Maciej Kostrubiec, Andrzej Łabyk, Justyna Pedowska-Włoszek, Anna Hrynkiewicz-Szymańska, Szymon Pacho, Krzysztof Jankowski, Barbara Lichodziejewska, Piotr Pruszczyk

Background: Recently, mean platelet volume (MPV) was reported to predict venous thromboembolism. Moreover, MPV correlates with platelet reactivity and indicates poor outcome in acute coronary syndromes. Objective: To examine the hypothesis that in acute pulmonary embolism (APE) MPV is elevated and may predict mortality. Methods and results: The study included consecutive 192 patients with APE, (79M/113F, 64+/-18 years) and 100 controls matched for age, sex and concomitant diseases. On admission blood samples were collected for MPV and troponin measurements. Although MPV did not differ between patients with APE and controls (10.0+/-1.2 vs 10.1+/-0.8 fl), it differed between low- and intermediate- or high-risk APE (9.4+/-1.2 fl, 10.3+/-1.1 fl, 10.3+/-1.8 fl; respectively, p<0.0001). Eighteen (9%) patients with APE died during the 30-day observation. MPV was higher in non-survivors than survivors (10.7+/-1.4 fl vs 9.9+/-1.2fl, p<0.01). The areas under receiver operating characteristic curves of MPV were 0.658 (95% CI 0.587 to 0.725) for predicting 30-day mortality, and 0.712 (95% CI 0.642 to 0.775) for 7-day mortality. MPV >10.9 fl, showed sensitivity, specificity, positive predictive value and negative predictive value for death within 30 days (39%, 81%, 18%, 93%, respectively) and for 7-day mortality (54%, 82%, 18%, 96%). Multivariable analysis showed that MPV was an independent mortality predictor for 7- and 30-day all-cause mortality (HR=2.0 (95% CI 1.3 to 3.0), p<0.001)) and 1.7 (95% CI 1.2 to 2.5), p<0.01)), respectively). MPVs were higher in patients with myocardial injury than in those without troponin elevation (10.2+/-1.1 fl vs 9.8+/-1.2 fl; p=0.02). There were correlations between MPV and right ventricular diameter and right ventricular dysfunction (r=0.28, p<0.01 and r=0.19, p<0.02, respectively). Conclusion: MPV is an independent predictor of early death in APE. Moreover, MPV in APE is associated with right ventricular dysfunction and myocardial injury.