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Mean platelet volume: An immanent predictor of subclinical atherosclerosis in psoriatic patients compared with interleukin-1α and interleukin-6
Abstract and Figures
Background Mean platelet volume (MPV), may help to determine atherosclerosis threat. Cardiovascular disease is one of the common causes of morbidity and mortality in patients having psoriasis. Objective To examine MPV as a biomarker for subclinical atherosclerosis in psoriasis patients, compared with interleukin (IL)-1α, IL-6, and carotid intima media thickness (CIMT). Patients and methods Psoriatic patients (n=70) and age-matched and sex-matched healthy controls (n=60) were enrolled. Psoriasis Area and Severity Index score was used to assess psoriasis severity. For all enrolled participants; evaluation of MPV, IL-1α, and IL-6 serum levels, and measuring of CIMT were done. Results The mean values of MPV, IL-1, IL-6, and CIMT, all were significantly elevated in psoriatic patients than controls (P<0.05 for all). They were significantly correlated with each other (P<0.001), and with severity of psoriasis. Receiver operating characteristic curve analysis showed the possible validity of MPV for detection of subclinical atherosclerosis in psoriatic patients (sensitivity=90.9%, specificity=61.5%, accuracy=80%, area under the curve=0.82, P<0.001, 95% confidence interval=0.71-92) with 8.95 fl/ml as a cutoff value. Conclusion MPV is a good sensitive test for early prediction of atherosclerosis in psoriatic patients. We recommend a follow-up large scale study on psoriasis to examine the use of antiplatelets.
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... In the present study, sociodemographic data are like Mahrous [15] who found nonsignificant differences between atherosclerotic and nonatherosclerotic patients regarding their ages. However, Farag et al. [16] reported that atherosclerotic patients were significantly elder than nonatherosclerotics. In the current study, it was found that psoriasis duration was significantly higher in atherosclerotic patients, whereas PASI score showed nonsignificant differences. ...
... In the current study, it was found that psoriasis duration was significantly higher in atherosclerotic patients, whereas PASI score showed nonsignificant differences. Mahrous [15] and Farag et al. [16] reported significant increases in psoriasis duration and PASI score in atherosclerotic patients compared with nonatherosclerotics. Duration of the disease and age of onset seem to be more important than disease severity in development of atherosclerosis in psoriasis patients. ...
... However, this may contradict with other studies [20][21][22]. In addition, estimated CCIMT in this study is confirming what was reported by several studies that psoriasis may be associated with subclinical atherosclerosis [15][16][17][22][23][24][25][26][27][28]. Despite the nonexistence of atherosclerotic risk factors, psoriasis patients were more vulnerable for development of atherosclerosis than healthy individuals denoting that psoriasis with its induced state of generalized inflammation encourages atherosclerosis [29]. ...
Background
Psoriasis is a chronic systemic disease. Inflammatory pathways activation in psoriasis may play a role in atherosclerosis development, independent of conventional risk factors. Platelets may have roles in psoriasis and atherosclerosis. Cardiovascular diseases prevention is based on early diagnosis of atherosclerosis. Platelet mass index means platelet count×mean platelet volume. Platelet mass index is a good indicator of inflammation, platelets activation, and atherosclerosis.
Objective
To evaluate platelet mass index as a marker of early diagnosis of subclinical atherosclerosis in psoriasis and its relation to different disease characteristics.
Patients and methods
In this case-control study, 100 psoriasis patients and 100 well-matched healthy controls were included. In all participants, common carotid intima-media thickness, platelet count, mean platelet volume, platelet mass index, and Psoriasis Area Severity Index (PASI) score were estimated.
Results
There were significant increases in platelet mass index and common carotid intimamedia thickness in patients compared with controls and in atherosclerotic patients compared with nonatherosclerotics. There was significant increase in psoriasis duration in atherosclerotic patients compared with nonatherosclerotics, whereas PASI score showed nonsignificant difference between them. There were significant positive correlations between platelet mass index and patient age, psoriasis duration, common carotid intima-media thickness, whereas there was significant inverse correlation between platelet mass index and age of psoriasis onset and no correlation with PASI score. Platelet mass index was more predictor of atherosclerosis than platelet count and mean platelet volume. Platelet mass index was valid as predictor for atherosclerosis with cutoff value 3322.
