Why the study?
Platelets appear to play a key role in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage, but individual trajectories of mean platelet volume over time were not established.
Does the trajectory of mean platelet volume (MPV) differ between patients with and without delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage?
Does the trajectory of mean platelet volume (MPV) differ between patients with and without delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage?
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While mean platelet volume trajectories differ significantly between patients with and without delayed cerebral ischemia after subarachnoid hemorrhage, high inter- and intra-individual variability limits its utility as a reliable predictive biomarker.
The morbidity of aneurysmal subarachnoid hemorrhage (aSAH) remains high, particularly because of secondary cerebral lesions that significantly aggravate the primary lesions. The main type of secondary lesions is delayed cerebral ischemia (DCI), in which platelets (PLT) appear to play a key role. Mean platelet volume (MPV) is an indirect marker of platelet activation. We aimed to determine the individual trajectories of MPV over time in patients with and without DCI during the course of aSAH. This is a single-center, retrospective, longitudinal analysis of individual trajectories of MPV over time, in a cohort of aSAH patients included in the Prospective, Observational Registry of Patient with Subarachnoid Hemorrhage in Neurocritical Care Unit (ProReSHA). A mixed-effects linear regression model was used to compare the trajectories of MPV and MPV/PLT ratio between patients who developed a DCI and those who did not. A total of 3634 MPV values were collected in 587 patients. The analysis of MPV as a function of DCI occurrence showed a significant difference in the trajectory over time between patients with DCI and those without, with an estimate of 0.02 (95%CI 0.01, 0.04, p = 0.009). The analysis of the MPV/PLT ratio as a function of DCI occurrence and other covariates showed a significant difference in the trajectory over time only for patients with a modified Fisher score less than 3, with an estimate of -0.59 (95%CI: -0.94, -0.23, p = 0.001). The individual trajectories of MPV over time differ between patients with DCI and those without. However, MPV values vary greatly over time and between patients. Thus it does not appear as a reliable biomarker for stratifying patients based on their specific risk of developing DCI. ClinicalTrials.gov identifier: (NCT02890004), registered in August 2016.
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Chardon et al. (2024) studied this question.
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