Journal List > J Rheum Dis > v.24(3) > 1064320

Byun, Jung, Song, Park, and Lee: Platelet Distribution Width and Mean Platelet Volume Are Not Correlated with the Disease Activity Indices of Ankylosing Spondylitis



We investigated the association of platelet distribution width (PDW) and mean platelet volume (MPV) with disease activity indices of ankylosing spondylitis (AS) in patients whose laboratory results or medical conditions would not affect PDW and MPV levels.


We analysed demographic and laboratory data of 88 patients with AS. On the same day as the laboratory tests were done, we assessed AS disease activity using the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Patients Global Score and Ankylosing Spondylitis Disease Activity Score (ASDAS), including erythrocyte sedimentation rate (ESR) (ASDAS-ESR) and C-reactive protein (CRP) (ASDAS-CRP). The association was analyzed by linear regression.


The median age of 88 patients was 38.0 years and the median length of observation was 5.5 years. The median platelet count was 266,500.0/μ L, the median PDW was 10.7 fL and the median MPV 9.6 fL. The median ESR was 19.0 mm/hr and CRP was 2.5 mg/L. Among acute reactants, only CRP was negatively correlated with MPV, but not PDW (r=−0.218, p<0.041). However, both PDW and MPV were not significantly correlated with any disease activity index of AS. On multivariate linear regression analysis, only the length of observation was significantly correlated with MPV (β=0.224, p<0.044).


PDW and MPV were not potent surrogate markers to reflect AS activity, with potential confounding strictly controlled, to affect MPV and PDW levels.


