See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/274700166

Mean platelet volume in patients with acute

and chronic cholecystitis

Article in Acta Medica Mediterranea · April 2013

CITATIONS READS

4 169

9 authors, including:

Ahmet Seker Ahmet Kucuk

Harran University Harran University
17 PUBLICATIONS 12 CITATIONS 39 PUBLICATIONS 76 CITATIONS

SEE PROFILE SEE PROFILE

Irfan Eser Ali Uzunkoy

Private Lara Anatolia Hospital, Antalya, Turkey Harran University school of medicine Turkey
49 PUBLICATIONS 108 CITATIONS 76 PUBLICATIONS 829 CITATIONS

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Irfan Eser on 08 April 2015.

The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document
and are linked to publications on ResearchGate, letting you access and read them immediately.
Acta Medica Mediterranea, 2013, 29: 515

MEAN PLATELET VOLUME İN PATIENTS WITH ACUTE AND CHRONIC CHOLECYSTITIS

AHMET SEKER1, ADNAN İNCEBIYIK2, AHMET KUCUK3, ALPASLAN TERZI1, YUSUF YUCEL1, RESIT CIFTCI1, IRFAN
ESER4, ABDULLAH OZGONUL1, ALI UZUNKOY1
1
Harran University Medical Faculty, Department of General Surgery, Sanliurfa, Turkey - 2Harran University Medical Faculty,
Department of Obstetrics and Gynecology, Sanliurfa, Turkey - 3Harran University Medical Faculty, Department of Anesthesiology
and Reanimation, Sanliurfa, Turkey - 4Harran University Medical Faculty, Thoracic Surgery, Sanliurfa, Turkey

ABSTRACT

Aim: The aim of present study was to evaluate the diagnostic value of mean platelet volume in the diagnosis of patients either
with acute or chronic cholecystitis.
Material and method: The study included 33 patients with acute cholecystitis and 32 patients with chronic cholecystitis who
were scheduled to surgical intervention at General Surgery Department of Harran University, Medicine School between January,
2010 and November, 2012. Twenty eight healthy individuals without a chronic disease or history of medication who presented to
our clinic for routine controls were employed as control group. Patients with chronic diseases such as peripheral vascular disease,
coronary artery disease, diabetes mellitus or hypertension and those on anticoagulant or non-steroidal anti-inflammatory medica-
tion were excluded as these medications can affect platelet functions. In all patients and controls, white blood cell (WBC) count,
platelet count and mean platelet volume (MPV) in complete blood count as well as C-reactive protein values were assessed.
Results: MPV values were found to be significantly lower in acute cholecystitis group when compared to those in chronic
cholecystitis and control groups (p<0.05). MPV values were negatively correlated to WBC and CRP values, whereas it was posi-
tively correlated to platelet counts. WBC and CRP values were found to be significantly higher in acute cholecystitis group than
those in chronic cholecystitis and control groups (p<0.05).
Conclusion: It is known that early diagnosis decreases morbidity and mortality in patients with acute cholecystitis. Thus, in
patients with acute cholecystitis, use of MPV in addition to available laboratory studies and imaging modalities could be helpful in
making diagnosis. Although there is a slight decrease in MPV values in patients with chronic cholecystitis, this doesn’t provide
additional benefit in making diagnosis.

Key words: Acute cholecystitis, chronic cholecystitis, mean platelet volume.

Received June 24, 2013; Accepted July 12, 2013

Introduction However, there is still need for a novel marker due

Acute cholecystitis is an acute inflammatory
disease of gallbladder which generally occur sec-
ondary to stasis resulted from obstruction of cystic
duct by a stone(1). There are strong evidence indicat-
ing that early diagnosis and management of acute
cholecystitis decrease morbidity, length of hospital
stay and hospital costs(2).
Currently, ultrasonography (US) is the most
valuable evaluation in the diagnosis of acute chole-
cystitis and ancillary laboratory studies are fre-
quently used to support diagnosis, including white
blood cell (WBC) count, erythrocyte sedimentation
rate (ESR) and C-reactive protein (CRP) (3) .
to disadvantages of ESR and CRP which are fre-
quently used to identify inflammatory events(4-6).
Chronic cholecystitis is a chronic inflammato-
ry disease leading thickening in the wall of gall-
bladder. The diagnosis is usually made by US based
on clinical suspicion(7). Currently, there is no labora-
tory finding specific to the disease. A method that is
helpful in making diagnosis will have of great
importance as many complications should occur in
untreated cases.
At the present day, it is suggested that platelets
doesn’t only play role in hemostasis but also regu-
lates inflammatory processes(8). An increase occurs
in the platelet activation following tissue injury and
516 Ahmet Seker, Adnan İncebiyik et Al

release of inflammatory mediators(8). Alterations in medical research involving human subjects.

