Acil Servise Başvuran Erişkin Hastalarda İnkarsere İnguinal Hernilerde Strangülasyonun Öngörülmesinde İnflamatuar Biyobelirteçlerin Değerlendirilmesi; Kesitsel Çalışma

Year 2024, Volume: 8 Issue: 3, 276 - 282, 30.12.2024

Nafis Vural , Murat Duyan , Ali Sarıdaş , Elif Ertaş , Hasan Can Güven

Abstract

Amaç: İnkarsere herni ile başvuran hastalarda strangulasyon tanısının hızlı ve yüksek doğrulukla belirlenmesi oldukça önemlidir.
Strangulasyonun erken tanısı bağırsak rezeksiyonu azalmaktadır. Çalışmamızda nötrofil lenfosit oranı (NLR) ile birlikte sistemik immüninflamasyon
indeks (SII), sistemik inflamasyon yanıt indeksi (SIRI), pan-immün- inflamasyon değeri (PIV) gibi yeni tanımlanan indekslerin
inkarsere hernilerde stangulasyonu öngörmedeki gücü ve güvenirliliği değerlendirme amaçlandı.
Gereç ve Yöntemler: Çalışmamız acil servise 01.01.2020 ile 01.01.2023 tarihleri arasında karın ağrısı ile başvuran ve tetkik sonucuna
göre inkarsere inguinal herni tanısı konulan 18 yaş üstü hastalar dahil edildi. Boğulmuş kasık fıtığı (SIH) ve boğulmamış kasık fıtığı (NSIH)
olmak üzere iki grup hasta vardı. Tanısal değer ölçümlerindeki kesme noktası, Alıcı İşletim Karakteristiği (ROC) analizi kullanılarak belirlendi.
Bulgular: Toplam 128 hasta (SIH:39 ve NSIH:89) kaydedildi. Nötrofil lenfosit oranı, SII, SIRI ve PIV'in SIH tespitinde kabul edilebilir tanısal
güce sahip olduğu bulundu (AUC:0,738-0,765).
Sonuç: İnkarsere hernilerde SIH’ı öngörmede SII, SIRI, PIV ve NLR gibi biyomarkırlar kullanılabilir

Keywords

Pan-immün-inflamatuar değeri, inkarsere herni, nötrofil lenfosit oranı, strangule inguinal herni, sistemik immüninflamatuar indeks, sistemik inflamasyon yanıt indeksi

Evaluation of Inflammatory Biomarkers in Predicting Strangulation in Incarcerated Inguinal Hernias in Adult Patients Admitted to the Emergency Department; Cross-Sectional Study

Abstract

Aim: It is very important to determine the diagnosis of strangulation quickly and with high accuracy in patients presenting with incarcerated
hernia. Early diagnosis of strangulation reduces the rate of bowel resection. The objective of our study was to assess the effectiveness
and consistency of recently established indices, namely neutrophil lymphocyte ratio (NLR), the systemic immune-inflammation index (SII),
systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV) in predicting the occurrence of strangulation in
incarcerated hernias.
Material and Methods: Our study included patients over the age of 18 who presented to the emergency department with abdominal
pain between 01.01.2020 and 01.01.2023 and were diagnosed with incarcerated inguinal hernia according to the examination results.
There were two groups of patients with strangulated inguinal hernia (SIH) and non-strangulated inguinal hernia (NSIH). Receiver Operating
Characteristic (ROC) analysis was used to define the cut-off in diagnostic value values.
Results: A total of 128 patients (39 SIH and 89 NSIH) were enrolled. Neutrophil lymphocyte ratio, There was determined to be acceptable
diagnostic power for SIH detection using SII, SIRI, and PIV (AUC:0.738-0.765).
Conclusion: Biomarkers such as SII, SIRI, PIV and NLR can be utilized for prediction SIH in incarcerated hernias.

Keywords

Pan-immune-inflammation value, incarcerated hernia, neutrophil lymphocyte ratio, systemic immune-inflammation index, strangulated inguinal hernia, systemic inflammation response index