Conclusion
Platelet mass index may be a good marker of platelet activity and subclinical atherosclerosis in psoriasis. Disease duration is more important than severity in atherosclerosis development. Dermatologists should advice patients to avoid traditional cardiovascular risk factors and to do routine cardiovascular checkup.
... An increased level of MPV, as an indicator of larger, more reactive platelets resulting from an elevation in platelet turnover, represents platelet morphological changes including both the spherical shape and pseudopodia formation. The rapidly expanding evidence of research in various populations supports that the value of MPV was significantly increased in patients with psoriasis compared with that of controls [19,[36][37][38][39][40][41][42][43][44][45] (Table 1). An elevated MPV level was found in psoriasis as well as psoriatic arthritis [39,41,44], and there was also a higher expression of MPV in patients with arthritis [44]. ...
... Besides, higher MPV levels were dramatically demonstrated among psoriatic patients with atherosclerosis and metabolic syndrome compared to psoriatic patients without atherosclerotic changes and metabolic syndrome [36,37,46]. MPV could be an early predictor to diagnose premature atherosclerosis more accurately and sensitively in psoriasis. ...
... Most studies have shown that elevated MPV values are positively correlated with disease severity measured by the psoriasis area and severity index (PASI) score [36][37][38][39][40][43][44][45]. However, the experimental data are rather controversial, and there is no general agreement about the positive relationship between MPV and disease severity. ...
Background:
Psoriasis is an immune-mediated inflammatory skin disease in conjunction with the systemic inflammatory process. It appears to be related to increased risks of cardiovascular disease events, especially in severe cases. The hemostatic balance is disrupted due to the prothrombotic bias in psoriasis, which might be mainly preserved by platelet hyperactivity. Platelets are also immune cells that initiate and regulate immune and inflammatory processes, except as the principal mediator of hemostasis and thrombosis, and platelet dysfunction is deeply involved in the pathogenesis of psoriasis.
Summary:
The aim of this study is to perform a review that expounds abnormal platelet function in psoriasis and explains the important role of platelets in the pathogenic mechanism of psoriasis in order to provide new targets for comprehensive medical treatment.
... MPV is significantly increased in patients with psoriasis. [32][33][34][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] Studies have shown a positive relationship between MPV and psoriasis severity expressed by the psoriasis area and severity index (PASI) score. Two recent meta-analyses studied platelet-associated parameters and blood count in patients with psoriasis and healthy controls. ...
Platelets are essential in maintaining blood homeostasis and regulating several inflammatory processes. They constantly interact with immune cells, have immuno- regulatory functions, and can affect, through immunologically active substances, endothelium, leukocytes, and other immune response components. In reverse, inflammatory and immune processes can activate platelets, which might be significant in autoimmune disease progression and arising complications. Thus, considering this interplay, targeting platelet activity may represent a new approach to treatment of autoimmune diseases. This review aims to highlight the role of platelets in the pathogenic mechanisms of the most frequent chronic autoimmune inflammatory diseases to identify gaps in current knowledge and to provide potential new targets for medical interventions.
... In this study, there was no significant difference in MPV before and after treatment, this agrees with a previous study that reported no difference in MPV between psoriasis patients and controls (8) . In contrast to our results, other studies demonstrated that MPV was significantly higher in psoriatic patients than that in controls, and was positively correlated with PASI score (9,10) . Ezgi and colleagues (7) demonstrated that MPV was significantly higher in patients with psoriasis Vulgaris, suggesting that platelets play an important role in the pathogenesis of psoriasis and may help assess treatment outcomes. ...
