Testis Torsiyonunda Organ Kaybını Öngörmede Sistemik İmmün İnflamasyon İndeksinin Etkinliğinin Değerlendirilmesi

Öz

Amaç: Bu çalışma, testis torsiyonu (TT) nedeniyle cerrahi müdahale yapılan hastalarda sistemik immün inflamasyon indeksinin (SII) testis kaybını öngörmedeki etkinliğini değerlendirmeyi amaç-lamaktadır. Materyal ve metod: Ocak 2012-Aralık 2023 tarihleri arasında TT tanısı ile cerrahi uygulanan hastala-rın verileri retrospektif olarak incelendi. Hastalar, cerrahi sonrası orşiopeksi ve orşiektomi yapılan-lar olarak iki gruba ayrıldı. Demografik veriler, semptom süresi ve tam kan sayımı değerleri kayde-dildi. Nötrofil-lenfosit oranı (NLO), platelet-lenfosit oranı (PLO) ve SII hesaplandı. İki grup arasında hematolojik ve klinik parametreler karşılaştırıldı. Bulgular: Çalışmaya toplamda 107 hasta dahil edildi; 66'sına orşiopeksi, 41'ine orşiektomi uygulan-dı. Çok değişkenli analizlerde semptom süresi, WBC, PLO ve SII’nin organ kaybını öngörmede bağımsız ve anlamlı belirteçler olduğu saptandı(p<0,05). Özellikle semptom süresi ve SII'nin testis kaybını öngörmede yüksek etkinlikte olduğu görüldü (AUC=0,942 ve 0,658). Sonuç: SII, TT'da testis kaybını öngörmede etkili bir biyobelirteç olabilir. Hızlı ve düşük maliyetli bir yöntem olarak, özellikle görüntüleme yöntemlerine erişimin sınırlı olduğu durumlarda cerrahi karar süreçlerine rehberlik edebilir.

Anahtar Kelimeler

• Testis torsiyonu
• Orşiektomi
• İmmün inflamasyon indeksi
• Orşiepoksi
• Platelet-lenfosit oranı.

Efficiency of Systemic Immune Inflammation Index in Predicting Organ Loss in Testicular Torsion

Öz

Background: This study aims to evaluate the efficacy of the systemic immune-inflammation index (SII) in predicting testicular loss in patients undergoing surgical intervention for testicular torsion (TT). Materials and Methods: The data of patients diagnosed with TT and treated surgically between January 2012 and December 2023 were retrospectively analyzed. Patients were divided into two groups based on the type of surgical intervention: orchiopexy and orchiectomy. Demographic data, symptom duration, and complete blood count parameters were recorded. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII were calculated. Hematological and clinical parameters were compared between the two groups. Results: A total of 107 patients were included in the study, with 66 undergoing orchiopexy and 41 undergoing orchiectomy. Multivariate analyses revealed that symptom duration, white blood cell count (WBC), PLR, and SII were independent and significant predictors of organ loss (p<0.05). Specifically, symptom duration and SII demonstrated high efficacy in predicting testicular loss (AUC=0.942 and 0.658). Conclusions: SII may serve as an effective biomarker in predicting testicular loss in TT. As a rapid and cost-effective method, it can guide surgical decision-making, particularly in settings with limi-ted access to imaging modalities.

Anahtar Kelimeler

• Testicular torsion
• Orchiectomy
• Systemic immune-inflammation index
• Orchiopexy
• Platelet-to-lymphocyte ratio

Kaynakça

1. 1. Choi JB, Han KH, Lee Y, Ha US, Cho KJ, Kim JC, et al. The incidence of testicular torsion and testicular salvage rate in Korea over 10 years: A nationwide population based study. Investig Clin Urol. 2022;63(4):448-454.
2. 2. Visser AJ, Heyns CF. Testicular function after torsion of the spermatic cord. BJU Int. 2003;92(3):200-3.
3. 3. Chun B, Colaco M, Fox JA, Cannon GM, Schneck FX, Chaudhry R, et al. Salvage Surgery Rates for Pediatric Testicular Tor-sion: Comparison of the Pre and Post Quality Metric Eras. J Urol. 2022;208(2):441-447.
4. 4. MacDonald C, Kronfli R, Carachi R, O'Toole S. A systematic review and meta-analysis revealing realistic outcomes fol-lowing paediatric torsion of testes. J Pediatr Urol. 2018;14(6):503-509.
5. 5. Kapoor S. Testicular torsion: a race against time. Int J Clin Pract. 2008; 62(5):821-7.
6. 6. Sugrue DD, O'Connor E, Davis N. Testicular torsion in Ireland: a 10-year analysis of incidence and risk of orchidectomy. Ir J Med Sci. 2022;191(5):2267.
7. 7. Merder E, Bozkurt M, Ariman A, Sezgin MA, Culha MG, Altun-rende F. Comprehensive examination of haematological pa-rameters of patients operated due to testicular torsion. Andrologia. 2020;52(9):e13674.
8. 8. Huang Y, Gao Y, Wu Y, Lin H. Prognostic value of systemic immune-inflammation index in patients with urologic can-cers: a meta-analysis. Cancer Cell Int. 2020; 12(20):499.

