The Effect of The Thrombolytic Treatment on Inflammatory Markers in Male Patients with Pulmonary Thromboembolism

Year 2021, , 593 - 600, 22.09.2021

Hüseyin Ören , Ayhan Coşgun

https://doi.org/10.31832/smj.812253

Abstract

Objective: Neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios play an important role in monitoring the progression of the disease and determining the course of the disease in patients with acute pulmonary thromboembolism (APTE). This study aims to determine whether there is any change in NLR, PLR, and C-reactive protein (CRP) in patients with APTE receiving thrombolytic therapy.
Materials and Methods: Sixty-five male patients with shortness of breath, chest pain, and palpitations, who were diagnosed with APTE by examinations and thorax computed tomography angiography, and who were hospitalized and given thrombolytic therapy were included in the study. The files of these patients were scanned retrospectively, and NLR and PLR and CRP values were recorded 1-2 days before and 1-4 days after thrombolytic therapy. Then, it was checked whether there was a difference between pre-treatment and post-treatment values.
Results: NLR, PLR, CRP and systolic pulmonary artery pressure values decreased statistically significantly in patients with APTE by thrombolytic therapy.
Conclusion: NLR, PLR, CRP and sPAP values were found to be statistically significantly decreased with thrombolytic treatment.

Keywords

C-Reactive Protein, Inflammation, Acute Pulmonary Thromboembolism

Pulmoner Tromboembolisi Olan Erkek Hastalarda Trombolitik Tedavinin İnflamatuvar Belirteçler Üzerindeki Etkisi

Abstract

Giriş: Nötrofil-lenfosit (NLR) ve trombosit-lenfosit (PLR) oranları, akut pulmoner tromboembolizm (APTE) olan hastalarda, hastalığın ilerlemesinin izlenmesinde ve hastalığın seyrinin belirlenmesinde önemli bir rol oynamaktadır. Bu çalışma, trombolitik tedavi alan APTE'li hastalarda NLR, PLR ve C-reaktif protein (CRP) 'de herhangi bir değişiklik olup olmadığını belirlemeyi amaçlamıştır.
Yöntemler: Muayeneler ve toraks bilgisayarlı tomografi anjiyografisi ile APTE tanısı konulan, nefes darlığı, göğüs ağrısı ve çarpıntı nedeniyle hastaneye yatırılıp trombolitik tedavi verilen 65 erkek hasta, çalışmaya dahil edildi. Bu hastaların dosyaları geriye dönük olarak tarandı ve trombolitik tedaviden 1-2 gün önce ve 1-4 gün sonra NLR, PLR ve CRP değerleri kaydedildi. Daha sonra tedavi öncesi ve sonrası değerler arasında fark olup olmadığı kontrol edildi.
Bulgular: Trombolitik tedavi ile APTE'li hastalarda NLR, PLR, CRP ve sistolik pulmoner arter basınç değerleri istatistiksel olarak anlamlı azaldı.
Sonuç: Trombolitik tedavi ile NLR, PLR, CRP ve sPAP değerlerinin istatistiksel olarak anlamlı derecede azaldığı bulundu.

