|Year : 2020 | Volume
| Issue : 2 | Page : 221-224
Platelet count and indices in patients with psoriasis: Are they associated with disease severity?
Santosh Sharma1, Shakti Kumar Yadav1, Roshina Naeem1, Namrata Sarin1, VK Khurana2, Sompal Singh1
1 Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, Delhi, India
2 Department of Dermatology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, Delhi, India
|Date of Submission||26-Apr-2020|
|Date of Decision||24-May-2020|
|Date of Acceptance||06-Oct-2020|
|Date of Web Publication||23-Dec-2020|
Dr. Sompal Singh
Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, Delhi
Source of Support: None, Conflict of Interest: None
Background and Aim: Psoriasis is an immunologically mediated chronic inflammatory skin disease. Altered platelets in psoriasis patients may have a role in predisposition to cardiovascular complications. The aim of this study is to study the platelet count (PLT) and indices in patients with psoriasis and to correlate platelet indices with Disease Area Severity Index score. Materials and Methods: The study was done in a tertiary care hospital. It was performed on 42 psoriasis patients (study group) and twenty healthy controls. Lifestyle factors, PLTs, and platelet indices were compared between psoriasis cases and controls. Correlation between these parameters and Psoriasis Area Severity Index (PASI) score was also studied in psoriasis patients. Chi-square test was applied to compare the categorical data from patients and controls. Spearman's rank correlation was used to correlate lifestyle factors with the severity of disease. Pearson's correlation coefficient was used to find the correlation between PASI and platelet parameters. Results: We found that PASI correlated with smoking (P = 0.042) and levels of psychological stress (P = 0.002). PLT (P = 0.043) and plateletcrit (P = 0.043) were significantly higher in the study group, whereas platelet distribution width (PDW) (P = 0.05) was lower in the study group. We found a significant correlation of PASI with PDW (P = 0.031), mean platelet volume (P = 0.050). and PLCR (0.028). Conclusion: Lifestyle factors such as smoking and levels of psychological stress play a significant role in psoriasis disease severity. There is a correlation of PLT and platelet indices with the pathogenesis and manifestation of disease.
Keywords: Platelet, platelet indices, psoriasis, Psoriasis Area Severity Index score
|How to cite this article:|
Sharma S, Yadav SK, Naeem R, Sarin N, Khurana V K, Singh S. Platelet count and indices in patients with psoriasis: Are they associated with disease severity?. Arch Med Health Sci 2020;8:221-4
|How to cite this URL:|
Sharma S, Yadav SK, Naeem R, Sarin N, Khurana V K, Singh S. Platelet count and indices in patients with psoriasis: Are they associated with disease severity?. Arch Med Health Sci [serial online] 2020 [cited 2021 Jun 22];8:221-4. Available from: https://www.amhsjournal.org/text.asp?2020/8/2/221/304728
| Introduction|| |
Psoriasis is a chronic inflammatory and immunologically mediated skin disease. It can present at any age, although most commonly presents between 50 and 69 years of age. The prevalence of psoriasis ranges from 0.91% to 8.5% in the adult population depending on the geographic location. It is related to various other chronic diseases such as Crohn's disease, ulcerative colitis, and rheumatoid arthritis. Psoriasis patients also have comorbidities such as metabolic syndrome, diabetes, hypertension, and dyslipidemia, which has been suggested by few authors as contributory factors for increased risk of cardiovascular disease.,
Platelet activation can occur through various stimuli. Various studies have explored the role of platelets in inflammatory diseases, and platelet activation has been implicated in the pathogenesis of various diseases such as coronary artery disease and atherosclerosis. Platelet activation can be assessed by platelet-derived granules, adhesion proteins, growth factors, chemokines, and coagulation factors, However, platelet indices such as mean platelet volume (MPV) and platelet distribution width (PDW) are being used as surrogate markers of platelet activation and function.
