EVALUATION OF THE SUCCESS OF THE SYSTEMIC IMMUNE-INFLAMMATORY INDEX IN DIAGNOSING, PREDICTING COMPLICATIONS AND MORTALITY IN PATIENTS WITH PEPTIC ULCER PERFORATION PRESENTING TO THE EMERGENCY DEPARTMENT

Abstract

Objective: Peptic ulcer perforation (PUP) is a severe complication of peptic ulcer disease, characterized by acute abdominal pain and systemic inflammation. The systemic immune-inflammatory index (SIII) has emerged as a promising biomarker for evaluating inflammation in various acute conditions, including PUP. This study investigates the diagnostic and prognostic value of SIII in PUP, focusing on its ability to predict complications and mortality. Material and Methods: This retrospective, single-center study included 150 PUP patients and 150 control patients who presented between January 2021 and December 2024. Data on the cases' demographics, vital signs, and laboratory findings were collected. Based on clinical and postoperative findings, patients were divided into complicated (CPUP) and non- complicated peptic ulcer perforation (NCPUP) groups. Statistical analyses, including ROC curve analysis, were performed to evaluate the diagnostic accuracy and prognostic value of SIII. Results: SIII levels were significantly higher in PUP patients than controls (p<0.001). In CPUP patients, SIII levels were higher than in NCPUP patients (p<0.001). ROC analysis showed high diagnostic performance of SIII in identifying PUP (AUC=0.945, sensitivity=84.7%, specificity=96%). In predicting complications and mortality, SIII demonstrated moderate diagnostic accuracy (AUC=0.693 and AUC=0.745, respectively). In gastric PUP cases, complication rates were higher, and mortality was associated with increased SIII, neutrophil-lymphocyte ratio, and decreased lymphocyte- neutrophil ratio. Conclusion: SIII is a reliable biomarker for the diagnostic success of PUP and for predicting complications and mortality. Its integration into clinical practice could improve patient management and outcomes. Further studies are needed to validate these findings in larger populations.

Keywords

• Peptic ulcer perforation
• systemic immune- inflammatory index
• emergency department
• complications

Acil Servise Başvuran Peptik Ülser Perforasyonu Olgularının Tanısında, Komplikasyon ve Mortaliteyi Öngörmede Sistemik İmmün İnflamatuvar İndeksin Başarısının Değerlendirmesi

Abstract

Amaç: Peptik ulkus perforasyonu (PUP), akut karın ağrısı ve sistemik inflamasyonla karakterize peptik ülser hastalığının ciddi bir komplikasyonudur. Sistemik immün-inflamatuvar indeks (SIII), PUP dahil olmak üzere çeşitli akut durumlarda inflamasyonu değerlendirmek için umut verici bir biyobelirteç olarak ortaya çıkmıştır. Bu çalışma, komplikasyonları ve mortaliteyi tahmin etme yeteneğine odaklanarak PUP'ta SIII'in tanısal ve prognostik değerliliğini araştırmaktadır. Gereç ve Yöntemler: Bu retrospektif, tek merkezli çalışmaya Ocak 2021 ile Aralık 2024 arasında başvuran 150 PUP hastası ve 150 kontrol hastası dahil edildi. Olguların demografi, vital ve laboratuvar bulgularıyla ilgili veriler toplandı. Hastalar klinik ve postoperatif bulgularına göre komplike (KPUP) ve komplike olmayan peptik ulcus perforasyonları (NKPUP) gruplarına ayrıldı. SIII'in tanısal doğruluğunu ve prognostik değerini değerlendirmek için ROC curve analiz de dahil olmak üzere istatistiksel analizler yapıldı. Bulgular: SIII düzeyleri PUP hastalarında kontrollere kıyasla önemli ölçüde daha yüksekti (p<0,001). KPUP hastalarında SIII düzeyleri NKPUP hastalarına kıyasla yüksekti (p<0,001). ROC analizi, PUP'u tanımlamada SIII için yüksek tanı performansı gösterdi (AUC=0,945, sensitivite=84,7%, spesifite=96%). Komplikasyonları ve mortaliteyi tahmin etmede SIII, orta düzeyde tanı doğruluğu gösterdi (sırasıyla AUC=0,693 ve AUC=0,745). Gastrik PUP vakalarında komplikasyon oranları daha yüksekti ve mortalite, artan SIII, nötrofil-lenfosit oranı ve azalan lenfosit-nötrofil oranı ile ilişkiliydi. Sonuç: SIII, PUP'un tanısal başarısı, komplikasyonları ve mortaliteyi öngörmesi açısından güvenilir bir biyobelirteçtir. Klinik uygulamaya entegrasyonu hasta yönetimini ve sonuçlarını iyileştirebilir. Bu bulguları daha geniş popülasyonlarda doğrulamak için daha fazla çalışma yapılması gerekmektedir.

