Karın ağrısı olan geriatrik hastalarda bilgisayarlı tomografideki patolojileri öngörmede laboratuvar testlerinin etkinliği

Year 2024, Volume: 49 Issue: 2, 278 - 286, 30.06.2024

Yaşar Çatal , Nazire Ülkü Kır , Sinan Genç , Ayça Koca , Müge Günalp , Onur Polat

https://doi.org/10.17826/cumj.1414439

Abstract

Amaç: Çalışmamız, karın ağrısı olan geriatrik hastaların abdominal bilgisayarlı tomografisindeki (BT) klinik olarak anlamlı patolojileri (CSPs) öngörmede laboratuvar testlerinin etkinliğini araştırmayı amaçladı.
Gereç ve Yöntem: Çalışmamız retrospektif bir vaka kontrol çalışmasıdır. Karın ağrısı nedeniyle acil servise başvuran, abdominal BT çekilen ve 65 yaş ve üzerinde olan tüm hastalar çalışmaya dahil edildi. Laboratuvar test sonuçları, başvuru sırasında alınan kan tahlillerinden elde edildi. BT sonuçlarına göre hastalar "CSPs (+)" ve "CSPs (-)" olmak üzere iki gruba ayrıldı. Laboratuvar sonuçları ile CSPs arasındaki ilişki istatistiksel olarak analiz edildi.
Bulgular: Çalışmaya 518 hasta dahil edildi. Hastaların %72,4’ünde BT’de CSPs (+) olduğu saptandı. Alkalen fosfataz (ALP), C-reaktif protein (CRP), beyaz kan hücreleri (WBC), trombosit, nötrofil ve nötrofil lenfosit oranı (NLR) değerleri CSPs (+) hastalarda istatistiksel olarak anlamlı derecede yüksekti. Testlerin optimal kesim değerleri WBC>10.75 (x10˄3/µL), CRP >150.5 (mg/L), NLR>4.4, ALP >92 (u/L) idi. Tüm testlerin receiver operating characteristic eğrisi altında kalan alanı 0.6'nın altındaydı ve tanısal kullanımda yeterli etkinlikte değildi.
Sonuç: Çalışmamız, karın ağrısı olan geriatrik hastalarda laboratuvar parametresi kullanımının BT’deki CSPs’yi öngörmede tek başına yeterli olmayacağını gösterdi.

Keywords

Geriatrik, karın ağrısı, acil servis, tomografi, laboratuvar testleri

Ethical Statement

Çalışma için Ankara Üniversitesi Etik Kuruldan onay alınmıştır.

Effectiveness of laboratory tests in predicting pathologies on computed tomography in geriatric patients with abdominal pain

Abstract

Purpose: Our study aimed to investigate the effectiveness of laboratory tests in predicting clinically significant pathologies (CSPs) on abdominal computed tomography (CT) in geriatric patients with abdominal pain.
Materials and Methods: Our study is a retrospective case-control study. All patients who were admitted to the emergency department due to abdominal pain had an abdominal CT scan and were 65 years of age or older were included in the study. Laboratory test results were obtained from blood tests taken at the time of admission. According to CT results, patients were grouped into two groups: "CSPs (+)" or "CSPs (-)". The relationship between laboratory results and CSPs was analyzed statistically.
Results: Five hundred eighteen patients were included in the study. CSPs (+) were detected on CT in 72.4% of the patients. Alkaline phosphatase (ALP), C-reactive protein (CRP), white blood cells (WBC), platelet, neutrophil, and neutrophil-lymphocyte ratio (NLR) values were statistically significantly higher in CSPs (+) patients. The optimal cut-off values of the tests were WBC>10.75 (x10˄3/µL), CRP >150.5 (mg/L), NLR>4.4, ALP >92 (U/L). The area under the receiver operating characteristic curve of all of these tests was below 0.6 and was not sufficiently effective for diagnostic use.
Conclusion: Our study showed that using laboratory parameters alone would not be sufficient to predict CSPs on CT in geriatric patients with abdominal pain.

Keywords

Geriatric, Abdominal pain, emergency service, tomography, laboratory tests

Ethical Statement

Ethical approval was obtained from the Ankara University Faculty Of Medicine Clinical Research Ethics Board by its decision dated 29/05/2020 and numbered İ5- 290-20.

