ENHANCING DIAGNOSTIC ACCURACY IN POLYCYSTIC OVARY SYNDROME USING NOVEL INFLAMMATORY INDICES

Öz

Objectives: Polycystic ovary syndrome (PCOS) is characterized by a complicated and incompletely understood pathophysiology. This study investigates the role of inflammation in its pathophysiology, compares the diagnostic performance of inflammatory indices, and assesses the clinical utility of novel biomarkers. Material and Methods: This retrospective study included 30 patients with PCOS and 32 healthy controls. Inflammatory indices including neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), neutrophil to monocyte ratio (NMR), platelet to lymphocyte ratio (PLR), platelet large cell ratio (PLCR), mean platelet volume to lymphocyte ratio (MPVLR), systemic immune inflammation index (SII), systemic inflammation response index (SIRI), multi-inflammatory index (MII), and monocyte to high density lipoprotein ratio (MHR) were calculated. Receiver operating characteristic (ROC) curve analysis evaluated their diagnostic performance. Biochemical, hormonal, hematological, and inflammatory parameters were measured using ELISA and an automated analyzer. Results: Inflammatory indices SII (p=0.006), SIRI (p=0.022), MII (p=0.013), and MHR (p=0.003) were significantly higher in patients, while PLCR was lower (p=0.024). Biochemical parameters CRP (p=0.027), insulin (p=0.021), and LDL (p=0.027) were elevated, HDL decreased (p=0.035). ROC analysis identified MHR as the most accurate biomarker (AUC=0.747, 100% specificity), followed by CRP (AUC=0.726) and MII (AUC=0.713). SII and SIRI showed moderate but relevant accuracy. All were statistically significant (p< 0.05). Conclusion: The present study highlights the potential of inflammation-based indices particularly MHR, MII, SII, SIRI, and CRP as valuable biomarkers in PCOS diagnosis. MHR showed the strongest diagnostic performance (100% specificity), while CRP and MII also demonstrated good accuracy. SIRI’s high sensitivity supports its role in early detection, and both SII and SIRI may serve as complementary markers. Overall, the results underscore the significance of inflammation in PCOS and support the clinical utility of these markers. PCOS influences hematological and biochemical parameters as well as inflammatory indices.

Anahtar Kelimeler

• PCOS
• inflammatory indices
• diagnostic accuracy.

Etik Beyan

Ethical approval was obtained from the non interventional research ethics committee of Kırıkkale University Faculty of Medicine (Date: 16.10.2024, Decision No: 2024.01.02).

Polikistik Over Sendromunda Tanısal Doğruluğun Yeni İnflamatuar İndekslerle Artırılması

Öz

Amaç: Polikistik over sendromu (PCOS), kompleks ve hâlen tam olarak aydınlatılamamış bir patofizyoloji ile karakterizedir. Bu çalışma, PCOS’un patofizyolojisinde inflamasyonun rolünü araştırmayı, inflamatuar indekslerin tanısal performanslarını karşılaştırmayı ve yeni biyobelirteçlerin klinik kullanım değerini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif çalışmaya, 30 PCOS hastası ve 32 sağlıklı kontrol birey dâhil edilmiştir. Nötrofil/lenfosit oranı (NLR), monosit/lenfosit oranı (MLR), nötrofil/monosit oranı (NMR), platelet/lenfosit oranı (PLR), büyük platelet oranı (PLCR), ortalama platelet hacmi/lenfosit oranı (MPVLR), sistemik immün-inflamasyon indeksi (SII), sistemik inflamasyon yanıt indeksi (SIRI), multi inflamatuar indeks (MII) ve monosit/yüksek yoğunluklu lipoprotein oranı (MHR) gibi inflamatuar indeksler hesaplanmıştır. Tanısal performansları, ROC eğrisi analizi ile değerlendirilmiştir. Biyokimyasal, hormonal, hematolojik ve inflamatuar parametreler ELISA ve otomatik analizör kullanılarak ölçülmüştür. Bulgular: SII (p=0,006), SIRI (p=0,022), MII (p=0,013) ve MHR (p=0,003) değerleri hasta grubunda anlamlı olarak yüksek bulunurken; PLCR değeri anlamlı şekilde düşüktü (p=0,024). Biyokimyasal parametrelerden CRP (p=0,027), insülin (p=0,021) ve LDL (p=0,027) düzeyleri artmış; HDL düzeyi ise azalmıştı (p=0,035). ROC analizinde, MHR en yüksek tanısal doğruluk gösteren biyobelirteç olarak tanımlandı (AUC=0,747, %100 özgüllük), bunu CRP (AUC=0,726) ve MII (AUC=0,713) izledi. SII ve SIRI, orta düzeyde ancak anlamlı tanısal doğruluk gösterdi. Tüm bulgular istatistiksel olarak anlamlıydı (p<0,05). Sonuç:Bu çalışma, özellikle MHR, MII, SII, SIRI ve CRP gibi inflamasyon temelli indekslerin PCOS tanısında değerli biyobelirteçler olabileceğini ortaya koymaktadır. MHR, %100 özgüllük ile en güçlü tanısal performansı göstermiştir. CRP ve MII de yüksek doğruluk oranlarıyla dikkat çekmiştir. SIRI’nin yüksek duyarlılığı, erken tanıda önemli bir belirteç olabileceğini desteklemektedir. Hem SII hem de SIRI, tamamlayıcı tanı araçları olarak değerlendirilebilir. Genel olarak, elde edilen sonuçlar inflamasyonun PCOS üzerindeki önemini vurgulamakta ve bu indekslerin klinik kullanım potansiyelini desteklemektedir. PCOS, hematolojik ve biyokimyasal parametreler kadar inflamatuar indeksleri de etkilemektedir.

Anahtar Kelimeler

• PCOS
• inflamatuar indeksler
• tanısal doğruluk

Kaynakça

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