RELATIONSHIP OF MEAN PLATELET VOLUME WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ITS SEVERITY- AN OBSERVATIONAL STUDY

Background & Objectives: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and inflammation. Mean platelet volume (MPV) may be used as a marker of inflammation. We aimed to study the association between MPV and COPD patients during acute attack and relationship of MPV with severity of COPD by FEV1 (%predicted), BODE Index, PaO2, mMRC grade and 6MWD test. Methods: 100 patients with COPD (50 with acute exacerbation and 50 with stable COPD) and 30 healthy controls were enrolled in the study. Mean platelet volume (MPV), spirometry, arterial blood gases, body mass index, renal function tests and BODE index (body mass index, airflow obstruction,dyspnoea and exercise) were assessed. Level of MPV was compared between cases and controls. Results: Of 100 COPD patients, 87(87%) were male and 13(13%)were female.MPV platelet and production of the platelets. It has been accepted as a marker of inflammation in various diseases. Increased MPV reported in myocardial infarction, diabetes mellitus and hypertension7-9 while decreased MPV reported in ankylosing spondylitis, rheumatoid arthritis and ulcerative colitis.10-12


ISSN: 2320-5407
Int. J. Adv. Res. 9 (10), 423-428 424 Mean platelet volume (MPV) refers the activation and production rate of the platelets. It has been accepted as a marker of inflammation in various diseases. Increased MPV reported in myocardial infarction, diabetes mellitus and hypertension7-9 while decreased MPV reported in ankylosing spondylitis, rheumatoid arthritis and ulcerative colitis. [10][11][12] Both increased13 and decreased14 MPV values have been reported in COPD patients in literature.

Material and Methods:-
This prospective observational study approved by institutional ethical committee was conducted in the department of General Medicine, J.L.N. Hospital, Ajmer from 01/01/2019 to 31/12/2019. This study included 100 COPD (50 with acute exacerbation and 50 with stable COPD) patients of either sex, >30 years of age, who attended OPD and IPD of the Hospital, and 30 healthy controls. Exclusion criteria-1. Preexisting renal disease were rule out on the basis of past history and blood biochemistry with elevated serum creatinine, BUN, K+, Ca+2, phosphorus, USG showing small renal size or presence of MAB (UACR >300mg/g). 2. CHF (Congestive Heart Failure) 3. Patient having other respiratory disease such as asthma, interstitial lung disease, obstructive sleep apnoea, acute infection, uncontrolled co-morbidities such as lung malignancy were excluded from study. 4. Diabetes mellitus, Hypertension. 5. Viral fever, dengue, malaria 6. Any hematological disease & drugs which affects the platelet count Detailed history and physical examination was carried out for every individual. Patients were examined clinically, radiologically and ABG analysis to establish diagnosis of COPD, as per GOLD guideline. PFT(Spirometry) was done in stable COPD patients (in acute exacerbation after stabilization of patients).Routine Blood investigations including haemoglobin, total leucocyte count (TLC), differential leucocyte count (DLC), fasting and post-prandial blood glucose, serum creatinine, liver enzymes, serum bilirubin, serum protein, serum albumin and urine microscopy was done in all the participants. Venous blood sample taken for routine investigations including MPV(Mean Platelet Volume). Normal range for MPV was between 7.5-11.5fL. Body mass index (BMI) was calculated by measuring weight and height. Exercise capacity was assessed by the 6-minute walk distance (6MWD). Dyspnoea was assessed using the modified British Medical Research Council (mMRC) dyspnoea scale. The multidimensional BODE (body-mass index, airflow obstruction, dyspnoea and exercise) index was calculated from BMI, forced expiratory volume in one second (FEV1 %), mMRC dyspnoea scale, and 6MWD.
Statistical analysis were done using SPSS version 20.0 software.   MPV with severity of COPD (Table 3) MPV  Bansal R et al19 found Lesser the paO2, higher was the mean platelet volume in these patients. There was a significant correlation between paO2 and MPV in this group (p < 0.05).

Results:-
Elevated MPV in our study explained by several mechanisms-Platelets are activated in response to inflammatory stimuli and activated platelets become larger in size.25 Inflammatory burden of acute exacerbation of COPD may interact with thrombopoiesis in bone marrow and cause production of larger platelets. However, by time, activated platelets involve and utilize at site of inflammation and remaining smaller platelets may cause a reduction in MPV levels in these population. Conflicting results in literature about MPV and COPD association could be explained with this phenomenon. In fact, beside inflammatory condition, MPV could be influenced by many co-factors, such as, method of the laboratory assay and the time between blood sampling and laboratory assessment.26 In conclusion Increased Mean Platelet Volume (MPV) was associated with acute exacerbation of COPD and Mean Platelet Volume (MPV) was increasing with severity of COPD by FEV1% predicted, BODE index, PaO2, mMRC grade and 6MWD test.
So, MPV may be useful as a marker of acute attack and severity of COPD.

Conflicts of Interest:
None