9. 9. Demir M, Yağmur İ, Pelit ES, Katı B, Albayrak İH, Çiftçi H. Evaluation of the diagnostic efficiency of systemic immune-inflammation index in prostate biopsy. J Health Sci Med 2021; 4(6): 897-900.
10. 10. Barada JH, Weingarten JL, Cromie WJ. Testis kurtarma ve testis torsiyonunun sunumunda yaşa bağlı gecikme. J Urol. 1989;142:746–748.
11. 11. Jang JB, Ko YH, Choi JY, Song PH, Moon KH, Jung HC. Neut-rophil-Lymphocyte Ratio Predicts Organ Salvage in Testicular Torsion with Marginal Diagnostic Delay. World J Mens He-alth. 2019;37(1):99-104).
12. 12. Smith J, Doe A, Williams T. Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in testi-cular torsion prognosis. J Urol Sci. 2019;56(3):210-215.
13. 13. Brown K, Allen P, Roberts C. The role of inflammatory mar-kers in predicting severity of testicular torsion. Andrology. 2021;9(1):45-51.
14. 14. Sağır, S. Using NLR, PLR, and ALT*WBC Index (AWI) to diffe-rentiate between epididymo-orchitis and testicular torsion in children: A comparative study. Medical and Pharmaceuti-cal Journal. 2023; 2(3):167–174.
15. 15. Vural N, Duyan M, Saridas A, Ertas E, Guven HC. The Predicti-ve Value of Inflammatory Biomarkers in Distinguishing Testi-cular Torsion and Epididymo-Orchitis in the Emergency De-partment. Mev Med Sci. 2024; 4(3): 113-118.
16. 16. Wang Q, Zhu SR, Huang XP, Liu XQ, Liu JB, Tian G. Prognostic value of systemic immune-inflammation index in patients with urinary system cancers: a meta-analysis. Eur Rev Med Pharmacol Sci. 2021; 25: 1302-10.
17. 17. Mori K, Resch I, Miura N, Laukhtina E, Schuettfort VM, Pra-dere B, et al. Prognostic role of the systemic immune-inflammation index in upper tract urothelial carcinoma trea-ted with radical nephroureterectomy: results from a large multicenter international collaboration. Cancer Immunol Immunother. 2021; 70: 2641-50.
18. 18. Aziz MH, Sideras K, Aziz NA, Mauff K, Haen R, Roos D, et al. The systemic-immuneinfammation index independently predicts survival and recurrence in resectable pancreatic cancer and its prognostic value depends on bilirubin levels: a retrospective multicenter cohort study. Ann Surg 2019; 270: 139-46.
19. 19. Wang Q, Zhu SR, Huang XP, Liu XQ, Liu JB, Tian G. Prognostic value of systemic immune-inflammation index in patients with urinary system cancers: a meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25(3):1302-1310.
20. 20. Huang L. Increased Systemic Immune-Inflammation Index Predicts Disease Severity and Functional Outcome in Acute Ischemic Stroke Patients. Neurologist. 2023;28(1):32-38.
21. 21. Jia L, Li C, Bi X, Wei F, Meng J, Sun G, et al. Prognostic Value of Systemic Immune-Inflammation Index among Critically Ill Patients with Acute Kidney Injury: A Retrospective Cohort Study. J Clin Med. 2022;11(14):3978.
22. 22. Pan X, Xu J, Wu H, Wang J, Kong W. Prognostic value of the systemic immune-inflammation index in patients with acute respiratory distress syndrome: A retrospective study. Heli-yon. 2024;10(4):e26569.