The Role of Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as A Prognostic Factor in Diabetic Patients in Intensive Care

Öz

Objective: Neutrophil lymphocyte ratio and platelet lymphocyte ratio are used to determine the prognosis of some diseases. In this study, it was aimed to determine the reliability of neutrophil lymphocyte ratio and platelet lymphocyte ratio, as a method in determining the 28-day mortality of diabetic patients followed in intensive care, and its correlation with APACHE II, SOFA, and MPM scores.

Material and Methods: Eighty diabetic patients who were followed up in intensive care unit in 2018 and 2019 were enrolled. Patients who survived 28 days were defined as Group 1, and patients who died within 28 days were defined as Group 2. The main neutrophil lymphocyte ratio, platelet lymphocyte ratio, APACHE II and MPM values of the patients in the two groups were used in the study.

Results: There was no difference between the groups in terms of 0, 48 and 72 hour neutrophil lymphocyte ratio values (p=0.111;0.061;0.071, respectively). However, neutrophil lymphocyte ratio values were lower in Group 1. There was no difference between the groups in terms of platelet lymphocyte ratios at 0, 48 and 72 hours. However, the platelet lymphocyte ratio value in Group 2 was peaking at the 48th hour. The APACHE II and MPM scores of Group NS in the three time frames were statistically significantly higher. Spearman's rho correlation test showed that there was a correlation between neutrophil lymphocyte ratio values and APACHE II (p=0.415) and MPM (p=0.176) scores in the first day of 80 patients. Also platelet lymphocyte ratio values and APACHE II (p=0.549) and MPM (p=0.896) scores on the first day of 80 patients were correlated.

Conclusion: Neutrophil lymphocyte ratio and platelet lymphocyte ratio values can be considered as an important marker in determining 28-day mortality in diabetic patients admitted to the intensive care unit.

Anahtar Kelimeler

• Intensive care
• diabetes mellitus
• mortality scoring
• neutrophil lymphocyte ratio
• platelet lymphocyte ratio

YOĞUN BAKIMDA DİYABETİK HASTALARDA PROGNOSTİK BİR FAKTÖR OLARAK NÖTROFİL-LENFOSİT VE PLATELET-LENFOSİT ORANLARININ ROLÜ

Öz

Amaç: Nötrofil lenfosit oranı ve platelet lenfosit oranı bazı hastalıkların prognozunun takibinde uygulanmaktadır. Bu çalışmada yoğun bakımda takip edilen diyabetik hastalarının 28 günlük mortalite oranının belirlenmesinde nötrofil lenfosit oranı ve platelet lenfosit oranı değerlerinin etkinliğinin tespiti amaçlandı ve ayrıca nötrofil lenfosit oranı ve platelet lenfosit oranı ile APACHE II, SOFA, MPM skorları arasındaki korelasyon araştırıldı.

Gereç ve Yöntemler: 2018 ve 2019 yıllarında 3. basamak yoğun bakım ünitesinde takip edilen 80 diyabetik hasta dahil edildi. Yirmi sekiz gün hayatta kalan hastalar Grup 1, 28 gün içinde hayatını kaybeden hastalar Grup 2 olarak tanımlandı. İki grupta yer alan hastaların başlıca nötrofil lenfosit oranı, platelet lenfosit oranı, APACHE II ve MPM değerleri çalışmada kullanıldı.

Bulgular: Gruplar arasında 0., 48. ve 72. saat nötrofil lenfosit oranı değerleri açısından fark yoktu (sırasıyla p=0.111; 0.061; 0.071). Ancak Grup 1’de nötrofil lenfosit oranı değerleri daha düşüktü. Platelet Lenfosit Oranları açısından 0., 48. ve 72. saatlerde gruplar arasında fark tespit edilmedi. Ancak 48. saatte Grup 2’de platelet lenfosit oranı değerinin pik yaptığı saptandı. İki grup APACHE II ve MPM skorları açısından karşılaştırıldığın da üç zaman diliminde Grup 2’nin APACHE II ve MPM skorları istatistiksel olarak anlamlı fark olacak şekilde daha yüksekti. Spearman's rho korolasyon testi ile yapılan değerlendirmede: toplam 80 hastanın ilk gün hesaplanan nötrofil lenfosit oranı değerleri ile APACHE II (p=0.415) ve MPM (p=0.176) skorları arasında ve yine 80 hastanın ilk gün platelet lenfosit oranı değerleri ile APACH II (p=0.549) ve MPM (p=0.896) skorları arasında korelasyon bulundu.

Sonuç: Nötrofil lenfosit oranı ve platelet lenfosit oranı değerleri, yoğun bakım ünitesine kabul edilen diyabetik hastalarda 28 günlük mortalitenin belirlenmesinde önemli bir belirteç olarak düşünülebilir.

