Potential predictive value of mean platelet volume and ratio of mean platelet volume to platelet count in vascular access failure of hemodialysis patients

doi:10.3877/cma.j.issn.2095-3216.2024.02.001

Abstract

Abstract:

Objective

To investigate the correlation of mean platelet volume (MPV) and MPV to platelet count ratio MPV/PLT with vascular access failure (VAF) in maintenance hemodialysis (MHD) patients, and to evaluate the predictive value of MPV and MPV/PLT for VAF events.

Methods

This study was a single center retrospective study. MHD patients with autologous arteriovenous fistula (AVF) as the vascular access at the Renal Blood Purification Center of Beijing Chaoyang Hospital from January 2015 to June 2021 were selected. The study subjects were divided into two groups based on the occurrence of vascular dysfunction: VAF group and non-VAF group. The differences in MPV and MPV/PLT changes between the two groups were compared with the mixed linear model. Kaplan Meier curve was used to compare the VAF incidence at different levels of MPV and MPV/PLT. The multivariate Cox regression model was applied to analyze independent risk factors for VAF events. The receiver operating characteristic (ROC) curve was used to evaluate the value of MPV and MPV/PLT in predicting VAF events in the hemodialysis patients.

Results

This study included 307 MHD patients, with 99 in the VAF group and 208 in the non-VAF group. The MPV, MPV/PLT, total cholesterol, uric acid, and dialysis age of the VAF group were higher than those of the non-VAF group (P<0.05). The mixed linear model comparison showed that there was no significant difference in MPV between the two groups, while MPV/PLT of the VAF group was significantly higher than that of the non-VAF group with the follow-up time prolonging (P<0.001). The Kaplan Meier curve showed statistically significant differences in the incidence of VAF at different levels of MPV and MPV/PLT(χ²=30.580, P<0.001 and χ²=9.599, P=0.008). The higher the levels of MPV and MPV/PLT, the higher the incidence of VAF events. After correction for the total cholesterol, uric acid, and dialysis age, multivariate Cox regression model analysis showed that MPV (HR=1.97, 95%CI: 1.60-2.42, P<0.001) and MPV/PLT (HR=1.59, 95%CI: 1.32-1.92, P<0.001) were independent risk factors for the occurrence of VAF. The area under the ROC curve (AUC) were 0.713 and 0.643, respectively, while the AUC of the combination of them was 0.716.

Conclusions

Elevated levels of MPV and MPV/PLT in the MHD patients were associated with the occurrence of VAF, and might have potential predictive value.

Key words: Vascular access failure, Hemodialysis, Mean platelet volume, Ratio of mean platelet volume to platelet count

Lijie Ma, Sumei Zhao, Fang Sun, Qianmei Sun. Potential predictive value of mean platelet volume and ratio of mean platelet volume to platelet count in vascular access failure of hemodialysis patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2024, 13(02): 61-67.

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Figures/Tables 8

References 25

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	非VAF组(n＝208)	VAF组(n＝99)	t/Z/χ²值	P值
性别(男/女)	122/86	53/46	0.717^c	0.397
年龄(岁)	58.2±12.6	59.1±13.5	0.549^a	0.583
透析龄	76 (58，121)	94.5(58，171)	6.315^b	0.012
血红蛋白(g/L)	110.2±9.4	110.1±9.9	0.011^a	0.992
血清白蛋白(g/L)	38.0±4.9	37.4±5.5	0.888^a	0.375
总胆固醇(mmol/L)	3.9±1.0	4.2±1.1	2.448^a	0.015
高密度脂蛋白胆固醇(mmol/L)	1.1±0.4	1.1±0.5	0.278^a	0.781
低密度脂蛋白胆固醇(mmol/L)	2.3±0.8	2.1±0.7	1.657^a	0.099
甘油三酯(mmol/L)	1.6(1.0，2.4)	1.4(1.0，2.1)	1.982^b	0.160
透析前血清肌酐(μmol/L)	854.2±295.6	868.7±290.6	0.405^a	0.686
透析前尿素氮(mmol/L)	24.7±8.9	23.3±7.3	1.520^a	0.130
透析前尿酸(mmol/L)	381.4±90.9	410.0±104.9	2.324^a	0.021
透析前校正血清钙(mmol/L)	2.2±0.3	2.2±0.2	0.232^a	0.817
透析前血清磷(mmol/L)	1.9(1.5，2.3)	1.7(1.5，2.2)	1.343^b	0.247
空腹血糖(mmol/L)	5.6(4.6，7.3)	6.4(4.8，8.6)	2.542^b	0.111
血清铁蛋白(μg/L)	185.0(95.1，357.2)	211.3(100.0，341.3)	0.426^b	0.514
全段甲状旁腺激素(ng/L)	268.0(156.5，406.5)	235.0(143.0，455.5)	0.250^b	0.617
C反应蛋白(mg/L)	1.8(1.1，3.0)	1.8(1.1，3.0)	0.178^b	0.673
吸烟(是/否)	12/196	10/89	1.892^c	0.169
合并糖尿病(有/无)	24/184	15/84	0.790^c	0.374
合并高血压(有/无)	39/169	22/77	0.508^c	0.476
MPV(fl)	10.1±0.8	10.8±1.0	6.199^a	<0.001
MPV/PLT	0.055±0.019	0.068±0.027	4.609^a	<0.001

