KEMOTERAPİ SONRASI FEBRİL NÖTROPENİ ATAĞI GEÇİREN PEDİATRİK ONKOLOJİ HASTALARINDA NÖTROFİL/LENFOSİT ORANI, PLATELET/LENFOSİT ORANI, SİSTEMİK İMMÜN-İNFLAMASYON İNDEKSİ VE ORTALAMA TROMBOSİT HACMİYLE İLİŞKİLİ İNDEKSLERİN DEĞERLENDİRİLMESİ

Year 2025, Volume: 26 Issue: 4, 286 - 294, 13.10.2025

Arzu Keskin Aktan , İbrahim Eker , Fatma Nur Üstün , Ali İhsan Karaman , Ahmet Eren Çağıl , Buket Çam , Ece Merve Sökmen , Nilüfer Bağcı , Tuana Kepel

https://doi.org/10.18229/kocatepetip.1477957

Abstract

AMAÇ: Febril nötropeni (FN), miyelosüpresif kemoterapinin en
yaygın görülen komplikasyonlarından biridir ve önemli oranda
hospitalizasyon ve mortalite nedenidir. Çalışmada kemoterapi
alan pediatrik onkoloji hastalarında görülen FN atağında nötrofil/
lenfosit oranı (NLR), platelet/lenfosit oranı (PLR), sistemik
immün-inflamasyon indeksi (SII) ve ortalama trombosit hacmiyle
(MPV) ilişkili hematolojik indekslerin değerlendirilmesi
amaçlandı.
GEREÇ VE YÖNTEM: Tek merkezli, retrospektif kohort çalışmada,
0-16 yaş aralığında kanser nedeniyle kemoterapi alan
hastalar (n = 98), kemoterapiden sonraki bir ay içinde FN atağı
olanlar (n = 40) ve olmayanlar (n = 58) şeklinde iki gruba ayrıldı.
Hastaların sosyodemografik özellikleri (yaş, cinsiyet), temel
klinik özellikleri (geliş nedeni, öykü, tanı, antibiyotik kullanımı,
komorbidite vb) ve hematolojik bulgularına ait veriler kaydedildi.
Hastaların mevcut hemogram verileri kullanılarak NLR, PLR,
SII, MPV/platelet oranı (MPV/PLT), MPV/C-reaktif protein oranı
(MPV/CRP) ve MPV/prokalsitonin oranı (MPV/PCT) hesaplandı.
Grupları karşılaştırmak için ki-kare, bağımsız örneklem t testi
veya Mann-Whitney U testi kullanıldı. Ayrıca lojistik regresyon
ve alıcı çalışma karakteristikleri (ROC) analizleri yapıldı. P < 0,05
düzeyi istatistiksel olarak anlamlı kabul edildi.
BULGULAR: FN grubunda NLR ve SII anlamlı olarak düşük, PLR
ise yüksek bulundu. MPV ilişkili indekslerden MPV/PLT, FN grubunda
anlamlı olarak yüksek iken MPV/CRP ve MPV/PCT ise düşüktü.
FN için potansiyel prediktif faktörler olarak tespit edilen
yaş, CRP, PLR ve MPV/PCT ile oluşturulan çok değişkenli lojistik
regresyon modelinde sadece MPV/PCT’nin FN için bağımsız
prediktif faktör olduğu bulundu. Ayrıca 57,33 optimal kesme
değeri için MPV/PCT’nin % 89,7 duyarlılık ve %100 özgüllüğe
sahip olduğu görüldü.
SONUÇ: Araştırdığımız indeksler arasında MPV/PCT’nin, pediatrik
onkoloji hastalarında kemoterapi sonrasında görülebilen FN
atağını yordayan başlıca değişken olduğu söylenebilir.

Keywords

Febril nötropeni , Kanser , Kemoterapi , Ortalama trombosit hacmi

Ethical Statement

Çalışmaya Afyonkarahisar Sağlık Bilimleri Üniversitesi Klinik Araştırmalar Etik Kurulu onayını takiben başlanmıştır (Tarih: 01.12.2023, Toplantı-Karar No: 2023/12-513).

Supporting Institution

-

Thanks

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PROGNOSTIC VALUE OF NEUTROPHIL/LYMPHOCYTE RATIO, PLATELET/LYMPHOCYTE RATIO, SYSTEMIC IMMUNE-INFLAMMATION INDEX, AND MEAN PLATELET VOLUME-RELATED INDICES IN PEDIATRIC ONCOLOGY PATIENTS EXPERIENCING FEBRILE NEUTROPENIA EPISODES AFTER CHEMOTHERAPY

Abstract

OBJECTIVE: Febrile neutropenia (FN) is one of the most common
complications of myelosuppressive chemotherapy and
a significant cause of hospitalization and mortality. The study
aimed to evaluate hematological indices, including neutrophil/
lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic
immune-inflammation index (SII), and mean platelet volume
(MPV) related indices in the FN episodes in pediatric oncology
patients receiving chemotherapy.
MATERIAL AND METHODS: In a single-center, retrospective
cohort study, patients aged 0-16 years receiving chemotherapy
for cancer (n = 98) were divided into two groups: those who
experienced an FN episode within one month following chemotherapy
(n = 40) and those who did not (n = 58). Socio-demographic
characteristics (age, gender), basic clinical features
(reason for admission, history, diagnosis, antibiotic use, comorbidities,
etc.), and hematologic findings data were recorded. Based
on the patients' current hemogram data, NLR, PLR, SII, MPV/
platelet ratio (MPV/PLT), MPV/C-reactive protein ratio (MPV/
CRP), and MPV/procalcitonin ratio (MPV/PCT) were calculated.
Chi-square, independent sample t-test, or Mann-Whitney U-test
were used to compare groups. Logistic regression and receiver
operating characteristics (ROC) analyses were also conducted.
A level of P < 0.05 was considered statistically significant.
RESULTS: In the FN group, NLR and SII were significantly lower
whereas PLR was significantly higher. Among the MPV related
indices, MPV/PLT was significantly higher in the FN group, whereas
MPV/CRP and MPV/PCT were significantly lower. In the
multivariate logistic regression model constructed with age,
CRP, PLR, and MPV/PCT as potential predictive factors for FN,
only MPV/PCT was identified as an independent predictive factor
for FN. Additionally, it was observed that MPV/PCT had a
sensitivity of 89.7% and a specificity of 100% for FN at the optimal
cut-off value of 57.33.
CONCLUSIONS: It can be said that among the indices we investigated,
the MPV/PCT is the primary variable predicting FN episodes
that may occur in pediatric oncology patients following
chemotherapy.

Keywords

Febrile neutropenia , Cancer , Chemotherapy , Mean platelet volume

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