A New Prognostic Factor in Patients with Acute Tonsillitis and Peritonsillar Abscess; C-Reactive Protein / Albumin Ratio

Yıl 2021, , 270 - 275, 20.09.2021

Fatih Yüksel , Ekrem Özsöz İsa Aydın Mehmet Erkan Kahraman

https://doi.org/10.54005/geneltip.996818

Öz

Background: Peritonsillar abscess is a serious infectious disease of the tonsil tissue. Treatment usually requires both medical and surgical approaches to relieve symptoms. Recently, some tests such as C-reactive protein (CRP) and albumin in addition to clinical follow-up are thought to be additional inflammatory monitoring markers.

Aim: The aim of this study is to investigate whether the CRP/albumin ratio can be used to predict conversion to peritonsillar abscess in patients with acute tonsillitis.

Patients and methods: This study was conducted by retrospectively evauating the CRP / albumin ratios of 138 patients with acute tonsillitis and 106 patients with peritonsillar abcess who were admitted to our clinic between January 2003 and June 2020. Leukocyte count, neutrophil count, lymphocyte count, C – reactive protein, albumin and neutrophil – lymphocyte ratio values were simultaneously analyzed and compared between groups.

Results: CRP / albumin ratio levels were significantly higher in the peritonsillar abscess group than in the acute tonsillitis group (p < 0.05). There was no significant difference between peritonsillar abscess and acute tonsillitis group in neutrophil-lymphocyte ratio levels (p > 0.05). While the rate of albumin was found to be significantly lower in the peritonsillar abscess group, the lymphocyte count was found to be significantly higher. There was no significant difference between the groups in terms of white blood cell count, neutrophil count, C-reactive protein values (p > 0.05).

Conclusion: The CRP / albumin ratio is thought to be an easy-to-measure, reproducible, non-invasive prognostic score that can be used to predict peritonsillar abscess formation in patients with acute tonsillitis.

Anahtar Kelimeler

Peritonsillar abscess, C-reactive protein, Acute tonsillitis, Albumin

Akut Tonsillit ve Peritonsiller Apseli Hastalarda Yeni Bir Prognostik Faktör; C-Reaktif Protein / Albumin Oranı

Öz

Amaç: Peritonsiller apse, tonsil dokusunun ciddi bir enfeksiyon hastalığıdır. Tedavisinde genellikle semptomları hafifletmek için hem tıbbi hem de cerrahi yaklaşımlar gerekir. Son zamanlarda, klinik takibe ek olarak C-reaktif protein (CRP) ve albumin gibi bazı parametrelerin, ek enflamatuar izleme belirteçleri olduğu düşünülmektedir. Bu çalışmanın amacı akut tonsillitli hastaların peritonsiller apseye dönüşümünü tahmin etmek için CRP / albumin oranının kullanılıp kullanılamayacağını araştırmaktır.

Hastalar ve Yöntem: Bu çalışma Ocak 2003 ile Haziran 2020 tarihleri arasında Konya Şehir Hastanesi Kulak Burun Boğaz Kliniği’nde yatış yapılarak takip edilen 138 akut tonsillitli ve 106 peritonsiller apseli hastanın retrospektif olarak CRP/albumin oranları değerlendirilerek gerçekleştirildi. Aynı zamanda lökosit, nötrofil ve lenfosit sayıları ile CRP, albümin ve nötrofil / lenfosit (NLO) oranı değerleri de retrospektif olarak analiz edildi ve hasta grupları arasında karşılaştırıldı.

Bulgular: CRP / albumin oranı düzeyleri peritonsiller apse grubunda, akut tonsillit grubuna göre anlamlı olarak daha yüksekti (p<0.05). Peritonsiller apse ile akut tonsillit grubu arasında NLO düzeylerinde anlamlı bir fark yoktu (p>0.05). Peritonsiller apse grubunda albümin oranı anlamlı olarak düşük bulunurken (p<0.05). lenfosit sayısı anlamlı oranda yüksek bulundu. (p<0.05). Beyaz küre sayısı, nötrofil sayısı, C-reaktif protein değerlerinde gruplar arasında anlamlı olarak fark yoktu (p>0.05).

Sonuç: CRP / albümin oranının, akut tonsillitli hastalarda peritonsiler apse dönüşümünü tahmin etmek için kullanılabilecek ölçülmesi kolay, tekrarlanabilir, invaziv olmayan ve inflamasyona dayalı prognostik bir skor olabileceği düşünülmektedir.

