Prognostic Value of Mean Platelet Volume in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

Introduction: Acute ischemic stroke (AIS), a significant public health concern, causes severe functional impairments. Mean platelet volume (MPV), a marker of platelet activity, is associated with increased platelet aggregation and elevated thromboxane-A2 and β-thromboglobulin levels, factors linked to heightened stroke risk and potentially its severity. This review aims to evaluate the prognostic value of MPV in predicting functional outcome in acute ischemic stroke patients. 

Methods: A comprehensive systematic search of MEDLINE, Google Scholar, ScienceDirect, and Europe PMC databases was conducted using keywords related to MPV, ischemic stroke, and outcome. Cross-sectional, retrospective, and prospective studies from 2016 to 2023 reporting association of MPV with functional outcome measured with modified Rankin scale (mRS) in AIS patients were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) for certainty assessment.

Discussion: Nine good-quality studies with 1,514 participants and six good-quality studies with 1,030 participants were included in the systematic review and meta-analysis, respectively, with very low certainty based on GRADE. Pooled results demonstrated a significantly lower MPV in the good outcome group than in the poor outcome group at 3-month follow-up (SMD -0.38; 95% CI -0.72, -0.04; p=0.03; I2 84%). Subgroup analysis showed no significant differences in MPV among patients receiving thrombolysis.

Conclusion: While lower MPV appeared associated with better outcomes, these findings are insufficient to support its use as a prognostic marker of AIS due to marked heterogeneity and inconsistency. Further studies are warranted to validate its clinical utility.