Araştırma Makalesi
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Akut pankreatitli hastalarda mortalite göstergesi olarak yeni belirteçler: 48. saat NLR ve PLR

Yıl 2019, Cilt: 3 Sayı: 12, 873 - 876, 03.12.2019
https://doi.org/10.28982/josam.658773

Öz

Amaç: Son yıllarda akut pankreatit prognozunu öngörmede basit, etkili ve hızlı laboratuvar belirteçleri önem kazanmıştır. Bu çalışmada, mevcut skorlarla sistemik inflamasyonun dolaylı belirteçleri arasında AP ile ilişkili mortalite tahmininde bir fark olup olmadığını ortaya koymak amaçlandı (48. saatte RDW, MPV, PLR ve NLR).

Yöntemler: Bu çalışmada, Gastroenteroloji Bölümü'ne başvuran Akut pankreatitli hastaların dosyaları geriye dönük olarak incelendi. Genel olarak, 667 hastanın verileri dahil edildi. 48. saatte akut faz reaktan değerleri çalışmaya alındı. CRPo başvuru sırasındaki CRP'yi gösterirken CRP, RDW, MPV, NLR ve PLR 48. saatte değerleri gösterir. Tüm hastalarda Ranson skoru, Atlanta skoru, NLR ve PLR değerleri hesaplandı.

Bulgular: Hastalar sağ kalanlar (n=641; %96,1) ve ölenler (n=26; %3,9) olarak 2 gruba ayrıldı. Hem NLR hem de PLR, hayatta kalan grupta anlamlı olarak yüksek bulundu (sırasıyla P<0,001 ve P=0,02). NLR ile mortalite arasında zayıf, pozitif bir korelasyon vardı. Yine PLR ile mortalite arasında zayıf ve pozitif bir korelasyon vardı.

Sonuç: Çalışmamızda MPV değeri ile mortalite arasında ilişki saptanmazken, RDW ile mortalite arasında zayıf-pozitif bir ilişki olduğu görüldü. Başvurunun 48. Saatinde elde edilen NLR ve PLR değerlerinin mortaliteyi gösteren etkili parametreler olduğunu saptadık. Bu ulaşılması kolay ve düşük maliyetli testler, gerektiğinde hastaları daha yakından takip etmek amacıyla kullanılabilir.

Kaynakça

  • 1. Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase. Medicine (Baltimore). 2019 Apr;98(16):e15275.
  • 2. Han C, Zeng J, Lin R, Liu J, Qian W, Ding Z, et al. The utility of neutrophil to lymphocyte ratio and fluid sequestration as an early predictor of severe acute pancreatitis. Sci Rep. 2017;7:10704.
  • 3. Tee YS, Fang HY, Kuo IM, Lin YS, Huang SF, Yu MC. Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis. Medicine (Baltimore). 2018;97:e9654.
  • 4. Suppiah A, Malde D, Arab T, Hamed M, Allgar V, Smith AM, et al. The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: identification of an optimal NLR. J Gastrointest Surg. 2013;17:675–81.
  • 5. Cho SK, Jung S, Lee KJ, Kim JW. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC Gastroenterol. 2018 25;18(1):18.
  • 6. Mitchell RM, Byrne MF, Baillie J. Pancreatitis. Lancet. 2003;361:1447–55.
  • 7. Larvin M. Assessment of clinical severity and prognosis. In: The Pancreas, Beger HG, Warshaw AL, Buchler MW, et al (Eds), Blackwell Science, Oxford 1998. p.489.
  • 8. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. The American Journal of Gastroenterology. 1974;61:443–51.
  • 9. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.
  • 10. Fagenholz PJ, Fernández-del Castillo C, Harris NS, Pelletier AJ, Camargo CA Jr. Direct medical costs of acute pancreatitis hospitalizations in the United States. Pancreas. 2007;35:302–7.
  • 11. Whitcomb DC. Clinical practice. Acute pancreatitis. The New England Journal of Medicine. 2006;354:2142–50.
  • 12. Wang D, Yang J, Zhang J, Zhang S, Wang B, Wang R, et al. Red cell distribution width predicts deaths in patients with acute pancreatitis. Journal of research in medical sciences. 2015;20:424–8.
  • 13. Mutinga M, Rosenbluth A, Tenner SM, Odze RR, Sica GT, Banks PA. Does mortality occur early or late in acute pancreatitis? Int J Pancreatol. 2000;28:91–5.
  • 14. Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108:1400-15;1416.
  • 15. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. European Journal of Cancer. 2011;47:2633–41.
  • 16. Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Review of Cardiovascular Therapy. 2013;11:55–9.
  • 17. Wang Y, Fuentes HE, Attar BM, Jaiswal P, . Evaluation of the prognostic value of neutrophil to lymphocyte ratio in patients with hypertriglyceridemia-induced acute pancreatitis. Pancreatology. 2017;17:893–7.
  • 18. Jeon TJ, Park JY. Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis. World J Gastroenterol. 2017;23:3883–9.
  • 19. 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.
  • 20. İlhan M, İlhan G, Gök AF, Bademler S, Atmaca FV, Ertekin C. Evaluation of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red blood cell distribution width-platelet ratio as early predictor of acute pancreatitis in pregnancy. J Matern Fetal Neonatal Med. 2016;29:1476–80.
  • 21. Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Annals of Surgical Oncology. 2012; 19: 217–24.
  • 22. Kaplan M, Ates I, Oztas E, Yuksel M, Akpinar MY, Coskun O, et al. Early predictor of acute pancreatitis: PLR-NLR combination. J Med Biochem. 2018;37(1).
  • 23. Başak F, Hasbahçeci M, Şişik A, Acar A, Tekesin K, Baş G, et al. Can C-reactive protein levels increase the accuracy of the Ranson score in predicting the severity and prognosis of acute pancreatitis? A prospective cohort study. Turk J Gastroenterol. 2017;28(3):207-13.

