PANKREATİTLİ ÇOCUKLARDA HEMATOLOJİK PARAMETRELERİN KLİNİK ÖNEMİ

Year 2024, Volume: 25 Issue: 1 - OCAK 2024 SAYISI, 37 - 42, 17.01.2024

Ayşegül Bükülmez , Özge Vural , Ahmet Ali Tuncer

https://doi.org/10.18229/kocatepetip.1056282

Abstract

AMAÇ: Bu çalışmada, akut pankreatit (AP) ve akut rekürren
pankreatit (ARP) tanısı alan çocuklarda akut pankreatitin inflamatuar
sürecinde tanıda yeni hematolojik parametrelerin önemini
retrospektif olarak değerlendirmeyi amaçladık. Bu çalışma
pankreatitli çocuklarda yeni hematolojik parametreleri; (eritrosit
dağılım genişliği (RDW), eritrosit dağılım genişliği kalsiyum
oranı (RDWCaR), nötrofil lenfosit oranı (NLR), lenfosit monosit
oranı (LMR), trombosit lenfosit oranı (PLR), eritrosit dağılım
genişliği trombosit oranı (RDWPR), ortalama trombosit hacmi
(MPV))'ni retrospektif olarak değerlendiren literatürdeki ilk çalışmadır.
GEREÇ VE YÖNTEM: Ocak 2014 - Aralık 2019 tarihleri arasında
hastaneye başvuran ve AP ve ARP tanısı alan 55 hastanın tıbbi
kayıtları geriye dönük olarak incelendi. 0 ve 48. saatlerde RDW,
RDWCaR, MPVPR, NLR, LMR, RDWPR ve PLR değerleri geriye dönük
olarak değerlendirildi. Grup 1 akut pankreatit, Grup 2 akut
rekürren pankreatit hastalardan oluşmaktadır. İstatistiksel olarak
p<0,05 değeri anlamlı kabul edildi.
BULGULAR: Grup 1 ve Grup 2'nin RDW48h değerleri, RDW0h değerlerinden
anlamlı derecede düşük bulundu (sırasıyla p<0,001
ve p=0,006). Her iki grupta da RDWCaR48h değerleri de RDWCaR0h'den
anlamlı derecede düşük bulundu (sırasıyla p= 0,003
ve p= 0,012). Grup 1'de NLR48h değeri NLR0h'den düşük saptandı
(p= 0,004). Ayrıca Grup 2'de RDWPR48h değeri RDWPR0h'ye göre
daha düşük bulundu (p=0,041).
SONUÇ: Bu çalışmada AP ve ARP'li çocukların tanı ve takibinde
ilk 48 saat içindeki RDW, RDWCaR, NLR ve RDWPR değerlerinin
önemli olduğunu belirledik.

Keywords

Eritrosit dağılım genişliği, Pankreatit, Çocuk.

