Comparison of Mean Platelet Volume (MPV) in Patients with Psoriasis and Healthy Individuals

By Komal Shehzade¹, Saulat Zahra², Rabia Ishfaq³, Kayinat Samreen⁴, Maria Khalid¹, Fahad Usman⁵

Doi: https://doi.org/10.36283/ziun-pjmd14-1/011

How to cite: Shehzade K, Zahra S, Ishfaq R, Samreen K, Khalid M, Usman F Comparison of Mean Platelet Volume (MPV) in Patients with Psoriasis and Healthy Individuals. Pak J Med Dent. 2025 Jan ;14(1): 67-73. Doi: https://doi.org/10.36283/ziun-pjmd14-1/011.

Received: Wed, August 28, 2024 Accepted: Thu, December 19, 2024 Published: Fri, January 10, 2025.

Background: Psoriasis is a chronic inflammatory skin condition affecting quality of life, with evidence suggesting a role for platelets in its pathogenesis. Mean Platelet Volume (MPV), a marker of platelet activation, may serve as a biomarker for systemic inflammation. This study aimed to compare MPV levels between psoriasis patients and healthy controls to assess its clinical utility.

Methods:  A comparative cross-sectional study was conducted at Imran Idrees Teaching Hospital, Sialkot, from October 25, 2023, to March 25, 2024, with 200 participants aged 20-60, selected via non-probability consecutive sampling. Exclusion criteria included recent surgery, obesity (BMI > 30), and cardiovascular disease. Participants were divided into psoriasis patients (n=31) and healthy controls (n=169). MPV was measured using a Swelab Lumi hematology analyzer, and data were analyzed using SPSS version 23.0, with t-tests for group comparisons (p<0.05).

Results: A total of 200 participants were included in the study, of which 15.5% were diagnosed with psoriasis. The mean MPV was significantly higher in the psoriasis group (8.86 ± 1.42 fL) compared to controls (7.23 ± 0.57 fL), with a p-value of 0.00002. This elevation in MPV suggests a potential association between platelet activation and psoriasis-related inflammation.

Conclusions: This study shows a significant difference in MPV levels between psoriasis patients and healthy controls, indicating a role for platelets in psoriasis pathogenesis. Elevated MPV may serve as a non-invasive biomarker for systemic inflammation. Further research is needed to validate its clinical utility in diagnosis and management.

Keywords: Psoriasis, Platelet Volume, Inflammation

Psoriasis is a chronic, systemic inflammatory disorder characterized by hyperproliferative, erythematous, and scaly plaques that can significantly impair quality of life¹. This multifactorial disease affects approximately 2-3% of the global population and presents a considerable burden due to its lifelong duration and associated comorbidities². The pathogenesis of psoriasis is complex, involving genetic, environmental, and immunological factors with a prominent role in T-cell-mediated immunity. Recent advances in understanding the inflammatory pathways have highlighted the involvement of various cellular components, including platelets, which are increasingly recognized for their role beyond hemostasis³.

Platelets, small anucleate cytoplasmic fragments derived from megakaryocytes, are known primarily for their role in thrombosis and hemostasis. However, they are also pivotal in inflammatory processes, where they contribute to immune modulation, angiogenesis, and tissue repair. In the context of inflammatory diseases like psoriasis, platelets can exacerbate the inflammatory milieu by releasing pro-inflammatory cytokines and chemokines, thereby recruiting and activating leukocytes⁴. This activation and aggregation of platelets can reflect changes in their function and production, which can be quantitatively assessed by examining mean platelet volume (MPV)⁵.MPV, a routine but informative component of standard complete blood count tests, represents the average size of platelets and is an indirect marker of platelet activation. Larger platelets are biochemically and enzymatically more active than smaller ones, and an elevated MPV is considered a marker of platelet activation. Studies have linked high MPV values with various cardiovascular diseases, diabetes mellitus, and other inflammatory conditions, suggesting its potential utility as a biomarker for systemic inflammation⁶.

