Research Article
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The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width as Inflammatory Markers in Brucellosis

Year 2022, Volume: 75 Issue: 4, 508 - 514, 20.01.2023

Abstract

Objectives: Brucellosis is a zoonotic infectious disease. C-reactive protein (CRP) is widely used in the diagnosis, treatment and follow-up of
brucellosis. However, CRP is not a specific test. In this study, it is aimed to investigate the role of neutrophil to lymphocyte ratio (NLR), platelet to
lymphocyte ratio and red cell distribution width (RDW) as inflammatory markers in brucellosis.

Materials and Methods: In our study, ≥18 year old brucellosis patients followed between January 1st, 2017 and January 1st, 2019 were included.
Patients’ data were obtained through hospital information systems. Initial and monthly consecutive values of neutrophil counts, lymphocyte counts, platelet counts, RDW and CRP levels were recorded.

Results: One hundredand thirty-six patients were included in the study. 63.2% (n=86) of the cases were male. It was determined that Brucella
spp. was cultured in 7.4% of the patients’ samples. The patients were given antibacterial treatment during the median period of 7 (6-40) weeks. Under treatment, CRP and NLR declined significantly (p<0.05). At the end of the first and second months, RDW declined significantly but the same association could not be detected at the end of the third month (p=0.059). It was found that only NLR was correlated with CRP levels and its declining trend (p<0.05).

Conclusion: It is concluded that the values of NLR and RDW are useful to monitor treatment response in brucellosis patients. These values provide advantage since they can speedily be measured via automated complete blood count analyzer with no necessity for additional cost and human capital.

