Association between mean platelet volume and acute cholecystitis in pregnant patients with right upper quadrant pain: A multicenter retrospective cohort study.

چکیده اصلی

BACKGROUND: Physiological and hematological changes during pregnancy may complicate the interpretation of conventional inflammatory markers in patients with suspected acute cholecystitis (AC). This study aimed to evaluate the association between mean platelet volume (MPV), derived from routine complete blood count analysis, and AC in pregnant patients and to investigate whether this association remained consistent across pregnancy trimesters. METHODS: This retrospective multicenter exploratory cohort study included 112 pregnant patients presenting with right upper quadrant pain between 2022 and 2025. According to retrospective classification based on the Tokyo Guidelines 2018 criteria, 89 patients were classified as AC and 23 as non-cholecystitis (NC). MPV and other hematological parameters were compared between the groups. Logistic regression analysis adjusted for pregnancy trimester was performed to evaluate the association between MPV and AC. Receiver operating characteristic (ROC) curve analysis with confidence intervals (CIs) was performed to assess the exploratory discriminative performance of MPV. RESULTS: MPV levels were significantly higher in the AC group than in the NC group (10.6 fL vs. 10.3 fL, p=0.034). In univariable logistic regression analysis, MPV was significantly associated with AC (odds ratio [OR]: 1.734, 95% CI: 1.203-2.500, p=0.003), and this association remained significant after adjustment for pregnancy trimester (OR: 1.870, 95% CI: 1.251-2.794, p=0.002). No significant associations were observed for white blood cell, neutrophil-to-lymphocyte ratio, platelet count, or platelet-to-lymphocyte ratio. ROC analysis demonstrated limited discriminative performance for MPV (area under the curve: 0.655). At the identified cut-off value of 8.70 fL, sensitivity was 95.2% and specificity was 36.4%. CONCLUSION: MPV was significantly associated with AC in pregnant patients; however, its limited discriminative performance and low specificity suggest that it should not be used as an independent diagnostic marker. MPV may provide supportive diagnostic value when interpreted together with clinical and ultrasonographic findings. Larger prospective studies including standardized MPV measurements and pregnancy-specific diagnostic frameworks are needed to better define the diagnostic role of MPV in pregnant patients with suspected AC.

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