The role of combined hematological inflammatory indices in predicting poor outcomes in patients with acute pancreatitis

Öz

Aim The aim of the instant study is to evaluate the predictability of AISI, NLPR, and SIRI in patients with acute pancreatitis, which predicts more than 7 days of hospitalization, the need for intensive care, and 30-day mortality. Material and Method This retrospective observational study was conducted in patients diagnosed with acute pancreatitis who applied to the emergency medicine clinic of XXX Hospital between July 15, 2017 and February 15, 2021.Statistical analysis was performed using SPSS v. 26.0. Results The study included 592 patients, 58.3% of which were women. A statistically significant difference was found between high NLPR, and hospital stay longer than 7 days (p = 0.01). No statistically significant correlation was found between AISI and SIRI and the length of hospital stay (p = 0.16, p = 0.19, respectively). There was a statistically significant correlation between high NLPR, and mortality (p = 0.03). No statistically significant correlation was found between AISI, SIRI, and mortality (p = 0.866, p = 0.311, respectively). There was a statistically significant correlation between high NLPR, and hospitalization in the intensive care unit (p = 0.018) No statistically significant relationship was found between AISI, SIRI, and admission to the intensive care unit (p = 0.89, p = 0.6, respectively). Conclusion Acute pancreatitis is an inflammatory process that requires serious approach. Hematological parameters are helpful in predicting the prognosis, but there is a need for differently developed hematological indices in managing acute pancreatitis.

Anahtar Kelimeler

• acute pancreatitis
• NLPR
• AISI
• SIRI

Kombine hematolojik inflamatuar indekslerin akut pankreatit hastalarında kötü sonlanımı öngörmedeki rolü

Öz

Amaç Akut pankreatit hastalarında NLPR, AISI ve SIRI nın 7günden fazla hastane yatışı, yoğun bakım ihtiyacı ve 30 günlük mortaliteyi öngörebilirliğini değerlendirmek amaçlandı. Materyal ve Metod Bu retrospektif gözlemsel çalışma, 15 Temmuz 2017 ile 15 Şubat 2021 tarihleri arasında XXX Hastanesi acil tıp kliniğine başvuran akut pankreatit tanılı hastalarda yapılmıştır. İstatistiksel analiz için SPSS v.26.0 kullanıldı. Bulgular Çalışmamıza 592 hasta dahil edilmiş olup, %58,3’ü kadındı. NLPR yüksekliği ile 7 günden daha uzun süre hastane kalış süresi arasında istatistiksel anlamlılık tespit edildi (p=0.01). AISI ve SIRI ile ise hastanede kalış süresi arasında istatistiksel olarak anlamlı ilişki tespit edilemedi (sırası ile p=0.16, p=0.19). Hastalarımızın %5.1’i ex oldu. NLPR yüksekliği ile mortalite arasında istatistiksel olarak anlamlı ilişki mevcuttu (p=0.03). AISI ve SIRI ile mortalite arasında istatistiksel olarak anlamlı ilişki tespit edilemedi (sırası ile p=0.866, p=0.311). NLPR yüksekliği ile yoğun bakıma yatış arasında istatistiksel olarak anlamlı ilişki mevcuttu (p=0.018). AISI ve SIRI ile yoğun bakıma yatış arasında istatistiksel olarak anlamlı ilişki tespit edilemedi (p=0.89, p=0.6) Sonuç Akut pankreatit, ciddi yaklaşım gerektiren enflamatuar bir süreçtir. Hematolojik parametreler prognozu öngörmede yardımcıdırlar fakat akut pankreatit yönetiminde farklı şekillerde geliştirilmiş hematolojik indekslere ihtiyaç vardır.

