 0.47), indicating no significant asymmetry in the funnel plot. CONCLUSIONS: Platelet parameters varied at different stages of IBD disease activity. Active patients had significantly higher PLT, PF4, and FIB levels and significantly lower MPV levels than inactive patients. Continuous monitoring of platelet parameters is an effective strategy to learn about the activity of IBD disease and an efficient means of reducing negative outcomes.