	非VAF组(n＝208)	VAF组(n＝99)	t/Z/χ²值	P值
性别(男/女)	122/86	53/46	0.717^c	0.397
年龄(岁)	58.2±12.6	59.1±13.5	0.549^a	0.583
透析龄	76 (58，121)	94.5(58，171)	6.315^b	0.012
血红蛋白(g/L)	110.2±9.4	110.1±9.9	0.011^a	0.992
血清白蛋白(g/L)	38.0±4.9	37.4±5.5	0.888^a	0.375
总胆固醇(mmol/L)	3.9±1.0	4.2±1.1	2.448^a	0.015
高密度脂蛋白胆固醇(mmol/L)	1.1±0.4	1.1±0.5	0.278^a	0.781
低密度脂蛋白胆固醇(mmol/L)	2.3±0.8	2.1±0.7	1.657^a	0.099
甘油三酯(mmol/L)	1.6(1.0，2.4)	1.4(1.0，2.1)	1.982^b	0.160
透析前血清肌酐(μmol/L)	854.2±295.6	868.7±290.6	0.405^a	0.686
透析前尿素氮(mmol/L)	24.7±8.9	23.3±7.3	1.520^a	0.130
透析前尿酸(mmol/L)	381.4±90.9	410.0±104.9	2.324^a	0.021
透析前校正血清钙(mmol/L)	2.2±0.3	2.2±0.2	0.232^a	0.817
透析前血清磷(mmol/L)	1.9(1.5，2.3)	1.7(1.5，2.2)	1.343^b	0.247
空腹血糖(mmol/L)	5.6(4.6，7.3)	6.4(4.8，8.6)	2.542^b	0.111
血清铁蛋白(μg/L)	185.0(95.1，357.2)	211.3(100.0，341.3)	0.426^b	0.514
全段甲状旁腺激素(ng/L)	268.0(156.5，406.5)	235.0(143.0，455.5)	0.250^b	0.617
C反应蛋白(mg/L)	1.8(1.1，3.0)	1.8(1.1，3.0)	0.178^b	0.673
吸烟(是/否)	12/196	10/89	1.892^c	0.169
合并糖尿病(有/无)	24/184	15/84	0.790^c	0.374
合并高血压(有/无)	39/169	22/77	0.508^c	0.476
MPV(fl)	10.1±0.8	10.8±1.0	6.199^a	<0.001
MPV/PLT	0.055±0.019	0.068±0.027	4.609^a	<0.001

变量	HR(95%CI)	P值
MPV	1.98(1.62～2.43)	<0.001
MPV/PLT	1.66(1.38～1.99)	<0.001
年龄	1.00(0.99～1.02)	0.545
性别	1.05(0.92～1.08)	0.625
血红蛋白	1.00(0.98～1.02)	0.811
血清白蛋白	0.99(0.95～1.02)	0.450
总胆固醇	1.25 (1.06～1.41)	0.008
高密度脂蛋白胆固醇	0.92(0.54～1.58)	0.761
低密度脂蛋白胆固醇	0.76(0.57～1.00)	0.052
甘油三酯	0.89(0.76～1.05)	0.185
血肌酐	1.00(1.00～1.00)	0.678
尿素	0.98(0.96～1.01)	0.175
尿酸	1.03(0.92～1.05)	0.014
血清校正钙	1.11(0.53～2.36)	0.779
血清磷	1.00(0.71～1.41)	0.988
空腹血糖	1.05(0.99～1.12)	0.087
血清铁蛋白	1.00(1.00～1.00)	0.914
全段甲状旁腺激素	1.00(1.00～1.00)	0.978
C反应蛋白	0.94(0.85～1.03)	0.189
透析龄	1.23(1.03～1.47)	0.019
吸烟	1.60(0.83～3.08)	0.158
糖尿病	1.31(0.76～2.27)	0.338
高血压	1.17(0.78～1.97)	0.525

变量	HR(95%CI)	P值
MPV	1.98(1.62～2.43)	<0.001
MPV/PLT	1.66(1.38～1.99)	<0.001
年龄	1.00(0.99～1.02)	0.545
性别	1.05(0.92～1.08)	0.625
血红蛋白	1.00(0.98～1.02)	0.811
血清白蛋白	0.99(0.95～1.02)	0.450
总胆固醇	1.25 (1.06～1.41)	0.008
高密度脂蛋白胆固醇	0.92(0.54～1.58)	0.761
低密度脂蛋白胆固醇	0.76(0.57～1.00)	0.052
甘油三酯	0.89(0.76～1.05)	0.185
血肌酐	1.00(1.00～1.00)	0.678
尿素	0.98(0.96～1.01)	0.175
尿酸	1.03(0.92～1.05)	0.014
血清校正钙	1.11(0.53～2.36)	0.779
血清磷	1.00(0.71～1.41)	0.988
空腹血糖	1.05(0.99～1.12)	0.087
血清铁蛋白	1.00(1.00～1.00)	0.914
全段甲状旁腺激素	1.00(1.00～1.00)	0.978
C反应蛋白	0.94(0.85～1.03)	0.189
透析龄	1.23(1.03～1.47)	0.019
吸烟	1.60(0.83～3.08)	0.158
糖尿病	1.31(0.76～2.27)	0.338
高血压	1.17(0.78～1.97)	0.525

变量	HR(95%CI)	P值
MPV	1.97(1.60～2.42)	<0.001
MPV/PLT	1.59 (1.32～1.92)	<0.001

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