Anahtar Kelimeler

• akut pankreatit
• NLPR
• AISI
• SIRI

Kaynakça

1. Li Y, Zhao Y, Feng L, Guo R. Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study. BMJ Open 2017;7:e013206. Doi:10.1136/bmjopen-2016-013206.
2. Khanna AK, Meher S, Prakash S et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg 2013:367581. Doi:10.1155/2013/367581.
3. Khan NA, Haider Kazmi SJ, Singh M et al. Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis. Cureus 2021;13(7): e16752. Doi:10.7759/cureus.16752.
4. He P, Yang H, Lai Q et al. The diagnostic value of blood cell-derived indexes in subacute thyroiditis patients with thyrotoxicosis: a retrospective study. Ann Transl Med 2022;10(6):322. Doi:10.21037/atm-22-719.
5. Erre GL, Buscetta G, Mangoni AA et al. Diagnostic accuracy of different blood cells-derived indexes in rheumatoid arthritis: A cross-sectional study. Medicine (Baltimore) 2020;99(44):e22557. Doi:10.1097/MD.0000000000022557.
6. Zinellu A, Collu C, Nasser M et al. The Aggregate Index of Systemic Inflammation (AISI): A Novel Prognostic Biomarker in Idiopathic Pulmonary Fibrosis. Journal of Clinical Medicine 2021;10(18):4134. Doi:10.3390/jcm10184134.
7. Mochimaru T, Ueda S, Suzuki Y, Asano K, Fukunaga K. Neutrophil-to-lymphocyte ratio as a novel independent predictor of severe exacerbation in patients with asthma. Ann Allergy Asthma Immunol 2019;122(3):337-9. Doi:10.1016/j.anai.2018.11.029.
8. Paliogiannis P, Fois AG, Sotgia S et al. The neutrophil-to-lymphocyte ratio as a marker of chronic obstructive pulmonary disease and its exacerbations: a systematic review and meta-analysis. Eur J Clin Invest 2018;48(8):e12984. Doi: 10.1111/eci.12984.

9. Akilli NB, Yortanlı M, Mutlu H et al. Prognostik importance of neutrophil/lymphocyte Ratio İn Critically İll Patients-Short And Long Term Outcomes,Amj Emerg med 2014;32(12):1476-80. Doi: 10.1016/j.ajem.2014.09.001.
10. Urbanowicz T, Michalak M, Olasińska-Wiśniewska A et al. Neutrophil Counts, Neutrophil-to-Lymphocyte Ratio, and Systemic Inflammatory Response Index (SIRI) Predict Mortality after Off-Pump Coronary Artery Bypass Surgery. Cells 2022;11(7):1124. Doi:10.3390/cells11071124.
11. Eissa M, Shaarawy S, Abdellateif MS. The Role of Different Inflammatory Indices in the Diagnosis of COVID-19. Int J Gen Med 2021;14:7843-53. Doi:10.2147/IJGM.S337488.
12. Fois AG, Paliogiannis P, Scano V et al. The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients. Molecules 2020;25(23):5725. Doi: 10.3390/molecules25235725.
13. Hamad DA, Aly MM, Abdelhameid MA et al. Combined Blood Indexes of Systemic Inflammation as a Mirror to Admission to Intensive Care Unit in COVID-19 Patients: A Multicentric Study. J Epidemiol Glob Health 2022;12:64-73. Doi: 10.1007/s44197-021-00021-5.
14. Ergenç H, Ertürk Z, Eminler AT, Cinemre H. Diagnostic and Prognostic Value of Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratios on Acute Pancreatitis Patients. OTJHS 2022;7(1):80-5. Doi:10.26453/otjhs.1022717.
15. Gulumsek E, Yesildal F, Avci BS et al. Monocyte to high-density lipoprotein and derived neutrophil to lymphocyte ratio in patients with acute pancreatitis are associated with the severity of the disease. Int J Med Biochem 2022;5(2):77-83. Doi: 10.14744/ijmb.2022.20981.
16. Garg A, Naskar D, Gupta N, Yelamanchi R, Gupta AK. Comparison of Red Cell Distribution Width and Neutrophil Lymphocyte Ratio with APACHE II Score in Predicting Severity of Acute Pancreatitis. Indian J Surg (2022). Doi:10.1007/s12262-022-03345-z.