POWER OF INFLAMMATORY MARKERS IN PREDICTING THE SEVERITY, SURVIVAL, AND COMPLICATIONS OF ACUTE MESENTERIC ISCHEMIA

Öz

Objective: Acute mesenteric ischaemia (AMI) carries high morbidity and mortality. Early risk stratification in the emergency department (ED) remains challenging. This study aimed to evaluate the discriminatory performance of inflammation- and nutrition-based laboratory indices calculated at ED admission for predicting in-hospital mortality (IHM) and complication development in patients with AMI.

Material and Methods: This retrospective single-centre observational study included adult patients diagnosed with AMI at ED presentation. Admission laboratory parameters were used to calculate haemoglobin-albumin-lymphocyte-platelet (HALP) score, red cell distribution width-to-albumin ratio (RAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), blood urea nitrogen-to-albumin ratio (BAR), and CRP-to-albumin ratio (CAR). The primary outcome was IHM; the secondary outcome was in-hospital complication development. Discriminatory performance was assessed using receiver operating characteristic curve analysis.

Results: Seventy-five patients were included (median age 69 years [IQR 61-80]; 52% female). IHM occurred in 36 patients (48%), and 40 patients (53.3%) developed complications. For mortality prediction, BAR demonstrated the highest discriminatory performance (area under the curve [AUC] 0.825, 95% confidence interval 0.733-0.918), followed by HALP (AUC 0.789) and RAR (AUC 0.763). PLR showed borderline acceptable discrimination (AUC 0.708), whereas SII, NLR, and CAR were not statistically significant. For complication prediction, SII (AUC 0.711) and PLR (AUC 0.709) demonstrated acceptable discrimination.

Conclusion: Inflammation- and nutrition-based indices demonstrated variable discriminatory performance for IHM and complications in AMI. BAR, HALP, and RAR showed acceptable performance for mortality, whereas SII and PLR showed acceptable performance for complications. However, moderate AUC values indicate limited precision. Larger prospective multicentre studies are required.

Anahtar Kelimeler

• Mesenteric Ischemia
• Biomarkers
• Inflammation
• Prognosis
• Mortality

Akut Mezenter İskeminin Ciddiyetinin, Sağkalımının ve Komplikasyonlarının Öngörülmesinde İnflamatuvar Belirteçlerin Gücü

Öz

Amaç: Akut mezenterik iskemi (AMI), yüksek morbidite ve mortalite ile ilişkili bir klinik tablodur. Acil serviste (AS) erken risk sınıflaması halen güçtür. Bu çalışmada, AS başvurusunda hesaplanan inflamasyon ve beslenme temelli laboratuvar indekslerinin, AMI hastalarında hastane içi mortaliteyi (HİM) ve komplikasyon gelişimini öngörmedeki ayırt edici performansı değerlendirildi.

Gereç ve Yöntem: Bu retrospektif, tek merkezli, gözlemsel çalışmaya, AS başvurusunda AMI tanısı alan erişkin hastalar dahil edildi. Başvuru laboratuvar verileri kullanılarak hemoglobin-albümin-lenfosit-trombosit (HALP) skoru, eritrosit dağılım genişliği/albümin oranı (RAR), nötrofil/lenfosit oranı (NLR), trombosit/lenfosit oranı (PLR), sistemik immün-inflamasyon indeksi (SII), kan üre nitrojeni/albümin oranı (BAR) ve C-reaktif protein/albümin oranı (CAR) hesaplandı. Birincil sonlanım HİM, ikincil sonlanım hastane içi komplikasyon gelişimiydi. Ayırt edici performans ROC eğrisi analizi ile değerlendirildi.

Bulgular: Toplam 75 hasta dahil edildi (medyan yaş 69 yıl [IQR 61-80]; %52 kadın). HİM 36 hastada (%48), komplikasyon ise 40 hastada (%53,3) gelişti. Mortalitenin öngörülmesinde BAR en yüksek performansı gösterdi (AUC 0,825; %95 GA 0,733-0,918); bunu HALP (AUC 0,789) ve RAR (AUC 0,763) izledi. PLR sınırda kabul edilebilir ayırt edicilik gösterirken (AUC 0,708), SII, NLR ve CAR anlamlı değildi. Komplikasyon öngörüsünde SII (AUC 0,711) ve PLR (AUC 0,709) kabul edilebilir performans gösterdi.