CLINICAL SIGNIFICANCE OF HEMATOLOGICAL PARAMETERS IN CHILDREN WITH PANCREATITIS

Abstract

OBJECTIVE: In this study, we aimed to retrospectively evaluate
the significance of new hematological parameters in the
diagnosis of the inflammatory process of acute pancreatitis in
children diagnosed with acute pancreatitis (AP) and acute recurrent
pancreatitis (ARP). This is the first study in the literature
assessing new hematological parameters (Red cell distribution
width (RDW), red cell distribution width to calcium ratio (RDWCaR),
neutrophile to lymphocyte ratio (NLR), lymphocyte to monocyte
ratio (LMR), platelet to lymphocyte ratio (PLR), Red cell
distribution width to platelet ratio (RDWPR) and mean platelet
volume (MPV)) in children with pancreatitis retrospectively.
MATERIAL AND METHODS: The medical records of 55 patients,
who were admitted to the hospital between January 2014 and
December 2019 were diagnosed with AP and ARP, were examined
retrospectively. RDW, RDWCaR, MPV, NLR, LMR, RDWPR and
PLR values at 0 and 48 hours were evaluated retrospectively.
Group 1 consists of patients with acute pancreatitis, Group 2
consists of patients with acute recurrent pancreatitis. A p value
of <0.05 was considered statistically significant.
RESULTS: RDW48h values of Group 1 and Group 2 were found to
be significantly lower than RDW0h values (p<0.001 and p=0.006,
respectively). RDWCaR48h values in both groups were also found
to be significantly lower than RDWCaR0h (p= 0.003 and p=
0.012, respectively). NLR48h value was detected to be lower than
NLR0h in Group 1 (p= 0.004). Moreover, the RDWPR48h value was
found to be lower compared to RDWPR0h in Group 2 (p=0.041).
CONCLUSIONS: In this study, we determined that RDW, RDWCaR,
NLR and RDWPR values within the first 48 hours were important
in the diagnosis and follow-up of children with AP and
ARP.

