Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 8, 2015; 7(7): 1001-1006
Published online May 8, 2015. doi: 10.4254/wjh.v7.i7.1001
Mean platelet volume as a novel predictor of systemic inflammatory response in cirrhotic patients with culture-negative neutrocytic ascites
Marisol Gálvez-Martínez, Alfredo I Servín-Caamaño, Eduardo Pérez-Torres, Francisco Salas-Gordillo, Xaira Rivera-Gutiérrez, Fátima Higuera-de la Tijera
Marisol Gálvez-Martínez, Eduardo Pérez-Torres, Francisco Salas-Gordillo, Fátima Higuera-de la Tijera, Gastroenterology Department, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico
Alfredo I Servín-Caamaño, Internal Medicine Department, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico
Xaira Rivera-Gutiérrez, Faculty of Medicine, “Universidad Veracruzana”, Veracruz 91090, Mexico
Author contributions: Gálvez-Martínez M contributed with the acquisition, analysis and interpretation of data, and contributed with the manuscript drafting; Servín-Caamaño AI and Pérez-Torres E contributed with the acquisition, analysis and interpretation of data; Salas-Gordillo F contributed with the acquisition of data; Rivera-Gutiérrez X made grammatical corrections and edited the final manuscript; Higuera-de la Tijera F provided technical and material support, provided the concept and design of the study, supervised the study, and contributed with the manuscript drafting; all authors read and approved the final manuscript.
Supported by Hospital General de México Dr. Eduardo Liceaga.
Ethics approval: The study was reviewed and approved by the Gastroenterology Department, Hospital General de México “Dr. Eduardo Liceaga”. Institutional Review Board.
Informed consent: All study participants, or their legal guardian, were contacted via telephone f in order to use data from their medical records.
Conflict-of-interest: The authors have not conflict of interest to declare. None of the researchers involved in the present study have received fees for serving as a speaker, consultant or as advisory board member for any organization.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at fatimahiguera@yahoo.com.mx. Consent for data sharing was not obtained but the present data are anonymized and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fátima Higuera-de la Tijera, MD, MSc, Gastroenterology Department, Hospital General de México “Dr. Eduardo Liceaga”, Dr. Balmis 148, Mexico City 06720, Mexico. fatimahiguera@hotmail.com
Telephone: +52-55-27892000-1358
Received: January 14, 2015
Peer-review started: January 16, 2015
First decision: February 7, 2015
Revised: February 21, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: May 8, 2015
Processing time: 119 Days and 0.9 Hours
Abstract

AIM: To identify a mean platelet volume (MPV) cutoff value which should be able to predict the presence of bacterial infection.

METHODS: An observational, analytic, retrospective study. We evaluated medical records of cirrhotic patients who were hospitalized from January 2012 to January 2014 at the Gastroenterology Department of “Hospital General de México Dr. Eduardo Liceaga”, we included 51 cirrhotic patients with ascites fluid infection (AFI), and 50 non-infected cirrhotic patients as control group. Receiver operator characteristic curves were used to identify the best cutoff value of several parameters from hematic cytometry, including MPV, to predict the presence of ascites fluid infection.

RESULTS: Of the 51 cases with AFI, 48 patients (94.1%) had culture-negative neutrocytic ascites (CNNA), 2 (3.9%) had bacterial ascites, and one (2%) had spontaneous bacterial peritonitis. Infected patients had greater count of leucocytes and polymorphonuclear cells, greater levels of MPV and cardiac frequency (P < 0.0001), and lower mean arterial pressure compared with non-infected patients (P = 0.009). Leucocytes, polymorphonuclear count, MPV and cardiac frequency resulted to be good or very good predictive variables of presence of AFI in cirrhotic patients (area under the receiving operating characteristic > 0.80). A cutoff MPV value of 8.3 fl was the best to discriminate between cirrhotic patients with AFI and those without infection.

CONCLUSION: Our results support that MPV can be an useful predictor of systemic inflammatory response syndrome in cirrhotic patients with AFI, particularly CNNA.

Keywords: Mean platelet volume; Cirrhosis; Ascites fluid infection; Culture negative neutrocytic ascites; Systemic inflammatory response

Core tip: To suspect and recognize promptly those patients with ascites fluid infection (AFI) is crucial. Systemic inflammatory response syndrome and clinical signs are not always present in cirrhotic patients with AFI, and gold standard tests for diagnosis, such as neutrophils count and ascites cultures are not always quickly available in many clinical settings. The mean platelet volume (MPV) is a very good predictor of systemic inflammatory response. A MPV cutoff value equal or greater than 8.3 fl predicts the presence of AFI particularl culture-negative neutrocytic ascites.