Ethical Statement

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Supporting Institution

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Project Number

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Thanks

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References

  • 1. Keşli R, Bilgin H, Yılmaz H. Determination of in vitro susceptibilities of Brucella spp. strains against 11 different antibacterial gents isolated from blood cultures. Mikrobiyol Bul. 2017;51:260–268.
  • 2. Yüce A, Alp-Çavuş S. Türkiye’de bruselloz: Genel bakış. Klimik Derg. 2006;19:87–97.
  • 3. Young EJ. Brucella Species. In: Mandell GL, Bennet JE, Dolin R, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia: Churchill Livingstone Elsevier, 2010. pp.2921–5.
  • 4. Çalık S, Gökengin AD. Human brucellosis in Turkey: a review of the literature between 1990 and 2009. Turk J Med Sci. 2011;41:549–55.
  • 5. Hekmatimoghaddam S, Sadeh M, Khalili MB, et al. Comparison of PCR, wright agglutination test and blood culture for diagnosis of brucellosis in suspected patients. Pakistan Journal of Biological Sciences. 2013;16(22):1589–1592.
  • 6. Öztürk ZA, Sayıner H, Kuyumcu ME, et al. Mean platelet volume in assessment of brucellosis disease. Biomed Res. 2012;23(4):541.
  • 7. Kayipmaz AE, Findik M, Kavalci C, et al. Red Blood Cell Distribution Width Increases During Infection in Renal and Liver Graft Recipients. Exp Clin Transplant. 2017;15(1):61-64.
  • 8. Ertek M, Yazgı H, Kadanalı A, et al. Complications of Brucella infection among adults: an 18 year retrospective evaluation. Turk J Med Sci. 2006;36:377–81.
  • 9. Aygen B, Doganay M, Sümerkan B, et al. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Méd Mal Infect. 2002;32:485–93.
  • 10. Kazak E, Akalın H, Yılmaz E, et al. Brucellosis: a retrospective evaluation of 164 cases. Singapore Med J. 2016;57(11):624-629.
  • 11. Joint FAO/WHO Expert Committee on Brucellosis. Sixth report. Technical report series no. 740.Geneva: World Health Organization; 1986.
  • 12. Sanaei Dashti A, Karimi A. Skeletal involvement of Brucella melitensis in children: a systematic review. Iran J Med Sci. 2013;38(4):286–92
  • 13. Brown AS, Hong Y, de Belder A, et al. Megakaryocyte ploidy and platelet changes in human diabetes and atherosclerosis. Arterioscler Thromb Vasc Biol. 1997;17(4):802–7.
  • 14. Ulu-Kilic A, Karakas A, Erdem H, et al. Update on treatment options for spinal brucellosis. Clin Microbiol Infect. 2014;20(2):75–82.
  • 15. 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(1):5–14.
  • 16. Kartal O, Kartal AT. Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Lek Listy. 2017;118(9):513-516.
  • 17. Bozbay M, Uyarel H. Neutrophil-to-lymphocyte ratio: A novel and simple prognostic marker for infective endocarditis. J Crit Care. 2015;30(4):822.
  • 18. Ljungström L, Pernestig AK, Jacobsson G, et al. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. PLoS One. 2017;12(7):e0181704.
  • 19. Zwerdling A, Delpino MV, Pasquevich KA, et al. Brucella abortus activates human neutrophils. Microbes Infect. 2009;11(6-7):689-97.
  • 20. Skendros P, Boura P. Immunity to brucellosis. Rev Sci Tech. 2013;32:137–147.
  • 21. Gibson PH, Croal BL, Cuthbertson BH, et al. Preoperative neutrophillymphocyte ratio and outcome from coronary artery bypass grafting. American heart journal. 2007;154(5):995–1002.
  • 22. Halazun KJ, Aldoori A, Malik HZ, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2008;34(1):55–60.
  • 23. Olt S, Ergenç H, Açıkgöz SB. Predictive contribution of neutrophil/lymphocyte ratio in diagnosis of brucellosis. Biomed Res Int. 2015;2015:210502.
  • 24. Cift A, Yucel MO. Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis. Int Braz J Urol. 2018;44(4):771-778.
  • 25. Bozdemir ŞE, Altıntop YA, Uytun S, et al. Diagnostic role of mean platelet volume and neutrophil to lymphocyte ratio in childhood brucellosis. Korean J Intern Med. 2017;32:1075–1081.
  • 26. Allen LA, Felker GM, Mehra MR, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail. 2010;16(3):230-8.
  • 27. Lorente L, Martín MM, Abreu-González P, et al. Red blood cell distribution width during the first week is associated with severity and mortality in septic patients. PLoS One. 2014;9(8):e105436.
  • 28. Jo YH, Kim K, Lee JH, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med. 2013;31(3):545-548.
  • 29. Scharte M, Fink MP. Red blood cell physiology in critical illness. Crit Care Med. 2003;31(12 Suppl):S651-S657.
  • 30. Maury CP, Andersson LC, Teppo AM, et al. Mechanism of anaemia in rheumatoid arthritis: demonstration of raised interleukin 1 beta concentrations in anaemic patients and of interleukin 1 mediated suppression of normal erythropoiesis and proliferation of human erythroleukaemia (HEL) cells in vitro. Ann Rheum Dis. 1988;47(12):972-8.
  • 31. Küçükbayrak A, Taş T, Tosun M, et al. Brusellozun seyrinde eritrosit parametreleri. Abant Tıp Dergisi. 2013;2(1):36–9.
  • 32. Chandrashekara S, Mukhtar Ahmad M, Renuka P, et al. Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int J Rheum Dis. 2017;20(10):1457-1467.
  • 33. Guray Y, Ipek EG, Guray U, et al. Red cell distribution width predicts mortality in infective endocarditis. Arch Cardiovasc Dis. 2014;107(5):299- 307.
  • 34. Al-Kindi SG, Kim CH, Morris SR, et al. Brief Report: Elevated Red Cell Distribution Width Identifies Elevated Cardiovascular Disease Risk in Patients With HIV Infection. J Acquir Immune Defic Syndr. 2017;74(3):298-302.
  • 35. Kayipmaz AE, Findik M, Kavalci C, et al. Red Blood Cell Distribution Width Increases During Infection in Renal and Liver Graft Recipients. Exp Clin Transplant. 2017 Feb;15(1):61-64.
  • 36. Togan T, Narci H, Turan H, et al. The impact of acute brucellosis on mean platelet volume and red blood cell distribution. Jundishapur J Microbiol. 2015;8(2):e20039.
  • 37. Aktar F, Tekin R, Bektaş MS, et al. Diagnostic role of inflammatory markers in pediatric Brucella arthritis. Ital J Pediatr. 2016;42:3.
  • 38. Okan DH, Gökmen Z, Seyit B, et al. Mean platelet volume in brucellosis: correlation between brucella standart agglutination test results, platelet count, and C-reactive protein. Afr Health Sci. 2014;14(4):797–801.
  • 39. Meng X, Wei G, Chang Q, et al. The platelet-to-lymphocyte ratio, superior to the neutrophil-to-lymphocyte ratio, correlates with hepatitis C virus infection. Int J Infect Dis. 2016;45:72-7.