Keywords

Red cell distribution width, Pancreatitis, Children

References

• 1. Uc A, Fishman DS. Pancreatic Disorders. Pediatr Clin North Am. 2017;64(3):685-706. 2. Husain SZ, Srinath AI. What's unique about acute pancreatitis in children: risk factors, diagnosis and management. Nat Rev Gastroenterol Hepatol. 2017;14(6):366-72.
• 3. Abu-El-Haija M, Kumar S, Quiros JA, et al. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr. 2018;66(1):159- 76.
• 4. Westerdijk K, Simons KS, Zegers M, Wever PC, Pickkers P, de Jager CPC. The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the Intensive Care Unit: A retrospective cohort study. PLoS One. 2019;14(2):e0212861.
• 5. Djordjevic D, Rondovic G, Surbatovic M, et al. Neutrophil- to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia? Mediators Inflamm. 2018 ;2018:3758068.
• 6. O'Connell RM, Boland MR, O'Driscoll J, et al. Red cell distribution width and neutrophil to lymphocyte ratio as predictors of outcomes in acute pancreatitis: A retrospective cohort study. Int J Surg. 2018;55:124-7.
• 7. Şenol K, Saylam B, Kocaay F, Tez M. Red cell distribution width as a predictor of mortality in acute pancreatitis. Am J Emerg Med. 2013;31(4):687-9.
• 8. Zahorec R. Ratio of neutrophil to lymphocyte countsrapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
• 9. Tekin YK, Tekin G. Mean Platelet Volume-to-Platelet Count Ratio, Mean Platelet Volume-to-Lymphocyte Ratio, and Red Blood Cell Distribution Width-Platelet Count Ratio as Markers of Inflammation in Patients with Ascending Thoracic Aortic Aneurysm. Braz J Cardiovasc Surg. 2020;35(2):175-80.
• 10. Valga F, Monzón T, Henriquez F, Antón-Pérez G. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as biological markers of interest in kidney disease. Nefrologia (Engl Ed). 2019;39(3):243-9. 11. Cao Z, Li Z, Xiang H, et al. Prognostic role of haematological indices in sudden sensorineural hearing loss: Review and meta-analysis. Clin Chim Acta. 2018;483:104-111.
• 12. Mazza MG, Lucchi S, Tringali AGM, et al. Neutrophil/ lymphocyte ratio and platelet/lymphocyte ratio in mood disorders: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2018;84: 229-36.
• 13. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680-1.
• 14. Chen Q, Chen DY, Xu XZ, et al. Platelet/Lymphocyte, Lymphocyte/Monocyte, and Neutrophil/Lymphocyte Ratios as Biomarkers in Patients with Rheumatoid Arthritis and Rheumatoid Arthritis-Associated Interstitial Lung Disease. Med Sci Monit. 2019;25:6474-81.
• 15. Wang Q, Ma J, Jiang Z, Ming L. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol. 2018;37(1):4-11.
• 16. Zhao Z, Zhao X, Lu J, Xue J, Liu P, Mao H. Prognostic roles of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in ovarian cancer: a metaanalysis of retrospective studies. Arch Gynecol Obstet. 2018;297(4):849-57.
• 17. Tuncer AA, Cavus S, Balcioglu A, et al. Can mean platelet volume, Neutrophil-to-Lymphocyte, Lymphocyte- to-Monocyte, Platelet-to-Lymphocyte ratios be favourable predictors for the differential diagnosis of appendicitis? J Pak Med Assoc. 2019;69(5):647-54.
• 18. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47-58.
• 19. Zhang T, Liu H, Wang D, et al. Predicting the severity of acute pancreatitis with red cell distribution width at early admission stage. Shock. 2018;49:551-5.
• 20. Yılmaz EM, Kandemir A. Significance of red blood cell distribution width and C-reactive protein/albumin levels in predicting prognosis of acute pancreatitis. Ulus Travma Acil Cerrahi Derg. 2018;24(6):528-31.
• 21. Wang X, Meng H, Xu L, et al. Mean platelet volume as an inflammatory marker in patients with severe periodontitis. Platelets. 2015;26(1):67-71.
• 22. Gravito-Soares M, Gravito-Soares E, Gomes D, Almeida N, Tomé L. Red cell distribution width and red cell distribution width to total serum calcium ratio as major predictors of severity and mortality in acute pancreatitis. BMC Gastroenterol. 2018;18(1):108.
• 23. Azab B, Jaglall N, Atallah JP, et al. Neutrophillymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology. 2011;11(4):445-52.
• 24. Binnetoğlu E, Akbal E, Güneş F, Sen H. The prognostic value of neutrophil-lymphocyte ratio in acute pancreatitis is controversial. J Gastrointest Surg. 2014;18(4):885.
• 25. Gülen B, Sonmez E, Yaylaci S, et al. Effect of harmless acute pancreatitis score, red cell distribution width and neutrophil/lymphocyte ratio on the mortality of patients with nontraumatic acute pancreatitis at the emergency department. World J Emerg Med. 2015;6(1):29-33.
• 26. Jain V, Nath P, Patro S. Evaluation of diagnostic accuracy of inflammation markers [Neutrophil-Lymphocyte Ratio (NLR), Red cell Distribution Width (RDW), Prognostic Nutritional Index (PNI) and Lymphocyte Monocyte Ratio (LMR)] for outcomes in patients with acute pancreatitis. J Assoc Physicians India. 2022;70(4):11-12.
• 27. Cho SK, Jung S, Lee KJ, Kim JW. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC Gastroenterol. 2018;18(1):18.
• 28. Kwon HC, Kim SH, Oh SY, et al. Clinical significance of preoperative neutrophil-lymphocyte versus plateletlymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012;17:216–22.
• 29. İlhan M, İlhan G, Gök AF, et al. Evaluation of neutrophillymphocyte ratio, platelet-lymphocyte ratio and red blood cell distribution width-platelet ratio as early predictor of acute pancreatitis in pregnancy. J Matern Fetal Neonatal Med. 2016;29(9):1476-80.
• 30. Zhou H, Mei X, He X, et al. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine (Baltimore). 2019;98(16):e15275.
• 31. Cetinkaya E, Senol K, Saylam B, Tez M. Red cell distribution width to platelet ratio: new and promising prognostic marker in acute pancreatitis. World J Gastroenterol. 2014;20(39):14450-4.
• 32. Zhang FX, Li ZL, Zhang ZD, Ma XC. Prognostic value of red blood cell distribution width for severe acute pancreatitis. World J Gastroenterol. 2019;25(32):4739-48.
• 33. Wang X, Zhu L, Tao K, et al. Red cell distribution width to serum albumin ratio as an early prognostic marker for severe acute pancreatitis: A retrospective study.Arab J Gastroenterol. 2022;23(3):206-9.