Systemic Inflammatory Response Indices in the Clinical Management of Patients Monitored for Tubo-Ovarian Abscess

Abstract

Aim: This study aimed to evaluate the potential usefulness of the systemic immune response index (SIRI) and systemic immune inflammation index (SII) as biomarkers for forecasting disease severity and clinical outcomes in patients receiving treatment for tubo-ovarian abscess (TOA). Materials and Methods: The records of 64 patients diagnosed and treated for TOA between January 2021 and December 2023 were retrospectively analyzed. The values of SIRI (neutrophil × monocyte / lymphocyte ratio) and SII (neutrophil × platelet / lymphocyte ratio) were calculated using pre- and post-treatment complete blood count parameters. Results: In this study, in patients receiving only medical treatment, a significant reduction was noted in hemoglobin, neutrophil, leukocyte, monocyte, CRP, SII, and SIRI values after treatment. In contrast, platelet values significantly increased (p<0.05). Among patients undergoing combined medical and surgical therapy, significant reductions were observed in hemoglobin, neutrophil, leukocyte, monocyte, CRP, SII, and SIRI values. At the same time, lymphocyte and platelet levels significantly increased after treatment compared to pre-treatment levels (p<0.05). When comparing pre- and post-treatment measurements in all patients, significant decreases were observed in hemoglobin, leukocyte, neutrophil, and monocyte levels, and significant increases in lymphocyte and platelet levels were detected (p<0.05). CRP, SII, and SIRI values significantly decreased after treatment (p<0.001). Conclusion: Systemic inflammatory indices are gaining importance in the clinical follow-up of TOA, A critical disease associated with marked morbidity and mortality. Comprehensive prospective studies are needed to validate their use as inflammatory markers in the management of TOA.

Keywords

• Tubo-ovarian abscess
• systemic immune response index
• systemic immune-inflammation index

Project Number

356725

Ethical Statement

Ethical approval for this study was obtained from the Clinical Research Ethics Committee of Sakarya University Faculty of Medicine (April 30, 2024; Approval No: 356725)

Tubaovaryan Apse Nedeniyle Takip Edilen Hastaların Klinik Yönetiminde Sistemik İnflamatuar Yanıt İndeksleri

Abstract

Öz Amaç: Tubaovaryan apse (TOA) nedeniyle tedavi edilen hastalarda sistemik immün yanıt indeksi (SIRI) ile sistemik immün inflamasyon indeksi (SII) parameterlerinin, hastalığın ciddiyetini ve klinik sonuçları öngörmede potansiyel bir biyobelirteç olarak kullanılabilirliğinin araştırılması amaçlandı. Gereç ve yöntemler: TOA tanısıyla Ocak 2021 tarihinden Aralık 2023 tarihin kadar, takip ve tedavi edilen 64 hastanın kayıtları retrospektif olarak analiz edildi. Hastaların tedavi öncesi ve sonrasındaki tam kan sayımı parametreleri temel alınarak SIRI (nötrofil × monosit/ lenfosit oranı) ve SII (nötrofil × platelet/ lenfosit oranı) değerleri hesaplandı. Bulgular: Bu çalışmada yalnızca medikal tedavi uygulanan hastalarda, tedavi sonrası dönemde tedavi öncesine kıyasla hemoglobin, nötrofil, lökosit, monosit, CRP, SII ve SIRI düzeylerinde anlamlı bir düşüş gözlemlenirken; platelet düzeylerinde ise anlamlı bir artış saptanmıştır (p<0.05). Medikal ve cerrahi tedavi uygulanan hastalarda, tedavi sonrası dönemde hemoglobin, nötrofil, lökosit, monosit, CRP, SII ve SIRI seviyelerinde istatistiksel olarak anlamlı bir azalma; lenfosit ve platelet seviyelerinde ise belirgin bir artış gözlemlenmiştir (p<0.05). Tüm hastalarda tedavi öncesi ve sonrası yapılan ölçümlerin karşılaştırılmasında, tedavi sonrasında hemoglobin, nötrofil, lökosit ve monosit düzeylerinde istatistiksel olarak anlamlı bir azalma; lenfosit ve platelet düzeylerinde ise anlamlı bir artış saptandı (p<0.05), CRP, SII ve SIRI düzeylerinde ise tedavi sonrası dönemde anlamlı ölçüde bir düşüş gözlemlendi (p<0.001). Sonuç: Ciddi morbidite ve mortaliteye yol açabilen önemli bir hastalık olan TOA’nın klinik takibinde sistemik inflamatuar indeksler önem kazanmaktadır. TOA yönetiminde bir inflamasyon belirteci olarak kullanılabilmesi için prospektif geniş sayılı çalışmalara ihtiyaç vardır.