Bruselloz Olgularında Nötrofil Lenfosit Oranı, Platelet Lenfosit Oranı ve Eritrosit Dağılım Genişliğinin Enflamasyon Göstergesi Olarak Rolü

Year 2022, Volume: 75 Issue: 4, 508 - 514, 20.01.2023

Abstract

Amaç: Bruselloz zoonotik bir enfeksiyon hastalığıdır. C-reaktif protein (CRP) bruselloz tanı ve tedavi takibinde yaygın bir biçimde kullanılmaktadır. Ancak, CRP özgül bir test değildir. Bu çalışmada nötrofil lenfosit oranı (NLO), platelet lenfosit oranı ve eritrosit dağılım genişliğinin (RDW) brusellozda enflamasyon göstergesi olarak rolünün araştırılması amaçlanmıştır.

Gereç ve Yöntem: Çalışmamıza 1 Ocak 2017 ve 1 Ocak 2019 tarihleri arasında takip edilen ≥18 yaş ve üzeri bruselloz hastaları dahil edildi. Hastaların verileri hastane bilgi sistemleri vasıtasıyla elde edildi. Başlangıç ve aylık ardışık nötrofil, lenfosit ve platelet sayıları, RDW ve CRP değerleri kaydedildi.

Bulgular: Çalışmaya 136 hasta dahil edildi. Olguların %63,2’si (n=86) erkekti. Hastaların %7,4’ünde kültürde Brucella spp. ürediği saptandı. Hastalara ortanca 7 (6-40) hafta süreyle antibakteriyel tedavi verildi. CRP ve NLO tedavi altında anlamlı biçimde geriledi (p<0,05). RDW birinci ve ikinci ay sonunda anlamlı değişiklik göstermekteyken (p<0,05), aynı ilişki üçüncü ay sonunda saptanamadı (p=0,059). CRP değerleri ve değişimiyle yalnız NLO ve değişimi arasında anlamlı korelasyon bulundu (p<0,05).

Sonuç: Bruselloz olgularında NLO ve RDW değerlerinin tedavi yanıtının izleminde yararlı olduğu sonucuna varılmıştır. Bu değerler otomatize tam
kan sayımıyla, hızlı bir şekilde ve ek maliyet ve iş gücü gerekmeksizin ölçülebildiğinden avantaj taşımaktadırlar.

Ethical Statement

Çalışma için Balıkesir Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından 10 Nisan 2019 tarihinde, 2019/62 karar numarasıyla onay alınmıştır