Psoriasis is a chronic inflammatory skin disease with a prevalence of 0.14% to 1.99%. The underlying pathology is mainly driven by the abnormal immune responses including activation of Th1, Th17, Th22 cells and secretion of cytokines. Patients with psoriasis are more likely to develop cardiovascular disease (CVD) which has been well recognized as a comorbidity of psoriasis. As mediators of hemostasis and thromboinflammation, platelets play an important part in CVD. However, less is known about their pathophysiological contribution to psoriasis and psoriasis-associated CVD. A comprehensive understanding of the role of platelet activation in psoriasis might pave the path for more accurate prediction of cardiovascular (CV) risk and provide new strategies for psoriasis management, which alleviates the increased CV burden associated with psoriasis. Here we review the available evidence about the biomarkers and mechanisms of platelet activation in psoriasis and the role of platelet activation in intriguing the common comorbidity, CVD. We further discussed the implications and efficacy of antiplatelet therapies in the treatment of psoriasis and prevention of psoriasis-associated CVD.
The role of platelet function indices—platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), immature platelet fraction (IPF), and platelet mass index (PMI)—in psoriasis is uncertain. This systematic review and meta-analysis aimed to evaluate the association of these platelet biomarkers with both presence and severity of psoriasis. We searched MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library from inception to November 2021. To evaluate the association of platelet function indices and psoriasis, we recorded mean differences (MD) and 95% confidence intervals (CI) as well as correlation coefficients (r) for each included study, and generated summary estimates using random-effects inverse-variance modelling. We screened 1,079 unique studies, and included 33 studies with 6724 patients in the quantitative analyses. Compared with controls, patients with psoriasis had higher PLT (MD 12.86 × 10 ⁹ /L, 95% CI 6.34–19.39, p < 0.001), MPV (MD 0.61fL, 95% CI 0.31–0.92, p < 0.001), and PCT (MD 0.05%, 95% CI 0.01–0.09, p = 0.010), but similar PDW (MD 0.16%, 95% CI -0.46–0.79, p = 0.610). Psoriasis Area and Severity Index (PASI) was weakly correlated with PLT (r 0.17, 95% CI 0.06–0.28, p = 0.003), MPV ( r 0.36, 95% CI 0.22–0.49, p < 0.001), and PDW ( r 0.17, 95% CI 0.08–0.26, p < 0.001). Study numbers were insufficient to judge the relationship of IPF and PMI with psoriasis presence, or PCT, IPF, and PMI with psoriasis severity. In summary, PLT, MPV, and PCT are significantly elevated in patients with psoriasis, and PLT, MPV, and PDW are weakly correlated with PASI. Future studies are needed to evaluate the independent diagnostic and prognostic potentials of these biomarkers in patients with psoriasis.
Background
The predictive role of hematological indexes of mean platelet volume (MPV) and red cell distribution width (RDW) has been demonstrated in cardiovascular disease concomitant with psoriasis. This meta-analysis is intended to assess whether MPV and RDW can also serve as biomarkers for the early diagnosis and disease severity assessment of psoriasis.
Material and methods
13 studies which enrolled 1331 psoriasis patients and 919 healthy volunteers were included after screening the search results from PubMed, Embase and the Cochrane Library since inception to Mar 14, 2020. MPV of psoriasis participants and their counterparts was assessed in 10 studies, and RDW was evaluated in 4 studies, while the disease severity was measured by the Psoriasis Area and Severity Index (PASI) in 11 studies. Random-effect model analysis was applied to calculate pooled standard mean difference (SMD) with 95% confidence interval (95% CI).
Results
Associations of MPV and RDW with the presence of psoriasis were demonstrated (MPV: SMD = 0.503, 95% CI: 0.242–0.765; RDW: SMD = 0.522, 95% CI: 0.228–0.817), but no statistically significant correlation of MPV and disease severity of psoriasis was found in meta-regression analysis (p = 0.208). Subgroup analysis revealed that the diagnosis value of MPV and RDW was consistent regardless of PASI and study type. Heterogeneity analysis between studies was implemented by chi-squared test and I² statistics. Begg’s and Egger’s test were utilized for the evaluation of publication bias. The sensitivity analysis revealed no significant alteration no matter which study was excluded.
Conclusion
MPV and RDW could serve as promising predictive diagnostic biomarkers of psoriasis.
Background:
The relationship between platelet-associated parameters and psoriasis has been controversial. The purpose of our meta-analysis was to assess whether platelet count, platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW) are associated with psoriasis.