To this point, extensive research has been conducted on markers associated with psoriasis. However, the identification of a precise biomarker remains elusive³. Given the systemic inflammatory nature of psoriasis, MPV could serve as an important biomarker in this condition. It is hypothesized that the inflammatory burden in patients with psoriasis might influence platelet behavior, potentially leading to an increase in MPV.⁷ Observing MPV variations could thus provide insights into the inflammatory status and cardiovascular risk profiles of these patients. This hypothesis is supported by previous research indicating altered platelet indices in psoriatic patients, which may correlate with disease severity and systemic inflammation^7,8. The potential of MPV as a biomarker in psoriasis has significant clinical implications. First, if MPV is proven to be consistently different between psoriatic patients and healthy individuals, it could be utilized as a simple, cost-effective screening tool in clinical settings to assess systemic involvement and possibly predict the risk of developing psoriatic arthritis or cardiovascular diseases in these patients⁹. Furthermore, understanding the relationship between MPV and psoriasis could lead to more personalized treatment strategies, focusing not only on the skin lesions but also on the systemic inflammatory aspects of the disease⁶.

This study aims to rigorously evaluate and compare the MPV values among patients with psoriasis and healthy controls. By doing so, it seeks to clarify the role of MPV in the pathophysiology of psoriasis and determine whether MPV can be effectively used as a non-invasive biomarker for systemic inflammation in affected individuals. A better understanding of MPV variations in disease activity could also aid in monitoring disease progression or remission in response to therapeutic interventions.

The study was designed and, conducted at the Dermatology Department of Imran Idrees Teaching Hospital Sialkot from October 25, 2023, to March 25, 2024. The sample size was calculated by using the Raosoft online sample size calculator and was determined as 200 using a 95% confidence level and a 5% margin of error based on the expected prevalence of psoriasis (11.4%)¹⁰. Participants were selected using non-probability consecutive sampling from the outpatient department (OPD) of Dermatology, including individuals aged 20 to 60 years from both genders. The study excluded patients with diabetes mellitus (BSF >126 mg/dl), hypertension (BP>140/90), dyslipidemia (Triglycerides >150 mg/dl, HDL <40 mg/dl, LDL >100 – 129 mg/dl, total Cholesterol >200 mg/dl), obesity (BMI>30), those with a recent history of surgery, or those currently on anti-platelet drug therapy.

Data collection commenced following the approval from the ethical committee of Sialkot Medical College (IRB NO. MRC/IRB/23022). A total of 200 participants were enrolled after fulfilling the inclusion and exclusion criteria and providing informed consent. The participants were divided into two groups: Group A 31 patients diagnosed with psoriasis and Group B 169 healthy individuals without psoriasis. Essential biodata was recorded on a predesigned proforma. For each participant, 2cc of venous blood was collected and sent to the laboratory for analysis. Blood samples were analyzed using a Swelab Lumi hematology analyzer, with MPV measured as part of a complete blood count. The MPV values were then compared between the two groups and recorded on the proforma. Data were analyzed using SPSS version 23.0. Qualitative variables such as gender and type of psoriasis were presented as frequencies and percentages. Quantitative variables including age, duration of disease, and MPV were assessed using Mean±SD. The t-test was employed to compare MPV values between psoriatic patients and healthy individuals with a significance level set at p<0.05.

Fig.1 Shows that among 200 individuals enrolled, 111 (55.5%) were male and 89 (44.5%) were female

Figure 1: Gender Distribution

Table 1: Age Distribution 

Table 1 Regarding age distribution, the majority of participants fell within the age ranges of 31-45 years (36.5%) and 45-60 years (37.0%), with smaller proportions in the 20-30 years age group (26.5%).

Table 2: Frequency Distribution of Psoriasis

Table 2 shows that among 200 participants, the majority of participants, 169 individuals, accounting for 84.5% of the sample, reported not having psoriasis. On the other hand, only 31 individuals, constituting 15.5% of the sample, reported experiencing psoriasis.

Table 3: Comparison of MPV Levels Between Groups

Table 3 represents the comparison of Mean Platelet Volume (MPV) levels between individuals with psoriasis and those in the control group revealing significant differences. In the psoriasis group, comprising 31 individuals, the mean MPV is notably higher at 8.86 (SD = 1.42), while in the group without psoriasis 169 individuals, the mean MPV is lower at 7.23 (SD = 0.57). The p-value associated with the comparison of MPV levels between the psoriasis and comparison groups is extremely low (p = 0.00002), indicating a statistically significant difference in MPV levels between the two groups.

