Evaluation of the Determination of Platelet/Lymphocyte and Neutrophil/Lymphocyte Ratios in the Diagnosis of Acute Abdomen
Öz
Objective: Biomarkers are of great importance in shortening the length of hospital stay and reducing the rates of mortality and morbidity in patients who present to the emergency department with abdominal pain. In this study, the importance of platelet lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR) in determining the severity of the complaints of patients presenting with abdominal pain, the relationship between the severity of the disease and the superiority of white blood cell (WBC), PLR and NLR over each other in showing acute abdomen were evaluated.
Materials and Methods: This study was conducted prospectively on 200 patients who applied to the 3rd Level University Hospital Emergency Medicine Clinic with the complaint of abdominal pain and were diagnosed with "acute abdomen" radiologically and 100 healthy control groups.
Results: A total of 300 cases, 200 patient group and 100 control group were included in our study. WBC sensitivity 79%, specificity 79%, PKD level 88.3%, NKD level 65.3%, NLR sensitivity 85%, specificity 83%, PKD level 90.9%, NKD level 73.5%, PLO sensitivity 69%, specificity in differentiating patient and control groups 68%, PKD level was 81.2%, NKD level was 52.3%. It was determined that there was a positive correlation of 0.510 between the NLR values and WBC values of the cases, and a statistically significant correlation of 0.115 in the positive direction between the PLO values and the WBC values.
Conclusion: WBC, NLR, and PLR values are markers of acute inflammation, and we think that NLR will guide the clinician in identifying critical patients presenting with abdominal pain, reducing the number of advanced imaging, and predicting the primary outcome.
Anahtar Kelimeler
Complete Blood Cell Emergency Service Neutrophil Lymphocyte Ratio Platelet Lymphocyte Ratio White Blood Cell
Kaynakça
- Gans, S.L, Pols, M.A, Stoker, J, Boermeester, M.A, expert steering group, Guideline for the diagnostic pathway in patients with acute abdominal pain, Digestive surgery, 2015, 32(1), 23-31.
- Xu, Z.S, Zhang, F.P, Zhang, Y, Ou-Yang, Y.P, Yu, X.W, Wang, W.L et al, Prognostic role of the pre-treatment platelet-lymphocyte ratio in pancreatic cancer: a meta-analysis, Oncotarget, 2017, 8(58), 99003-99012.
- Liaw, F.Y, Huang, C.F, Chen, W.L, Wu, L.W, Peng, TC, Chang, Y.W et al, Higher Platelet-to-Lymphocyte Ratio Increased the Risk of Sarcopenia in the Community-Dwelling Older Adults, Scientific reports, 2017, 7(1), 16609.
- Gao, Y, Wang, W.J, Zhi, Q, Shen, M, Jiang, M, Bian, X et al, Neutrophil/lymphocyte ratio is a more sensitive systemic inflammatory response biomarker than platelet/lymphocyte ratio in the prognosis evaluation of unresectable pancreatic cancer, Oncotarget, 2017,8(51),88835-88844.
- Zheng, J, Cai, J, Li, H, Zeng, K, He, L, Fu, H et al, Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Prognostic Predictors for Hepatocellular Carcinoma Patients with Various Treatments: a Meta-Analysis and Systematic Review, Cellular Physiology and Biochemistry, 2017, 44(3), 967-981.
- Wang, L, Liang, D, Xu, X, Jin, J, Li, S, Tian, G et al, The prognostic value of neutrophil to lymphocyte and platelet to lymphocyte ratios for patients with lung cancer, Oncology Letters, 2017, 14(6), 6449-6456.
- İlhan, M, İlhan, G, Gök, A.F, Bademler, S, Verit Atmaca, F, Ertekin, C, Evaluation of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red blood cell distribution width-platelet ratio as early predictor of acute pancreatitis in pregnancy, The Journal of Maternal-Fetal & Neonatal Medicine, 2016, 29(9),1 476-1480.
- Demircan, A, Aygencel, G, Karamercan, M, Ergin, M, Yılmaz, T.U, Karamercan, A, Ultrasonographic findings and evaluation of white blood cell counts in patients undergoing laparotomy with the diagnosis of acute appendicitis, Turkish Journal of Trauma and Emergency Surgery, 2010, 16(3), 248-252.
