Monosit-HDL-kolesterol akut pankreatitte hastalık şiddetinin belirleyicisi midir?

Abstract

Amaç: Akut pankreatit, lokal dokuları veya uzak organ sistemlerini etkileyebilen pankreasın inflamatuar bir sürecidir. Son çalışmalar, monosit sayısının yüksek yoğunluklu lipoprotein (HDL) kolesterol oranına (MHR) önemli bir prognostik belirteç olarak tanımlamıştır. Bu çalışmanın amacı AP tanılı hastalarda MHR ile hastalık şiddeti arasındaki ilişkiyi araştırmaktır. Yöntemler: Bu çalışmaya 166 AP hastası dahil edildi. Tüm çalışma katılımcıları için MHR ve inflamatuar parametreler ölçüldü. Hastalık şiddeti başvuru sırasında Ranson skoru kullanılarak ölçüldü ve vakalar hafif veya şiddetli AP olarak sınıflandırıldı. MHR daha sonra gruplar arasında karşılaştırıldı. Bulgular: MHR değerleri şiddetli AP hastalarında (25,2, aralık 7,89-77,8) hafif AP hastalarına (14,32, aralık 0,71-80) kıyasla anlamlı derecede yüksekti (P = 0,006). Ranson kriterlerine göre, şiddetli AP'yi belirlemede MHR'nin genel doğruluğu, duyarlılık %72,7 ve özgüllük %69'dur (EAA: 0,762; P = 0,006). MHR'nin hastalık şiddetini öngörmedeki genel doğruluğu, diğer inflamatuar belirteçlerden üstündü. Sonuç: Çalışma bulguları AP hastalarında MHR değerlerinin anlamlı olarak yüksek olduğunu ve hastalık şiddetinin belirlenmesinde kullanılabileceğini göstermiştir.

Keywords

• Monosit
• HDL
• MHR
• Ranson
• Enflamasyon

Monocyte-to-HDL-cholesterol as a predictor of disease severity in acute pancreatitis

Abstract

Aims: Acute pancreatitis is an inflammatory process of the pancreas that can affect local tissues or distant organ systems. Recent studies have described the monocyte count to high density lipoprotein (HDL) cholesterol ratio (MHR) as a significant prognostic marker. The aim of this study was to investigate the relationship between the MHR and disease severity in patients diagnosed with AP. Methods: One hundred sixty-six AP patients were enrolled in this study. MHR and inflammatory parameters were measured for all study participants. Disease severity was measured using the Ranson score on admission, and cases were classified as mild or severe AP. MHR was then compared between the groups. Results: MHR values were significantly higher in severe AP patients (25.2, range 7.89-77.8) compared with mild AP patients (14.32, range 0.71-80) (P=0.006). Based on the Ranson criteria, the overall accuracy of MHR in determining severe AP was sensitivity 72.7% and specificity 69% (AUC: 0.762; P=0.006). The overall accuracy of MHR in predicting disease severity was superior to other inflammatory markers. Conclusion: The study findings indicated that MHR values are significantly elevated and capable of use in determining disease severity in AP patients.

Keywords

• Monocyte
• HDL
• MHR
• ranson
• inflammation

References

1. Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med. 2016;375(20):1972-1981. doi:10.1056/NEJMra1505202
2. Mortele KJ, Wiesner W, Intriere L, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol. 2004;183(5):1261-1265. doi:10.2214/ajr.183.5.1831261
3. Slawinski C, O’Reilly DA. Management of acute pancreatitis: a practical guide. Br J Hosp Med (Lond). 2017;78(11):C171-C175. doi:10.12968/hmed.2017.78.11.C171
4. Frank B, Gottlieb K. Amylase normal, lipase elevated: is it pancreatitis? A case series and review of the literature. Am J Gastroenterol. 1999;94(2):463-469. doi:10.1111/j.1572-0241.1999.878_g.x
5. Balthazar EJ. CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am. 1989;27(1):19-37.
6. 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;2013:367581. doi:10.1155/2013/367581
7. Basit H, Gordon JR, Sandeep M. “Ranson Criteria.” StatPearls (Internet). StatPearls Publishing, 2019.
8. Beyazit Y, Sayilir A, Torun S, et al. Mean platelet volume as an indicator of disease severity in patients with acute pancreatitis. Clin Res Hepatol Gastroenterol. 2012;36(2):162-168. doi:10.1016/j.clinre.2011.10.003

