The Glucose/Potassium Ratio Exhibits a Predictive Role That is Both Earlier and More Efficacious Compared to The İnflammatory Response in The Context of Isolated Thoracic Trauma

Yıl 2024, Cilt: 34 Sayı: 3, 358 - 364, 30.06.2024

Demet Acar , Emine Kadıoğlu , Nazlı Kenan , Emine Doğan , Asiye Müminat Çap , Yavuz Yılmaz

https://doi.org/10.54005/geneltip.1428167

Öz

Background/Aim: This study was designed to elucidate the relationship between the AIS 90 thoracic score, which is commonly used to assess the severity of trauma in trauma patients, and the relatively limited studies and data available on the Glucose Potassium Ratio (GPR). Additionally, the study aims to highlight the superiority, if any, of GPR in terms of trauma severity and prognosis, along with the Neutrophil Lymphocyte Ratio (NLR), which plays an important role in trauma severity and prognosis.
Material-Methods: Between June 2020 and June 2022, individuals aged 18 and older admitted to the emergency department with isolated thoracic trauma were included in the study. Data pertaining to these patients were retrospectively analyzed with the AIS 90 thoracic score serving as the reference point. The retrospective screening data of the patients enrolled in the study facilitated the categorization of individuals into three groups based on criteria delineating outpatient treatment, hospitalization and admission to the intensive care unit. The mean values of the GPR and the NLR across these three groups were assessed utilizing Analysis of Variance (ANOVA). Tukey tests were used for homogeneous groups and Tamhane tests were used for non-homogeneous groups to determine specific groups that caused significant differences. ANOVA homogeneity was checked by the Levene test and if homogeneity could not be achieved, the Welch test was used.
Results: The analysis of 89 patients with isolated thoracic trauma revealed no statistically significant difference in the GPR values between the three groups (Levene p < 0.05, ANOVA p=0.025). However, further exploration through Tukey multiple comparisons indicated that the observed significant difference was attributable to patients admitted to the intensive care unit. Likewise, a statistically significant difference was observed between the three groups in the analysis of NLR values. (Levene p=0.252, Welch p=0.028). Following Tukey’s multiple comparisons, it was determined that the significant difference could be attributed to patients hospitalized in the intensive care unit.
Conclusion: The findings of the study support the conclusion that individuals with an AIS 90 thoracic score above 3 and who need to be admitted to intensive care show higher GPR values than other groups. The association between high GPR values and heightened lung parenchymal injury was evident. Consequently, it can be inferred that a high GPR value may serve as an indicator of lung parenchymal damage, suggesting a greater need for intensive care unit admission in such patients.

Anahtar Kelimeler

thoracic trauma, glucose/potassium ratio, intensive care unit hospitalization, Abbreviated Injury Scale(AIS 90)

İzole Torasik Travmalarında; Glukoz/Potasyum Oranı, İnflamatuar Yanıta Kıyasla Hem Daha Erken Hem de Daha Etkili Bir Öngörücü Rol Sergiler