Anahtar Kelimeler

• diyabetes mellitus
• yoğun bakım
• mortalite skorlamaları
• nötrofil lenfosit oranı
• platelet lenfosit oranı

Kaynakça

1. 1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N et al. Global and regional diyabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diyabetes Federation Diyabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157(1):107843.
2. 2. Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diyabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88-98.
3. 3. Rodriguez-Gutierrez R, Gonzalez-Gonzalez JG, Zuniga-Hernandez JA, McCoy RG. Benefits and harms of intensive glycemic control in patients with type 2 diyabetes. BMJ. 2019;367(1):l5887.
4. 4. Balintescu A, Martensson J. Hemoglobin A1c and permissive hyperglycemia in patients in the intensive care unit with diabetes. Crit Care Clin. 2019;35(2):289-300.
5. 5. Christiansen CF, Johansen MB, Christensen S, O'Brien JM, Tonnesen E, Sorensen HT. Type 2 diabetes and 1-year mortality in intensive care unit patients. Eur J Clin Invest. 2013;43(3):238-47.
6. 6. Akilli NB, Yortanli M, Mutlu H, Gunaydin YK, Koylu R, Akca HS et al. Prognostic importance of neutrophil-lymphocyte ratio in critically ill patients: short- and long-term outcomes. Am J Emerg Med. 2014;32(12):1476-80.
7. 7. Kutlucan L, Kutlucan A, Basaran B, Dagli M, Basturk A, Kozanhan B et al. The predictive effect of initial complete blood count of intensive care unit patients on mortality, length of hospitalization, and nosocomial infections. Eur Rev Med Pharmacol Sci. 2016;20(8):1467-73.
8. 8. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.

9. 9. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The platelet-to-lymphocyte ratio as an ınflammatory marker in rheumatic diseases. Annals of Laboratory Medicine. 2019;39(4):345-57.
10. 10. Yao C, Liu X, Tang Z. Prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for hospital mortality in patients with AECOPD. Int J Chron Obstruct Pulmon Dis. 2017;12(1):2285-90. 11. Telo S, Kuluozturk M, Deveci F, Kirkil G. The relationship between platelet-to-lymphocyte ratio and pulmonary embolism severity in acute pulmonary embolism. Int Angiol. 2019;38(1):4-9.
11. 12. Cheng S, Hou G, Liu Z, Lu Y, Liang S, Cang L et al. Risk prediction of in-hospital mortality among patients with type 2 diabetes mellitus and concomitant community-acquired pneumonia. Ann Palliat Med. 2020;9(5):3313-25.
12. 13. DiGangi C. Neutrophil-lymphocyte ratio: Predicting cardiovascular and renal complications in patients with diyabetes. J Am Assoc Nurse Pract. 2016;28(8):410-4.
13. 14. Forget P, Khalifa C, Defour J-P, Latinne D, Van Pel M-C, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Research Notes. 2017;10(1):12.
14. 15. Bilgin S, Aktas G, Zahid Kocak M, Atak BM, Kurtkulagi O, Duman TT et al. Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men. Aging Male. 2019;23(5):1-5.
15. 16. Duman TT, Aktas G, Atak BM, Kocak MZ, Erkus E, Savli H. Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diyabetes mellitus. Afr Health Sci. 2019;19(1):1602-6.
16. 17. Lin CC, Li CI, Yang SY, Liu CS, Chen CC, Fuh MM et al. Variation of fasting plasma glucose: a predictor of mortality in patients with type 2 diabetes. Am J Med. 2012;125(4):416 e9-18.
17. 18. Simic S, Svagusa T, Prkacin I, Bulum T. Relationship between hemoglobin A1c and serum troponin in patients with diabetes and cardiovascular events. J Diabetes Metab Disord. 2019;18(2):693-704.
18. 19. Shiny A, Bibin YS, Shanthirani CS, Regin BS, Anjana RM, Balasubramanyam M et al. Association of neutrophil-lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Technol Ther. 2014;16(8):524-30.
19. 20. Metineren H, Dulgeroglu TC. Comparison of the neutrophil/lymphocyte ratio and C-reactive protein levels in patients with amputation for diabetic foot ulcers. Int J Low Extrem Wounds. 2017;16(1):23-8.
20. 21. Eren MA, Gunes AE, Kirhan I, Sabuncu T. The role of the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers: A retrospective comparative study. Acta Orthop Traumatol Turc. 2020;54(2):127-31.
21. 22. Higgins TL, Teres D, Copes WS, Nathanson BH, Stark M, Kramer AA. Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III). Crit Care Med. 2007;35(3):827-35.
22. 23. Wang J, Wang H, Liu W, Zhang D, Guo S. Assessment values of procalcitonin, lactic acid, and disease severity scores in patients with sepsis. Zhonghua wei zhong bing ji jiu yi xue. 2019;31(8):938-41.