Neutrophil-Lymphocyte Ratio in Septic Arthritis Diagnosis and Treatment Follow-Up

Yıl 2024, Cilt: 14 Sayı: 1, 25 - 30, 30.04.2024

Rıfat Şahin Mehmet Sabri Balık

Öz

Aim: This study aimed to determine the availability of neutrophilto- lymphocyte ratio (NLR) in diagnosis and treatment follow-up by determining the changing values when septic arthritis (SA) is diagnosed and during treatment.
Material and Method: This retrospective study is based on examining the laboratory results of 44 adult patients with a diagnosis of SA. Laboratory values, white blood cell count (WBC), C-reactive protein (CRP), and NLR of the patients on days 0, 5, 10, and 14 and the results of the joint fluid analysis were evaluated.
Results: The mean number of cells in the joint fluid of the patients was 46 thousand, and the mean PMNL rate was 89.4%. Microorganisms were seen in gram staining of joint puncture fluid of only four patients (9.1%). The number of patients with growth in joint fluid culture was only 11 (25%). The mean values for days 0, 5, 10, and 14 were, respectively, 135.2, 88.1, 47.3, and 22.2 for CRP; 9.94, 7.86, 7.42, and 7.44 for WBC; 4.9, 3.8, 3.0 and 2.4 for NLR.
Conclusion: NLR may serve as a valuable biomarker for diagnosing and monitoring treatment in SA, particularly given the low prevalence of microorganisms in gram stains and joint fluid cultures and the variability in cell counts in joint fluid samples. In patients diagnosed with SA, the mean NLR value is 4.9 and consistently decreases during treatment. Within two weeks of initiating treatment, NLR typically decreases by approximately half. This biomarker can aid in diagnosing and ongoing managing SA, offering a cost-effective and readily available indicator that should be routinely considered.