Sonuç: BAR, HALP ve RAR mortalite; SII ve PLR komplikasyon öngörüsünde kabul edilebilir performans gösterdi. Ancak orta düzeydeki AUC değerleri, bu indekslerin doğruluğunun sınırlı olduğunu düşündürmektedir. Daha büyük prospektif çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Mezenterik İskemi
• Biyobelirteçler
• İnflamasyon
• Prognoz
• Mortalite

Kaynakça

1. 1. Bala M, Catena F, Kashuk J, De Simone B, Gomes C, Weber D, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022;17(1):54.
2. 2. Bolat F, Keyif MF, Şit M, Özer B, Çatal O, Özer SP. Diagnostic utility of inflammatory ratios and nutritional scores in acute mesenteric ischemia: a retrospective single-center study. Turk J Surg. 2025;41(3):283-8.
3. 3. Blaser R, Starkopf J, Björck M, Forbes A, Kase K, Kiisk E, et al. Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis. World J Emerg Surg. 2023;18:44.
4. 4. Çınaroğlu OS, Bora ES, Efgan MG, Çınaroğlu D, Payza U. Can biomarkers be used for prognosis prediction in patients with acute mesenteric ischemia? Istanbul Med J. 2023;24(4):364-9.
5. 5. Augène E, Lareyre F, Chikande J, Guidi L, Ballaith A, Bossert JN, et al. Platelet-to-lymphocyte ratio as a predictive factor of 30-day mortality in patients with acute mesenteric ischemia. PLoS One. 2019;14(7):e0219763.
6. 6. Pan H, Lin S. Association of hemoglobin, albumin, lymphocyte and platelet score with risk of cerebrovascular, cardiovascular and all-cause mortality in the general population: results from NHANES 1999-2018. Front Endocrinol (Lausanne). 2023;14:1173399.
7. 7. Azapoğlu Kaymak B, Eksioglu M, Cimilli Öztürk T, Köroğlu M. Hemoglobin, albumin, lymphocyte and platelet score as a novel predictor of mortality and rebleeding in patients with upper gastrointestinal bleeding. Int J Gen Med. 2025;18:2391-400.
8. 8. Kurt E, Eke Kurt S. Investigation of the relationship between HALP score and mortality in patients with acute ischemic stroke. Disaster Emerg Med J. 2022;7(4):203-8.

9. 9. Güler İ, Ustaalioğlu İ. Predictive power of HALP score in estimating short-term mortality in patients with acute pancreatitis. Ulus Travma Acil Cerrahi Derg. 2023;29(10):1098-102.
10. 10. Li H, Zhou Y, Zhang X, Yao R, Li N. The relationship between hemoglobin, albumin, lymphocyte and platelet (HALP) score and 28-day mortality in patients with sepsis: a retrospective analysis of the MIMIC-IV database. BMC Infect Dis. 2025;25(1):333.
11. 11. Karakayali M, Omar T, Artac I, Ilis D, Arslan A, Altunova M, et al. The prognostic value of HALP score in predicting in-hospital mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis. 2023;34(7):483-8.
12. 12. Ma C, Liang G, Wang B, Eisenhut M, Urrechaga E, Wiedermann CJ, et al. Clinical value of the red blood cell distribution width-to-albumin ratio in the assessment of prognosis in critically ill patients with sepsis: a retrospective analysis. J Thorac Dis. 2024;16(1):516-29.
13. 13. Eraslan BZ, Kodalak Cengiz S, İçmeli OS, Beyhan Sagmen S, Şener Cömert S. Red cell distribution width to albumin ratio and mortality in acute pulmonary thromboembolism. Biomol Biomed. 2024;26(1):150-8.
14. 14. Chen X, Luo Y, Liu S. Association between red cell distribution width-to-albumin ratio and all-cause mortality in patients with acute pancreatitis admitted to the intensive care unit: a retrospective study based on the MIMIC-IV database. Front Med (Lausanne). 2025;12:1503378.
15. 15. Li L, Li C, Zhu J. Nonlinear relationship between blood urea nitrogen-to-albumin ratio and mortality risk in older patients with cerebrovascular and cardiovascular diseases: an NHANES analysis. PLoS One. 2025;20:e0334538.
16. 16. Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-82.
17. 17. Aslam H, Oza F, Ahmed K, Kopel J, Aloysius M, Ali A, et al. The role of red cell distribution width as a prognostic marker in chronic liver disease: a literature review. Int J Mol Sci. 2023;24:43487.
18. 18. Hiraoka A, Kumada T, Tsuji K, Takaguchi K, Itobayashi E, Kariyama K, et al. Validation of modified ALBI grade for more detailed assessment of hepatic function in hepatocellular carcinoma patients: a multicenter analysis. Liver Cancer. 2018;8:121-9.