platelet production, activation and function cause
MPV changes. MPV was previously investigated in Exclusion criteria
sepsis, pulmonary embolism, acute respiratory dis-
tress syndrome, ischemic events, rheumatoid arthri- To achieve standardization among groups,
tis, ankylosing spondylitis, pancreatitis, appendici- patients with chronic diseases such as peripheral
tis and ischemic conditions and reported to have vascular disease, coronary artery disease, diabetes
diagnostic value(8-14). However, to best of our knowl- mellitus or hypertension were excluded. In addi-
edge, there isn’t any study investigating MPV tion, patients on anticoagulant or non-steroidal anti-
changes in patients with acute or chronic cholecys- inflammatory medication were excluded as these
titis so far. medications can affect platelet functions.
Given the changes in MPV value in the dis-
eases in which inflammatory and tissue injury are Statistical analysis
present together, we hypothesized that MPV value
will decrease in patients with acute or chronic Statistical analysis was performed using SPSS
cholecystitis. In the present manuscript, we aimed for Windows, version 17 (SPSS, Chicago, IL).
to investigate whether MPV value represented in Distribution of continuous variables was analyzed
CBC routinely evaluated in patients with acute or with one-sample Kolmogorov–Smirnov test and all
chronic cholecystitis will provide additional benefit data were distributed normally. Among groups,
in the diagnosis. comparisons regarding MPV, CRP, platelet and
WBC were performed by using one-way analysis of
Materials and methods variance (ANOVA) with the Bonferroni post hoc
test. The Pearson’s correlation analysis was per-
Thirty three patients who had been followed formed to identify the correlations among MPV and
with a diagnosis of acute cholecystitis (Group 1) in WBC, CRP and Platelet counts. Multivariate linear
General Surgery Department of Harran University, regression analyses were performed to identify the
Medicine School between January, 2010 and independent predictors of MPV. Two-sided p≤0.05
November, 2012 and 32 patients who underwent was interpreted as statistically significant. Gender
surgery with a diagnosis of chronic cholecystitis at was expressed as number and percentage whereas
the same period (Group 2) were retrospectively numerical variables were expressed as mean ± stan-
included in the study. Control group (Group 3) con- dard deviation.
sisted of 28 healthy individuals without a chronic
disease or history of medication who presented to Results
our clinic for routine controls. The diagnosis of
acute cholecystitis was made by physical examina- Table 1 summarizes the demographic charac-
tion findings including tenderness at right subcostal teristics of acute and chronic patient groups as well
region, presence of rebound tenderness as well as as control group. No significant difference was
laboratory evaluations such as US, elevated ESR, detected between groups regarding age and sex.
positive CRP, leukocytosis in patients presented
Acute Chronic Control
with abdominal pain at right upper quadrant, fever, cholecystitis cholecystitis groups p
nausea and vomiting. The diagnosis of chronic (n=33) (n=32) (n=28)
cholecystitis was made by US in patients who had
Age (years) 56.4±15.7 51.4±13.8 54.7±9.61 >0.05
chronic pain at right upper quadrant which radiates
to back and dyspeptic complaints. Male 14 11 14 >0.05
WBC count, platelet count, MPV values in Gender
Female 19 21 14 >0.05
CBC results and CRP results obtained from patient
records in patients with acute and chronic cholecys- Table 1. Demographic variables.
titis and those obtained from blood samples drawn n: number
in controls were evaluated.
The study was approved by Institutional Table 2 presents WBC, PLT, MPV and CRP
Ethics Committee. This study was conducted in results of all groups included. As expected, WBC
accordance to Declaration of Helsinki, 2008 on count and CRP value were found to be significantly
Mean platelet volume in patients with acute and chronic cholecystitis 517

higher in patients in acute cholecystitis group than
those in patients in chronic cholecystitis and control
groups (p<0.05).
MPV values were detected as 6.38±0.88 in
acute cholecystitis group; 7.78±0.75 in chronic
cholecystitis group; and 7.78±0.74 in control group.
When MPV values were assessed among groups,
MPV value was found to be significantly lower in
acute cholecystitis group (p<0.05; Table 2; Figure 1).
Platelet count was found to be lower in
patients in acute and chronic cholecystitis groups
than controls (p<0.05; Table 2).
In our study, a negative correlation was found
between MPV value and results of WBC and CRP.
In other words, it was found that as MPV value
decreased WBC count and CRP value increased .
However, a positive correlation was detected
between MPV and platelet count (Table 3).

