Correlation Between Clot Load Burden with Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Patients with Acute Pulmonary Embolism

Year 2017, , 13 - 19, 01.01.2017

Mehmet Burak Cildag Songul Cildag

https://doi.org/10.5455/umj.20170224013949

Abstract

Background: The correlation between neutrophil-lymphocyte ratio NLR and acute pulmonary embolism APE related mortality, platelet-lymphocyte ratio PLR and clinical severity classification of APE were demostrated. Clot load also burden one of the prognostic criteria of pulmonary embolism. Method: The pulmonary arterial computed tomographic obstruction index ratio PACTOIR was calculated in 62 patients diagnosed with APE, retrospectively. Patients were divided into two groups according to their PACTOIR values. NLR and PLR were calculated from the blood samples collected on the day of diagnosis. Results: Mean PACTOIR, mean NLR and mean PLR of all patients with APE were calculated as 23.58%, 4.4 and 186.5, respectively. A positive correlation was observed between PACTOIR and NLR and PLR. A statistically significant difference was found between the NLR and PLR levels of low and high PACTOIR groups. Conclusion: A statistically significant correlation was found between PACTOIR and NLR and PLR in patients with APE. According to the findings of our study, NLR and PLR ratios may give an idea about the thrombus load in patients with clinically suspected APE.

Keywords

Acute Pulmonary Embolism, Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio.

References

• 1. Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva VL, et al. New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angioraphic index and echocardiography. AJR Am J Roentgenol 2001;176:1415-1420.
• 2. Wu AS, Pezzulo JA, Cronan JJ, Hou DD, Mayo-Smithet WW. CT Pulmonary Anjiography: Quantification of Pulmonary Embolus as a Predictor of Patient OutcomeInitial Experience. Radiology 2004; 230:831-835.
• 3. P Apfaltrer, T Henzler, M. Meyer, Roeger S, Haghi D, Gruettner J,et al. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism.European Journal of Radiology 2012;81:2867-71.
• 4. Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 2005;172:1041–6.
• 5. Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170:1383–9.
• 6. Agterof MJ, Schutgens RE, Snijder RJ, Epping G, Peltenburg HG, Posthuma EF, et al. Out of hospital treatment of acute pulmonary embolism in patients with a low NT-proBNP level. J Thromb Haemost 2010;8:1235–41.
• 7. Hellenkamp K, Kaeberich A, Schwung J, Konstantinides S, Lankeit M. Risk stratification of normotensive pulmonary embolism based on the sPESI: does it work for all patients? Int J Cardiol 2015;197:162–3.
• 8. Lankeit M, Jiménez D, Kostrubiec M, Dellas C, Kuhnert K, Hasenfuß G, et al. Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism. Eur Respir J 2014;43:1669–77.
• 9. Jiménez D, Kopecna D, Tapson V, Briese B, Schreiber D, Lobo JL, et al, for the PROTECT Investigators. Derivation and validation of multimarker prognostication for normo tensive patients with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med 2014;189:718–26.
• 10. Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of Pulmonary Embolism: An Update. JACC 2016; 67: 976-90.
• 11. Hotchkiss RS, Karl IE: The pathophysiology and treatment of sepsis. N Engl J Med. 2003; 348:138–150.
• 12. Kayrak M, Erdoğan Hİ, Solak Y, Akilli H, Gül EE, Yildirim O, et al. Prognostic value of Neutrophil to lymphocyte Ratio in Patients with Acute Pulmonary Embolism: ARetrospective Study. Heart, Lung and Circulation 2014;23:56-62.
• 13. Kundi H, Balun A,Cicekcioglu H, Cetin M, Kiziltunc E, Cetin ZG, et al. The relation between platelet-to-lymphocyte ratio and Pulmonary Embolism Severity Index in acute pulmonary embolism. Heart & Lung 2015;44 340-343.
• 14. Giuntini C, Di Ricco G, Marini C, Melillo E, Palla A. Pulmonary embolism: epidemiology. Chest 1995;107:3s-9s.
• 15. Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis. Radiographics 2004;24:1219-38.
• 16. Remy-Jardin M, Pistolesi M, Goodman LR, Gefter WB, GottschalkA, Mayo JR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. Radiology 2007;245: 315-29.
• 17. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033-69.
• 18. Tresoldi S, Kim YH, Baker SP, Kandarpa K. MDCT of 220 consecutive patients with suspected acute pulmonary embolism: incidence of pulmonary embolism and of other acute or non-acute thoracic findings. Radiol Med 2008;113: 373-84.
• 19. Ritchie G, McGurk S, McCreath C, Graham C, Murchison JT. Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning. Thorax 2007;62:536-40.
• 20. Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006;354:2317- 27.
• 21. Mühl D, Füredi R, Cristofari J, Ghosh S, Bogár L, Borsiczki B, et al. Evaluation of oxidative stress in the thrombolysis of pulmonary embolism.J Thromb Thrombolysis. 2006;22:221- 228.
• 22. Marchena YP, Nieto RJ, Serrano MS, Belinchón Moya O, Cortés Carmona A, Díaz de Tuesta A, et al. Acute-phase reactants and markers of inflammation in venous thrombo embolic disease: correlation with clinical and evolution parameters. An Med Interna. 2006;23:105-110.
• 23. Afzal A, Noor HA, Gill SA, Brawner C, Stein PD. Leukocytosis in acute pulmonary embolism. Chest 1999;155: 1329-32.
• 24. Huang CM, Lin YC, Lin YJ, Chang SL, Lo LW, Hu YF, et al. Risk stratification and clinical outcomes in patients with acute pulmonary embolism. Clin Biochem 2011;44:1110-5.
• 25. Yüksel M, Yıldız A, Oylumlu M, Akyüz A, Aydın M, Kaya H, et al. The association between platelet/lymphocyte ratio and coronary artery disease severity. Anatol J Cardiol 2015; 15:640-7.
• 26. Soylu K, Gedikli Ö, Ekşi A, Avcıoğlu Y, Soylu Aİ, Yüksel S, et al. Neutrophil-to-lymphocyte ratio for the assesment of hospital mortality in patients with acute pulmonary embolism. Arch Med Sci 2016;12(1):95-100.