İnflamatuvar İndeksler Tekrarlayan İdrar Yolu Enfeksiyonu olan Gebelerde Olumsuz Gebelik Sonuçlarını Tahmin Etmek için Kullanılabilir mi?

Yıl 2022, Cilt: 24 Sayı: 3, 215 - 220, 30.12.2022

Ayşe Keleş , Gulsah Dagdeviren , Ozge Yucel Celik , Azize Cemre Öztürk , Mehmet Obut , Şevki Çelen , Ali Çağlar

https://doi.org/10.18678/dtfd.1109001

Cited By: 1

Öz

Amaç: Bu çalışmanın amacı tekrarlayan idrar yolu enfeksiyonu olan hamile kadınlarda inflamatuar indekslerin olumsuz maternal ve neonatal sonuçları tahmin etmedeki yararını araştırmaktır.
Gereç ve Yöntemler: Bu geriye dönük çalışma, 2017 ve 2021 yılları arasında semptomatik idrar yolu enfeksiyonu (İYE) nedeniyle tedavi edilen gebeler üzerinde yapılmıştır. İki veya daha fazla semptomatik İYE atağı olan gebeler çalışma grubuna dahil edilmiştir. Kontrol grubuna tek İYE geçiren gebeler dahil edilmiştir. Çalışma grubu 91 (%46,9) hastadan ve kontrol grubu ise 103 (%53,1) hastadan oluşmuştur. Gruplar klinik özellikler, olumsuz sonuçlar ve inflamatuar indeksler açısından karşılaştırıldı.
Bulgular: Kontrol grubu ile karşılaştırıldığında, çalışma grubunda daha fazla olumsuz maternal ve neonatal sonuçların meydana geldiği bulundu (sırasıyla p=0,021 ve p<0,001). Olumsuz maternal sonuçları öngörmek için trombosit-lenfosit oranı (TLR), nötrofil-lenfosit oranı (NLR) ve sistemik immün-inflamasyon indeksi (Sİİ) için kesim değerleri sırasıyla, 185,00 (p=0,015; eğri altında kalan alan (EAA)=0,604; %95 güven aralığı (GA)=0,558-0,782), 4,34 (p=0,051; EAA=0,584; %95 GA=0,514-0,746) ve 1210,48 (p=0,008; EAA=0,614; %95 GA=0,547-0,771) idi. Negatif neonatal sonuçları tahmin etmek için PLR, NLR ve Sİİ için kesim değerleri sırasıyla, 192,98 (p=0,001; EAA=0,692; %95 GA=0,572-0,812), 4,67 (p=0,166; EAA=0,583; %95 GA=0,475-0,740) ve 1339,47 (p=0,006; EAA=0,666; %95 GA=0,526-0,777) idi.
Sonuç: Ayırt etme başarısı zayıf olmakla birlikte, TLR ve Sİİ, tekrarlayan İYE'li gebe kadınlarda olumsuz maternal ve neonatal sonuçları tahmin etmek için faydalı olabilir.

Anahtar Kelimeler

olumsuz gebelik sonuçları, İnflamatuar indeksler, tekrarlayan idrar yolu enfeksiyonları

Can Inflammatory Indices be Used to Predict Adverse Pregnancy Outcomes in Pregnant Women with Recurrent Urinary Tract Infection?

Öz

Aim: This study aimed to investigate the utility of inflammatory indices in predicting adverse maternal and neonatal outcomes in pregnant women with recurrent urinary tract infections.
Material and Methods: This retrospective study was conducted on pregnant women treated for symptomatic urinary tract infection (UTI) between 2017 and 2021. Pregnant women with two or more episodes of symptomatic UTI were included in the study group. Pregnant women with one UTI were included in the control group. The study group consisted of 91 (46.9%) patients and the control group consisted of 103 (53.1%) patients. The groups were compared in terms of clinical characteristics, adverse outcomes, and inflammatory indices.
Results: It was found that more adverse maternal and neonatal outcomes occurred in the study group compared to the control group (p=0.021, and p<0.001, respectively). The cut-off values for platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) to predict adverse maternal outcomes were found 185.00 (p=0.015, area under the curve (AUC)=0.604, 95% confidence interval (CI)=0.558-0.782,), 4.34 (p=0.051, AUC=0.584, 95% CI=0.514-0.746), and 1210.48 (p=0.008, AUC=0.614, 95% CI=0.547-0.771), respectively. The cut-off values for PLR, NLR, and SII for predicting negative neonatal outcomes were found 192.98 (p=0.001, AUC=0.692, 95% CI=0.572-0.812), 4.67 (p=0.166, AUC=0.583, 95% CI=0.475-0.740), and 1339.47 (p=0.006, AUC=0.666, 95% CI=0.526-0.777), respectively.
Conclusion: Although the success of discrimination is weak, PLR and SII may be useful to predict adverse maternal and neonatal outcomes in pregnant women with recurrent UTI.

