Yoğun Bakım Ünitesinde Pnömosepsis Hastalarında Mortaliteyi Öngörmede Sistemik İmmün-İnflamasyon İndeksi (SII), Trombosit-Lenfosit Oranı (PLR) ve Nötrofil-Lenfosit Oranının (NLR) Prognostik Değeri

Yıl 2024, Cilt: 21 Sayı: 3, 490 - 495, 27.12.2024

Kamuran Uluç , Hamdiye Turan

https://doi.org/10.35440/hutfd.1583285

Öz

Amaç: Bu çalışma, pnömosepsis tanısı almış hastalarda yoğun bakım ünitesinde mortaliteyi öngörmek amacıyla Sistemik İmmün-İnflamasyon İndeksi (SII), Trombosit-Lenfosit Oranı (PLR) ve Nötrofil-Lenfosit Oranı'nın (NLR) prognostik değerini değerlendirmeyi amaçlamaktadır.
Materyal ve Metod: Çalışma retrospektif olarak gerçekleştirilmiş ve pnömosepsis tanısı almış hastaların klinik verileri analiz edilmiştir. Hastaların yaşı, cinsiyeti, eşlik eden hastalıkları, yoğun bakımda kalış süresi, Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) skoru, Akut Fizyoloji ve Kronik Sağlık Değerlen-dirmesi II (APACHE II) skoru, SII, PLR, NLR değerleri ve prognozları hasta dosyaları ve hastane kayıt sisteminden elde edilerek kaydedilmiştir.
Bulgular: Çalışmaya toplam 68 hasta dahil edilmiştir. Hastaların %60,3’ü erkek, %39,7’si kadındır. Hayatını kaybeden hastaların yaş ortalaması, taburcu edilen hastalara kıyasla istatistiksel olarak anlamlı şekilde daha yüksek bulunmuştur (p = 0,016). Çalışmada 22 hasta taburcu edilirken, 46 hasta hayatını kaybetmiştir. Taburcu edilen grupta ortalama SII değeri 464,05±107,31 iken, hayatını kaybedenlerde bu değer 845,53±111,04 olarak tespit edilmiştir (p<0.001). Benzer şekilde PLR değeri taburcu edilen-lerde 88,14 ± 10,66, hayatını kaybedenlerde ise 114,89±12,97’dir (p<0.001). NLR değeri ise taburcu edilen grupta 3,5±0,86 hayatını kaybeden grupta 6,73±0,84 olarak bulunmuştur (p<0.001).
Sonuç: Bu çalışma, yoğun bakım ünitesindeki pnömosepsis hastalarında SII, NLR ve PLR indekslerinin mortaliteyi öngörmede önemli ve güvenilir göstergeler olduğunu ortaya koymaktadır.

Anahtar Kelimeler

Sistemik immün-inflamasyon indeks, Trombosit/lenfosit oranı, Nötrofil/lenfosit oranı, Pnömosepsis, Yoğun bakım ünitesi

Prognostic Value of Systemic Immune-Inflammation Index (SII), Platelet-Lymphocyte Ratio (PLR) and Neutrophil-Lymphocyte Ratio (NLR) in Predicting Mortality in Pneumosepsis Patients in Intensive Care Unit

Öz

Background: This study aims to evaluate the prognostic value of Systemic Immune-Inflammation Index (SII), Platelet-Lymphocyte Ratio (PLR) and Neutrophil-Lymphocyte Ratio (NLR) to predict mortality in patients with pneumosepsis in the intensive care unit (ICU).
Materials and Methods: The study was conducted retrospectively and clinical data of patients diag-nosed with pneumosepsis were analyzed. Age, gender, comorbidities, length of stay (LOS) in the ICU, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, SII, PLR, NLR values and prognoses were obtained from patient files and hospital records system.
Results: A total of 68 patients were included in the study. 60.3% of the patients were male and 39.7% were female. The mean age of deceased patients was statistically significantly higher than that of discharged patients (p = 0.016). In the study, 22 patients were discharged and 46 patients died. While the mean SII value was 464.05±107.31 in the discharged group, this value was 845.53±111.04 in those who died (p<0.001). Similarly, the PLR value was 88.14 ± 10.66 in those discharged and 114.89±12.97 in those who died (p<0.001). The NLR value was 3.5 ± 0.86 in the discharged group and 6.73±0.84 in the deceased group (p<0.001).
Conclusions: This study reveals that SII, NLR and PLR indices are important and reliable indicators for predicting mortality in pneumosepsis patients in the ICU.

Anahtar Kelimeler

Systemic immune-inflammation index, Platelet/lymphocyte ratio, Neutrophil/lymphocyte ratio, Pneumosepsis, Intensive care unit

Etik Beyan

Approval was obtained from the Ethics Committee of Health Sciences University Diyarbakır Gazi Yaşargil Training and Research Hospital (Approval no: 187 ). The study was conducted in accordance with the Declaration of Helsinki.

