Mean platelet volume as a Low-Cost discriminatory marker for thrombotic risk assessment in Yemeni type 2 diabetic patients: A proposal for Resource-Limited settings

BACKGROUND: Thrombotic complications are a leading cause of mortality in type 2 diabetes mellitus (T2DM). In resource-limited settings, identifying affordable and accessible predictive biomarkers is paramount for risk stratification. However, population-specific Mean Platelet Volume (MPV) thresholds and their cost-effectiveness in conflict settings remain unknown, hindering its implementation in guidelines. OBJECTIVES: This study aimed to evaluate the discriminatory value of mean platelet volume (MPV) for thrombotic risk and propose a low-cost screening strategy for patients with type 2 diabetes mellitus (T2DM) in Yemen, a resource-limited conflict setting. DESIGN: A cross-sectional study. SETTING: Major hospitals in Aden Governorate, Yemen. PARTICIPANTS: 140 adult Yemeni patients with clinically diagnosed T2DM. INTERVENTIONS: Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the predictive performance (sensitivity, specificity, area under the curve) of MPV for a composite thrombotic risk endpoint. The secondary outcome was the strength of correlation between MPV and glycemic control (HbA1c). RESULTS: MPV was significantly elevated in patients with poor glycemic control (HbA1c ≥ 7%). ROC analysis identified an MPV value of 11.5 fL as a robust predictor of thrombotic risk, with a sensitivity of 78% and a specificity of 85% (AUC = 0.82, 95% CI: 0.74-0.89). A strong positive correlation was found between HbA1c and MPV (r = 0.52, p < 0.001), demonstrating a dose-response relationship across glycemic strata. CONCLUSION: MPV ≥ 11.5 fL shows promise as a highly discriminatory, low-cost marker of thrombotic risk in Yemeni T2DM patients. We propose that routine MPV testing should be considered for integration into national diabetic guidelines in Yemen and similar conflict-affected settings. This evidence-based, low-cost strategy could contribute to improved preventive care and reduce the burden of thrombosis where resources are most scarce.