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Diagnostic Value of Neutrophil/Lymphocyte Ratio in Distinguishing Peripheral and Central Vertigo in Patients with Dizziness

Year 2024, Volume: 9 Issue: 3, 240 - 245
https://doi.org/10.26453/otjhs.1461279

Abstract

Objective: Neutrophil/lymphocyte ratio (NLR) is an inexpensive parameter that gives an idea about systemic inflammatory response and cellular immune response. This study aims to investigate the value of NLR in distinguishing peripheral and central vertigo.
Materials and Methods: Patients presenting with acute vertigo at the emergency clinic were included between January 2017 and December 2018. Hemogram, brain computerized tomography, and diffusion magnetic resonance imaging data were reviewed to categorize patients into peripheral and central vertigo groups. Laboratory parameters were compared between these groups.
Results: Neutrophil, lymphocyte, and C-reactive protein levels were higher in patients with central vertigo than those with peripheral vertigo (p=0.003, p=0.003, p=0.022, respectively). Moreover, the NLR value was significantly elevated in central vertigo cases (median: 3.99) in contrast to peripheral vertigo cases (median: 2.32) (p <0.001).
Conclusions: The NLR is a valuable marker for distinguishing peripheral and central vertigo in emergency department patients with dizziness. Higher NLR values suggest central vertigo.

References

  • Bayındır T, Kalcıoğlu MT. Peripheral vertigo. Journal of Turgut Ozal Medical Center. 2010;17:155-163.
  • Fu Y, Liu Q, Anrather J, Shi FD. Immune interventions in stroke. Nat Rev Neurol 2015;11:524-535.
  • Delémont C, Rutschmann O. Vertiges: tout tourne-t-il autour de la clinique? [Vertigo: it all revolves around the physical exam]. Rev Med Suisse. 2007;3(121):1826-1828.
  • Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008;102:653-657.
  • Talley NJ. Therapeutic options in nonulcer dyspepsia. J Clin Gastroenterol. 2001;32:286–293.
  • Fu Y, Liu Q, Anrather J, Shi FD. Immune interventions in stroke. Nat Rev Neurol. 2015;11:524-535.
  • Wang J. Preclinical and clinical research on inflammation after intracerebral hemorrhage. Prog Neurobiol. 2010;92:463-477.
  • Temirbekov D, Sakallı E. Effects of peripheral vertigo on ınflammatory and ımmunologic laboratory markers. Ear, Nose & Throat Journal. 2020;99(7):470-474. doi:10.1177/0145561320920149
  • Ozbay I, Kahraman C, Balikci HH, et al. Neutrophil-to-lymphocyte ratio in patients with peripheral vertigo: a prospective controlled clinical study. Am J Otolaryngol. 2014;35(6):699-702. doi:10.1016/j.amjoto.2014.08.004
  • Lee SH, Yun SJ, Ryu S, et al. Utility of neutrophil-to-lymphocyte ratio (NLR) as a predictor of acute infarction in new-onset acute vertigo patients without neurologic and computed tomography abnormalities. J Emerg Med. 2018;54:607-614.
  • Celikbilek A, Ismailogullari S, Zararsiz G. Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. J Clin Lab Anal. 2014;28:27-31.
  • Tokgoz S, Kayrak M, Akpinar Z, Seyithanoğlu A, Güney F, Yürüten B. Neutrophil lymphocyte ratio as a predictor of stroke. J Stroke Cerebrovasc Dis. 2013;22:1169-1174.
  • Zhu RT, Van Rompaey V, Ward BK, Van de Berg R, Van de Heyning P, Sharon JD. the interrelations between different causes of dizziness: A conceptual framework for understanding vestibular disorders. Ann Otol Rhinol Laryngol. 2019;128(9):869-878. doi:10.1177/0003489419845014
  • Hackenberg B, O'Brien K, Döge J, et al. Vertigo and its burden of disease-results from a population-based cohort study. Laryngoscope Investig Otolaryngol. 2023;8(6):1624-1630. doi:10.1002/lio2.1169
  • Von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population-based study. J Neurol Neurosurg Psychiatry. 2007;78:710-715.
  • Lempert T, Neuhauser H. Epidemiology of vertigo, migraine and vestibular migraine. J Neurol. 2009;256(3):333-8. doi:10.1007/s00415-009-0149-2
  • Gambacorta V, Ricci G, D'Orazio A, et al. Evaluation of cochlear symptoms in migraine patients without vestibular migraine and/or ménière's disease. Audiol Res. 2023;6;13(6):967-977. doi:10.3390/audiolres13060084
  • Narita S, Kurose M, Kobayashi K, Himi T. Study on 242 inpatients reporting vertigo and dizziness. Nippon Jibiinkoka Gakkai Kaiho. 2003;106:21-27.
  • Chawla N, Olshaker JS. Diagnosis and management of dizziness and vertigo. Med Clin North Am. 2006;90:291-304.
  • Goldman B. Chapter- 231: Vertigo and dizziness. In: Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 6th Ed. America: The McGraw-Hill Companies; 2010.
  • Tun NN, Arunagirinathan G, Munshi SK, Pappachan JM. Diabetes mellitus and stroke: A clinical update. World J Diabetes. 2017;8(6):235-248. doi:10.4239/wjd.v8.i6.235
  • Steenerson KK. Acute vestibular syndrome. Continuum (Minneap Minn). 2021;1;27(2):402-419. doi:10.1212/CON.0000000000000958
  • StatPearls. Vestibular Dysfunction. https://www.ncbi.nlm.nih.gov/books/NBK558926/. Accessed June, 2024.
  • Swain K.S. Management of vertigo made easy. New Delhi, India: Jaypee Brothers Medical Publishers. 2016;29.
  • Gibson WPR. Meniere's Disease. Adv Otorhinolaryngol. 2019;82:77-86. doi:10.1159/000490274
  • Wang F, Hu S, Ding Y, et al. Neutrophil-to-lymphocyte ratio and 30-day mortality in patients with acute intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2016;25:182-187.
  • Wang Z, Gong Q, Guo C, Luo Y, Chen L. Neutrophil-to-lymphocyte ratio predicts hematoma growth in intracerebral hemorrhage. J Int Med Res. 2019;47:2970-2975.