Anahtar Kelimeler

Peritonsiller apse, Akut tonsillit, C-reaktif protein, Albumin

Kaynakça

• Powell EL, Powell J, Samuel JR, Wilson JA. A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation. J Antimicrob Chemother. 2013;68(9):1941-1950. doi:10.1093/jac/dkt128
• Powell J, Wilson JA. An evidence-based review of peritonsillar abscess. Clin Otolaryngol Off J ENT-UK Off J Neth Soc Oto-Rhino-Laryngol Cervico-Facial Surg. 2012;37(2):136-145. doi:10.1111/j.1749-4486.2012.02452.x
• Christensen AMG, Thomsen MK, Ovesen T, Klug TE. Are procalcitonin or other infection markers useful in the detection of group A streptococcal acute tonsillitis? Scand J Infect Dis. 2014;46(5):376-383. doi:10.3109/00365548.2014.885656
• Kinoshita A, Onoda H, Imai N, Nishino H, Tajiri H. C-Reactive Protein as a Prognostic Marker in Patients with Hepatocellular Carcinoma. Hepatogastroenterology. 2015;62(140):966-970.
• Rhodes B, Fürnrohr BG, Vyse TJ. C-reactive protein in rheumatology: biology and genetics. Nat Rev Rheumatol. 2011;7(5):282-289. doi:10.1038/nrrheum.2011.37
• Ateş H, Ateş İ, Bozkurt B, Çelik HT, Özol D, Yldrm Z. What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia? Blood Coagul Fibrinolysis Int J Haemost Thromb. 2016;27(3):252-258. doi:10.1097/MBC.0000000000000391
• Lelubre C, Anselin S, Zouaoui Boudjeltia K, Biston P, Piagnerelli M. Interpretation of C-reactive protein concentrations in critically ill patients. BioMed Res Int. 2013;2013:124021. doi:10.1155/2013/124021
• Goh SL, De Silva RP, Dhital K, Gett RM. Is low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies? Interact Cardiovasc Thorac Surg. 2015;20(1):107-113. doi:10.1093/icvts/ivu324
• Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J. 2010;9:69. doi:10.1186/1475-2891-9-69
• Passy V. Pathogenesis of peritonsillar abscess. The Laryngoscope. 1994;104(2):185-190. doi:10.1288/00005537-199402000-00011
• Mohamad I, Yaroko A. Peritonsillar swelling is not always quinsy. Malays Fam Physician Off J Acad Fam Physicians Malays. 2013;8(2):53-55.
• Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2004;62(12):1545-1550. doi:10.1016/j.joms.2003.12.043
• Froehlich MH, Huang Z, Reilly BK. Utilization of ultrasound for diagnostic evaluation and management of peritonsillar abscesses. Curr Opin Otolaryngol Head Neck Surg. 2017;25(2):163-168. doi:10.1097/MOO.0000000000000338
• Ophir D, Bawnik J, Poria Y, Porat M, Marshak G. Peritonsillar abscess. A prospective evaluation of outpatient management by needle aspiration. Arch Otolaryngol Head Neck Surg. 1988;114(6):661-663. doi:10.1001/archotol.1988.01860180075034
• Herzon FS. Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. The Laryngoscope. 1995;105(8 Pt 3 Suppl 74):1-17. doi:10.1288/00005537-199508002-00001
• Herzon FS. Permucosal needle drainage of peritonsillar abscesses. A five-year experience. Arch Otolaryngol Chic Ill 1960. 1984;110(2):104-105. doi:10.1001/archotol.1984.00800280038011
• Savolainen S, Jousimies-Somer HR, Mäkitie AA, Ylikoski JS. Peritonsillar abscess. Clinical and microbiologic aspects and treatment regimens. Arch Otolaryngol Head Neck Surg. 1993;119(5):521-524. doi:10.1001/archotol.1993.01880170045009
• Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2003;128(3):332-343. doi:10.1067/mhn.2003.93
• Kawabata M, Umakoshi M, Makise T, et al. Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. Auris Nasus Larynx. 2016;43(2):182-186. doi:10.1016/j.anl.2015.09.014
• Souza DLS, Cabrera D, Gilani WI, et al. Comparison of medical versus surgical management of peritonsillar abscess: A retrospective observational study. The Laryngoscope. 2016;126(7):1529-1534. doi:10.1002/lary.25960
• Sakaguchi M, Sato S, Asawa S, Taguchi K. Computed tomographic findings in peritonsillar abscess and cellulitis. J Laryngol Otol. 1995;109(5):449-451. doi:10.1017/s0022215100130415
• Patel KS, Ahmad S, O’Leary G, Michel M. The role of computed tomography in the management of peritonsillar abscess. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 1992;107(6 Pt 1):727-732. doi:10.1177/019459988910700603.1
• Grant MC, Guarisco JL. Association Between Computed Tomographic Scan and Timing and Treatment of Peritonsillar Abscess in Children. JAMA Otolaryngol-- Head Neck Surg. 2016;142(11):1051-1055. doi:10.1001/jamaoto.2016.2035
• Buckley AR, Moss EH, Blokmanis A. Diagnosis of peritonsillar abscess: value of intraoral sonography. AJR Am J Roentgenol. 1994;162(4):961-964. doi:10.2214/ajr.162.4.8141026