Methods:
We performed a thorough documentation retrieval via PubMed, EMBASE, and Web of Science until June 2021. Pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model.
Results:
Overall, 22 studies involving 1749 patients with psoriasis and 1538 healthy controls were selected for the meta-analysis. The outcomes showed that platelet count presented non-significant differences between psoriatic patients and normal individuals (SMD = 0.12, 95% CI = -0.07 to 0.32, P = .210), while PLR (SMD = 0.28, 95% CI = 0.03-0.53, P = .031), MPV (SMD = 0.55, 95% CI = 0.30-0.79, P < .001), and PDW (SMD = 0.29, 95% CI = 0.03-0.55, P = .027) were remarkably greater in the psoriatic patients than in the healthy individuals, and similar results were found in subgroup analyses. The analytical results of susceptibility revealed that the outcomes were robust, and no evidence of substantial publication bias was identified.
Conclusion:
Patients with psoriasis present significantly higher PLR, MPV, and PDW than healthy individuals, suggesting that psoriasis is accompanied by low-grade systemic inflammation and platelet activation.
Introduction : Psoriasis is a chronic inflammatory disease associated with a significantly higher morbidity and various comorbidities (obesity, metabolic syndrome, diabetes). Previous studies focused mainly on patients with severe psoriasis who were found to have increased markers of early atherosclerosis, higher intima-media thickness (IMT) values.
Aim : To evaluate the association between the severity or duration of psoriasis and carotid IMT in patients with mild and moderate psoriasis.
Material and methods : We studied seventy four patients with mild and moderate psoriasis. Clinical assessment and common carotid artery (CCA) IMT measurements were performed in all patients.
Results : The mean CCA IMT value was 1.03 ±0.37 mm, mean PASI score (psoriasis area severity index) was 18.6 ±10.5. There was a significant association between PASI score and IMT values (r = 0.33; p = 0.007) adjusted for age, psoriasis duration, blood pressure and smoking. However, we found no correlations between carotid IMT and disease duration or other clinical variables.
Conclusions : The severity of psoriasis is associated with carotid IMT even in patients with mild and moderate psoriasis.
To inform the WHO Global report on psoriasis, a new comprehensive worldwide systematic review of the epidemiology of psoriasis was undertaken. The aim of this study was to systematically review the worldwide literature regarding the epidemiology of psoriasis, including prevalence and incidence, in adults and in children. A search of 15 electronic medical databases was performed. Using a rigorous systematic protocol, eligible articles were analysed. No language, regional or temporal restrictions were applied. A total of 76 study observations met all eligibility criteria and were included in the systematic review. The estimates of the prevalence of psoriasis in adults ranged from 0.51% to 11.43%, and in children from 0% to 1.37%. Psoriasis is a common disease, occurring more frequently with advancing age. Limited data on the epidemiology of psoriasis are available. The available prevalence data come from only 20 countries, meaning there are huge geographic gaps in knowledge, especially from low- and middle-income settings.
Psoriasis is a chronic inflammatory skin disease characterized by alterations in cytokines produced by both Th1 and Th17 pathways. The aim of this study was to evaluate serum levels of pivotal cytokines and correlate them with clinical parameters. Serum samples from 53 psoriasis patients and 35 healthy volunteers, matched by the proportion of sex and age ratios, were collected for ELISA cytokine detection. Psoriasis Area and Severity Index (PASI) was assessed at the time of sampling in psoriasis patients. Our findings demonstrate that IL-17A, IL-22, and IL-6 serum concentrations were significantly higher in psoriasis patients than in the control group. No statistical correlation could be found between cytokines concentrations, PASI score, and age in this study. Although our results do not show any correlation between serum levels of IL-17A, IL-22, and IL-6 and disease activity, the present study confirms that they were increased in Brazilian psoriasis patients in comparison to healthy volunteers.
