prognostic value of platelet indices in patients with acute pulmonary thromboembolism

Introduction: given the role of platelets in thrombus formation, markers of platelet activation may be able to predict outcomes in patients with acute pulmonary thromboembolism (pte). methods: in a prospective cohort study, 492 patients with acute pte were enrolled. patients were evaluated for platelet indices including mean platelet volume (mpv), platelet distribution width (pdw), and platelet-lymphocyte-ratio (plr), as well as for the simplified pulmonary embolism severity index (pesi) risk score. the primary endpoint was in-hospital all-cause mortality. major adverse cardiopulmonary events (macpe, composite of mortality, thrombolysis, mechanical ventilation and surgical embolectomy during index hospitalization) and all-cause death during follow-up were secondary endpoints. results: mpv, pdw and plr were 9.9±1.0 fl, 13.5±6.1%, and 14.7±14.5, respectively, in the total cohort. whilst mpv was higher in those with adverse events (10.1±1.0 vs 9.9±1.0 fl; p = 0.019), pdw and plr were not different between two groups. mpv with a cut-off point of 9.85 fl had a sensitivity of 81% and a specificity of 50% in predicting in-hospital mortality, but it had lower performance in predicting macpe (area under the curve: auc 0.58; 95%ci 0.52-0.63) or long-term mortality (auc 0.54; 95% ci 0.47-0.61). the auc for all these three markers were lower than the auc calculated for the simplified pesi score (0.80; 0.71-0.88). conclusion: platelet indices had only fair-to-good predictive performance in predicting in-hospital all-cause death. established pte risk scoring models such as simplified pesi outperform these indices in predicting adverse outcomes.