Baş Dönmesi Olan Hastalarda Periferik ve Santral Vertigonun Ayırt Edilmesinde Nötrofil/Lenfosit Oranının Tanısal Değeri

Year 2024, Volume: 9 Issue: 3, 240 - 245
https://doi.org/10.26453/otjhs.1461279

Abstract

Amaç: Nötrofil/lenfosit oranı (NLR), sistemik inflamatuar yanıt ve hücresel bağışıklık yanıtı hakkında fikir veren düşük maliyetli bir parametredir. Bu çalışmanın amacı, NLR'nin periferik ve merkezi vertigo arasındaki farkı ayırt etmedeki değerini araştırmaktır.
Materyal ve Metot: Ocak 2017 ile Aralık 2018 tarihleri arasında acil klinikte akut vertigo ile başvuran hastalar çalışmaya dahil edildi. Hastaları periferik ve merkezi vertigo gruplarına ayırmak için hemogram, beyin bilgisayarlı tomografi ve difüzyon manyetik rezonans görüntüleme verileri incelendi. Laboratuvar parametreleri bu gruplar arasında karşılaştırıldı.
Bulgular: Nötrofil, lenfosit ve C-reaktif protein düzeyleri, periferik vertigo hastalarına kıyasla merkezi vertigo hastalarında daha yüksek bulundu (sırasıyla p=0,03, p=0,003, p=0,022). Ayrıca, NLR değeri merkezi vertigo vakalarında (ortalama: 3,99), periferik vertigo vakalarına kıyasla (ortalama: 2,32) anlamlı derecede yüksekti (p <0,001).
Sonuç: NLR, vertigo semptomlarıyla acil servise başvuran hastalarda periferik ve merkezi vertigo arasındaki farkı ayırt etmede değerli bir belirleyicidir. Yüksek NLR değerleri merkezi vertigoyu düşündürmektedir.