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Keşli R, Bilgin H, Yılmaz H. Determination of in vitro susceptibilities of Brucella spp. strains against 11 different antibacterial gents isolated from blood cultures. Mikrobiyol Bul. 2017;51:260–268.
  • 2. Yüce A, Alp-Çavuş S. Türkiye’de bruselloz: Genel bakış. Klimik Derg. 2006;19:87–97.
  • 3. Young EJ. Brucella Species. In: Mandell GL, Bennet JE, Dolin R, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia: Churchill Livingstone Elsevier, 2010. pp.2921–5.
  • 4. Çalık S, Gökengin AD. Human brucellosis in Turkey: a review of the literature between 1990 and 2009. Turk J Med Sci. 2011;41:549–55.
  • 5. Hekmatimoghaddam S, Sadeh M, Khalili MB, et al. Comparison of PCR, wright agglutination test and blood culture for diagnosis of brucellosis in suspected patients. Pakistan Journal of Biological Sciences. 2013;16(22):1589–1592.
  • 6. Öztürk ZA, Sayıner H, Kuyumcu ME, et al. Mean platelet volume in assessment of brucellosis disease. Biomed Res. 2012;23(4):541.
  • 7. Kayipmaz AE, Findik M, Kavalci C, et al. Red Blood Cell Distribution Width Increases During Infection in Renal and Liver Graft Recipients. Exp Clin Transplant. 2017;15(1):61-64.
  • 8. Ertek M, Yazgı H, Kadanalı A, et al. Complications of Brucella infection among adults: an 18 year retrospective evaluation. Turk J Med Sci. 2006;36:377–81.
  • 9. Aygen B, Doganay M, Sümerkan B, et al. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Méd Mal Infect. 2002;32:485–93.
  • 10. Kazak E, Akalın H, Yılmaz E, et al. Brucellosis: a retrospective evaluation of 164 cases. Singapore Med J. 2016;57(11):624-629.
  • 11. Joint FAO/WHO Expert Committee on Brucellosis. Sixth report. Technical report series no. 740.Geneva: World Health Organization; 1986.
  • 12. Sanaei Dashti A, Karimi A. Skeletal involvement of Brucella melitensis in children: a systematic review. Iran J Med Sci. 2013;38(4):286–92
  • 13. Brown AS, Hong Y, de Belder A, et al. Megakaryocyte ploidy and platelet changes in human diabetes and atherosclerosis. Arterioscler Thromb Vasc Biol. 1997;17(4):802–7.
  • 14. Ulu-Kilic A, Karakas A, Erdem H, et al. Update on treatment options for spinal brucellosis. Clin Microbiol Infect. 2014;20(2):75–82.
  • 15. 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(1):5–14.
  • 16. Kartal O, Kartal AT. Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Lek Listy. 2017;118(9):513-516.
  • 17. Bozbay M, Uyarel H. Neutrophil-to-lymphocyte ratio: A novel and simple prognostic marker for infective endocarditis. J Crit Care. 2015;30(4):822.
  • 18. Ljungström L, Pernestig AK, Jacobsson G, et al. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. PLoS One. 2017;12(7):e0181704.
  • 19. Zwerdling A, Delpino MV, Pasquevich KA, et al. Brucella abortus activates human neutrophils. Microbes Infect. 2009;11(6-7):689-97.
  • 20. Skendros P, Boura P. Immunity to brucellosis. Rev Sci Tech. 2013;32:137–147.
  • 21. Gibson PH, Croal BL, Cuthbertson BH, et al. Preoperative neutrophillymphocyte ratio and outcome from coronary artery bypass grafting. American heart journal. 2007;154(5):995–1002.
  • 22. Halazun KJ, Aldoori A, Malik HZ, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2008;34(1):55–60.
  • 23. Olt S, Ergenç H, Açıkgöz SB. Predictive contribution of neutrophil/lymphocyte ratio in diagnosis of brucellosis. Biomed Res Int. 2015;2015:210502.
  • 24. Cift A, Yucel MO. Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis. Int Braz J Urol. 2018;44(4):771-778.
  • 25. Bozdemir ŞE, Altıntop YA, Uytun S, et al. Diagnostic role of mean platelet volume and neutrophil to lymphocyte ratio in childhood brucellosis. Korean J Intern Med. 2017;32:1075–1081.
  • 26. Allen LA, Felker GM, Mehra MR, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail. 2010;16(3):230-8.
  • 27. Lorente L, Martín MM, Abreu-González P, et al. Red blood cell distribution width during the first week is associated with severity and mortality in septic patients. PLoS One. 2014;9(8):e105436.
  • 28. Jo YH, Kim K, Lee JH, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med. 2013;31(3):545-548.
  • 29. Scharte M, Fink MP. Red blood cell physiology in critical illness. Crit Care Med. 2003;31(12 Suppl):S651-S657.
  • 30. Maury CP, Andersson LC, Teppo AM, et al. Mechanism of anaemia in rheumatoid arthritis: demonstration of raised interleukin 1 beta concentrations in anaemic patients and of interleukin 1 mediated suppression of normal erythropoiesis and proliferation of human erythroleukaemia (HEL) cells in vitro. Ann Rheum Dis. 1988;47(12):972-8.
  • 31. Küçükbayrak A, Taş T, Tosun M, et al. Brusellozun seyrinde eritrosit parametreleri. Abant Tıp Dergisi. 2013;2(1):36–9.
  • 32. Chandrashekara S, Mukhtar Ahmad M, Renuka P, et al. Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int J Rheum Dis. 2017;20(10):1457-1467.
  • 33. Guray Y, Ipek EG, Guray U, et al. Red cell distribution width predicts mortality in infective endocarditis. Arch Cardiovasc Dis. 2014;107(5):299- 307.
  • 34. Al-Kindi SG, Kim CH, Morris SR, et al. Brief Report: Elevated Red Cell Distribution Width Identifies Elevated Cardiovascular Disease Risk in Patients With HIV Infection. J Acquir Immune Defic Syndr. 2017;74(3):298-302.
  • 35. Kayipmaz AE, Findik M, Kavalci C, et al. Red Blood Cell Distribution Width Increases During Infection in Renal and Liver Graft Recipients. Exp Clin Transplant. 2017 Feb;15(1):61-64.
  • 36. Togan T, Narci H, Turan H, et al. The impact of acute brucellosis on mean platelet volume and red blood cell distribution. Jundishapur J Microbiol. 2015;8(2):e20039.
  • 37. Aktar F, Tekin R, Bektaş MS, et al. Diagnostic role of inflammatory markers in pediatric Brucella arthritis. Ital J Pediatr. 2016;42:3.
  • 38. Okan DH, Gökmen Z, Seyit B, et al. Mean platelet volume in brucellosis: correlation between brucella standart agglutination test results, platelet count, and C-reactive protein. Afr Health Sci. 2014;14(4):797–801.
  • 39. Meng X, Wei G, Chang Q, et al. The platelet-to-lymphocyte ratio, superior to the neutrophil-to-lymphocyte ratio, correlates with hepatitis C virus infection. Int J Infect Dis. 2016;45:72-7.
There are 39 citations in total.