- Akıncı, E, Erbay, A, Çolpan, A, Bodur, H, Çevik, M.A, Eren, S.S, Yoğun Bakım İnfeksiyonlarının Tanısında Vücut Isısı, Beyaz Küre Sayısı ve C-Reaktif Proteinin Değeri: Prospektif Bir Çalışma, Flora, 2005, 10(3), 125-130.
- De Jager, C.P, van Wijk, P.T, Mathoera, R.B, de Jongh-Leuvenink, J, van der Poll, T, Wever, PC, Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit, Critical Care, 2010, 14(5), 1-8.
- Templeton, A.J, Ace, O, McNamara, M.G, Al-Mubarak, M, Vera-Badillo, F.E, Hermanns, T et al, Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis, Cancer Epidemiology and Prevention Biomarkers, 2014, 23(7), 1204-1212.
- Kruip, M.J, Leclercq, M.G, Heul, C.V.D, Prins, M.H, Büller, H.R, Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies. A systematic review, Annals of internal medicine, 2003, 138(12), 941-951.
- Mills, A.M, Baumann, B.M, Chen, E.H, Zhang, K.Y, Glaspey, L.J, Hollander, J.E et al. The impact of crowding on time until abdominal CT interpretation in emergency department patients with acute abdominal pain, Postgraduate Medicine, 2010, 122(1), 75-81.
- Di Somma, S, Paladino, L, Vaughan, L, Lalle, I, Magrini, L, Magnanti, M, Overcrowding in emergency department: an international issue, Internal and Emergency Medicine, 2015, 10(2), 171-5.
- Pines, J.M, Hollander, J.E, Emergency department crowding is associated with poor care for patients with severe pain, Annals of Emergency Medicine, 2008, 51(1), 1-5.
- O'Leary, M.R, Smith, M, Olmsted, W.W, Curtis, D.J, Physician assessments of practice patterns in emergency department radiograph interpretation, Annals of Emergency Medicine, 1988, 17(10), 1019-1023.
- Kucuk, A, Erol, M.F, Senel, S, Eroler, E, Yumun, H.A, Uslu, A.U et al, The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis, The Korean journal of Internal Medicine, 2016, 31(2), 386-391.
- Jung, S.K, Rhee, D.Y, Lee, W.J, Woo, S.H, Seol, S.H, Kim, D.H et al, Neutrophil-to-lymphocyte count ratio is associated with perforated appendicitis in elderly patients of emergency department, Aging Clinical And Experimental Research, 2017, 29(3), 529-536.
- Aktimur, R, Cetinkunar, S, Yildirim, K, Aktimur, S.H, Ugurlucan, M, Ozlem, N, Neutrophil-to-lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia, European Journal of Trauma and Emergency Surgery, 2016, 42(3), 363-368.
- Tamhane, U.U, Aneja, S, Montgomery, D, Rogers, E.K, Eagle, K.A, Gurm, H.S, Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome, The American Journal of Cardiology, 2008, 102(6), 653-657.
- Paolillo, C, Spallino, I, Can C-reactive protein and white blood cell count alone rule out an urgent condition in acute abdominal pain? Internal And Emergency Medicine, 2016, 11(1), 141-142.
- Yeniocak, S, Turkmen, S, Uzun, O, Karaca, Y, Tatli, O, Turedi, S et al, Analysis of patients presenting to the emergency department with acute abdominal pain/Akut karin agrisiyla acil servise basvuran hastalarin analizi, The Journal of Academic Emergency Medicine, 2012, 212-216.
Platelet/Lenfosit ve Nötrofil/Lenfosit Oranlarının Akut BatınTanısında ki Belirleyeciliğinin Değerlendirilmesi
Öz
Giriş ve Amaç: Acil servise karın ağrısı ile başvuran hastalarda hastanede kalış süresini kısaltma ve mortalite, morbitide oranlarının azaltılmasında biyobelirteçlerin önemi büyüktür. Bu çalışmada karın ağrısı ile başvuran hastaların başvuru şikayetlerinin ciddiyetini belirleyebilmede platelet lenfosit oranı (PLO), nötrofil lenfosit oranının (NLO) önemi, hastalığın ciddiyeti arasındaki ilişkisi ve akut karını göstermede beyaz küre (WBC), PLO ve NLO’nun birbirine üstünlükleri değerlendirilmiştir.