Öz

Giriş: Bu çalışma, travma hastalarında travmanın şiddetini değerlendirmede yaygın olarak kullanılan AIS 90 torasik skoru ile Glukoz Potasyum Oranı (GPR) arasındaki ilişkiyi aydınlatmayı amaçlayan, bu konuda sınırlı sayıda mevcut çalışma ve veri ışığında tasarlanmıştır. Ek olarak, çalışma, travma şiddeti ve prognozunda önemli rol oynayan Nötrofil Lenfosit Oranı (NLO) ile birlikte travma şiddeti ve prognoz açısından GPR’nin (varsa) üstünlüğünü vurgulamayı amaçlamaktadır.
Gereç ve Yöntemler: Haziran 2020-Haziran 2022 tarihleri arasında acil servise izole toraks travması ile başvuran 18 yaş ve üzeri bireyler çalışmaya dahil edildi. Bu hastalara ait veriler retrospektif olarak incelendi ve AIS 90 torasik skoru referans noktası olarak kullanıldı. Çalışmaya dahil edilen hastaların retrospektif tarama verileri, bireylerin ayaktan tedavi, hastaneye yatış ve yoğun bakım ünitesine yatış kriterlerine göre üç gruba ayrılmasını kolaylaştırdı. Bu üç gruptaki Glukoz Potasyum Oranı (GPR) ve Nötrofil Lenfosit Oranı (NLO) ortalama değerleri, Varyans Analizi (ANOVA) kullanılarak değerlendirildi.
Homojen gruplar için Tukey testleri, homojen olmayan gruplar için Tamhane testleri kullanılarak anlamlı farklılıklara neden olan spesifik gruplar belirlendi. ANOVA homojenliği Levene testi ile kontrol edilmiş, homojenlik sağlanamazsa Welch testi kullanılmıştır.
Bulgular: İzole toraks travması geçiren 89 hastanın analizinde, GPR değerleri açısından üç grup arasında istatistiksel olarak anlamlı bir fark saptanmadı (Levene p < 0.05, ANOVA p = 0.025). Bununla birlikte, Tukey çoklu karşılaştırmaları yoluyla yapılan daha ayrıntılı analiz, gözlenen anlamlı farkın yoğun bakım ünitesine kabul edilen hastalara atfedilebileceğini göstermiştir.
Benzer şekilde, NLO değerlerinin analizinde üç grup arasında istatistiksel olarak anlamlı bir fark gözlendi. (Levene p=0.252, Welch p=0.028). Türkiye’nin çoklu karşılaştırmalarını takiben, anlamlı farkın yoğun bakım ünitesinde yatan hastalara atfedilebileceği belirlendi.
Sonuç: Çalışmanın bulguları, AIS 90 torasik skoru 3’ün üzerinde olan ve yoğun bakım ünitesine yatış gerektiren bireylerin diğer gruplara göre yüksek GPR değerleri gösterdiği sonucunu desteklemektedir. Yüksek GPR değerleri ile artmış akciğer parankimal hasarı arasındaki ilişki belirgindi. Sonuç olarak, yüksek bir GPR değerinin akciğer parankimal hasarının bir göstergesi olabileceği sonucuna varılabilir, bu da bu tür hastalarda yoğun bakım ünitesine yatış ihtiyacının daha fazla olduğunu düşündürür.

Anahtar Kelimeler

Toraks Travması, Glukoz Potasyum Oranı (GPR), Yoğun Bakım Ünitesinde Yatış, Kısaltılmış Yaralanma Skalası (AIS 90)