Keywords

• Tubaovaryan apse
• sistemik immün yanıt indeksi
• sistemik immün inflamasyon indeksi

Project Number

356725

Ethical Statement

Bu çalışma için etik onay, Sakarya Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu’ndan alınmıştır (30 Nisan 2024; Onay No: 356725)

References

1. 1. Edelman, D. A., Berger, G. S. Contraceptive practice and tuboovarian abscess. American Journal of Obstetrics and Gynecology, 1980, 138(5), 541–544. https://doi.org/10.1016/0002-9378(80)90283-5
2. 2. Mirhashemi, R., Schoell, W. M., Estape, R., Angioli, R., Averette, H. E. Trends in the management of pelvic abscesses. Journal of the American College of Surgeons, 1999, 188(5), 567-572. https://doi.org/10.1016/S1072-7515(99)00040-X
3. 3. Ribak, R., Schonman, R., Sharvit, M., Schreiber, H., Raviv, O., Klein, Z. Can the Need for Invasive Intervention in Tubo-ovarian Abscess Be Predicted? The Implication of C-reactive Protein Measurements. Journal of Minimally Invasive Gynecology, 2020, 27(2), 541–547. https://doi.org/10.1016/j.jmig.2019.04.027
4. 4. Granberg, S., Gjelland, K., Ekerhovd, E. The management of pelvic abscess. Best Practice & Research Clinical Obstetrics & Gynaecology, 2009, 23(5), 667–678. https://doi.org/10.1016/j.bpobgyn.2009.01.010
5. 5. Lee, S. W., Rhim, C. C., Kim, J. H., Lee, S. J., Yoo, S. H., Kim, S. Y., et al. Predictive Markers of Tubo-Ovarian Abscess in Pelvic Inflammatory Disease. Gynecologic and Obstetric Investigation, 2016, 81(2), 97–104. https://doi.org/10.1159/000381772
6. 6. Sahin, R., Tanacan, A., Serbetci, H., Agaoglu, Z., Karagoz, B., Haksever, M., et al. The role of first-trimester NLR (neutrophil to lymphocyte ratio), systemic immune-inflammation index (SII), and, systemic immune-response index (SIRI) in the prediction of composite adverse outcomes in pregnant women with systemic lupus erythematosus. Journal of Reproductive Immunology, 2023, 158, 103978. https://doi.org/10.1016/j.jri.2023.103978
7. 7. Bruno, M., Bizzarri, N., Teodorico, E., Certelli, C., Gallotta, V., Pedone Anchora, et al. The potential role of systemic inflammatory markers in predicting recurrence in early-stage cervical cancer. European Journal of Surgical Oncology, 2024, 50(1). https://doi.org/10.1016/j.ejso.2023.107311
8. 8. Fang, J., Lin, Y., Chen, Z., Lin, Y., Pan, M. The Association of Inflammatory Markers with Maternal-Neonatal Outcome After Cervical Cerclage. Journal of Inflammation Research, 2023, 16, 245–255. https://doi.org/10.2147/JIR.S393666

9. 9. Huang, H., Liu, Q., Zhu, L., Zhang, Y., Lu, X., Wu, Y., et al. Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Patients with Cervical Cancer. Scientific Reports, 2019, 9(1), 3284. https://doi.org/10.1038/s41598-019-39150-0
10. 10. Alay, I., Kaya, C., Karaca, I., Eren, E., Hosgoren, M., Aslanova, F., et al. The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo‐ovarian abscess. Journal of Obstetrics and Gynaecology Research, 2019, 45(6), 1183-1189.
11. 11. Yildirim, M., Turkyilmaz, E., Avsar, A. F. Preoperative neutrophil-to-lymphocyte ratio has a better predictive capacity in diagnosing tubo-ovarian abscess. Gynecologic and Obstetric Investigation, 2015, 80(4), 234-239.
12. 12. Grivennikov, S. I., Greten, F. R., Karin, M. (2010). Immunity, inflammation, and cancer. Cell, 2010, 140(6), 883-899.
13. 13. Huang, H., Wu, K., Chen, L., Lin, X. Study on the application of systemic inflammation response index and platelet–lymphocyte ratio in ovarian malignant tumors. International Journal of General Medicine, 2021, 10015-10022. https://doi.org/10.2147/IJGM.S346610
14. 14. Yang, R., Chang, Q., Meng, X., Gao, N., Wang, W. Prognostic value of systemic immune-inflammation index in cancer: a meta-analysis. Journal of Cancer, 2018, 9(18), 3295.
15. 15. Zhong, J. H., Huang, D. H., Chen, Z. Y. Prognostic role of systemic immune-inflammation index in solid tumors: a systematic review and meta-analysis. Oncotarget, 2017, 8(43), 75381.
16. 16. Qi, Q., Zhuang, L., Shen, Y., Geng, Y., Yu, S., Chen, H., et al. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy. Cancer, 2016, 122(14), 2158-2167.
17. 17. Wei, L., Xie, H., Yan, P. Prognostic value of the systemic inflammation response index in human malignancy: a meta-analysis. Medicine, 2020, 99(50), e23486.