Keywords

• Peptik ülser perforasyonu
• sistemik immün inflamatuvar indeks
• acil servis
• komplikasyon

References

1. Tarasconi A, Coccolini F, Biffl WL et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg. 2020;15:3.
2. Dunlap JJ, Patterson S. Peptic ulcer disease. Gastroenterol Nurs. 2019;42(5):451-454.
3. Ge P, Luo Y, Okoye CS et al. Intestinal barrier damage, systemic inflammatory response syndrome, and acute lung injury: A troublesome trio for acute pancreatitis. Biomed Pharmacother. 2020;132:110770.
4. Şener K, Çakır A, Kılavuz H, Altuğ E, Güven R. Diagnostic value of systemic immune inflammation index in acute appendicitis. Rev Assoc Med Bras. 2023;69(2):291-296.
5. Altuğ E, Altundağ İ, Çakır A et al. Prognostic value of systemic immune-inflammation index in patients with pediatric blunt abdominal trauma. Glob Emerg Crit Care. 2024;3(2):87-92.
6. Çakır A, Şener K, Güven R. Diagnostic value of systemic immune–inflammation index (SIII) in acute ischemic stroke. J Contemp Med. 2023;13(2):187-192.
7. Wang RH, Wen WX, Jiang ZP et al. The clinical value of neutrophil-to-lymphocyte ratio (NLR), systemic immune- inflammation index (SIII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage. Front Immunol. 2023;14:1115031.
8. Kapci M, Sener K, Cakir A, Altug E, Guven R, Avci A. Prognostic value of systemic immune-inflammation index in the diagnosis of preeclampsia. Heliyon. 2024;10(6):e28181.

9. Søreide K, Thorsen K, Harrison EM et al. Perforated peptic ulcer. Lancet. 2015;386(10000):1288-1298.
10. Zittel TT, Jehle EC, Becker HD. Surgical management of peptic ulcer disease today-indication, technique and outcome. Langenbecks Arch Surg. 2000;385(2):84-96.
11. Kocer B, Surmeli S, Solak C et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol. 2007;22(4):565- 570.
12. Bilge H, Başol Ö. The effect of platelet-albumin ratio on mortality and morbidity in peptic ulcer perforation. Medicine (Baltimore). 2022;101(31):e29582.
13. Jafarzadeh A, Akbarpoor V, Nabizadeh M, Nemati M, Rezayati MT. Total leukocyte counts and neutrophil- lymphocyte count ratios among Helicobacter pylori- infected patients with peptic ulcers: Independent of bacterial CagA status. Southeast Asian J Trop Med Public Health. 2013;44(1):82-88.
14. Kondo Y, Joh T, Sasaki M et al. Helicobacter pylori eradication decreases blood neutrophil and monocyte counts. Aliment Pharmacol Ther. 2004;20 Suppl 1:74-79.
15. Aydin O, Pehlivanlı F. Is the platelet to lymphocyte ratio a potential biomarker for predicting mortality in peptic ulcer perforation?. Surg Infect (Larchmt). 2019;20(4):326- 331.
16. Seow JG, Lim YR, Shelat VG. Low serum albumin may predict the need for gastric resection in patients with perforated peptic ulcer. Eur J Trauma Emerg Surg. 2017;43(3):293-298.
17. Taş İ, Ülger BV, Önder A, Kapan M, Bozdağ Z. Risk factors influencing morbidity and mortality in perforated peptic ulcer disease. Ulus Cerrahi Derg. 2014;31(1):20- 25.
18. Ugochukwu AI, Amu OC, Nzegwu MA, Dilibe UC. Acute perforated peptic ulcer: On clinical experience in an urban tertiary hospital in south east Nigeria. Int J Surg. 2013;11(3):223-227.
19. Kang JY, Elders A, Majeed A, Maxwell JD, Bardhan KD. Recent trends in hospital admissions and mortality rates for peptic ulcer in Scotland 1982-2002. Aliment Pharmacol Ther. 2006;24(1):65-79.
20. Lassen A, Hallas J, Schaffalitzky de Muckadell OB. Complicated and uncomplicated peptic ulcers in a Danish county 1993-2002: A population-based cohort study. Am J Gastroenterol. 2006;101(5):945-953.
21. Fong IW. Septic complications of perforated peptic ulcer.Can J Surg. 1983;26(4):370-372