References

• National Hospital Ambulatory Medical Care Survey: 2021 Emergency Department Summary Tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2021-nhamcs-ed-web-tables-508.pdf (accessed Dec 2023).
• Lewis LM, Banet GA, Blanda M, Hustey FM, Meldon SW, Gerson LW. Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. J Gerontol A Biol Sci Med Sci. 2005;60:1071-6.
• Spangler R, Van Pham T, Khoujah D, Martinez JP. Abdominal emergencies in the geriatric patient. Int J Emerg Med. 2014;7:1-8.
• Magidson PD, Martinez JP. Abdominal pain in the geriatric patient. Emerg Med Clin. 2016;34:559-74.
• Raja AS, Mortele KJ, Hanson R, Sodickson AD, Zane R, Khorasani R. Abdominal imaging utilization in the emergency department: trends over two decades. Int J Emerg Med. 2011;4:1-6.
• Mettler FA, Jr., Bhargavan M, Faulkner K, Gilley DB, Gray JE, Ibbott GS, et al. Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources--1950-2007. Radiology. 2009;253:520-31.
• Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician. 2006;74:1537-44.
• Gardner CS, Jaffe TA, Nelson RC. Impact of CT in elderly patients presenting to the emergency department with acute abdominal pain. Abdom Imaging. 2015;40:2877-82.
• Platon A, Frund C, Meijers L, Perneger T, Andereggen E, Becker M et al. Concomitant leukocytosis and lymphopenia predict significant pathology at CT of acute abdomen: a case-control study. BMC Emerg Med. 2019;19:10.
• Gans SL, Atema JJ, Stoker J, Toorenvliet BR, Laurell H, Boermeester MA. C-reactive protein and white blood cell count as triage test between urgent and nonurgent conditions in 2961 patients with acute abdominal pain. Medicine (Baltimore). 2015;94:e569.
• Farmer HR, Wray LA, Haas SA. Race, gender, and socioeconomic variations in C-reactive protein using the Health and Retirement Study. J Gerontol: Series B. 2021;76:583-95.
• Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol. 2018;9:754.
• Uludağ SS, Akıncı O, Güreş N, Tunç E, Erginöz E, Şanlız AN et al. Effectiveness of pre-operative routine blood tests in predicting complicated acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2022;28:1590-6.
• Atema JJ, Gans SL, Beenen LF, Toorenvliet BR, Laurell H, Stoker J et al. Accuracy of white blood cell count and C‐reactive protein levels related to duration of symptoms in patients suspected of acute appendicitis. Acad Emerg Med. 2015;22:1015-24.
• Budak YU, Polat M, Huysal K. The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochem Med. 2016;26:178-93.
• Pérez-Soto RH, Ponce de León-Ballesteros G, Álvarez-Bautista F, Trolle-Silva AM, Medina-Franco H. Thrombocytosis and hyponatremia as predictors of complicated acute appendicitis: predictors of appendicitis. J Surg Res. 2021;261:369-75.
• Shen G, Li S, Shao Z, Liu L, Liu Q, Yu H et al. Platelet indices in patients with acute appendicitis: a systematic review with meta-analysis. Updates Surg. 2021;73:1327-41.
• Choi SJ. A Systematic approach to patients with elevated levels of serum amylase or lipase. Korean J Gastroenterol. 2023;81:189-96.
• Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014;349:48-59.
• Rompianesi G, Hann A, Komolafe O, Pereira SP, Davidson BR, Gurusamy KS. Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis. Cochrane Database Syst Rev. 2017;4:CD012010.
• Padda M, Singh S, Tang S, Rockey D. Liver test patterns in patients with acute calculous cholecystitis and/or choledocholithiasis. Aliment Pharmacol Ther. 2009;29:1011-8.
• Beliaev AM, Angelo N, Booth M, Bergin C. Evaluation of neutrophil-to-lymphocyte ratio as a potential biomarker for acute cholecystitis. J Surg Res. 2017;209:93-101.
• Yaow CYL, Chong RIH, Chan KS, Chia CTW, Shelat VG. Should Procalcitonin Be Included in Acute Cholecystitis Guidelines? A Systematic Review. Medicina. 2023;59:805.
• Meyer ZC, Schreinemakers JM, Mulder PG, Schrauwen L, de Waal RA, Ermens AAet al. Procalcitonin in the recognition of complications in critically ill surgical patients. J Surg Res. 2014;187:553-8.
• Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122:474-88.
• Tuncer AA, Cavus S, Balcioglu A, Silay S, Demiralp I, Calkan E et al. Can mean platelet volume, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, platelet-to-lymphocyte ratios be favourable predictors for the differential diagnosis of appendicitis. J Pak Med Assoc. 2019;69:647-54.
• Jung SK, Rhee DY, Lee WJ, Woo SH, Seol SH, Kim DH et al. Neutrophil-to-lymphocyte count ratio is associated with perforated appendicitis in elderly patients of emergency department. Aging Clin Exp Res. 2017;29:529-36.
• Destek S, Yabacı A, Abik YN, Gül VO, Değer KC. Predictive and prognostic value of L-lactate, D-dimer, leukocyte, C-reactive protein and neutrophil/lymphocyte ratio in patients with acute mesenteric ischemia. Ulus Travma Acil Cerrahi Derg. 2020;26:86-94.
• Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC. The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. Acad Emerg Med. 2013;20:1087-100.
• Kumar S, Maurya J, Kumar S, Patne SK, Dwivedi AND. A study of C-reactive protein and D-dimer in patients of appendicitis. J Family Med Prim Care. 2020;9:3492-5.
• Li H, Sun D, Sun D, Xiao Z, Zhuang J, Yuan C. The diagnostic value of coagulation indicators and inflammatory markers in distinguishing between strangulated and simple intestinal obstruction. Surg Laparosc Endosc Percutan Tech. 2021;31:750-5