Acute Chronic Control

p Discussion
cholecystitis cholecystitis groups
(ANOVA)
(n=33) (n=32) (n=28)
In the present study, we hypothesized that
WBC (x109/L) 11960±3839.32* 8306±1851.91 8053.57±1392.70 <0.05
MPV value, a one of the parameters in CBC,
CRP (mg/L) 4.31±6.15* 1.10±2.27 0.19±0.26 <0.05 will be lower in patients with acute or chronic
cholecystitis in which inflammation and tissue
MPV (fL) 6.38±0.88* 7.78±0.75 7.88±0.74 <0.05
injury occur together than healthy controls. As
PLT (x109/L) 265.39±67.8 279.75±10.04 390.67±11.27+ <0.05 a result of our study, we reached the following
findings: 1) leukocyte count and CRP value
Table 2. Comparison of groups regarding WBC, CRP, MPV ve
were higher in patients with acute or chronic
PLT measurements.
*<0.05 (post hoc Bonferroni) compared with group chronic cholecystitis
cholecystitis; 2) MPV value was significantly
and control lower in patients with acute cholecystitis; 3)
+<0.05 (post hoc Bonferroni) compared with a cute and chronic cholecy- Although MPV value decreased in patients
stitis with chronic cholecystitis, the difference was
n: number, WBC: white blood cell, CRP: C reactive protein, MPV: mean
found to be insignificant; 4) there was a posi-
platelet volume, PLT: platelet.
tive correlation between platelet count and
MPV value; and 5) there was a negative correlation
between MPV value and results of WBC and CRP
studies.
Chronic cholecystitis is a chronic inflammato-
ry process leading thickening in the wall of gall-
bladder, which is generally accompanied by a gall-
bladder stone. The disease presents with pain at
right upper quadrant radiating to back. As there is
no specific laboratory finding, the diagnosis is usu-
ally based on clinical suspicion and US(7). Untreated
Fig. 1. MPV values according to the groups. cases may cause complications including obstruc-
tion in common bile duct, cholangitis, perforation
with pericholecystic abscess formation, cholecysto-
Pearson correlation Beta regression
p p duodenal fistula, bile peritonitis and pancreatitis.
coefficient coefficient
There is an ongoing research attempts to introduce
MPV
a disease-specific laboratory finding because of
WBC -0.419 <0.001 -0,311 0,006 challenges in diagnosis and above-mentioned com-
plications.
CRP -0.369 <0.001 -0,208 0,061
Acute cholecystitis is an acute inflammatory
PLT 0.206 0,047 0,206 0,047 disease of gallbladder which presents as an infec-
tious event accompanying to gallbladder stone(1).
Table 3.Relationship between MPV and WBC, CRP, The disease manifests as severe pain at right upper
PLT. quadrant, nausea, vomiting and fever(15). On physical
WBC: white blood cell, CRP: C reactive protein, MPV: mean
examination, there is tenderness at right subcostal
platelet volume, PLT: platelet.
region, rebound tenderness and muscle rigidity.
518
The most valuable evaluation is US in the
diagnosis of acute cholecystitis; however, laborato-
ry parameters such as WBC count, ESR and CRP
are also used to support diagnosis(16,17). However,
there is still need for a novel marker due to disad-
vantages of ESR and CRP which are frequently
used to identify inflammatory events(4-6).
ESR and CRP level measurements are the
most commonly used laboratory studies to identify
inflammatory events. However, ESR is limited as it
is affected from age, sex and presence of non-
inflammatory events such as anemia or renal fail-
ure. CRP use is also limited as it begins to increase
48 hours after onset of symptoms and has disadvan-
tages similar to ESR. These problems related to use
of both markers result in growing need to a novel
marker that can reflect inflammatory conditions(4-6).
In recent years, MPV can gain value for this end.
MPV is the measure of platelet volume which
is one of the parameters of complete blood count(18).
It has been proposed that MPV is an indicator of
platelet function and activation(19). It was shown that
MPV value decreased in active rheumatoid arthritis,
ankylosing spondylitis, ulcerative colitis and famil-
