Since coronavirus disease 2019 (COVID-19), a life-threatening infectious disease sustained by the severe respiratory syndrome coronavirus 2 (SARS-CoV-2), is frequently complicated by thrombotic episodes, both venous and arterial, we provide here an updated analysis of current scientific literature data exploring the association between mean platelet volume (MPV) and illness severity in patients with COVID-19. total number of 18 studies were finally included in our analysis, with 3,433 COVID-19 patients, 780 (22.7%) of who had severe illness. In all studies, the difference of MPV values between patients with or without severe COVID-19 illness was positive, reaching statistical significance in 14 of 18 (78%). Overall, the WMD of MPV was 0.63 (95% CI, 0.35–0.90) fL using a quality effects model, increasing to 0.74 (95% CI, 0.51–0.97) fL using a random effects model. MPV values were found to be increased by 6.3% (95% CI, 3.6–9.0%) in COVID-19 patients with adverse clinical outcomes compared with those without progression to severe disease. In a subanalysis of the four studies that included only mortality as clinical endpoint, the WMD of MPV values in random effects model further increased to 1.2 (95% CI, 0.38–2.01) fL between patients who died and those who survived. In conclusion, the results of our pooled analysis highlight that platelet volume is very frequently increased in COVID-19 patients with severe illness, especially in those at higher risk of dying, such that routine measurement of MPV along with other useful laboratory parameters29,30 should be considered for identifying those cases at higher risk of adverse progression, needing more assiduous and even more aggressive care.
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