Elvinger Sebastien, Kuehne Stephanie G, Patrignani Andrea, Tscharre Maximilian, Freynhofer Matthias, Perl Leor, Kornowski Ran, Cesari Francesca, Marcucci Rossella, Novelli Laura, Bernlochner Isabell, Raake Philip W, Chiarito Mauro, Bongiovanni Dario
Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Augsburg, Germany.
Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy.
Eur J Clin Invest. 2025 Oct;55(10):e70078. doi: 10.1111/eci.70078. Epub 2025 May 19.
Platelets play a crucial role in immune responses and haemostasis. Among them, reticulated platelets (RPs) have gathered attention for their association with prothrombotic states and as a potential biomarker for cardiovascular events. However, the sex-specific prognostic value of RPs remains underexplored.
This study aimed to systematically review and analyse sex-specific differences in the prognostic role of RPs in cardiovascular disease.
We conducted a comprehensive search on studies that reported patient outcomes related to RPs. Study authors were contacted to provide sex-specific patient-level data. Two studies were excluded due to data unavailability. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints included cardiovascular death, myocardial infarction, stroke, urgent revascularization, and bleeding incidents. All outcomes were stratified by sex.
The analysis included 5 studies, reporting outcomes in 1835 patients (527 females and 1308 males). RPs are a significant predictor of MACCE independently of sex males (OR 1.99 [95% CI 1.3, 3.05; I = 29%]), females (2.29 [95% CI 1.31, 3.99; I = 10%]). For cardiovascular death RPs were predictive in females (OR 3.29 [95% CI 1.69, 6.40] I = .83%) and showed a trend toward significance in males (OR 2.19 95% CI [.98, 4.9] I = 42.72%). No sex-specific differences were observed in all other secondary endpoints.
RPs significantly predict MACCE in cardiovascular disease independently from sex and may have a stronger association with cardiovascular death in females. Further research is needed to explore the sex-specific mechanisms of RPs' prognostic value.
血小板在免疫反应和止血过程中发挥着关键作用。其中，网织血小板（RPs）因其与血栓前状态的关联以及作为心血管事件的潜在生物标志物而受到关注。然而，RPs的性别特异性预后价值仍未得到充分研究。
本研究旨在系统评价和分析RPs在心血管疾病预后作用中的性别特异性差异。
我们对报告了与RPs相关患者结局的研究进行了全面检索。联系研究作者以提供性别特异性的患者水平数据。两项研究因数据不可用而被排除。主要终点是主要不良心血管和脑血管事件（MACCE）。次要终点包括心血管死亡、心肌梗死、中风、紧急血运重建和出血事件。所有结局均按性别分层。
分析纳入了5项研究，报告了1835例患者（527例女性和1308例男性）的结局。RPs是MACCE的显著预测因子，与性别无关，男性（OR 1.99 [95% CI 1.3, 3.05；I² = 29%]），女性（2.29 [95% CI 1.31, 3.99；I² = 10%]）。对于心血管死亡，RPs在女性中具有预测性（OR 3.29 [95% CI 1.69, 6.40] I² = 0.83%），在男性中显示出显著趋势（OR 2.19 95% CI [0.98, 4.9] I² = 42.72%）。在所有其他次要终点中未观察到性别特异性差异。
RPs可独立于性别显著预测心血管疾病中的MACCE，并且可能与女性心血管死亡的关联更强。需要进一步研究以探索RPs预后价值的性别特异性机制。
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