ial Mediterranean fever (FMF)(13, 20-22). Furthermore,
there are articles suggesting that MPV value further
decreased by the increase in disease morbidity in
FMF(22), as well as it can be used to detect disease
activity in inflammatory disease such as ulcerative
colitis(23). To best of our knowledge, the value of
MPV as an inflammatory marker hasn’t been evalu-
ated in the setting of acute and chronic cholecystitis
(Mesh database, English language, Blood platelets,
acute cholecystitis, chronic cholecystitis). In our
study, it was found that MPV values were lower in
patients with acute or chronic cholecystitis than
controls in agreement with literature. Again, as
expected, the increase in WBC count and CRP level
used to identify inflammatory events were more
substantial in the cholecystitis groups.
There are two theories proposing an explana-
tion for decreased MPV values in cases in which
inflammation and tissue injury occur together. In
first theory, it is proposed that decrease in MPV
values results from increased consumption of
platelets in inflammatory bowel diseases and
sequestration of large, active platelets at vascular
segments and inflamed intestinal segments(24).
In the second theory, it is proposed that inter-
leukin-6 may account from decreased MPV values
in high-grade inflammatory diseases including sys-
temic lupus erythematosus, rheumatoid arthritis,
Ahmet Seker, Adnan İncebiyik et Al
acute pancreatitis and inflammatory bowel diseases.
It has been suggested that increased interleukin-6
causes a decrease in MPV value by reducing
platelet production(20, 21, 25-27). As it was shown that
interleukin-6 levels increased in the studies on
patients with cholecystitis(28), we also think that the
decrease in MPV value is mediated by inflammato-
ry cytokines.
There are some limitations in our study,
including small sample size and being a single-cen-
ter study.
In conclusion, we think that MPV is a helpful
acute phase reactant that can aid to diagnosis in
patients with cholecystitis. MPV and other serologi-
cal markers could be just of interest to address
physicians toward the need of execute higher level
diagnostic tools. Moreover, MPV can be a benefi-
cial, time-saving, readily available marker without
additional cost as it is one of the parameters already
studied during routine CBC.
References
1) Weigand K, Koninger J, Encke J, et al. Acute cholecys-
titis - early laparoskopic surgery versus antibiotic ther-
apy and delayed elective cholecystectomy: ACDC-
study. Trials 2007; 8: 29.
2) Chandler CF, Lane JS, Ferguson P, et al. Prospective
evaluation of early versus delayed laparoscopic chole-
cystectomy for treatment of acute cholecystitis. The
American Surgeon 2000 Sep; 66(9): 896-900.
3) Hirota M, Takada T, Kawarada Y, et al. Diagnostic cri-
teria and severity assessment of acute cholecystitis:
Tokyo Guidelines. Journal of Hepato-biliary-pancreatic
Surgery 2007; 14(1): 78-82.
4) Colglazier CL, Sutej PG. Laboratory testing in the
rheumatic diseases: a practical review. Southern
Medical Journal 2005 Feb; 98(2): 185-91.
5) Nakamura RM. Progress in the use of biochemical and
biological markers for evaluation of rheumatoid arthri-
tis. Journal of Clinical Laboratory Analysis 2000;
14(6): 305-13.
6) Kavanaugh A. The role of the laboratory in the evalua-
tion of rheumatic diseases. Clinical Cornerstone 1999;
2(2): 11-25.
7) Elwood DR. Cholecystitis. The Surgical Clinics of
North America 2008 Dec; 88(6): 1241-52.
8) Beyazit Y, Sayilir A, Torun S, et al. Mean platelet vol-
ume as an indicator of disease severity in patients with
acute pancreatitis. Clin Res Hepatol Gas 2012 Apr;
36(2): 162-8.
9) Becchi C, Al Malyan M, Fabbri LP, et al. Mean platelet
volume trend in sepsis: is it a useful parameter?
Minerva Anestesiologica 2006 Sep; 72(9): 749-56.
10) Kostrubiec M, Labyk A, Pedowska-Wloszek J, et al.
Mean platelet volume predicts early death in acute pul-
 Mean platelet volume in patients with acute and chronic cholecystitis 519