Kaynakça

• Özpek A, Yücel M, Atak İ, Baş G, Alimoğlu O. Multivariate analysis of patients with blunt trauma and possible factors affecting mortality. Ulus. Travma Acil Cerrahi Derg. 2015; 21: 477-483.
• Tekinbaş C, Eroğlu A, Kürkçüoğlu IC, Türkyilmaz A, Yekeler E, Karaoğlanoğlu N. Chest trauma: analysis of 592 cases. Ulus Travma Acil Cerrahi Derg. 2003 ; 9: 275-280.
• Pfeifer R, Teuben M, Andruszkow H, Barkatali BM, Pape HC. Mortality Patterns in Patients with Multiple Trauma: A Systematic Review of Autopsy Studies. PLoS One. 2016; 11(2): e0148844.
• Pezzella AT, Silva WE, Lancey RA. Cardiothoracic trauma.Curr Probl Surg. 1998; 35: 647-789.
• Lenz A, Franklin GA, Cheadle WG. Systemic inflammation after trauma.Injury. 2007; 38: 1336-1345.
• Mifsud S, Schembri EL, Gruppetta M. Stress-induced hyperglycemia. Br J Hosp Med (Lond). 2018; 79: 634-639.
• Reid JL, Whyte KF, Struthers AD. Epinephrine-induced hypokalemia: the role of beta-adrenoceptors. Am J Cardiol. 1986; 57: 23F-27F.
• Xiao-Yu Wu , Yao-Kun Zhuang , Yong Cai , Xiao-Qiao Dong , Ke-Yi Wang , Quan Du , Wen-Hua Yu . Serum glucose and potassium ratio as a predictive factor for prognosis of acute intracerebral hemorrhage. J Int Med Res. 2021; 49: 3000605211009689.
• Ferit Boyuk, The Predictor Potential Role of the Glucose to Potassium Ratio in the Diagnostic Differentiation of Massive and Non-Massive Pulmonary Embolism. Clin Appl Thromb Hemost. 2022; 28: 10760296221076146.
• Shibata A, Matano F, Saito N, Fujiki Y, Matsumoto H, Mizunari T, Morita A. Serum Glucose-To-Potassium Ratio as a Prognostic Predictor for Severe Traumatic Brain Injury. J Nippon Med Sch. 2021; 88: 342-346.
• Burak Katipoğlu, Erdal Demirtaş, Assessment of serum glucose potassium ratio as a predictor for morbidity and mortality of blunt abdominal trauma. Ulus Travma Acil Cerrahi Derg. 2022; 28:134-139.
• Lefering R. Trauma scoring systems.Curr Opin Crit Care. 2012;18: 637-640.
• Loftis KL, Price J, Gillich PJ.Evolution of the Abbreviated Injury Scale: 1990-2015.Traffic Inj Prev. 2018;19: S109-S113.
• Grevitt MP, Muhivdeen HA, Griffiths C. Trauma care in a military hospital, JR Army Med. Corps. 1991. Oct;137(3):131-5. Doi:10.1136/jramc-137-03-06
• Joon Min Park. Neutrophil-to-lymphocyte ratio in trauma patients. J Trauma Acute Care Surg. 2017;82: 225-226.
• Sharif AF, Kasemy ZA, Mabrouk HA, Shoeib O, Fayed MM. Could the serum glucose/potassium ratio offer an early reliable predictor of life-threatening events in acute methylxanthine intoxication? Toxicol Res (Camb). 2023; 12: 310-320.
• Ersin Turan, Alpaslan Şahin, Role of glucose/potassium ratio and shock index in predicting mortality in patients with isolated thoracoabdominal blunt trauma. Ulus Travma Acil Cerrahi Derg.2022; 28: 1442-1448.
• Galvagno SM Jr, Massey M, Bouzat P, Vesselinov R, Levy MJ, Millin MG, Stein DM, Scalea TM, Hirshon JM.Correlation Between the Revised Trauma Score and Injury Severity Score: Implications for Prehospital Trauma Triage.Prehosp Emerg Care. 2019; 23: 263-270.
• Palmer CS, Gabbe BJ, Cameron PA.Defining major trauma using the 2008 Abbreviated Injury Scale. Injury. 2016; 47: 109-115.
• Evren Dilektasli , Kenji Inaba, Tobias Haltmeier, Monica D Wong, Damon Clark, Elizabeth R Benjamin, Lydia Lam, Demetrios Demetriades. The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients. J Trauma Acute Care Surg. 2016; 81: 882-888.
• Duchesne JC, Tatum D, Jones G, Davis B, Robledo R, DeMoya M, O'Keeffe T, Ferrada P, Jacome T, Schroll R, Wlodarczyk J, Prakash P, Smith B, Inaba K, Khor D, Duke M, Khan M. Multi-institutional analysis of neutrophil-to-lymphocyte ratio (NLR) in patients with severe hemorrhage: A new mortality predictor value. J Trauma Acute Care Surg. 2017; 83: 888-893.
• Koo CH, Eun Jung D, Park YS, Bae J, Cho YJ, Kim WH, Bahk JH. Neutrophil, Lymphocyte, and Platelet Counts and Acute Kidney Injury After Cardiovascular Surgery. J Cardiothorac Vasc Anesth. 2018; 32: 212-222.
• Yun Jeong Chae, Jiyoung Lee, Ji Hyun Park, Do-Gyun Han, Eunji Ha, In Kyong Yi, Late Mortality Prediction of Neutrophil-to-Lymphocyte and Platelet Ratio in Patients With Trauma Who Underwent Emergency Surgery: A Retrospective Study. J Surg Res. 2021; 267:755-761.
• Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR, and PLR in COVID-19 patients.Int Immunopharmacol. 2020; 84:106504.
• Bessey PQ, Watters JM, Aoki TT, Wilmore DW. Combined hormonal infusion simulates the metabolic response to injury. Ann Surg. 1984; 200: 264-281.
• Kurtz P, Claassen J, Schmidt JM, Helbok R, Hanafy KA, Presciutti M, Lantigua H, Connolly ES, Lee K, Badjatia N, Mayer SA. Reduced brain/serum glucose ratios predict cerebral metabolic distress and mortality after severe brain injury. Neurocrit Care. 2013; 19: 311-319.
• Hyun Min Jung , Jin Hui Paik , Sin Young Kim , Dae Young Hong . Association of Plasma Glucose to Potassium Ratio and Mortality After Aneurysmal Subarachnoid Hemorrhage. Front Neurol.2021:12: 661689.
• Zhou J, Yang CS, Shen LJ, Lv QW, Xu QC. The usefulness of serum glucose and potassium ratio as a predictor for 30-day death among patients with severe traumatic brain injuryClin Chim Acta. 2020; 506:166-171.