Novel markers for mortality in patients with acute pancreatitis: NLR and PLR at the 48th hour

Yıl 2019, Cilt: 3 Sayı: 12, 873 - 876, 03.12.2019
https://doi.org/10.28982/josam.658773

Öz

Aims: In recent years, simple, effective, and rapid laboratory markers have become important to predict acute pancreatitis prognosis. In this study, we aimed to demonstrate whether there was a difference in predicting AP-related mortality between current scores and indirect markers of systemic inflammation, namely, red cell distribution width (RDW), mean platelet volume (MPV), platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) obtained at the 48th hour. 

Methods: We retrospectively reviewed files of AP patients admitted to Gastroenterology Department of two hospitals to include the acute phase reactant values of 667 patients obtained at the 48th hour. CRP0 indicates CRP value at presentation while CRP, RDW, MPV, NLR and PLR indicate values at the 48th hour. In all patients, Ranson score, Atlanta score, NLR and PLR values were calculated.

Results: The patients were classified into 2 groups as survivors (n=641; 96.1%) and non-survivors (n=26; 3.9%). Both NLR and PLR were found to be significantly higher in the non-survivor group (P<0.001 and P=0.02). Both NLR and PLR were weakly and positively correlated to mortality. 

Conclusion: Based on our results, MPV was not correlated with mortality, while RDW was weakly and positively correlated. However, we found that NLR and PLR values obtained at the 48th hour after presentation are effective parameters in predicting mortality in AP. These easily accessible and low-cost tests may be used for closer monitoring of these patients when necessary.