Many studies have suggested that cardiovascular risk factors seem to be more common in patients with psoriasis than in the general population. In this study we aimed to determine the prevalence of cardiovascular risk factors in patients with chronic plaque psoriasis depending on the severity of disease. We conducted a prospective study in Braşov County (Romania) including 142 patients with chronic plaque psoriasis and disease duration of at least six months and 167 controls without psoriasis. The severity of psoriasis was assessed using the psoriasis area and severity index (PASI) score. Along with a thorough medical history and physical examination, serum lipid profile and fasting plasma glucose tests were carried out. The 10-year Framingham risk score (FRS) for general cardiovascular disease, which includes age, gender, total cholesterol, HDL-cholesterol, systolic blood pressure, smoking status, and diabetes mellitus, was applied. The severity of chronic plaque psoriasis was mild in 32 patients (22.53%) and moderate to severe in 110 patients (77.47%). We found a significant higher prevalence of metabolic syndrome in the patient group compared to controls. Individual components of metabolic syndrome like waist circumference, elevated triglycerides, reduced HDL-C, impaired fasting plasma glucose, and arterial hypertension were also more prevalent in patients than in controls. Mean triglycerides, total cholesterol, LDL-cholesterol and HDL-cholesterol levels were significantly raised in patients with psoriasis when compared to controls. The 10-year FRS was significantly higher in patients with psoriasis than in controls (8.36±5.75 vs. 6.61±4.13; P<0.001). FRS was higher in men (P=0.012) and in patients older than 50 years (P=0.008). According to the severity of psoriasis, FRS increases significantly from mild to moderate-to-severe psoriasis (6.82±4.48 to 8.8±6.71; P=0.003). Psoriasis, and especially moderate to severe psoriasis, seems to represent a risk factor for cardiovascular disease. Patients with psoriasis should be risk-assessed for cardiovascular diseases, and comorbidities should be actively managed.
This retrospective study was done to investigate the mean platelet volume (MPV) level in patients with psoriasis vulgaris and its relationship with disease severity.
We undertook a cross-sectional study on 176 patients and 101 healthy controls to examine the association between MPV and psoriasis. Various clinical and laboratory parameters were analyzed and compared.
Platelet distribution width and MPV were significantly higher in patients with psoriasis than controls. In addition, there was positive correlation between Psoriasis Area Severity Index (PASI) and MPV. When psoriasis patients were grouped into mild psoriasis (PASI<10) and moderate to severe psoriasis (PASI≥10), the MPV of the latter group was significantly elevated. Nevertheless, patients with higher MPV level (MPV≥10.4 fL) did not show higher PASI than lower MPV level (MPV<10.4 fL). MPV levels significantly decreased after improvements of psoriasis with various treatments. The variations of MPV and PASI also showed significant correlation.
We have shown that MPV is increased in psoriasis patients and correlates with disease severity. Therefore, MPV levels may be considered as a marker of disease severity of psoriasis.
Inflammation plays a major role in the induction and progression of several skin diseases. Overexpression of the major epidermal proinflammatory cytokines interleukin (IL) 1 alpha (IL-1α) and 1 beta (IL-1β) is positively correlated with symptom exacerbation and disease progression in psoriasis, atopic dermatitis, neutrophilic dermatoses, skin phototoxicity, and skin cancer. IL-1β and the interleukin-1 receptor I (IL-1RI) have been used as a therapeutic target for some autoinflammatory skin diseases; yet, their system-wide effects limit their clinical usage. Based on the local effects of extracellular IL-1α and its precursor, pro-IL-1α, we hypothesize that this isoform is a promising drug target for the treatment and prevention of many skin diseases. This review provides an overview on IL-1α and IL-β functions, and their contribution to inflammatory and malignant skin diseases. We also discuss the current treatment regimens, and ongoing clinical trials, demonstrating the potential of targeting IL-1α, and not IL-1β, as a more effective strategy to prevent or treat the onset and progression of various skin diseases.
The association between psoriasis and cardiovascular disease risk has been supported by recent epidemiological data. Because of increased prevalence of cardiovascular co morbidities in patients with psoriasis, dermatologists should consider the disease as a possible multisystem disease and warn these patients for the prospective negative effects of their disease. Therefore, studies should concentrate on instituting the exact mechanisms that concluding cardiovascular disease risk in psoriasis so that proper protective strategies and treatment guidelines can be created.