Hemodiyaliz hastalarında lökosit bazlı enflamatuar indeksler ile kemik mineral yoğunluğu arasındaki ilişki

Abstract

Amaç: Osteoporoz ve osteopeni, hemodiyaliz (HD) hastalarında yaygın olarak görülmektedir, ancak mevcut risk sınıflandırma yöntemleri sınırlıdır. Bu çalışma, HD hastalarında lökosit bazlı enflamatuar indeksler ile osteoporoz ve osteopeni arasındaki ilişkiyi araştırmayı ve bu indekslerin bu durumları ayırt etmedeki tanısal performansını değerlendirmeyi amaçladı. Yöntemler: İkili enerji X-ray absorbsiyometri ölçümleri ile T skorlarına göre normal kemik mineral yoğunluğu (KMY) (n=43), osteopeni (n=70) ve osteoporoz (n=55) olarak sınıflandırılan 168 hemodiyaliz hastası üzerinde retrospektif bir analiz yapıldı. Lökosit bazlı enflamatuar indeksler aşağıdaki şu şekilde hesaplandı: Trombosit-Lenfosit Oranı (PLR) = trombosit sayısı / lenfosit sayısı; Nötrofil-Lenfosit Oranı (NLR) = nötrofil sayısı / lenfosit sayısı; Sistemik İmmün Enflamasyon İndeksi (SII) = trombosit sayısı × nötrofil sayısı / lenfosit sayısı; Sistemik Enflamasyon Yanıt İndeksi (SIRI) = nötrofil sayısı × monosit sayısı / lenfosit sayısı. Bulgular: Hastaların %41,7’sinde osteopeni, %32,7’sinde osteoporoz tespit edildi. Osteoporozu olan hastalarda nötrofil ve monosit sayıları daha yüksek, lenfosit sayıları ise daha düşüktü (p < 0,001). Tüm enflamatuar indeksler, osteoporoz grubunda diğer gruplara kıyasla daha yüksek bulundu. Ayrıca, osteopeni grubunda da normal KMY grubuna göre daha yüksek değerler gözlendi. SIRI, osteopeniyi normal KMY’den ayırt etmede en güçlü belirleyici olarak tespit edildi (AUC = 0,84; duyarlılık = %81,4; özgüllük = %79,2; p < 0,001). Osteoporozu osteopeniden ayırt etmede de güçlü bir performans gösterdi (AUC = 0,86; duyarlılık = %82,5; özgüllük = %78,6; p < 0,001). Sonuç: Lökosit bazlı enflamatuar indeksler, özellikle SIRI, HD hastalarında düşük KMY ile anlamlı şekilde ilişkilidir ve osteopeni ve osteoporoz riski yüksek olan hastaları belirlemede kolay erişilebilir biyogöstergeler olarak kullanılabilir.

Keywords

• emik Mineral Yoğunluğu
• Hemodiyaliz
• Osteoporoz
• Sistemik Enflamasyon

Association between leukocyte-based inflammatory indices and bone mineral density in hemodialysis patients

Abstract

Aims: Osteoporosis and osteopenia are common among hemodialysis (HD) patients, yet current methods for risk stratification remain limited. This study aimed to investigate the relationship between leukocyte-based inflammatory indices and osteoporosis and osteopenia in HD patients and to assess their diagnostic performance in differentiating these conditions. Methods: A retrospective analysis was conducted on 168 HD patients classified into normal bone mineral density (BMD) (n=43), osteopenia (n=70), and osteoporosis (n=55) based on T-scores by dual-energy X-ray absorptiometry measurements. The leukocyte-based inflammatory indices were calculated as follows: Platelet to lymphocyte ratio (PLR)=platelet count/ lymphocyte count ratio; neutrophil o lymphocyte ratio (NLR)=neutrophil count/ lymphocyte count ratio; systemic immune inflammation index (SII)=platelet count×neutrophil count / lymphocyte count ratio, and systemic inflammation response index (SIRI)=neutrophil count×monocyte count/ lymphocyte count ratio. Results: Osteopenia and osteoporosis were identified in 41.7% and 32.7% of patients, respectively. Patients with osteoporosis exhibited higher neutrophil and monocyte counts and lower lymphocyte count (p<0.001). All inflammatory indices were higher in osteoporosis group compared to other group. Also, these indices were higher in osteopenia group compared to normal BMD group. SIRI showed the strongest discriminative power for differentiating osteopenia from normal BMD (AUC=0.84; sensitivity=81.4%; specificity=79.2%, p<0.001) and osteoporosis from osteopenia (AUC=0.86; sensitivity=82.5%; specificity=78.6%; p<0.001). Conclusion: Leukocyte-based inflammatory indices, particularly SIRI, are significantly associated with reduced BMD in HD patients and may serve as accessible biomarkers for identifying those at heightened risk of osteopenia and osteoporosis.

Keywords

• Bone mineral density
• hemodialysis
• osteoporosis
• systemic inflammation

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