Anahtar Kelimeler

arthritis, septic, neutrophils, lymphocytes; biomarkers

Kaynakça

• 1. Clerc O, Prod’hom G, Greub G, Zanetti G, Senn L. Adult native septic arthritis: a review of 10 years of experience and lessons for empirical antibiotic therapy. J Antimicrob Chemother. 2011;66(5):1168–73.
• 2. Elsissy JG, Liu JN, Wilton PJ, Nwachuku I, Gowd AK, Amin NH. Bacterial Septic Arthritis of the Adult Native Knee Joint: A Review. JBJS Rev,. 2020;8(1):e0059.
• 3. Wyllie DH, Bowler IC, Peto TE. Bacteraemia prediction in emergency medical admissions: role of C reactive protein. J Clin Pathol. 2005;58(4):352–6.
• 4. Manohar V, Prasad SB, Raj S, Sreekrishnan TP, Gireesh Kumar KP. The Eminence of Neutrophil-lymphocyte Count Ratio in Predicting Bacteremia for Community-acquired Infections at an Emergency Medicine Department in a Tertiary Care Setting. J Emerg Trauma Shock. 2018;11(4):271–5.
• 5. Hwang SY, Shin TG, Jo IJ, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically ill septic patients. Am J Emerg Med. 2017;35(2):234–9.
• 6. Prozan L, Shusterman E, Ablin J, et al. Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection. Sci Rep. 2021;2;11(1):21519.
• 7. Stojkovic Lalosevic M, Pavlovic Markovic A, Stankovic S, et al. Combined Diagnostic Efficacy of Neutrophil-to-Lymphocyte Ratio (NLR) , Platelet-to-Lymphocyte Ratio (PLR) , and Mean Platelet Volume (MPV) as Biomarkers of Systemic Inflammation in the Diagnosis of Colorectal Cancer. Dis Markers. 2019;17;2019:6036979.
• 8. Sarı R, Karakurt Z, Ay M, et al. Neutrophil to lymphocyte ratio as a predictor of treatment response and mortality in septic shock patients in the intensive care unit. Turk J Med Sci. 2019;24;49(5):1336–49.
• 9. Johns BP, Loewenthal MR, Dewar DC. Open Compared with Arthroscopic Treatment of Acute Septic Arthritis of the Native Knee. J Bone Joint Surg Am. 2017;15;99(6):499–5.
• 10. Fowler ML, Zhu C, Byrne K, et al. Pathogen or contaminant? Distinguishing true infection from synovial fluid culture contamination in patients with suspected septic arthritis. Infection. 2017;45(6):825–30.
• 11. Hindle P, Davidson E, Biant LC. Septic arthritis of the knee: the use and effect of antibiotics prior to diagnostic aspiration. Ann R Coll Surg Engl. 2012;94(5):351–5.
• 12. Setya D, Pandey P, Ranjan S, Kumar D, Das S. Recapping error: A case of false positive result due to minuscule contamination by re-closure of vacutainer. Indian J Pathol Microbiol. 2020;63(4):678–80.
• 13. Montgomery TL, Paavola M, Bruce EA, Botten JW, Crothers JW, Krementsov DN. Laboratory Worker Self-Contamination with Noninfectious SARS-CoV-2 DNA Can Result in FalsePositive Reverse Transcriptase PCR-Based Surveillance Testing. J Clin Microbiol. 2021;18;59(7):e0072321.
• 14. Gupta MN, Sturrock RD, Field M. Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis. Ann Rheum Dis. 2003;62(4):327–31.
• 15. Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982–1991. Ann Rheum Dis. 1999;58(4):214–9.
• 16. Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA. 2007;4;297(13):1478–88.
• 17. Kochanek M, Böll B, Hallek M, von Bergwelt-Baildon M. Neutropenie und Sepsis [Neutropenia and sepsis]. Internist (Berl) . 2013;54(9):1061–9.
• 18. Póvoa P, Coelho L, Almeida E, et al. Early identification of intensive care unit-acquired infections with daily monitoring of C-reactive protein: a prospective observational study. Crit Care. 2006;10(2):R63.
• 19. Peres Bota D, Mélot C, Lopes Ferreira F, Vincent JL. Infection Probability Score (IPS): A method to help assess the probability of infection in critically ill patients. Crit Care Med. 2003;31(11):2579–84.
• 20. Adnet F, Borron SW, Vicaut E, et al. Value of C-reactive protein in the detection of bacterial contamination at the time of presentation in drug-induced aspiration pneumonia. Chest. 1997;112(2):466–1.
• 21. Alper B, Erdogan B, Erdogan MÖ, Bozan K, Can M. Associations of Trauma Severity with Mean Platelet Volume and Levels of Systemic Inflammatory Markers (IL1β, IL6, TNFα, and CRP). Mediators Inflamm. 2016:9894716.
• 22. Du Clos TW. Function of C-reactive protein. Ann Med. 2000;32(4):274–8.
• 23. Muñoz JL, Alvarez MO, Cuquerella V, et al. Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program. Surg Endosc. 2018;32(9):4003–10.
• 24. Shen J, Hernandez D, McNeill LH, Chow WH, Zhao H. Associations of serum CRP levels with demographics, health behaviors, and risk of cancer among the Mexican American Mano A Mano Cohort. Cancer Epidemiol. 2019;60:1–7.
• 25. Paepegaey AC, Genser L, Bouillot JL, Oppert JM, Clément K, Poitou C. High levels of CRP in morbid obesity: the central role of adipose tissue and lessons for clinical practice before and after bariatric surgery. Surg Obes Relat Dis. 2015;11(1):148–54.
• 26. Long B, Koyfman A, Gottlieb M. Evaluation and Management of Septic Arthritis and its Mimics in the Emergency Department. West J Emerg Med. 2019;20(2):331–41.
• 27. Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidencebased diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781–96.
• 28. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;26;5(1):2.
• 29. Huang Z, Fu Z, Huang W, Huang K. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emerg Med. 2020;38(3):641–7.
• 30. Kumarasamy C, Sabarimurugan S, Madurantakam RM, et al. Prognostic significance of blood inflammatory biomarkers NLR, PLR, and LMR in cancer-A protocol for systematic review and meta-analysis. Medicine (Baltimore) . 2019;98(24):e14834.
• 31. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;3;10(1):12.
• 32. Gürol G, Çiftci İH, Terizi HA, Atasoy AR, Ozbek A, Köroğlu M. Are there standardized cutoff values for neutrophillymphocyte ratios in bacteremia or sepsis? J Microbiol Biotechnol. 2015;25(4):521–5.
• 33. Erre GL, Paliogiannis P, Castagna F, et al. Meta-analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in rheumatoid arthritis. Eur J Clin Invest. 2019;49(1):e13037.
• 34. Diem S, Schmid S, Krapf M, et al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer. 2017;111:176–81