Details

Primary Language English
Subjects Clinical Microbiology
Journal Section Research Article
Authors

Ezgi Gülten 0000-0003-0248-7716

Sengül Üçer 0000-0002-1764-3198

Sümeyye Kazancıoğlu 0000-0003-3869-6130

Project Number -
Publication Date January 20, 2023
Published in Issue Year 2022 Volume: 75 Issue: 4

Cite

APA Gülten, E., Üçer, S., & Kazancıoğlu, S. (2023). The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width as Inflammatory Markers in Brucellosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 75(4), 508-514. https://doi.org/10.4274/atfm.galenos.2022.12754
AMA Gülten E, Üçer S, Kazancıoğlu S. The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width as Inflammatory Markers in Brucellosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası. January 2023;75(4):508-514. doi:10.4274/atfm.galenos.2022.12754
Chicago Gülten, Ezgi, Sengül Üçer, and Sümeyye Kazancıoğlu. “The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width As Inflammatory Markers in Brucellosis”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75, no. 4 (January 2023): 508-14. https://doi.org/10.4274/atfm.galenos.2022.12754.
EndNote Gülten E, Üçer S, Kazancıoğlu S (January 1, 2023) The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width as Inflammatory Markers in Brucellosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75 4 508–514.
IEEE E. Gülten, S. Üçer, and S. Kazancıoğlu, “The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width as Inflammatory Markers in Brucellosis”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 4, pp. 508–514, 2023, doi: 10.4274/atfm.galenos.2022.12754.
ISNAD Gülten, Ezgi et al. “The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width As Inflammatory Markers in Brucellosis”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75/4 (January2023), 508-514. https://doi.org/10.4274/atfm.galenos.2022.12754.
JAMA Gülten E, Üçer S, Kazancıoğlu S. The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width as Inflammatory Markers in Brucellosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;75:508–514.
MLA Gülten, Ezgi et al. “The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width As Inflammatory Markers in Brucellosis”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 4, 2023, pp. 508-14, doi:10.4274/atfm.galenos.2022.12754.
Vancouver Gülten E, Üçer S, Kazancıoğlu S. The Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Red Cell Distribution Width as Inflammatory Markers in Brucellosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;75(4):508-14.