Akut Pankreatit Hastalarında Nötrofil/Lenfosit ve Trombosit/Lenfosit Oranlarının Tanısal ve Prognostik Değeri

Öz

Amaç: Bu çalışmada, pankreatit hastalarının hastalık şiddetinin izlenmesinde nötrofil-lenfosit oranı (NLO) ve trombosit-lenfosit oranlarının (TLO) bir parametre olarak kullanılıp kullanılamayacağını göstermeyi amaçladık.
Materyal ve Metot: Akut pankreatit tanısı ile gastroenteroloji servisinde yatan ve takip edilen, dosyaları retrospektif olarak incelenen toplam 200 hasta çalışmaya dahil edildi. Akut pankreatitin şiddeti ve prognozu Atlanta sınıflaması ile değerlendirildi.
Bulgular: NLO ortalaması hasta grubunda 9,84±9,60, kontrol grubunda ise 2,00±0,86 idi. Hasta grubunda NLO düzeyi yüksek saptandı ve cut-off değeri 2,85 olarak bulundu (Duyarlılık: %86 ve özgüllük: %81). Hastalık şiddetine göre NLO ortalamasında anlamlı bir değişiklik bulunmamakla birlikte, gruplar arasında NLO ortalamasındaki düşüş 48 saatte anlamlı bulundu.
Sonuç: Sadece ilk 48 saatteki NLO düzeyindeki değişikliğin hastalık şiddeti ile ilişkili olabileceğini bulduk. NLO'nun kullanılabilecek, uygulanabilecek ve kolay ulaşılabilecek bir parametre olduğunu gördük. 

Anahtar Kelimeler

• Akut pankreatit
• Nötrofil/Lenfosit Oranı
• Platelet/Lenfosit Oranı
• prognostik faktörler

Diagnostic and Prognostic Value of Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratios on Acute Pancreatitis Patients

Abstract

Objective: In this study, we aim at demonstrating whether we can use neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratios (PLR) as a parameter in monitoring the disease severity of Pancreatitis Patients.
Materials and Methods: A total of 200 patients diagnosed with acute pancreatitis, hospitalized and monitored in gastroenterology service, whose files had retrospectively been studied, were included in the study. The severity and prognosis of acute pancreatitis were evaluated with the Atlanta classification.
Results: The average of NLR was 9.84±9.60 in the patient group but 2.00±0.86 in the control group. The NLR level was found higher in the patient group. The cut-off value was found as 2.85 (Sensitivity: 86% and specificity: 81%). Although no significant change was found in terms of the average of NLR concerning the disease severity, the decrease in the average of NLR among the groups was found significant in 48 hours.
Conclusion: We have found that only the change in NLR level in the first 48th-hour could be associated with the disease severity. We found NLR as a parameter that can be used, applied, and accessed easily.

Keywords

• Acute pancreatitis
• neutrophil / lymphocyte ratio
• platelet / lymphocyte ratio
• prognostic factors

References

1. Akdur G, Bardakci O, Akdur O, Beyazit Y. Diagnostic utility of hematological indices in predicting adverse outcomes and severity of acute pancreatitis based on BISAP and modified Glasgow score. Turkish Journal of Trauma and Emergency Surgery. 2021. doi:10.14744/tjtes.2020.26348
2. Elbeyli A, Kurtul BE, Ozcan SC, Ozarslan Ozcan D. The diagnostic value of systemic immune-inflammation index in diabetic macular oedema. Clinical and Experimental Optometry. 2021. doi:10.1080/08164622.2021.1994337
3. Fang L, Yan F-H, Liu C, et al. Systemic inflammatory biomarkers, especially fibrinogen to albumin ratio, predict prognosis in patients with pancreatic cancer. Cancer Research And Treatment: Official Journal of Korean Cancer Association. 2021;53(1):131-139. doi:10.4143/crt.2020.330
4. Alagappan M, Pollom EL, von Eyben R, et al. Albumin and neutrophil-lymphocyte ratio (NLR) predict survival in patients with pancreatic adenocarcinoma treated with SBRT. American Journal Of Clinical Oncology. 2018;41(3):242-247.
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 Of Inflammation. 2018. doi:10.1155/2018/3758068.
6. Gao Y, Wang WJ, Zhi Q, et al. Neutrophil/lymphocyte ratio is a more sensitive systemic inflammatory response biomarker than platelet/lymphocyte ratio in the prognosis evaluation of unresectable pancreatic cancer. Oncotarget. 2017;8(51):88835-88844. doi:10.18632/oncotarget.21340
7. Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis. Gastroenterology. 2019;156(7):2008-2023.
8. Zhang C, Liu H, Wang H, et al. The Predictive Value of Potential Hematological Biomarkers in Acute Coronary Syndrome. Clinical Laboratory. 2019;65(10). doi:10.7754/clin.lab.2019.181232