Kaynakça

• 1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: interna-tional guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–247.
• 2. Fleischmann-Struzek C, Mellhammar L, Rose N, Cassini A, Rudd KE, Schlattmann P, et al. Incidence and mortality of hospital- and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis. In-tensive Care Med. 2020;46(8):1552-562.
• 3. Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA. 2017;318(13):1241-249.
• 4. Marrie TJ, Huang JQ. Epidemiology of community-acquired pneumonia in Edmonton, Alberta: An emergency depart-ment-based study. Can Respir J. 2005;12(3):139-42.
• 5. Campling J, Jones D, Chalmers J, Jiang Q, Vyse A, Madhava H, et al. Clinical and financial burden of hospitalised com-munity-acquired pneumonia in patients with selected un-derlying comorbidities in England. BMJ Open Respir Res. 2020;7(1):e000703.
• 6. Kim WY, Lee YJ, Yeon Lim S, Ok Koh S, Choi WI, Chan Kim S, et al. Clinical characteristics and prognosis of pneumonia and sepsis: Multicenter study. Minerva Anestesiol. 2013;79(12):1365-65.
• 7. Fulton II MR, Zubair M, Taghavi S. Laboratory Evaluation of Sepsis. StatPearls. 2024.
• 8. Erdoǧan M, Findikli HA. Prognostic value of the lac-tate/albumin ratio for predicting mortality in patients with pneumosepsis in intensive care units. Medicine (United States). 2022;101(4):e28748.
• 9. 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.
• 10. Lengkong WY, Iskandar A. Gambaran Platelet-To-Lymphocyte Ratıo (Plr) Pada Sepsıs Dan Syok Septık. CHMK Health Journal. 2020;4(3):222-26.
• 11. Ho KM, Dobb GJ, Knuiman M, Finn J, Lee KY, Webb SA. A comparison of admission and worst 24-hour Acute Physiol-ogy and Chronic Health Evaluation II scores in predicting hospital mortality: a retrospective cohort study. Crit Care. 2006;10(1):R4.
• 12. Vincent JL, de Mendonca A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunc-tion/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis- related prob-lems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26:1793-800.
• 13. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Prac-tice Guideline of the American Thoracic Society and Infec-tious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
• 14. Singer M, Deutschman CS, Seymour C, Shankar-Hari M, Annane D, Bauer M, et al. The third international consen-sus definitions for sepsis and septic shock (sepsis-3). JA-MA. 2016 ;315(8):801-10.
• 15. Lagunas-Alvarado M, Mijangos-Huesca FJ, Terán-González JO, Lagunas-Alvarado MG, Martínez-Zavala N, Reyes-Franco I, et al. Índice de inmunidad-inflamación sistémica en sepsis. Med Int Méx. 2017;33(3):303-9.
• 16. Mangalesh S, Dudani S, Malik A. The systemic immune-inflammation index in predicting sepsis mortality. Postgrad Med. 2023;135(4):345–51.
• 17. Acar E, Demir A, Yıldırım B, Kaya MG, Gökçek K. The role of hemogram parameters and C-reactive protein in predicting mortality in COVID-19 infection. Int J Clin Pract. 2021;75(7): e14256.
• 18. Jiang D, Bian T, Shen Y, Huang Z. Association between admission systemic immune-inflammation index and mor-tality in critically ill patients with sepsis: a retrospective cohort study based on MIMIC-IV database. Clin Exp Med. 2023;23(7):3641-50.
• 19. Li X, Gu L, Chen Y, Chong Y, Wang X, Guo P, et al. Systemic immune-inflammation index is a promising non-invasive biomarker for predicting the survival of urinary system can-cers: a systematic review and meta-analysis. Ann Med. 2021;53(1):1827-38.
• 20. Wu X, Wang H, Xie G, Lin S, Ji C. Increased systemic im-mune-inflammation index can predict respiratory failure in patients with Guillain-Barré syndrome. Neurol Sci. 2022;43(2):1223-31
• 21. Agus HZ, Kahraman S, Arslan C, Yildirim C, Erturk M, Kalkan AK, et al. Systemic immune-inflammation index predicts mortality in infective endocarditis. J Saudi Heart Assoc. 2020;32(1):58-64.
• 22. Li S, Liu K, Gao Y, Zhao L, Zhang R, Fang H, et al. Prognostic value of systemic immune-inflammation index in acute/subacute patients with cerebral venous sinus throm-bosis. Stroke Vasc Neurol. 2020;5(4):368-73.
• 23. de Jager CPC, van Wijk PTL, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergen-cy care unit. Crit Care. 2010;14(5):R192.
• 24. Huang Z, Fu Z, Huang W, Huang K. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emeg Med. 2020;38(3):641-47.
• 25. Chen F fang, Zhong M, Liu Y, Zhang Y, Zhang K, Su D zhen, et al. The characteristics and outcomes of 681 severe cases with COVID-19 in China. J Crit Care. 2020;60:32-7.
• 26. Shen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: Interaction effect with disease severity - A retrospective study. BMJ Open. 2019;9(1):e022896.