References

  • Bayındır T, Kalcıoğlu MT. Peripheral vertigo. Journal of Turgut Ozal Medical Center. 2010;17:155-163.
  • Fu Y, Liu Q, Anrather J, Shi FD. Immune interventions in stroke. Nat Rev Neurol 2015;11:524-535.
  • Delémont C, Rutschmann O. Vertiges: tout tourne-t-il autour de la clinique? [Vertigo: it all revolves around the physical exam]. Rev Med Suisse. 2007;3(121):1826-1828.
  • Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008;102:653-657.
  • Talley NJ. Therapeutic options in nonulcer dyspepsia. J Clin Gastroenterol. 2001;32:286–293.
  • Fu Y, Liu Q, Anrather J, Shi FD. Immune interventions in stroke. Nat Rev Neurol. 2015;11:524-535.
  • Wang J. Preclinical and clinical research on inflammation after intracerebral hemorrhage. Prog Neurobiol. 2010;92:463-477.
  • Temirbekov D, Sakallı E. Effects of peripheral vertigo on ınflammatory and ımmunologic laboratory markers. Ear, Nose & Throat Journal. 2020;99(7):470-474. doi:10.1177/0145561320920149
  • Ozbay I, Kahraman C, Balikci HH, et al. Neutrophil-to-lymphocyte ratio in patients with peripheral vertigo: a prospective controlled clinical study. Am J Otolaryngol. 2014;35(6):699-702. doi:10.1016/j.amjoto.2014.08.004
  • Lee SH, Yun SJ, Ryu S, et al. Utility of neutrophil-to-lymphocyte ratio (NLR) as a predictor of acute infarction in new-onset acute vertigo patients without neurologic and computed tomography abnormalities. J Emerg Med. 2018;54:607-614.
  • Celikbilek A, Ismailogullari S, Zararsiz G. Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. J Clin Lab Anal. 2014;28:27-31.
  • Tokgoz S, Kayrak M, Akpinar Z, Seyithanoğlu A, Güney F, Yürüten B. Neutrophil lymphocyte ratio as a predictor of stroke. J Stroke Cerebrovasc Dis. 2013;22:1169-1174.
  • Zhu RT, Van Rompaey V, Ward BK, Van de Berg R, Van de Heyning P, Sharon JD. the interrelations between different causes of dizziness: A conceptual framework for understanding vestibular disorders. Ann Otol Rhinol Laryngol. 2019;128(9):869-878. doi:10.1177/0003489419845014
  • Hackenberg B, O'Brien K, Döge J, et al. Vertigo and its burden of disease-results from a population-based cohort study. Laryngoscope Investig Otolaryngol. 2023;8(6):1624-1630. doi:10.1002/lio2.1169
  • Von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population-based study. J Neurol Neurosurg Psychiatry. 2007;78:710-715.
  • Lempert T, Neuhauser H. Epidemiology of vertigo, migraine and vestibular migraine. J Neurol. 2009;256(3):333-8. doi:10.1007/s00415-009-0149-2
  • Gambacorta V, Ricci G, D'Orazio A, et al. Evaluation of cochlear symptoms in migraine patients without vestibular migraine and/or ménière's disease. Audiol Res. 2023;6;13(6):967-977. doi:10.3390/audiolres13060084
  • Narita S, Kurose M, Kobayashi K, Himi T. Study on 242 inpatients reporting vertigo and dizziness. Nippon Jibiinkoka Gakkai Kaiho. 2003;106:21-27.
  • Chawla N, Olshaker JS. Diagnosis and management of dizziness and vertigo. Med Clin North Am. 2006;90:291-304.
  • Goldman B. Chapter- 231: Vertigo and dizziness. In: Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 6th Ed. America: The McGraw-Hill Companies; 2010.
  • Tun NN, Arunagirinathan G, Munshi SK, Pappachan JM. Diabetes mellitus and stroke: A clinical update. World J Diabetes. 2017;8(6):235-248. doi:10.4239/wjd.v8.i6.235
  • Steenerson KK. Acute vestibular syndrome. Continuum (Minneap Minn). 2021;1;27(2):402-419. doi:10.1212/CON.0000000000000958
  • StatPearls. Vestibular Dysfunction. https://www.ncbi.nlm.nih.gov/books/NBK558926/. Accessed June, 2024.
  • Swain K.S. Management of vertigo made easy. New Delhi, India: Jaypee Brothers Medical Publishers. 2016;29.
  • Gibson WPR. Meniere's Disease. Adv Otorhinolaryngol. 2019;82:77-86. doi:10.1159/000490274
  • Wang F, Hu S, Ding Y, et al. Neutrophil-to-lymphocyte ratio and 30-day mortality in patients with acute intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2016;25:182-187.
  • Wang Z, Gong Q, Guo C, Luo Y, Chen L. Neutrophil-to-lymphocyte ratio predicts hematoma growth in intracerebral hemorrhage. J Int Med Res. 2019;47:2970-2975.
There are 27 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Research article
Authors

İskender Sertbaş 0000-0001-9948-3716

Mustafa Çiçek 0000-0003-4307-3261

Metin Yadigaroğlu 0000-0003-1771-5523

Sinan Paslı 0000-0003-0052-2258

Selman Yeniocak 0000-0002-1124-396X

Abdulkadir Gündüz 0000-0001-8591-9769

Early Pub Date September 11, 2024
Publication Date
Submission Date March 31, 2024
Acceptance Date September 3, 2024
Published in Issue Year 2024 Volume: 9 Issue: 3

Cite

AMA Sertbaş İ, Çiçek M, Yadigaroğlu M, Paslı S, Yeniocak S, Gündüz A. Diagnostic Value of Neutrophil/Lymphocyte Ratio in Distinguishing Peripheral and Central Vertigo in Patients with Dizziness. OTJHS. September 2024;9(3):240-245. doi:10.26453/otjhs.1461279

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