key: cord-0940323-ex6nip42 authors: Gumus, Huseyin; Demir, Abit; Yükkaldıran, Ahmet title: Is mean platelet volume a predictive marker for the diagnosis of COVID‐19 in children? date: 2020-12-18 journal: Int J Clin Pract DOI: 10.1111/ijcp.13892 sha: 284395b3388c4cc3f5c2e18d3e3c384cb48bd423 doc_id: 940323 cord_uid: ex6nip42 AIM: To investigate the mean platelet volume (MPV) in asymptomatic children infected with COVID‐19. METHODS: The study included 55 children infected with COVID‐19 and 60 healthy children for the comparison of leukocyte and thrombocyte count, MPV and serum C‐reactive protein (CRP) levels. Demographic data and clinical findings of all the participants were recorded, including age, gender, weight, temperature, cough, shortness of breath and contact history. RESULTS: The MPV values were determined to be statistically significantly high (P < .001) and the lymphocyte values were significantly low (p:0.002) in the asymptomatic children infected with COVID‐19 compared with the healthy control children. No difference was determined between the groups in respect of CRP level, leukocyte and thrombocyte counts (P > .05). The optimal cutoff point for MPV was determined as 8.74 fl (Area under the curve—AUC:0.932) with 81.82% sensitivity and 95% specificity for the determination of children infected with COVID‐19. A cutoff value of <2.12/mm(3) for lymphocytes (AUC:0.670) was determined with 49.09% sensitivity and 86.67% specificity for the prediction of COVID‐19. Based on the ROC analysis, the sensitivity and specificity of MPV were determined to be higher than that of lymphocyte levels. CONCLUSION: The results of this study indicate that MPV levels are significantly high in asymptomatic children infected with COVID‐19 demonstrate that this is an important predictive value and has better predictive capacity than lymphocyte values. The evaluation of MPV and lymphocyte levels together could increase diagnostic success in asymptomatic COVID‐19 patients. change. Mean platelet volume shows the mean size of thrombocytes and thrombocyte activation. Mean platelet volume levels show variation according to the severity of inflammation. Changes in MPV levels have been defined as a diagnostic and prognostic predictor in diseases such as sepsis, infective endocarditis, pneumonia, brucellosis, cellulitis and acute pyelonephritis. [13] [14] [15] [16] [17] [18] The hypothesis of this study was that as COVID-19 causes inflammation, it could affect thrombocyte indexes. The aim of the study was to evaluate the correlation between COVID-19 and thrombocyte indexes. This prospective study included 55 paediatric patients who presented at the Emergency Department between January 2020 and July 2020 with clinical findings suggestive of COVID-19 or with a history of contact with COVID-19-infected people, and who were then determined COVID- 19 A blood sample of 2 ml for full blood count (FBC) was taken from all the people included in the study during first presentation at the hospital before any treatment was started. FBC was examined from the obtained samples with an automatic blood count device (Abbott Celldyn 3500, IL, USA). A venous blood sample of 2cc was taken for the measurement of C-reactive protein (CRP) levels, which were obtained using a spectrophotometric chemical analysis device (Architect C16000, Abbott Diagnostics, Abbott Park, IL, USA). Data obtained in the study were analysed statistically using NCSS software (Number Cruncher Statistical System, Utah, USA). the Shapiro-Wilk test and box-plot graphs. Descriptive statistics were stated as mean ± standard deviation, and median values, or number and percentage. In the comparisons between groups, the Student's t test was applied to variables showing normal distribution and the Mann-Whitney test to variables that did not show normal distribution. The Pearson Chi-Square test was used in the comparison of qualitative data. In the determination of cutoff points for MPV and lymphocytes, diagnostic screening tests and ROC analysis were used. A value of P < .05 was accepted as statistically significant. No statistically significant difference was determined between the two groups in respect of age and gender. Leukocyte, neutrophil and platelet counts were lower in the COVID-19-positive patients but not to a statistically significant level. No statistically significant difference was determined in respect of CRP measurements. MPV measurements were determined to be statistically significantly high in COVID-19-positive patients (P < .01) and lymphocyte levels were significantly low (P < .01) ( Table 1) . MPV and lymphocyte distribution showed a significant difference between the groups (Figure 1 ). • It has been stated that healthy children who have tested positive for COVID-19 are mild, or more often asymptomatic carriers, and thus play a major role in the spread of the disease. • The evaluation of MPV and lymphocyte levels together could increase diagnostic success in asymptomatic COVID-19 cases. The MPV measurements were found to be higher and the lymphocyte counts were lower in the COVID-19-positive patients than in the control group (Table 1) In the early laboratory values of a study of paediatric patients by Sehen et al, 19 leukocyte count was determined to be normal or low, and an increase was determined in lymphopenia and CRP level. In a study by Chen et al, 23 it was reported that CRP could be normal or high in paediatric patients. Consistent with these findings in literature, lymphocyte measurements in the current study were determined to be significantly low in COVID-19-positive patients. Although the leukocyte, neutrophil and platelet counts were lower than those of the control group, this decrease was not determined to be statistically significant (P > .05). No significant difference was determined between the groups with respect of the CRP levels. MPV is a simple, inexpensive and easily obtained biomarker of thrombocyte function, and can be measured in almost all laboratories. Thrombocyte volume shows a correlation with thrombocyte function and activation. 24 In addition to primary haemostatic functions, thrombocytes play a role in the pathogenesis of infectious diseases. 25 Previous studies have suggested that megakaryocyte ploidy may be affected by cytokines such as IL-3 and IL-6, and this could lead to greater and more reactive production of thrombocytes. 26 Acute hepatitis A is characterised by a low or only moderate level of acute-phase reaction, especially in children with an asymptomatic course. 27 Torre et al 28 High levels of IL-6 in COVID-19 may be a result of increasing MPV. Based on these observations of MPV, it can be concluded that this inflammation marker could be used for the diagnosis of COVID-19. To the best of our knowledge, this is the first study to have in- The authors have declared no conflicts of interest for this article. https://orcid.org/0000-0002-9326-2194 Ahmet Yükkaldıran https://orcid.org/0000-0002-1335-4110 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): the epidemic and the challenges Emerging threats from zoonotic coronaviruses-from SARS and MERS to 2019-nCoV Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan Clinical features of patients infected with 2019 novel coronavirus in Wuhan Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia Remdesivir for SARS-CoV-2 pneumonia The repertoire of maternal anti-viral antibodies in human newborns Virus-virus interactions impact the population dynamics of influenza and the common cold Epidemiological characteristics of new coronavirus diseases (COVID-19): features of risk factors and clinical features of the child population Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study Effect of severe sepsis on platelet count and their indices The impact of various platelet indices as prognostic markers of septic shock Mean platelet volume (MPV) may simply predict the severity of sepsis in preterm infants Changes in the mean platelet volume levels after bloodstream infection have prognostic value Association of mean platelet volume level with in-hospital major adverse events in infective endocarditis Evaluation of mean platelet volume (MPV) levels in brucellosis patients The association between serum YKL-40 levels, mean platelet volume, and c-reactive protein in patients with cellulitis Is the mean platelet volume a predictive marker for the diagnosis of acute pyelonephritis in children? 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