9. Hira¹ S, Tamam C. Diagnostic value of hematological parameters in patients with osteoarthritis. Cukurova Medical Journal. 2017;42(1):120-125.
10. Yang Y, Yan S, Tian H, Bao Y. Macrophage inhibitory cytokine-1 versus carbohydrate antigen 19–9 as a biomarker for diagnosis of pancreatic cancer: A PRISMA-compliant meta-analysis of diagnostic accuracy studies. Medicine. 2018;97(9). doi:10.1097/MD.0000000000009994
11. James TW, Crockett SD. Management of acute pancreatitis in the first 72 hours. Current Opinion In Gastroenterology. 2018;34(5):330-335. doi:10.1097/MOG.0000000000000456
12. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. International Immunopharmacology. 2020;84(1):104-106.
13. Kaplan M, Ates I, Oztas E, et al. A new marker to determine prognosis of acute pancreatitis: PLR and NLR combination. Journal of Medical Biochemistry. 2018;37(1):21-30. doi:10.1515/jomb-2017-0039
14. Kong W, He Y, Bao H, Zhang W, Wang X. Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: a meta-analysis. Disease Markers. 2020. doi:10.1155/2020/9731854
15. Liu G, Tao J, Wang W. The early prognostic value of inflammatory markers in patients with acute pancreatitis. Clinics and Research In Hepatology And Gastroenterology. 2019;43(3):330-337.
16. Van Dijk S, Hallensleben N, van Santvoort H, et al. Dutch pancreatitis study group. Acute pancreatitis: recent advances through randomised trials. Gut. 2017;66(11):2024-2032.
17. Liu JX, Li A, Zhou LY, et al. Significance of combined preoperative serum Alb and dNLR for diagnosis of pancreatic cancer. Future Oncology. 2018;14(3):229-239.
18. Teng F, Ye H, Xue T. Predictive value of neutrophil to lymphocyte ratio in patients with acute exacerbation of chronic obstructive pulmonary disease. PLoS One. 2018. doi:10.1371/journal.pone.0204377
19. Zhang Z, Pan B, Lv S, et al. Integrating MicroRNA expression profiling studies to systematically evaluate the diagnostic value of MicroRNAs in pancreatic cancer and validate their prognostic significance with the cancer genome atlas data. Cellular Physiology and Biochemistry. 2018;49(2):678-695.
20. Machicado JD, Yadav D. Epidemiology of recurrent acute and chronic pancreatitis: similarities and differences. Digestive Diseases and Sciences. 2017;62(7):1683-1691.
21. Song J, Zheng Q, Ma X, et al. Predictive roles of neutrophil-to-lymphocyte ratio and C-reactive protein in patients with calcific aortic valve disease. International Heart Journal. 2019;60(2):345-351.
22. Zhao R, Shi R. Diagnostic value of peripheral blood nlr and plr in gastrointestinal pancreatic neuroendocrine neoplasm. Cancer Research on Prevention and Treatment. 2019;46(08):724-728.
23. Makal GB, Yıldırım O. Are the C-reactive protein/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (NLR) novel inflammatory biomarkers in the early diagnosis of postoperative complications after laparoscopic sleeve gastrectomy? Obesity Research & Clinical Practice. 2020;14(5):467-472.
24. Recio-Boiles A, Nallagangula A, Veeravelli S, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios inversely correlate to clinical and pathologic stage in patients with resectable pancreatic ductal adenocarcinoma. Annals of Pancreatic Cancer. 2019. doi:10.21037/apc.2019.06.01
25. Sendler M, Weiss FU, Golchert J, et al. Cathepsin B-mediated activation of trypsinogen in endocytosing macrophages increases severity of pancreatitis in mice. Gastroenterology. 2018;154(3):704-718.
26. Zheng SH, Huang JL, Chen M, Wang BL, Ou QS, Huang SY. Diagnostic value of preoperative inflammatory markers in patients with glioma: a multicenter cohort study. Journal of Neurosurgery. 2017;129(3):583-592.
27. Mandalia A, Wamsteker EJ, DiMagno MJ. Recent advances in understanding and managing acute pancreatitis. F1000Research. 2018. doi:10.12688/f1000research.14244.2
28. Mourad M, Evans R, Kalidindi V, Navaratnam R, Dvorkin L, Bramhall S. Prophylactic antibiotics in acute pancreatitis: endless debate. The Annals of The Royal College of Surgeons of England. 2017;99(2):107-112.
29. Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine. 2019. doi:10.1097/MD.0000000000015275