Platelet mass index is increased in psoriasis. A possible link between psoriasis and atherosclerosis

Abstract

<b>Introduction: </b> Psoriasis, whose relation with atherosclerosis etc. has long been known, is a chronic inflammatory disease. Besides providing hemostasis, platelets play important roles in inflammatory reactions and immune responses and contribute to endothelial damage, thus leading to atherosclerotic plaque formation. Mean platelet volume (MPV) has been previously reported as a platelet activation marker. Platelet mass index (PMI) is also related to platelet functionality and is thought to be a useful parameter for plaque formation capacity of platelets.<br /> <b>Material and methods</b>: Sex, age, age of onset, disease duration, family history, psoriasis area severity index, nail and joint involvement, platelet count, mean platelet volume, platelet mass index, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of 320 patients with psoriasis and 200 healthy persons were evaluated.<br /> <b>Results</b>: Mean platelet counts were 277.7 ±73.374 and 265.06 ±59.682 (p = 0.032); MPV values were 8.248 ±1.150 and 7.442 ±1.626 (p < 0.001); and PMI values were 2259 ±545.617 and 1964 ±622.762 (p < 0.001) respectively in the psoriasis and control group. The MPV showed a significant but inverse correlation with hs-CRP (p = 0.047, r = –0.149), and no correlation with ESR (p > 0.05). Platelet count and PMI had a significant and positive correlation with ESR (p < 0.001, r = 0.404 and p < 0.001, r = 0.371), but had no correlation with hs-CRP (p > 0.05).<br /> <b>Conclusions</b>: Higher PMI and MPV values, which mean higher plaque formation capacity and more active platelets, in psoriasis may make psoriasis patients more sensitive to atherosclerotic plaque formation and complications. On the other hand, because of the positive PMI correlation with ESR (MPV had no correlation with ESR and had a negative correlation with CRP), PMI may be a better predictor of inflammation than MPV in psoriasis.

Platelets: Underestimated Regulators of Autoinflammation in Psoriasis

“…Regarding adaptive immunity (Hottz et al, 2018), platelet-derived CXCL4 and CD40L induce T helper (Th) 1 cell trafficking (Mueller et al, 2008) or T-cell responses to viral stimuli, dendritic cell (DC) maturation, and B cell isotype switch (Elzey et al, 2003;Morrell et al, 2014). This highlights the pathophysiological impact of platelet-leukocyte interaction in orchestrating immune reactions (Canpolat et al, 2010;Gilliet et al, 2004;Scho ¨n and Erpenbeck, 2018;Scho ¨n et al, 2017;Unal, 2016).…”

Platelet-associated parameters in patients with psoriasis

“…The number of patients in the psoriatic and healthy groups changed from 20 to 320 and 20 to 200, respectively. Thirteen researches displayed that the PLT ranged from 202.0 to 296.8 Â 10 3 /mL in Karabudak, 2008 [17] Turkey Cross-sectional 23 ± 4 20/0 4 ± 4 1 3 ± 7 Tamagawa-Mineoka, 2010 [18] Japan Cross-sectional 47.0 ± 12.5 15/6 NA 16.2 ± 1.63 Canpolat, 2010 [19] Turkey Cross-sectional NA 31/27 13.5 ± 4 10.7 ± 7 Saleh, 2013 [20] Egypt Case-control 31.56 ± 10.09 13/12 6.22 ± 5.99 22.59 ± 18.07 Yurtdas ¸, 2014 [21] Turkey Cross-sectional 39 ± 9 32/19 7 ± 5 1 6 ± 11 Ahmad, 2014 [22] Pakistan Case-control 40.2 ± 10.4 16/14 NA NA Chandrashekar, 2015 [23] India Cross-sectional 44.5 ± 12.89 52/10 1.70 ± 1.74 14.90 ± 9.83 Kim, 2015 [24] Korea Case-control 39.82 ± 15.16 114/62 NA 8.56 ± 7.53 Pektas, 2016 [25] Turkey Cross-sectional 42.17 ± 11.98 84/88 NA 7.75 ± 6.85 Is ¸ik, 2016 [26] Turkey Case-control 46.00 ± 14.62 23/22 13.7 ± 11.3 16.3 ± 11.2 Unal, 2016 [27] Turkey Cross-sectional 32.41 ± 18.03 19/78 NA 5.96 ± 0.95 Kim, 2016 [28] Korea Cross-sectional 38.0 ± 16.6 62/49 NA NA Raghavan, 2017 [29] India Case-control 46.10 ± 11.99 38/12 NA 15.88 ± 2.51 Kılıç, 2017 [30] Turkey Case-control [31] Turkey Case-control 36.58 ± 9.82 25/21 13.21 ± 8.24 9.08 ± 8.78 Korkmaz, 2018 [32] Turkey Cross-sectional 43 ± 9.3 22/16 NA 3.04 ± 2.18 Farag, 2018 [33] Egypt Case-control 41.47 ± 8.16 40/30 8.4 ± 3.4 12.85 ± 4.97 Yavuz, 2019 [34] Turkey Cross-sectional 40.5 ± 15.2 NA 9.4 ± 7.3 8.1 ± 5.2 Yorulmaz, 2020 [35] Turkey Case-control 43.60 ± 13.6 102/69 9.5 ± 8.89 6.5 ± 7.56 Aktas ¸, 2020 [36] Turkey Case-control 38.28 ± 12.48 NA 10.0 ± 6.67 9.65 ± 7.78 Sirin, 2020 [37] Turkey Cross-sectional 37.91 ± 13.46 31/29 9.14 ± 7.81 10.2 ± 9.56 Özkur, 2020 [38] Turkey Case-control 45.4 ± 16. Pektas, 2016 [25] 172 Farag, 2018 [33] 70 NA NA Aktas ¸, 2020 [36] 94 NA 106.9…”

Relationship between histomorphological findings and platelet activation in psoriasis

“…MPV has also been shown to be high in psoriasis patients, correlated with the PASI score, and decreased after psoriasis improvements with biological treatment 16,17 . On the contrary, PMI was suggested as a better predictor than MPV of the inflammatory status in psoriasis patients due to the positive correlation between PMI and erythrocyte sedimentation rate 5 …”

“…Platelet count (PC) is shown to increase significantly in patients with psoriasis 4 . In addition to PC, mean platelet volume (MPV)—a marker of platelet activation, and Platelet Mass Index (PMI)—an indicator of hemostatic plug formation capacity, are shown to be elevated in patients with psoriasis 4,5 . Platelet activation has been associated with the severity of psoriasis, and patients with uncontrolled psoriasis have been shown to exhibit platelet hyperaggregation 6,7 .…”