Platelet distribution width (PDW) as a significant correlate of COVID-19 infection severity and mortality.

Platelet distribution width (PDW) as a significant correlate of COVID-19 infection severity and mortality.

Publication date: Sep 20, 2023

SARS-CoV-2 infection may cause a wide spectrum of symptoms, from asymptomatic, to mild respiratory symptoms and life-threatening sepsis. Among the clinical laboratory biomarkers analyzed during COVID-19 pandemic, platelet indices have raised great interest, due to the critical involvement of platelets in COVID-19-related thromboinflammation. Through an electronic literature search on MEDLINE, CINAHL, PubMed, EMBASE, Web of Science, and preprint servers we performed and updated a systematic review aimed at providing a detailed analysis of studies addressing the potential clinical utility of platelet distribution width, platelet distribution width (PDW), in laboratory medicine, exploring the possible association between increased PDW levels, disease severity, and mortality in COVID-19. Our systematic review revealed a wide heterogeneity of COVID-19 cohorts examined and a lack of homogenous expression of platelet indices. We found that 75 % of studies reported significantly elevated PDW values in COVID-19 infected cohorts compared to healthy/non-COVID-19 controls, and 40 % of studies reported that patients with severe COVID-19 showed increased PDW values than those with less-than-severe illness. Interestingly, 71. 4 % of studies demonstrated significant increased PDW values in non survivors vs. survivors. Overall, these results suggest that platelets are critically involved as major players in the process of immunothrombosis in COVID-19, and platelet reactivity and morphofunctional alterations are mirrored by PDW, as indicator of platelet heterogeneity. Our results confirm that the use of PDW as prognostic biomarkers of COVID-19 sepsis still remains debated due to the limited number of studies to draw a conclusion, but new opportunities to investigate the crucial role of platelets in thrombo-inflammation are warranted.

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Concepts Keywords
Covid COVID-19
Immunothrombosis PDW
Increased platelet
Lab platelet distribution width
Platelets SARS-CoV-2
systematic review


Type Source Name
disease MESH COVID-19
disease MESH infection
pathway REACTOME SARS-CoV-2 Infection
disease MESH sepsis
disease MESH thromboinflammation
disease VO LACK
disease IDO process
disease MESH inflammation
disease MESH Long Covid
disease MESH syndrome
disease MESH critical illness
disease VO time
disease VO population
disease MESH death
disease VO USA
disease MESH Hypertension
disease MESH thrombosis
disease MESH thrombocytopenia
disease VO volume
pathway KEGG Platelet activation
disease MESH hypercoagulability
disease IDO blood
disease MESH pulmonary embolism
disease MESH acute respiratory distress syndrome
disease MESH pneumonia
disease MESH shock
disease VO organ
disease IDO country
disease MESH influenza
disease IDO quality
disease VO pregnant women
drug DRUGBANK Acetylsalicylic acid
drug DRUGBANK Coenzyme M
disease MESH lung injury

Original Article

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