1. Sieper J. New treatment targets for axial spondyloarthritis. Rheumatology (Oxford). 2016; 55(suppl 2):ii38–ii42.
2. Dougados M, Gueguen A, Nakache JP, Velicitat P, Zeidler H, Veys E, et al. Clinical relevance of C-reactive protein in axial involvement of ankylosing spondylitis. J Rheumatol. 1999; 26:971–4.
3. Pedersen SJ, Sørensen IJ, Garnero P, Johansen JS, Madsen OR, Tvede N, et al. ASDAS, BASDAI and different treatment responses and their relation to biomarkers of inflammation, cartilage and bone turnover in patients with axial spondyloarthritis treated with TNFα inhibitors. Ann Rheum Dis. 2011; 70:1375–81.
4. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994; 21:2286–91.
5. Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994; 21:2281–5.
6. Jones SD, Steiner A, Garrett SL, Calin A. The bath ankylosing spondylitis patient global score (BAS-G). Br J Rheumatol. 1996; 35:66–71.
7. Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol. 1994; 21:1694–8.
8. van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, et al. ASDAS, a highly discriminatory ASAS-en-dorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis. 2009; 68:1811–8.
9. Leader A, Pereg D, Lishner M. Are platelet volume indices of clinical use? A multidisciplinary review. Ann Med. 2012; 44:805–16.
10. Hoffmann JJ. Reticulated platelets: analytical aspects and clinical utility. Clin Chem Lab Med. 2014; 52:1107–17.
11. Esen B, Atay AE, Gunoz N, Gokmen ES, Sari H, Cakir I, et al. The relation of mean platelet volume with microalbuminuria and glomerular filtration rate in obese individuals without other metabolic risk factors: the role of platelets on renal functions. Clin Nephrol. 2015; 83:322–9.
12. Kurt M, Onal IK, Sayilir AY, Beyazit Y, Oztas E, Kekilli M, et al. The role of mean platelet volume in the diagnosis of hepatocellular carcinoma in patients with chronic liver disease. Hepatogastroenterology. 2012; 59:1580–2.
13. Ju HY, Kim JK, Hur SM, Woo SA, Park KA, Park MY, et al. Could mean platelet volume be a promising biomarker of progression of chronic kidney disease? Platelets. 2015; 26:143–7.
14. Karabacak M, Dogan A, Turkdogan AK, Kapci M, Duman A, Akpinar O. Mean platelet volume is increased in patients with hypertensive crises. Platelets. 2014; 25:423–6.
15. Varol E, Ozaydin M. Mean platelet volume measurement in patients with hypercholesterolemia: a methodological issue. Angiology. 2013; 64:626.
16. Wang X, Xu XL, Li XM, Zhao R, Yang X, Cong HL. Diagnostic value of mean platelet volume combined with troponin i for acute coronary syndrome. Am J Med Sci. 2016; 352:159–65.
17. Tecer D, Sezgin M, Kanık A, İncel NA, Çimen ÖB, Biçer A, et al. Can mean platelet volume and red blood cell distribution width show disease activity in rheumatoid arthritis? Biomark Med. 2016; 10:967–74.
18. Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008; 75:291–4.
19. Şahin A, Yetişgin A, Şahin M, Durmaz Y, Cengiz AK. Can mean platelet volume be a surrogate marker of inflammation in rheumatic diseases? West Indian Med J. 2015; 65:165–9.
20. Yazici S, Yazici M, Erer B, Erer B, Calik Y, Bulur S, et al. The platelet functions in patients with ankylosing spondylitis: anti-TNF-alpha therapy decreases the mean platelet volume and platelet mass. Platelets. 2010; 21:126–31.
21. Sezgin M, Tecer D, Kanık A, Kekik FS, Yeşildal E, Akaslan E, et al. Serum RDW and MPV in ankylosing spondylitis: Can they show the disease activity? Clin Hemorheol Microcirc. 2017; 65:1–10.
22. Resorlu H, Resorlu M, Gokmen F, Akbal A, Adam G, Komurcu E, et al. Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging. J Phys Ther Sci. 2015; 27:1137–40.
23. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984; 27:361–8.
24. Cho SY, Jeon YL, Kim W, Kim WS, Lee HJ, Lee WI, et al. Mean platelet volume and mean platelet volume/platelet count ratio in infective endocarditis. Platelets. 2014; 25:559–61.
25. Bessman JD, Williams LJ, Gilmer PR Jr. Platelet size in health and hematologic disease. Am J Clin Pathol. 1982; 78:150–3.
26. Kaushansky K. The molecular mechanisms that control thrombopoiesis. J Clin Invest. 2005; 115:3339–47.
27. Lee SW, Park HJ, Kim BK, Han KH, Lee SK, Kim SU, et al. Leflunomide increases the risk of silent liver fibrosis in patients with rheumatoid arthritis receiving methotrexate. Arthritis Res Ther. 2012; 14:R232.
28. De Luca G, Secco GG, Iorio S, Verdoia M, Bellomo G, Marino P. Short-term effects of aspirin and clopidogrel on mean platelet volume among patients with acute coronary syndromes. A single-center prospective study. Blood Coagul Fibrinolysis. 2012; 23:756–9.

Figure 1.
Selection of the study population. HbA1c: haemoglobin A1c, INR: international normalized ratio.
Table 1.
Baseline characteristics of patients with ankylosing spondylitis (n=88)
Variable Value
Demographic data
 Age (yr) 38.0 (15.8)
 Male gender 68 (77.3)
 Follow-up duration (yr) 5.5 (8.5)
 Smoking 36 (40.9)
 BMI (kg/m2) 24.0 (5.0)
Platelet information
 Platelet×103 (/mm3) 266.5 (70.3)
 PDW (fL) 10.7 (1.9)
 MPV (fL) 9.6 (1.0)
Other laboratory results
 White blood cell (/mm3) 7,495.0 (2,650.0)
 Haemoglobin (g/dL) 14.9 (2.3)
 Prothrombin time (INR) 0.9 (0.1)
 Fasting glucose (mg/dL) 95.5 (12.8)
 HbA1c 5.5 (0.4)
 Blood urea nitrogen (mg/dL) 13.9 (4.5)
 Creatinine (mg/dL) 0.8 (0.2)
 Albumin (mg/dL) 4.5 (0.5)
 Alkaline phosphatase (IU/L) 70.0 (26.0)
 Aspartate aminotransferase (IU/L) 20.0 (9.0)
 Alanine aminotransferase (IU/L) 18.0 (17.0)
 Total cholesterol (mg/dL) 192.0 (40.3)
 High density cholesterol (mg/dL) 49.0 (16.0)
 Low density cholesterol (mg/dL) 105.0 (23.2)
 Triglyceride (mg/dL) 179.0 (184.3)
Acute reactants and disease activity indices
 ESR (mm/h) 19.0 (25.0)
 CRP (mg/L) 2.5 (5.3)
 ASDAS-ESR 2.3 (1.5)
 ASDAS-CRP 2.0 (1.5)
 BASDAI 3.6 (2.4)
 BAS-G 3.0 (4.0)
 BASFI 1.7 (3.3)

