Year 2019, Volume 5, Issue 2, Pages 369 - 374 2019-03-04

The utility of the neutrophil-to-lymphocyte ratio in predicting urolithiasis in acute abdominal pain accompanied by flank pain

Feride Sinem Akgün [1] , Orhun Sinanoğlu [2]

50 291

Objectives: To evaluate whether the neutrophil-to-lymphocyte ratio (NLR), can differentiate between urinary stone disease and inflammatory conditions in patients admitted to emergency department having acute abdominal pain accompanied by flank pain.

Methods: Data of 191 patients with acute abdominal pain accompanied by flank pain admitted to emergency department in a single institution during 1 year period was retrospectively reviewed. Complete blood count and urine analysis were evaluated, the definitive diagnosis was established radiologically. The NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count. The cut off value for the NLR in relation to stone status was calculated.

Results: Of the 191 patients 51.3% (n = 98) were males, 48.7% (n = 93) were females (p > 0.05). White blood counts of the patients according to the presence of stone does not show a statistically significant difference (p > 0.05). NLR measurement of patients according to the presence of stone shows a statistically significant difference (p = 0.009). NLR of patients with urinary stones were significantly lower than patients without urinary stones. NLR measurements did not differ significantly according to stone location. A cut-off point of ≤ 2.16 for the NLR was determined according to the stone status of the patients. NLR values were higher in patients with acute abdominal pain/flank pain due to inflammatory pathologies.

Conclusion: As the diagnosis and treatment of urolithiasis take long time and require elaborate methods, NLR may be used as a simple method in the differential diagnosis of pain due to urinary stone disease or inflammatory condition. 