• Strong EB, Woodward PJ, Johnson LP. Intraoral ultrasound evaluation of peritonsillar abscess. The Laryngoscope. 1995;105(8 Pt 1):779-782. doi:10.1288/00005537-199508000-00002
• Nogan S, Jandali D, Cipolla M, DeSilva B. The use of ultrasound imaging in evaluation of peritonsillar infections. The Laryngoscope. 2015;125(11):2604-2607. doi:10.1002/lary.25313
• Fordham MT, Rock AN, Bandarkar A, et al. Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. The Laryngoscope. 2015;125(12):2799-2804. doi:10.1002/lary.25354
• Spiekermann C, Russo A, Stenner M, Rudack C, Roth J, Vogl T. Increased Levels of S100A8/A9 in Patients with Peritonsillar Abscess: A New Promising Diagnostic Marker to Differentiate between Peritonsillar Abscess and Peritonsillitis. Dis Markers. 2017;2017:9126560. doi:10.1155/2017/9126560
• Walsh AJ, Bryant RV, Travis SPL. Current best practice for disease activity assessment in IBD. Nat Rev Gastroenterol Hepatol. 2016;13(10):567-579. doi:10.1038/nrgastro.2016.128
• Chojkier M. Inhibition of albumin synthesis in chronic diseases: molecular mechanisms. J Clin Gastroenterol. 2005;39(4 Suppl 2):S143-146. doi:10.1097/01.mcg.0000155514.17715.39
• Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17(6):432-437. doi:10.1111/j.0894-0959.2004.17603.x
• Zhou T, Zhan J, Hong S, et al. Ratio of C-Reactive Protein/Albumin is An Inflammatory Prognostic Score for Predicting Overall Survival of Patients with Small-cell Lung Cancer. Sci Rep. 2015;5:10481. doi:10.1038/srep10481
• Ranzani OT, Zampieri FG, Forte DN, Azevedo LCP, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PloS One. 2013;8(3):e59321. doi:10.1371/journal.pone.0059321
• Fairclough E, Cairns E, Hamilton J, Kelly C. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med Lond Engl. 2009;9(1):30-33. doi:10.7861/clinmedicine.9-1-30
• Wang X, Cui Z, Li H, et al. Nosocomial mortality and early prediction of patients with severe acute pancreatitis. J Gastroenterol Hepatol. 2010;25(8):1386-1393. doi:10.1111/j.1440-1746.2010.06376.x
• Qin G, Tu J, Liu L, et al. Serum Albumin and C-Reactive Protein/Albumin Ratio Are Useful Biomarkers of Crohn’s Disease Activity. Med Sci Monit Int Med J Exp Clin Res. 2016;22:4393-4400. doi:10.12659/msm.897460
• Zhang Y, Zhou G-Q, Liu X, et al. Exploration and Validation of C-Reactive Protein/Albumin Ratio as a Novel Inflammation-Based Prognostic Marker in Nasopharyngeal Carcinoma. J Cancer. 2016;7(11):1406-1412. doi:10.7150/jca.15401
• Sayar S, Kurbuz K, Kahraman R, et al. A practical marker to determining acute severe ulcerative colitis: CRP/albumin ratio. North Clin Istanb. 2020;7(1):49-55. doi:10.14744/nci.2018.78800
• Qin G, Tu J, Liu L, et al. Serum Albumin and C-Reactive Protein/Albumin Ratio Are Useful Biomarkers of Crohn’s Disease Activity. Med Sci Monit Int Med J Exp Clin Res. 2016;22:4393-4400. doi:10.12659/msm.897460
• Öçal R, Akın Öçal FC, Güllüev M, Alataş N. Is the C-reactive protein/albumin ratio a prognostic and predictive factor in sudden hearing loss? Braz J Otorhinolaryngol. 2020;86(2):180-184. doi:10.1016/j.bjorl.2018.10.007
• Kokcu A, Kurtoglu E, Celik H, Tosun M, Malatyalıoglu E, Ozdemir AZ. May the platelet to lymphocyte ratio be a prognostic factor for epithelial ovarian cancer? Asian Pac J Cancer Prev APJCP. 2014;15(22):9781-9784. doi:10.7314/apjcp.2014.15.22.9781
• Baglam T, Binnetoglu A, Yumusakhuylu AC, Gerin F, Demir B, Sari M. Predictive value of the neutrophil-to-lymphocyte ratio in patients with deep neck space infection secondary to acute bacterial tonsillitis. Int J Pediatr Otorhinolaryngol. 2015;79(9):1421-1424. doi:10.1016/j.ijporl.2015.06.016
• Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N. Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol. 2014;33(3):223-227. doi:10.3109/15569527.2013.834498
• Farah R, Khamisy-Farah R. Association of neutrophil to lymphocyte ratio with presence and severity of gastritis due to Helicobacter pylori infection. J Clin Lab Anal. 2014;28(3):219-223. doi:10.1002/jcla.21669
• Ishizuka M, Shimizu T, Kubota K. Neutrophil-to-lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2012;97(4):299-304. doi:10.9738/CC161.1
• Özler G. The Relationship Between Neutrophil to Lymphocyte Ratio and Recurrent Aphthous Stomatitis. J Clin Anal Med. 2016;7. doi:10.4328/JCAM.2619
• Kayabasi S, Hizli O, Cayir S. A Novel Predictor Parameter for Active Recurrent Aphthous Stomatitis: C-Reactive Protein to Albumin Ratio. Cureus. 2019;11(10):e5965. doi:10.7759/cureus.5965