Various studies have investigated the role of MPV and PDW in psoriasis and so far the results are conflicting.,,, However, the role of plateletcrit (PCT) and platelet larger cell ratio (PLCR) has not been studied in psoriasis patients.
| Materials and Methods|| |
This case–control study was conducted at a tertiary care hospital. The duration of the study was 6 months.
A total of 42 new psoriasis patients and 20 matched healthy controls were enrolled in the study. Details about age, sex, economic status, food habits, smoking, alcohol, psychological stress, obesity hypertension, diabetes, and family history of psoriasis were recorded during the clinical examination of patients. Patients undergoing therapy were excluded from the study. Stress levels of the patients were measured using the Perceived Stress Scale by Sheldon Cohen. Body mass index of 25 kg/m2 was used as a cutoff value to categorize patients with and without obesity. Kuppuswamy Socioeconomic Scale was used to assess socioeconomic level. Venous blood was collected in EDTA vacutainers from all patients and controls. For the analysis of platelet counts (PLT) and platelet indices such as PDW, MPV, PCT, and PLCR, samples were analyzed in a five-part hematology analyzer Sysmex XT-2000i (?Sysmex Corporation, Chuo-ku, Kobe, Japan).
The Psoriasis Area Severity Index (PASI) score was calculated using the following formula:
PASI = 0.1 (EH + IH + DH) AH + 0.2 (EU + IU + D=) AU + 0.3 (ET + IT + DT) AT + 0.4 (EL + IL + AL) AL
Where E – erythema, I – indurations, D – desquamation, A – area of the skin affected, H – head, U – upper limb, T – trunk, and L – lower limb. The area of skin affected was taken as 0 (no skin involvement), 1 (1%–9% skin affected), 2 (10%–29%), 3 (30%–49%), 4 (50%–69%), 5 (70%–89%), and 6 (90%–100%).
The results were analyzed using SPSS 23 (IBM, Armonk, NY, USA) software. Chi-square test was applied to compare the categorical data from patients and controls. Spearman's rank correlation was used to correlate lifestyle factors with the severity of disease. Pearson's correlation was used to find the correlation between PASI and platelet parameters. P < 0.05 was considered statistically significant.
| Results|| |
A total of 42 cases of psoriasis and twenty controls were enrolled in this study. The mean age of the study group was 36 (standard deviation 18) years [Table 1]. There were 15 males (35.8%) and 27 females (64.2%). In our study, 23 (54.8%) patients had mild psoriasis, 11 (26.2%) had moderate psoriasis, and 8 (19%) had severe psoriasis.
Lifestyle characteristics of the study group are shown in [Table 2]. We found that PASI has a positive correlation with smoking (P = 0.042) and levels of stress (P = 0.002), while no significant correlation was seen with food habits, alcohol, obesity, hypertension, diabetes, family history, and economic status [Table 3].
|Table 3: Correlation of lifestyle factors with Psoriasis Area Severity Index|
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The median duration of the disease was 24 days (interquartile range = 45). We found a positive correlation between duration of disease and PASI score (rs = 0.303, P = 0.051) [Figure 1]a.
|Figure 1: Correlation of Psoriasis Area Severity Index with (a) duration of disease (rs = 0.303, P value 0.051) (b) platelet distribution width (Pearson's correlation r2 = 0.111 P = 0.031) (c) mean platelet volume (Pearson's correlation r2 = 0.093 P = 0.050) (d) platelet larger cell ratio (Pearson's correlation r2 = 0.115 P = 0.028)|
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We found that the PLTs and PCT were significantly higher in the study group (P = 0.043 and 0.043, respectively). While the PDW was found to be lower in the study group as compared to the control group (P = 0.051). However, there was no significant difference in MPV and PLCR between cases and controls [Table 4].