Gereç ve Yöntemler: Bu çalışma 3. Basamak Üniversite Hastanesi Acil Tıp Kliniğine karın ağrısı şikayetiyle başvuran ve radyolojik olarak “akut batın” tanısı konan 200 hasta ve sağlıklı 100 kontrol grubu üzerinde prospektif olarak yapılmıştır.
Bulgular: Çalışmaya 200’ü hasta grubu, 100’ü kontrol grubu olmak üzere toplam 300 olgu dahil edilmiştir. Hasta ve kontrol grubunu ayırt etmede WBC duyarlılığı %79, özgüllüğü %79, PKD düzeyi %88,3, NKD düzeyi %65,3, NLO duyarlılığı %85, özgüllüğü %83, PKD düzeyi %90,9, NKD düzeyi %73,5 ve PLO duyarlılığı %69, özgüllüğü %68, PKD düzeyi %81,2, NKD düzeyi %52,3 olarak saptanmıştır. Olguların NLO değerleri ile WBC değerleri arasında pozitif yönde 0.510 düzeyinde, PLO değerleri ile WBC değerleri arasında pozitif yönde 0.115 düzeyinde istatistiksel olarak anlamlı ilişki olduğu saptanmıştır.
Sonuç: WBC, NLO ve PLO değerleri akut inflamasyonu gösteren belirteçlerden olup NLO’nun karın ağrısı ile başvuran hastalarda kritik hastaları tanımlamak, ileri görüntüleme sayısının azaltılmasını sağlamak ve primer sonlanımı öngörmede klinisyene yol göstereceğini düşünmekteyiz.
Anahtar Kelimeler
Acil Servis Beyaz Küre Nötrofil Lenfosit Oranı Platelet Lenfosit Oranı Tam Kan Sayımı
Kaynakça
- Gans, S.L, Pols, M.A, Stoker, J, Boermeester, M.A, expert steering group, Guideline for the diagnostic pathway in patients with acute abdominal pain, Digestive surgery, 2015, 32(1), 23-31.
- Xu, Z.S, Zhang, F.P, Zhang, Y, Ou-Yang, Y.P, Yu, X.W, Wang, W.L et al, Prognostic role of the pre-treatment platelet-lymphocyte ratio in pancreatic cancer: a meta-analysis, Oncotarget, 2017, 8(58), 99003-99012.
- Liaw, F.Y, Huang, C.F, Chen, W.L, Wu, L.W, Peng, TC, Chang, Y.W et al, Higher Platelet-to-Lymphocyte Ratio Increased the Risk of Sarcopenia in the Community-Dwelling Older Adults, Scientific reports, 2017, 7(1), 16609.
- Gao, Y, Wang, W.J, Zhi, Q, Shen, M, Jiang, M, Bian, X et al, Neutrophil/lymphocyte ratio is a more sensitive systemic inflammatory response biomarker than platelet/lymphocyte ratio in the prognosis evaluation of unresectable pancreatic cancer, Oncotarget, 2017,8(51),88835-88844.
- Zheng, J, Cai, J, Li, H, Zeng, K, He, L, Fu, H et al, Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Prognostic Predictors for Hepatocellular Carcinoma Patients with Various Treatments: a Meta-Analysis and Systematic Review, Cellular Physiology and Biochemistry, 2017, 44(3), 967-981.
- Wang, L, Liang, D, Xu, X, Jin, J, Li, S, Tian, G et al, The prognostic value of neutrophil to lymphocyte and platelet to lymphocyte ratios for patients with lung cancer, Oncology Letters, 2017, 14(6), 6449-6456.