Values are expressed as median (interquartile range, IQR) and number (%). BMI: body mass index, PDW: platelet distribution width, MPV: mean platelet volume, INR: international normalized ratio, HbA1c: haemoglobin A1c, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, ASDAS: ankylosing spondylitis disease activity score, BASDAI: bath ankylosing spondylitis disease activity index, BAS-G: bath ankylosing spondylitis patient global score, BASFI: bath ankylosing spondylitis disease activity functional index.

Table 2.
Univariate and multivariate analysis of either PDW or MPV and other continuous variables
Variable Univariate analysis Multivariate analysis VIF
 Regression coefficient (Crude B) Correlation coefficient (R=β) p-value Standardized β* 95% confidential interval p-value
Analysis of PDW
 Demographic data
  Age (yr) 0.031 0.205 0.056 0.098 −0.015, 0.044 0.326 1.093
  Follow-up duration (yr r) 0.045 0.179 0.095 - - - -
  BMI (kg/m2) 0.053 0.096 0.893 - - - -
 Platelet information
  Platelet×103 (/mm3) −0.011 −0.369 <0.001 - - - -
  MPV (fL) 0.920 0.463 <0.001 - - - -
 Acute reactants and the disease activity indices
 ESR (mm/h) −0.008 −0.078 0.470 - - - -
 CRP (mg/L) −0.034 −0.170 0.114 - - - -
 ASDAS-ESR 0.091 0.051 0.635 - - - -
 ASDAS-CRP 0.165 0.094 0.382 −0.200 −0.902, 0.204 0.213 2.797
 BASDAI 0.193 0.200 0.062 0.284 −0.032, 0.581 0.079 2.818
 BAS-G 0.058 0.079 0.467 - - - -
 BASFI −0.003 −0.008 0.948 - - - -
Analysis of MPV
 Demographic data
  Age (yr) 0.021 0.274 0.010 0.129 −0.006, 0.025 0.209 1.176
  Follow-up duration (yr) 0.037 0.293 0.006 0.175 −0.003, 0.048 0.089 1.170
  BMI (kg/m2) 0.032 0.114 0.290 - - - -
 Platelet information
  Platelet×103 (/mm3) −0.003 −0.236 0.027 - - - -
  PDW (fL) 0.233 0.463 <0.001 - - - -
Acute reactants and the disease activity indices
  ESR (mm/h) 0.001 0.018 0.869 - - - -
  CRP (mg/L) −0.022 −0.218 0.041 - - - -
  ASDAS-ESR 0.075 0.083 0.440 - - - -
  ASDAS-CRP 0.123 0.140 0.193 0.020 −0.261, 0.296 0.901 2.882
  BASDAI 0.084 0.173 0.108 0.068 −0.122, 0.189 0.672 2.947
  BAS-G 0.051 0.039 0.198 - - - -
  BASFI 0.018 0.084 0.491 - - - -

Multivariate analyses for PDW were adjusted for age, ASDAS-CRP and BASDAI. We did not include MPV in multivariate analysis in order not to confound the interpretation of statistical results, because MPV is a variable closely correlated with PDW. Multivariate analyses for MPV were adjusted for age, disease duration, ASDAS-CRP and BASDAI. We did not include PDW in multivariate analysis in order not to confound the interpretation of statistical results, because PDW is a variable closely correlated with MPV. PDW: platelet distribution width, MPV: mean platelet volume, VIF: variance inflation factor, BMI: body mass index, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, ASDAS: ankylosing spondylitis disease activity score, BASDAI: bath ankylosing spondylitis disease activity index, BAS-G: bath ankylosing spondylitis patient global score, BASFI: bath ankylosing spondylitis disease activity functional index, −: not applicable.

Similar articles