Acute abdominal pain, emergency medicine, flank pain, neutrophil-to-lymphocyte ratio (NLR), urolithiasis
  • [1] O’brien MC. Acute abdominal pain. Tintinalli’s emergency medicine: a comprehensive study guide New York: McGraw-Hill. 2011:p. 2120.
  • [2] van Randen A, Laméris W, van Es HW, van Heesewijk HPM, van Ramshorst B, Ten Hove W, et al. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol 2011;21:1535-45.
  • [3] Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report 2008;6;1-38.
  • [4] Emet M, Eroğlu M, Aslan Ş, Öztürk G. [Approach to patient with abdominal pain]. Eurasian J Med 2007;39:136-41. [Article in Turkish]
  • [5] Marincek B. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies. Eur Radiol 2002;12:2136-50.
  • [6] Acar E, Ozcan O, Deliktaş H, Beydilli H, Kırlı İ, Alataş ÖD, et al. Laboratory markers has many valuable Parameters in the discrimination between acute appendicitis and renal colic. Ulus Travma Acil Cerrahi Derg 2016;22:17-22.
  • [7] 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.
  • [8] Koh CH, Bhoo-Pathy N, Ng KL, Jabir RS, Tan GH, See MH, et al. Utility of pre-treatment neutrophil–lymphocyte ratio and platelet–lymphocyte ratio as prognostic factors in breast cancer. Br J Cancer 2015;113:150-8.
  • [9] Durmus E, Kivrak T, Gerin F, Sunbul M, Sari I, Erdogan O. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are predictors of heart failure. Arq Bras Cardiol 2015;105:606-13.
  • [10] Bahadır A, Baltacı D, Türker Y, Türker Y, Iliev D, Öztürk S, et al. Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome? Anatol J Cardiol 2015;15:816-22.
  • [11] Kurtul S, Sarli B, Baktir AO, Demirbas M, Saglam H, Doğan Y, et al. Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with non-ST segment elevation myocardial infarction. Int Heart J 2015;56:18-21.
  • [12] Hyun S, Kwon S, Cho S, Park S, Jung W. Can the neutrophil-to-lymphocyte ratio appropriately predict carotid artery stenosis in patients with ischemic stroke?-A retrospective study. J Stroke Cerebrovasc Dis 2015;24:2646-51.
  • [13] Küçük E. The change of neutrophil lymphocyte ratio in acute appendicitis. Med-Science 2015;4:2379-87.
  • [14] Shimizu T, Ishizuka M, Kubota K. A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg Today 2016;46:84-9.
  • [15] Yardımcı S, Ugurlu MU, Coskun M. Neutrophil-lymphocyte ratio and mean platelet volume can be a predictor for the severity of acute appendicitis. Ulus Travma Acil Cerrahi Derg 2016;22:163-8.
  • [16] Serinken M, Karcioglu O, Turkcuer I, Ozkan HI, Keysan MK, Bukiran A. Analysis of clinical and demographic characteristics of patients presenting with renal colic in the emergency department. BMC Res Notes 2008;1:79.
  • [17] Akdag S, Akyol A, Asker M, Duz R, Gumrukcuoglu HA. Platelet-to-lymphocyte ratio may predict the severity of calcific aortic stenosis. Med Sci Monit 2015;21:3395-400.
  • [18] Furuncuoğlu Y, Tulgar S, Dogan AN, Cakar S, Tulgar YK, Cakiroglu B. How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study. Eur Rev Med Pharmacol Sci 2016;20:1300-6.
  • [19] Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res 2014;20:6212-22.
  • [20] Tulgar YK, Cakar S, Tulgar S, Dalkilic O, Cakiroglu B, Uyanik BS. The effect of smoking on neutrophil/lymphocyte and platelet/lymphocyte ratio and platelet indices: a retrospective study. Eur Rev Med Pharmacol Sci 2016;20:3112-8.
  • [21] Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer 2011;104:1288-95.
  • [29] Küçük A, Erol MF, Senel S, Eroler E, Yumun HA, Uslu AU, et al. The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis. Korean J Intern Med 2016;31:386-91.
  • [30] Müslümanoğlu AY, Tepeler A. Renal colic, diagnosis and treatment. Marmara Med J 2008;21;187-92.
  • [22] Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2012;110:621-7.
  • [23] 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;102:653-7.
  • [24] Günay E, Sarınç Ulaşlı S, Akar O, Ahsen A, Günay S, Koyuncu T, et al. Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study. Inflammation 2014;37:374-80.
  • [25] Kalelioglu T, Akkus M, Karamustafalioglu N, Genc A, Genc ES, Cansiz A, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratios as inflammation markers for bipolar disorder. Psychiatry Res 2015;228:925-7.
  • [26] Wu G, Yao Y, Bai C, Zeng J, Shi D, Gu X, et al. Combination of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio is a useful prognostic factor in advanced nonsmall cell lung cancer patients. Thorac Cancer 2015;6:275-87.
  • [27] Uyeturk U, Dagistan E, Aktas G, Ozyalvacli ME, Tekce H, Yilmaz B. Association between urinary stone disease and perirenal tissue thickness. Nat J Med Res 2014;4:193-6.
  • [28] Sfoungaristos S, Kavouras A, Katafigiotis I, Perimenis P. Role of white blood cell and neutrophil counts in predicting spontaneous stone passage in patients with renal colic. BJU Int 2012;110(8 Pt B):E339-45.
Primary Language en
Subjects Health Care Sciences and Services
Journal Section Original Articles
Authors

Orcid: 0000-0001-6537-866X
Author: Feride Sinem Akgün (Primary Author)
Institution: Department of Emergency Medicine, Maltepe University School of Medicine, İstanbul, Turkey
Country: Turkey


Orcid: 0000-0001-6341-505X
Author: Orhun Sinanoğlu
Institution: Department of Urology, Maltepe University School of Medicine, İstanbul, Turkey
Country: Turkey


Dates

Publication Date: March 4, 2019

EndNote %0 The European Research Journal The utility of the neutrophil-to-lymphocyte ratio in predicting urolithiasis in acute abdominal pain accompanied by flank pain %A Feride Sinem Akgün , Orhun Sinanoğlu %T The utility of the neutrophil-to-lymphocyte ratio in predicting urolithiasis in acute abdominal pain accompanied by flank pain %D 2019 %J The European Research Journal %P -2149-3189 %V 5 %N 2 %R doi: 10.18621/eurj.431227 %U 10.18621/eurj.431227