- İlhan, M, İlhan, G, Gök, A.F, Bademler, S, Verit Atmaca, F, Ertekin, C, Evaluation of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red blood cell distribution width-platelet ratio as early predictor of acute pancreatitis in pregnancy, The Journal of Maternal-Fetal & Neonatal Medicine, 2016, 29(9),1 476-1480.
- Demircan, A, Aygencel, G, Karamercan, M, Ergin, M, Yılmaz, T.U, Karamercan, A, Ultrasonographic findings and evaluation of white blood cell counts in patients undergoing laparotomy with the diagnosis of acute appendicitis, Turkish Journal of Trauma and Emergency Surgery, 2010, 16(3), 248-252.
- Akıncı, E, Erbay, A, Çolpan, A, Bodur, H, Çevik, M.A, Eren, S.S, Yoğun Bakım İnfeksiyonlarının Tanısında Vücut Isısı, Beyaz Küre Sayısı ve C-Reaktif Proteinin Değeri: Prospektif Bir Çalışma, Flora, 2005, 10(3), 125-130.
- De Jager, C.P, van Wijk, P.T, Mathoera, R.B, de Jongh-Leuvenink, J, van der Poll, T, Wever, PC, Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit, Critical Care, 2010, 14(5), 1-8.
- Templeton, A.J, Ace, O, McNamara, M.G, Al-Mubarak, M, Vera-Badillo, F.E, Hermanns, T et al, Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis, Cancer Epidemiology and Prevention Biomarkers, 2014, 23(7), 1204-1212.
- Kruip, M.J, Leclercq, M.G, Heul, C.V.D, Prins, M.H, Büller, H.R, Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies. A systematic review, Annals of internal medicine, 2003, 138(12), 941-951.
- Mills, A.M, Baumann, B.M, Chen, E.H, Zhang, K.Y, Glaspey, L.J, Hollander, J.E et al. The impact of crowding on time until abdominal CT interpretation in emergency department patients with acute abdominal pain, Postgraduate Medicine, 2010, 122(1), 75-81.
- Di Somma, S, Paladino, L, Vaughan, L, Lalle, I, Magrini, L, Magnanti, M, Overcrowding in emergency department: an international issue, Internal and Emergency Medicine, 2015, 10(2), 171-5.
- Pines, J.M, Hollander, J.E, Emergency department crowding is associated with poor care for patients with severe pain, Annals of Emergency Medicine, 2008, 51(1), 1-5.
- O'Leary, M.R, Smith, M, Olmsted, W.W, Curtis, D.J, Physician assessments of practice patterns in emergency department radiograph interpretation, Annals of Emergency Medicine, 1988, 17(10), 1019-1023.
- Kucuk, A, Erol, M.F, Senel, S, Eroler, E, Yumun, H.A, Uslu, A.U et al, The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis, The Korean journal of Internal Medicine, 2016, 31(2), 386-391.
- Jung, S.K, Rhee, D.Y, Lee, W.J, Woo, S.H, Seol, S.H, Kim, D.H et al, Neutrophil-to-lymphocyte count ratio is associated with perforated appendicitis in elderly patients of emergency department, Aging Clinical And Experimental Research, 2017, 29(3), 529-536.
- Aktimur, R, Cetinkunar, S, Yildirim, K, Aktimur, S.H, Ugurlucan, M, Ozlem, N, Neutrophil-to-lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia, European Journal of Trauma and Emergency Surgery, 2016, 42(3), 363-368.
- Tamhane, U.U, Aneja, S, Montgomery, D, Rogers, E.K, Eagle, K.A, Gurm, H.S, Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome, The American Journal of Cardiology, 2008, 102(6), 653-657.
- Paolillo, C, Spallino, I, Can C-reactive protein and white blood cell count alone rule out an urgent condition in acute abdominal pain? Internal And Emergency Medicine, 2016, 11(1), 141-142.
- Yeniocak, S, Turkmen, S, Uzun, O, Karaca, Y, Tatli, O, Turedi, S et al, Analysis of patients presenting to the emergency department with acute abdominal pain/Akut karin agrisiyla acil servise basvuran hastalarin analizi, The Journal of Academic Emergency Medicine, 2012, 212-216.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 10 Sayı: 1 |