9. Kaplan M, Ates I, Oztas E, et al. A New marker to determine prognosis of acute pancreatitis: PLR and NLR combination. J Med Biochem. 2018;37(1):21-30. doi:10.1515/jomb-2017-0039
10. Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: a retrospective study. Medicine (Baltimore). 2019;98(16):e15275. doi:10.1097/MD.0000000000015275
11. Önmez A, Bilir E, Torun S. The relationship between acute pancreatitis severity of platelet lymphocyte ratio, neutrophil lymphocyte ratio, erythrocyte distribution width and mean platelet volume. Konuralp Tıp Derg. 2019;11:24–29. doi:10.18521/ktd.492274
12. Ganjali S, Gotto AM Jr, Ruscica M, et al. Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol. 2018;233(12):9237-9246. doi:10.1002/jcp.27028
13. Dincgez Cakmak B, Dundar B, Ketenci Gencer F, Aydin BB, Yildiz DE. TWEAK and monocyte to HDL ratio as a predictor of metabolic syndrome in patients with polycystic ovary syndrome. Gynecol Endocrinol. 2019;35(1):66-71. doi:10.1080/09513590.2018.1490401
14. Inonu Koseoglu H, Pazarli AC, Kanbay A, Demir O. Monocyte count/HDL cholesterol ratio and cardiovascular disease in patients with obstructive sleep apnea syndrome: a multicenter study. Clin Appl Thromb Hemost. 2018;24(1):139-144. doi:10.1177/1076029616677803
15. You S, Zhong C, Zheng D, et al. Monocyte to HDL cholesterol ratio is associated with discharge and 3-month outcome in patients with acute intracerebral hemorrhage. J Neurol Sci. 2017;372:157-161. doi:10.1016/j.jns.2016.11.022
16. Vahit D, Akboga MK, Samet Y, Hüseyin E. Assessment of monocyte to high density lipoprotein cholesterol ratio and lymphocyte-to-monocyte ratio in patients with metabolic syndrome. Biomark Med. 2017;11(7):535-540. doi:10.2217/bmm-2016-0380
17. Camps J, Marsillach J, Joven J. The paraoxonases: role in human diseases and methodological difficulties in measurement. Crit Rev Clin Lab Sci. 2009;46(2):83-106. doi:10.1080/10408360802610878
18. Franco-Pons N, Marsillach J, Joven J, Camps J, Closa D. Serum paraoxonase undergoes inhibition and proteolysis during experimental acute pancreatitis. J Gastrointest Surg. 2008;12(5):891-899. doi:10.1007/s11605-008-0502-2
19. Tvarijonaviciute A, García-Martínez JD, Caldin M, et al. Serum paraoxonase 1 (PON1) activity in acute pancreatitis of dogs. J Small Anim Pract. 2015;56(1):67-71. doi:10.1111/jsap.12297
20. Waldthaler A, Schütte K, Malfertheiner P. Causes and mechanisms in acute pancreatitis. Dig Dis. 2010;28(2):364-372. doi:10.1159/000319416
21. Imamura T, Tanaka S, Yoshida H, et al. Significance of measurement of high-sensitivity C-reactive protein in acute pancreatitis. J Gastroenterol. 2002;37(11):935-938. doi:10.1007/s005350200157
22. Nalbant A, Kaya T, Varim C, Yaylaci S, Tamer A, Cinemre H. Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)?. Rev Assoc Med Bras (1992). 2020;66(6):746-751. doi:10.1590/1806-9282.66.6.746
23. Pirozzolo G, Gisbertz SS, Castoro C, van Berge Henegouwen MI, Scarpa M. Neutrophil-to-lymphocyte ratio as prognostic marker in esophageal cancer: a systematic review and meta-analysis. J Thorac Dis. 2019;11(7):3136-3145. doi:10.21037/jtd.2019.07.30
24. Park HS, In SG, Yoon HJ, Lee WJ, Woo SH, Kim D. Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatitis in the emergency department patients. J Lab Physicians. 2019;11(3):259-264. doi:10.4103/JLP.JLP_82_19
25. Abaylı B, Gençdal G, Değirmencioğlu Ş. Correlation between neutrophil/lymphocyte ratio and Ranson score in acute pancreatitis. J Clin Lab Anal. 2018;32(6):e22437. doi:10.1002/jcla.22437
26. Ganjali S, Gotto AM Jr, Ruscica M, et al. Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol. 2018;233(12):9237-9246. doi:10.1002/jcp.27028
27. Johnsen SH, Fosse E, Joakimsen O, et al. Monocyte count is a predictor of novel plaque formation: a 7-year follow-up study of 2610 persons without carotid plaque at baseline the Tromsø Study. Stroke. 2005;36(4):715-719. doi:10.1161/01.STR.0000158909.07634.83
28. Zheng J, Fan J, Huang C, et al. Dynamic detection of monocyte subsets in peripheral blood of patients with acute hypertriglyceridemic pancreatitis. Gastroenterol Res Pract. 2019;2019:5705782. doi:10.1155/2019/5705782
29. Dabrowski A, Osada J, Dabrowska MI, Wereszczynska-Siemiatkowska U. Monocyte subsets and natural killer cells in acute pancreatitis. Pancreatology. 2008;8(2):126-134. doi:10.1159/000123605
30. Schmidt AI, Seifert GJ, Lauch R, et al. Organ-specific monocyte activation in necrotizing pancreatitis in mice. J Surg Res. 2015;197(2):374-381. doi:10.1016/j.jss.2015.03.075
31. Açıkgöz SK, Açıkgöz E, Şensoy B, Topal S, Aydoğdu S. Monocyte to high-density lipoprotein cholesterol ratio is predictive of in-hospital and five-year mortality in ST-segment elevation myocardial infarction. Cardiol J. 2016;23(5):505-512. doi:10.5603/CJ.a2016.0026
32. Fahie-Wilson M, Mills R, Wilson K. HDL cholesterol and the acute phase reaction following myocardial infarction and acute pancreatitis. Clin Chim Acta. 1987;167(2):197-209. doi:10.1016/0009-8981(87)90372-x
33. Wu Q, Zhong X, Fu M, et al. High-density lipoprotein cholesterol to low-density lipoprotein cholesterol ratio in early assessment of disease severity and outcome in patients with acute pancreatitis admitted to the ICU. BMC Gastro. 2020; 20: 1–10.