Kaynakça

  • 1. Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase. Medicine (Baltimore). 2019 Apr;98(16):e15275.
  • 2. Han C, Zeng J, Lin R, Liu J, Qian W, Ding Z, et al. The utility of neutrophil to lymphocyte ratio and fluid sequestration as an early predictor of severe acute pancreatitis. Sci Rep. 2017;7:10704.
  • 3. Tee YS, Fang HY, Kuo IM, Lin YS, Huang SF, Yu MC. Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis. Medicine (Baltimore). 2018;97:e9654.
  • 4. Suppiah A, Malde D, Arab T, Hamed M, Allgar V, Smith AM, et al. The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: identification of an optimal NLR. J Gastrointest Surg. 2013;17:675–81.
  • 5. Cho SK, Jung S, Lee KJ, Kim JW. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC Gastroenterol. 2018 25;18(1):18.
  • 6. Mitchell RM, Byrne MF, Baillie J. Pancreatitis. Lancet. 2003;361:1447–55.
  • 7. Larvin M. Assessment of clinical severity and prognosis. In: The Pancreas, Beger HG, Warshaw AL, Buchler MW, et al (Eds), Blackwell Science, Oxford 1998. p.489.
  • 8. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Localio SA. Objective early identification of severe acute pancreatitis. The American Journal of Gastroenterology. 1974;61:443–51.
  • 9. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.
  • 10. Fagenholz PJ, Fernández-del Castillo C, Harris NS, Pelletier AJ, Camargo CA Jr. Direct medical costs of acute pancreatitis hospitalizations in the United States. Pancreas. 2007;35:302–7.
  • 11. Whitcomb DC. Clinical practice. Acute pancreatitis. The New England Journal of Medicine. 2006;354:2142–50.
  • 12. Wang D, Yang J, Zhang J, Zhang S, Wang B, Wang R, et al. Red cell distribution width predicts deaths in patients with acute pancreatitis. Journal of research in medical sciences. 2015;20:424–8.
  • 13. Mutinga M, Rosenbluth A, Tenner SM, Odze RR, Sica GT, Banks PA. Does mortality occur early or late in acute pancreatitis? Int J Pancreatol. 2000;28:91–5.
  • 14. Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108:1400-15;1416.
  • 15. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. European Journal of Cancer. 2011;47:2633–41.
  • 16. Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Review of Cardiovascular Therapy. 2013;11:55–9.
  • 17. Wang Y, Fuentes HE, Attar BM, Jaiswal P, . Evaluation of the prognostic value of neutrophil to lymphocyte ratio in patients with hypertriglyceridemia-induced acute pancreatitis. Pancreatology. 2017;17:893–7.
  • 18. Jeon TJ, Park JY. Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis. World J Gastroenterol. 2017;23:3883–9.
  • 19. 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.
  • 20. İlhan M, İlhan G, Gök AF, Bademler S, Atmaca FV, Ertekin C. Evaluation of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red blood cell distribution width-platelet ratio as early predictor of acute pancreatitis in pregnancy. J Matern Fetal Neonatal Med. 2016;29:1476–80.
  • 21. Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Annals of Surgical Oncology. 2012; 19: 217–24.
  • 22. Kaplan M, Ates I, Oztas E, Yuksel M, Akpinar MY, Coskun O, et al. Early predictor of acute pancreatitis: PLR-NLR combination. J Med Biochem. 2018;37(1).
  • 23. Başak F, Hasbahçeci M, Şişik A, Acar A, Tekesin K, Baş G, et al. Can C-reactive protein levels increase the accuracy of the Ranson score in predicting the severity and prognosis of acute pancreatitis? A prospective cohort study. Turk J Gastroenterol. 2017;28(3):207-13.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Gastroenteroloji ve Hepatoloji
Bölüm Araştırma makalesi
Yazarlar

Mehmet Suat Yalçın 0000-0003-1054-1882

Serkan Yalaki 0000-0001-8137-0924

Yayımlanma Tarihi 3 Aralık 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 3 Sayı: 12

Kaynak Göster

APA Yalçın, M. S., & Yalaki, S. (2019). Novel markers for mortality in patients with acute pancreatitis: NLR and PLR at the 48th hour. Journal of Surgery and Medicine, 3(12), 873-876. https://doi.org/10.28982/josam.658773
AMA Yalçın MS, Yalaki S. Novel markers for mortality in patients with acute pancreatitis: NLR and PLR at the 48th hour. J Surg Med. Aralık 2019;3(12):873-876. doi:10.28982/josam.658773
Chicago Yalçın, Mehmet Suat, ve Serkan Yalaki. “Novel Markers for Mortality in Patients With Acute Pancreatitis: NLR and PLR at the 48th Hour”. Journal of Surgery and Medicine 3, sy. 12 (Aralık 2019): 873-76. https://doi.org/10.28982/josam.658773.
EndNote Yalçın MS, Yalaki S (01 Aralık 2019) Novel markers for mortality in patients with acute pancreatitis: NLR and PLR at the 48th hour. Journal of Surgery and Medicine 3 12 873–876.
IEEE M. S. Yalçın ve S. Yalaki, “Novel markers for mortality in patients with acute pancreatitis: NLR and PLR at the 48th hour”, J Surg Med, c. 3, sy. 12, ss. 873–876, 2019, doi: 10.28982/josam.658773.
ISNAD Yalçın, Mehmet Suat - Yalaki, Serkan. “Novel Markers for Mortality in Patients With Acute Pancreatitis: NLR and PLR at the 48th Hour”. Journal of Surgery and Medicine 3/12 (Aralık 2019), 873-876. https://doi.org/10.28982/josam.658773.
JAMA Yalçın MS, Yalaki S. Novel markers for mortality in patients with acute pancreatitis: NLR and PLR at the 48th hour. J Surg Med. 2019;3:873–876.
MLA Yalçın, Mehmet Suat ve Serkan Yalaki. “Novel Markers for Mortality in Patients With Acute Pancreatitis: NLR and PLR at the 48th Hour”. Journal of Surgery and Medicine, c. 3, sy. 12, 2019, ss. 873-6, doi:10.28982/josam.658773.
Vancouver Yalçın MS, Yalaki S. Novel markers for mortality in patients with acute pancreatitis: NLR and PLR at the 48th hour. J Surg Med. 2019;3(12):873-6.