The study included 200 participants with a distribution of 55.5% males and 44.5% females. This relatively balanced gender representation ensures that the findings can be generalized across both genders, eliminating bias that might arise from a gender-dominated sample. Psoriasis often affects both genders, with a slight male predominance noted in several epidemiological studies¹¹.

The age distribution showed a fairly even spread across the three categories: 26.5% in the 20-30 years group, 36.5% in the 31-45 years group, and 37% in the 45-60 years group. This distribution allows the study to analyze the impact of age on MPV levels across a wide age range. These results are in contrast with a study conducted in China that showed a bimodal distribution with peaks in younger and older age groups^12,13. Out of the 200 participants, 15.5% (31 individuals) were diagnosed with psoriasis, and 84.5% were in the control group without psoriasis. This distribution is consistent with the global prevalence of psoriasis, which helps in making the study findings relevant and representative of the general population¹⁴.

The central finding of the study is the significant difference in MPV levels between the psoriasis group and the control group. Patients with psoriasis had a mean MPV of 8.86 (SD = 1.42) compared to 7.23 (SD = 0.57) in the control group, with a highly significant p-value of 0.00002.

These findings are similar to a study conducted in Turkey according to that study the individuals with psoriasis, both the mean platelet volume (MPV) and platelet count demonstrated statistically significant increases compared to the control cohort (p=0.012). This indicates a robust statistical difference suggesting that psoriasis patients have higher MPV levels^3,15.

This elevated MPV could be reflective of an increased thrombotic risk in psoriasis patients, which correlates with the known cardiovascular risks associated with the disease¹⁶.  The active platelets contribute to the formation of blood clots more readily. This increased clotting potential can lead to a higher risk of thrombosis—where blood clots form in the blood vessels, potentially blocking them. In psoriasis patients, this elevated risk is particularly concerning because it adds to the already higher likelihood of cardiovascular complications associated with the disease^17,18. Thus, monitoring MPV in psoriasis patients could serve as an indicator of systemic inflammation and an early warning sign of potential thrombotic and cardiovascular complications. This understanding helps clinicians manage and mitigate these risks more effectively, making MPV a valuable biomarker in the ongoing assessment and treatment of individuals with psoriasis^19,20.

The standard deviation in the psoriasis group is notably higher (1.42) compared to the control group (0.57), suggesting greater variability in MPV among psoriasis patients²¹. This could be due to varying levels of disease activity and systemic inflammation among these patients²². This is in line with an international study that revealed the standardized mean difference (SMD) for mean platelet volume (MPV) between individuals with psoriasis and controls was calculated as 0.503 signifying a notable correlation but the severity of the disease is unsure^23,24.

The findings underscore the potential of using MPV as a biomarker for psoriasis, which could help in stratifying patients based on their risk of developing the disease. Further studies are needed to validate the role of MPV as a specific marker in psoriasis and its potential diagnostic and prognostic implications²⁵.

 In conclusion, this study underscores the significance of elevated mean platelet volume (MPV) as a potential biomarker for systemic inflammation and thrombotic risk in psoriasis patients. The consistent elevation in MPV across our study population not only aligns with global prevalence data but also highlights the heterogeneity of psoriasis and its impact on platelet dynamics. These results support the need for incorporating MPV monitoring into the comprehensive care of psoriasis patients to better address both cutaneous and systemic manifestations of the disease. Further research is essential to validate these findings and to explore how MPV can be effectively integrated into personalized treatment protocols for psoriasis, potentially enhancing both clinical outcomes and quality of life for patients.

MPV – Mean Platelet Volume

SPSS – Statistical Package for the Social Sciences

OPD – Outpatient Department

BSF – Blood Sugar Fasting

BP – Blood Pressure

HDL – High-Density Lipoprotein

LDL – Low-Density Lipoprotein

BMI – Body Mass Index

IRB – Institutional Review Board

SD – Standard Deviation

N/A

None to declare

The approval from the ethical committee of Sialkot Medical College (IRB NO. MRC/IRB/23022).

KS: Principal Investigator, SZ: Supervised the project and data collection, RI: Conducted the literature review and data collection, KS: Performed statistical analysis and contributed to the literature review, MK: Provided final approval of the version to be published.FU: Critically revised the manuscript for important intellectual content.Top of Form

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