Keywords

C-Reaktif Protein, İnflamasyon, Akut Akciğer Tromboembolisi

References

• 1. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ., III Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158:585–93.).
• 2. Cohen AT, Agnelli G, Anderson FA, Arcelus JI, Bergqvist D, Brecht JG, et al. (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007;98:756–64.
• 3. Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, et al. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med. 2006;166:169–75.
• 4. Aksu K, Donmez A, Keser G. Inflammation-induced thrombosis: mechanisms, disease associations, and management. Curr Pharm Des. 2012;18:1478–93.
• 5. Kurtipek E, Buyukterzi Z, Buyukterzi M, Alpaydin MS, Erdem SS. Endothelial dysfunction in patients with pulmonary thromboembolism: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio. Clin Respir J. 2015. doi:10.1111/crj.12308.
• 6. Cavus UY, Yildirim S, Sonmez E, Ertan C, Ozeke O. Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. Turk J Med Sci. 2014;44:50–5.
• 7. Akgullu C, Omurlu IK, Eryilmaz U, Avcil M, Dagtekin E, Akdeniz M, et al. Predictors of early death in patients with acute pulmonary embolism. Am J Emerg Med. 2015;33:214–21.
• 8. Kayrak M, Erdogan HI, Solak Y, Akilli H, Gul EE, Yildirim O, et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a retrospective study. Heart Lung Circ. 2014;23:56–62.
• 9. Balta S, Demirkol S, Kucuk U. The platelet lymphocyte ratio may be useful inflammatory indicator in clinical practice. Hemodial Int. 2013;17:668–9.
• 10. Wang D, Yang JX, Cao DY, Wan XR, Feng FZ, Huang HF, et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther. 2013;6:211–6.
• 11. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Eur Heart J. 2008;29:2276–315.
• 12. Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer-Westendorf J, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med. 2014;370:1402–11.
• 13. Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M. Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" Trial) Am J Cardiol. 2013;111:273–7.
• 14. Konstantinides SV, Torbicki A, Agnelli G, et al. ESC Committee for Practice Guidelines (CPG). Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:3033–3069.
• 15. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386–1389.
• 16. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5–14.
• 17. Jo JY, Lee MY, Lee JW, Rho BH, Choi WI. Leukocytes and systemic inflammatory response syndrome as prognostic factors in pulmonary embolism patients. BMC Pulm Med. 2013;13:74. doi: 10.1186/1471-2466-13-74.
• 18. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995;92:657–671.
• 19. Hoffman M, Blum A, Baruch R, et al. Leukocytes and coronary heart disease. Atherosclerosis. 2004;172:1–6.
• 20. Mehmet Baran Karataş, Göktürk İpek, Tolga Onuk, Barış Güngör, Gündüz Durmuş, Yiğit Çanga, Yasin Çakıllı, Osman Bolca. Assessment of prognostic value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with pulmonary embolism. Acta Cardiol Sin. 2016 May;32(3):313-320.
• 21. Ghaffari S, Nadiri M, Pourafkari L, et al. The predictive value of total neutrophil count and neutrophil/lymphocyte ratio in predicting in-hospital mortality and complications after STEMI. J Cardiovasc Thorac Res. 2014;6:35–41.
• 22. Yildiz A, Yuksel M, Oylumlu M, et al. The utility of the platelet-lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction. Clin Appl Thromb Hemost. 2015; 21(3):223–228.
• 23. Kaya MG, Akpek M, Lam YY, et al. Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention: a prospective, multicenter study. Int J Cardiol. 2013;168:1154–9.
• 24. Soylu K, Yuksel S, Gulel O, et al. The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention. J Thorac Dis. 2013;5:258–64.
• 25. Balta S, Unlu M, Arslan Z, Demırkol S. Neutrophil-to-lymphocyte ratio in prognosis of gastric cancer. J Gastric Cancer. 2013;13:196–7.
• 26. Kaya A, Kurt M, Tanboga IH. Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology. 2014;65:59.
• 27. Uthamalingam S, Patvardhan EA, Subramanian S, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol. 2011;107:433–8.
• 28. Yıldız A, Kaya H, Ertaş F, et al. Association between neutrophil to lymphocyte ratio and pulmonary arterial hypertension. Turk Kardiyol Dern Ars. 2013;41:604–9.
• 29. Korhan Soylu, Ömer Gedikli, Alay Ekşi, Yonca Avcıoğlu, Ayşegül İdil Soylu, Serkan Yüksel, Gökhan Aksan, Okan Gülel, Özcan Yılmaz. Neutrophil-to-lymphocyte ratio fort he assessment of hospital mortality in patients with acute pulmonary embolism. Arch Med Sci 2016 Feb 1;12(1):95-100.
• 30. Ozcan Cetin EH, Cetin MS, Canpolat U, et al.Platelet-to-lymphocyte ratio as a novel marker of in-hospital and long-term adverse outcomes among patients with acute pulmonary embolism: a single-center large-scale study. Thromb Res 2017; 150: 33-40.