monary embolism. Heart 2010 Mar; 96(6): 460-5. 26) Kapsoritakis AN, Koukourakis MI, Sfiridaki A,
11) Canpolat FE, Yurdakok M, Armangil D, et al. Mean Potamianos SP, Kosmadaki MG, Koutroubakis IE, et
platelet volume in neonatal respiratory distress syn- al. Mean platelet volume: a useful marker of inflamma-
drome. Pediatrics international: official journal of the tory bowel disease activity. The American Journal of
Japan Pediatric Society 2009 Apr; 51(2): 314-6. Gastroenterology 2001 Mar; 96(3): 776-81.
12) Khode V, Sindhur J, Kanbur D, et al. Mean platelet vol- 27) Jaremo P, Sandberg-Gertzen H. Platelet density and
ume and other platelet volume indices in patients with size in inflammatory bowel disease. Thrombosis and
stable coronary artery disease and acute myocardial Haemostasis 1996 Apr; 75(4): 560-1.
infarction: A case control study. Journal of 28) Makarov AI, Vorob’eva NA, Dobrodeeva LK, et al.
Cardiovascular Disease Research 2012 Oct; 3(4): 272- Laboratory criteria of systemic inflammatory syndrome
5. by surgical abdominal infections. Khirurgiia 2009 (5):
13) Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet 40-5.
volume (MPV) as an inflammatory marker in ankylos-
ing spondylitis and rheumatoid arthritis. Joint Bone
Spine 2008 May; 75(3): 291-4.
14) Albayrak Y, Albayrak A, Albayrak F, et al. Mean
platelet volume: a new predictor in confirming acute
appendicitis diagnosis. Clinical and applied thrombo-
sis/hemostasis : official journal of the International
Academy of Clinical and Applied
Thrombosis/Hemostasis 2011 Aug; 17(4): 362-6.
15) Yusoff IF, Barkun JS, Barkun AN. Diagnosis and man-
agement of cholecystitis and cholangitis.
Gastroenterology Clinics of North America 2003 Dec;
32(4): 1145-68.
16) Li JC, Lee DW, Lai CW, et al. Percutaneous cholecys-
tostomy for the treatment of acute cholecystitis in the
critically ill and elderly. Hong Kong Medical Journal =
Xianggang yi xue za zhi / Hong Kong Academy of
Medicine 2004 Dec; 10(6): 389-93.
17) McKay A, Abulfaraj M, Lipschitz J. Short-and long-
term outcomes following percutaneous cholecystostomy
for acute cholecystitis in high-risk patients. Surgical
Endoscopy 2012 May; 26(5): 1343-51.
18) Sandhaus LM, Meyer P. How useful are CBC and retic-
ulocyte reports to clinicians? American Journal of
Clinical Pathology 2002 Nov; 118(5): 787-93.
19) Endler G, Klimesch A, Sunder-Plassmann H, et al.
Mean platelet volume is an independent risk factor for
myocardial infarction but not for coronary artery dis-
ease. British Journal of Haematology 2002 May;
117(2): 399-404.
20) Gasparyan AY, Sandoo A, Stavropoulos-Kalinoglou A,
et al. Mean platelet volume in patients with rheumatoid
arthritis: the effect of anti-TNF-alpha therapy.
Rheumatology International 2010 Jun; 30(8): 1125-9.
21) Yuksel O, Helvaci K, Basar O, et al. An overlooked
indicator of disease activity in ulcerative colitis: Mean
platelet volume. Platelets 2009; 20(4): 277-81.
22) Makay B, Turkyilmaz Z, Unsal E. Mean platelet vol-
ume in children with familial Mediterranean fever.
Clinical Rheumatology 2009 Aug; 28(8): 975-8.
23) Bilici S, Sekmenli T, Goksu M, et al. Mean Platelet
volume in diagnosis of acute appendicitis in children.
Afr Health Sci 2011; 11(3): 427-32.
________
24) Danese S, Motte Cd Cde L, Fiocchi C. Platelets in Request reprints from:
inflammatory bowel disease: clinical, pathogenic, and AHMET SEKER MD, Asst. Prof.
therapeutic implications. The American Journal of Harran University Medical Faculty
Gastroenterology 2004 May; 99(5): 938-45. Department of General Surgery
25) Gasparyan AY, Ayvazyan L, Mikhailidis DP, et al. Harran Üniversitesi, Tıp Fakültesi Dekanlığı,
Mean platelet volume: a link between thrombosis and Yenişehir Yerleşkesi
inflammation? Current Pharmaceutical Design 2011; 63300, Şanlıurfa
17(1): 47-58. (Turkey)

View publication stats