There was a negative correlation of PASI with PDW (r = -0.333, n = 42, P = 0.031), MPV (r = -0.304, n = 42, P = 0.050), and PLCR (r = -0.340, n = 42, P = 0.028) [Figure 1]b,[Figure 1]c,[Figure 1]d. However, there was no significant correlation between PASI with PLT and PCT.
| Discussion|| |
We found that the severity of psoriasis was more among smokers as compared to nonsmokers. Herron et al. observed an increased prevalence of smoking in psoriasis patients as compared to the general population and confirmed evidence of the association between tobacco smoking and psoriasis. A study by Gupta et al. suggested a linear association between smoking and psoriasis. A Canadian study compared the intensity of smoking and clinical severity of psoriasis and found that consumption of >20 cigarettes daily was associated with an increased risk of clinically severe psoriasis. They also found that the effect of smoking was stronger in women as compared to men. A larger nationwide cohort study from South Korea also suggested that there is a significant higher risk of developing psoriasis in smokers as compared to nonsmokers and there was a positive correlation between the risk of psoriasis and period of smoking.
Our study did not find any significant association between alcohol intake and severity of disease. Asokan et al. compared the severity of psoriasis with smoking and alcohol consumption in male patients >18 years of age and found that the mean PASI score of smokers was higher as compared to that of the nonsmokers. They also found that there was a significant correlation between PASI scores and index for nicotine dependence. However, they found that there was no association between the severity of psoriasis and alcohol consumption.
Our study showed a positive correlation between levels of psychological stress and PASI score. Gaston et al. found a positive correlation between severity of psoriasis and psychological stress levels. They suggested that some patients could benefit from psychological interventions and meditation. Verhoeven et al. studied the effect of daily stressors on the severity of psoriasis symptoms and found that the patients reported increased severity of disease during periods of higher daily stress.
We compared PLT and platelet indices including MPV, PCT, PDW, and PLCR between psoriasis patients and controls. Our finding showed that the mean PLT (P = 0.043) and PCT (P = 0.043) were significantly higher in psoriasis patients as compared to that of controls. Kim et al. compared 176 psoriasis patients with 101 healthy controls and did not find any significant differences in platelets count among cases and controls. Raghavan et al. in a study conducted on fifty psoriasis patients and fifty controls showed that the mean PLT was statistically significantly lower (P < 0.02) in patients with psoriasis (220.0 + 61.90) as compared to controls (256.44 + 81.02). Pektas et al. suggested that PCT can be used as a predictor for the presence of psoriasis.
PDW was significantly lower in psoriasis patients as compared to controls. However, contrary to our study results, Kim et al. found PDW to be significantly higher in psoriasis patients (11.48 + 1.45) as compared to controls (10.98 + 1.16). We did not find any significant difference in MPV among psoriasis patients and controls. Saleh et al. also failed to find any significant association between psoriasis and MPV in their study to find the role of platelet activation in psoriasis and subclinical atherosclerosis. They found CD62 to be a more important marker. Similarly, Isik et al. also did not find any significant differences in MPV between psoriasis patients and controls.
We found an inverse correlation between the severity of disease (PASI) and platelet indices such as MPV, PDW, and PLCR; however, there was no significant correlation of disease severity with PLT and PCT. Similar to our study (r = -0.304, n = 42, P = 0.050), Unal found an inverse correlation between MPV and PASI (r = -0.130, P = 0.020). They also suggested that higher activity of platelets in psoriasis may make psoriasis patients more sensitive to atherosclerotic plaque formation and further complications. In our study, PDW showed an inverse correlation with PASI (r2 = 0.111 P = 0.031). However, Chandrashekar et al. and Kim et al. showed no correlation between PASI and PDW. Pektas et al. found a positive correlation between PASI and PCT (r = 0.114, P = 0.001). No published literature discussed the correlation between PASI and PLCR.
| Conclusion|| |
The present study showed that PLT and platelet indices are correlated with the severity of disease. Platelet indices such as PDW, MPV, and PLCR have a negative correlation with PASI score. This finding suggested that platelets might be playing an important role in the pathogenesis and progression of the disease.
Ethics approval and consent to participate
The study has been approved by the hospital's Scientific and Ethical Committee of North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, Delhi, India. Written informed consent was obtained from all the participants of the study.
Availability of data and material
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]