Anahtar Kelimeler

Adverse pregnancy outcomes;, inflammatory indices, recurrent urinary tract infections

Kaynakça

• Serena C, Tosi N, Mecacci F, Petraglia F. Uncomplicated urinary tract infections in pregnancy. In: Bjerklund Johansen TE, Wagenlehner FME, Matsumoto T, Cho YH, Krieger JN, Shoskes D, et al. editors. Urogenital infections and inflammations. 3th ed. Berlin: German Medical Science; 2017. p.23-5.
• Hannan TJ, Hooton TM, Hultgren SJ. Estrogen and recurrent UTI: what are the facts? Sci Transl Med. 2013;5(190):190fs23.
• Schnarr J, Smaill F. Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. Eur J Clin Invest. 2008;38(Suppl 2):50-7.
• Kalinderi K, Delkos D, Kalinderis M, Athanasiadis A, Kalogiannidis I. Urinary tract infection during pregnancy: current concepts on a common multifaceted problem. J Obstet Gynaecol. 2018;38(4):448-53.
• Gilstrap LC 3rd, Ramin SM. Urinary tract infections during pregnancy. Obstet Gynecol Clin North Am. 2001;28(3):581-91.
• Jolley JA, Kim S, Wing DA. Acute pyelonephritis and associated complications during pregnancy in 2006 in US hospitals. J Matern Fetal Neonatal Med. 2012;25(12):2494-8.
• Dalal S, Nicolle L, Marrs CF, Zhang L, Harding G, Foxman B. Long-term Escherichia coli asymptomatic bacteriuria among women with diabetes mellitus. Clin Infect Dis. 2009;49(4):491-7.
• Delzell JE Jr, Lefevre ML. Urinary tract infections during pregnancy. Am Fam Physician. 2000;61(3):713-21.
• Pfau A, Sacks TG. Effective prophylaxis for recurrent urinary tract infections during pregnancy. Clin Infect Dis. 1992;14(4):810-4.
• Sandberg T, Brorson JE. Efficacy of long-term antimicrobial prophylaxis after acute pyelonephritis in pregnancy. Scand J Infect Dis. 1991;23(2):221-3.
• Romero R, Espinoza J, Gonçalves LF, Kusanovic JP, Friel LA, Nien JK. Inflammation in preterm and term labour and delivery. Semin Fetal Neonatal Med. 2006;11(5):317-26.
• Keles A, Iskender D, Celik OY, Dagdeviren G, Iskender C, Caglar AT, et al. Neutrophil-to-lymphocyte ratios in pregnant women with familial mediterranean fever. Bratisl Lek Listy. 2021;122(4):251-5.
• Tanacan A, Uyanik E, Unal C, Beksac MS. A cut-off value for systemic immune-inflammation index in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes. J Obstet Gynaecol Res. 2020;46(8):1333-41.
• Daglar HK, Kirbas A, Kaya B, Kilincoglu F. The value of complete blood count parameters in predicting preterm delivery. Eur Rev Med Pharmacol Sci. 2016;20(5):801-5.
• Oztas E, Erkenekli K, Ozler S, Ersoy AO, Kurt M, Oztas E, et al. Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy? J Perinat Med. 2015;43(6):667-74.
• 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(23):6212-22.
• Kuba K, Bernstein PS. ACOG Practice Bulletin No. 188: prelabor rupture of membranes. Obstet Gynecol. 2018;131(6):1163-4.
• ACOG Practice Bulletin No. 190: Gestational diabetes mellitus. Obstet Gynecol. 2018;131(2):e49-64.
• Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol. 2018;218(2S):S790-802.e1.
• ACOG Practice Bulletin No. 202: Gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133(1):1.
• ACOG Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin No. 43: Management of preterm labor. Int J Gynaecol Obstet. 2003;82(1):127-35.
• Ipe DS, Sundac L, Benjamin WH Jr, Moore KH, Ulett GC. Asymptomatic bacteriuria: prevalence rates of causal microorganisms, etiology of infection in different patient populations, and recent advances in molecular detection. FEMS Microbiol Lett. 2013;346(1):1-10.
• Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am J Obstet Gynecol. 2014;210(3):219.e1-6.
• Schieve LA, Handler A, Hershow R, Persky V, Davis F. Urinary tract infection during pregnancy: its association with maternal morbidity and perinatal outcome. Am J Public Health. 1994;84(3):405-10.
• Glaser AP, Schaeffer AJ. Urinary tract infection and bacteriuria in pregnancy. Urol Clin North Am. 2015;42(4):547-60.
• Schneeberger C, Geerlings SE, Middleton P, Crowther CA. Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database Syst Rev. 2015;2015(7):CD009279.
• Jain V, Das V, Agarwal A, Pandey A. Asymptomatic bacteriuria & obstetric outcome following treatment in early versus late pregnancy in north Indian women. Indian J Med Res. 2013;137(4):753-8.
• Preterm Birth. In: Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. editors. Williams Obstetrics. 25th ed. New York: McGraw-Hill; 2018. p.803-34.
• Nurden AT. Platelets, inflammation and tissue regeneration. Thromb Haemost. 2011;105(Suppl 1):S13-33.
• Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643-54.
• Kenyon S, Pike K, Jones DR, Brocklehurst P, Marlow N, Salt A, et al. Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow-up of the ORACLE II trial. Lancet. 2008;372(9646):1319-27.
• Nordeng H, Lupattelli A, Romøren M, Koren G. Neonatal outcomes after gestational exposure to nitrofurantoin. Obstet Gynecol. 2013;121(2 Pt 1):306-13.
• Miller JE, Pedersen LH, Sun Y, Olsen J. Maternal use of cystitis medication and childhood epilepsy in a danish population-based cohort. Paediatr Perinat Epidemiol. 2012;26(6):589-95.
• Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002;287(20):2701-10.
• Millar LK, Cox SM. Urinary tract infections complicating pregnancy. Infect Dis Clin North. 1997;11(1):13-26.