References

• 1. Kadioǧlu H, Ömür D, Bozkurt S, Ferlengez E, Memm N, Ersoy YE, Çıpe G, Müslümanoǧlu M. Ischemia Modified Albumin Can Predict Necrosis at Incarcerated Hernias. Dis Markers. 2013;35(6):807.
• 2. Horgan PG, Gorey TF. Operative assessment of intestinal viability. Surg Clin North Am. 1992;72(1):143–55.
• 3. Topçu H, Kemer Atik B, Ulaş MG, Çetin Efe A, Poslu Karademir F, Şerefoğlu Çabuk K. Farklı Seviyelerdeki Lakrimal Drenaj Sistemi Tıkanıklığı Olan Hastalarda Sistemik İnflamatuar Belirteçlerin ve Tedavi Başarısının Karşılaştırılması. Med J West Black Sea. 2023;7(3):331-7.
• 4. Açıkgöz M, Atasoy HT. İnme Hastalarında Lenfosit/Monosit Oranının Klinik ve Radyolojik Parametrelerle İlişkisi ve Kısa Süreli Sonuçlara Etkisi. Med J West Black Sea. 2023;7(2):148-55.
• 5. Dikbaş O, Erten N, Küçüker F, Yılmaz Akşehirli Ö. Relationship of Potential Inflammatory Markers Namely Neutrophile Lymphocyte Ratio and Platelet Lymphocyte Ratio With the Severity of Obstructive Sleep Apnea. Turk J Diab Obes. 2017;1(3):125- 31.
• 6. Icoz G, Makay O, Sozbilen M, Gurcu B, Caliskan C, Firat O, Kurt Z, Ersin S. Is D-dimer a Predictor of Strangulated Intestinal Hernia? World J Surg. 2006;30(12):2165–9.
• 7. Buldanlı MZ, Kesikli SA, Çimen Ş, Uçaner B. Evaluation and clinical significance of predictors for strangulation and intestinal resection in emergency anterior abdominal wall hernia surgery. Ulus Travma Acil Cerrahi Derg. 2023 Feb;29(2):183–92.
• 8. Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One. 2018;13(8).
• 9. Vironen J. Treatment of incarcerated hernia in adults. Duodecim. 2017 Jan 1 [cited 2024 Mar 22];133(9):849–54. Available from: https://europepmc.org/article/med/29240314
• 10. Nathan C. Neutrophils and immunity: challenges and opportunities. Nat Rev Immunol. 2006;6(3):173–82.
• 11. Bostancı MT, Yılmaz I, Seki A, Saydam M, Kosmaz K, Kaya IO. Haematological inflammatory markers for indicating ischemic bowel in patients with incarcerated abdominal wall hernias. Hernia. 2022;26(1):349–53. Available from: https://link.springer. com/article/10.1007/s10029-021-02518-1
• 12. Beji H, Bouassida M, Chtourou MF, Zribi S, Laamiri G, Kallel Y, Mroua B, Mighri MM, Touinsi H. Predictive factors of bowel necrosis in patients with incarcerated femoral hernia. Hernia. 2023;27(6):1491–6.
• 13. Zhou H, Ruan X, Shao X, Huang X, Fang G, Zheng X. Clinical value of the neutrophil/lymphocyte ratio in diagnosing adult strangulated inguinal hernia. Int J Surg. 2016;36:76–80.
• 14. Koroglu M, Ayvaz MA, Bakan SB, Sirin A, Akyuz U. Can quantitative surface antigen levels and systemic immune-inflammation index be predictive as a new indicator for the initiation of treatment in chronic hepatitis b? Eur J Gastroenterol Hepatol. 2024;36(4):489–97.
• 15. Chen L, Chen L, Wang YY, Zhang LX, Xia XG. A predictive model of bowel resection for incarcerated inguinal hernia based on the systemic immune-inflammation index. Front Surg. 2022;9.
• 16. Ceran B, Dizdar EA, Beśer E, Karaçaǧlar NB, Sarl FN. Diagnostic Role of Systemic Inflammatory Indices in Infants with Moderate-to-Severe Hypoxic Ischemic Encephalopathy. Am J Perinatol. 2021;41(03):248–54.
• 17. Guo J, Huang Y, Pang L, Zhou Y, Yuan J, Zhou B, Fu M. Association of systemic inflammatory response index with ST segment elevation myocardial infarction and degree of coronary stenosis: a cross-sectional study. BMC Cardiovasc Disord. 2024;24(1).
• 18. Yi HJ, Shin DS, Kim BT. Dynamic changes of systemic inflammation response index and systemic immune-inflammation index are associated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2024;33(5):107626.
• 19. Fucà G, Guarini V, Antoniotti C, Morano F, Moretto R, Corallo S, Marmorino F, Lonardi S, Rimassa L, Sartore-Bianchi A, Borelli B, Tampellini M, Bustreo S, Claravezza M, Boccaccino A, Murialdo R, Zaniboni A, Tomasello G, Loupakis F, Adamo V, Tonini G, Cortesi E, Braud F de, Cremolini C, Pietrantonio F. The Pan-Immune-Inflammation Value is a new prognostic biomarker in metastatic colorectal cancer: results from a pooled-analysis of the Valentino and TRIBE first-line trials. Br J Cancer. 2020;123(3):403–9.
• 20. Akkaya S, Cakmak U. Association between pan-immune-inflammation value and coronary slow flow phenomenon in patients with angiographically normal coronary arteries. Int J Cardiol. 2024;398:131631.
• 21. Han W, Yi HJ, Shin DS, Kim BT. Pan-immune-inflammation value predict delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage. J Clin Neurosci. 2024;121:47– 52.