Primer İmmün Trombositopenide Tedavi Yanıtının Öngördürücüsü Olarak Sistemik İmmün-İnflamasyon İndeksi (SII)

Öz

Primer immün trombositopeni (İTP), immün aracılı trombosit yıkımı ve trombosit üretiminde azalma sonucu gelişen izole trombositopeni ile karakterize otoimmün bir hastalıktır. Kortikosteroidler ve intravenöz immünoglobulin (IVIG) standart birinci basamak tedaviler olmasına rağmen, birçok hastada yeterli veya kalıcı yanıt elde edilememekte, bu da tedavi direncini erken öngörebilecek belirteçlerin önemini ortaya koymaktadır. Bu çalışmanın amacı, primer İTP hastalarında kortikosteroid ve IVIG tedavisine yanıtsızlıkla ilişkili klinik ve laboratuvar faktörleri belirlemek ve sistemik immün-inflamasyon indeksinin (SII) prognostik değerini araştırmaktır. Bu retrospektif çalışmaya Ocak 2008 - Aralık 2023 arasında primer İTP tanısı alan 109 erişkin hasta dahil edilmiştir. Demografik, klinik ve laboratuvar veriler hasta dosyalarından elde edilerek her hasta için SII değeri hesaplanmıştır. Tedavi yanıtını öngörmede optimal SII kesim değeri ROC analizi ile belirlenmiş, lojistik regresyon analizi ile kortikosteroid ve IVIG direncini etkileyen bağımsız faktörler saptanmıştır. Hastaların yaş ortalaması 51,5 ± 16,9 yıl olup, %72,5’i kadındır. Tüm hastalara birinci basamak tedavide sistemik steroid uygulanmış olup, %32,1’ine ek olarak IVIG uygulanmıştır. Steroid tedavisine tam yanıt oranı %50, yanıtsızlık oranı %31,3; IVIG tedavisine yanıtsızlık oranı ise %45,7 olarak saptanmıştır. ROC analizi sonucunda optimal SII kesim değeri 48,33 olarak bulunmuştur. Düşük SII düzeyine sahip hastalarda her iki tedaviye yanıt oranlarının anlamlı olarak daha yüksek olduğu bulunmuştur (p < 0,05). Çok değişkenli analiz, düşük SII’nin IVIG yanıtını bağımsız olarak öngördüğünü göstermiştir (OR = 8,25, %95 GA 1,15–59,00; p = 0,036). Sonuç olarak, tanı anındaki SII değeri birinci basamak tedavi yanıtını öngören bağımsız bir belirteçtir ve erken değerlendirilmesi, dirençli olguların erken dönemde ikinci basamak tedaviye yönlendirilmesine olanak sağlayacaktır.

Anahtar Kelimeler

• Primer immun trombositopeni (İTP)
• Sistemik immun inflamasyon indeksi (SII)
• İntravenöz immunoglobulin (IVIG)
• Kortikosteroidler

Systemic Immune-Inflammation Index (SII) as a Predictor of Treatment Response in Primary Immune Thrombocytopenia

Öz

Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia resulting from immune-mediated platelet destruction and impaired platelet production. Although corticosteroids and intravenous immunoglobulin (IVIG) are standard first-line therapies, many patients fail to achieve or maintain an adequate response, emphasizing the need for early predictors of treatment resistance. This study aimed to identify clinical and laboratory factors associated with unresponsiveness to corticosteroid and IVIG therapy in primary ITP and to explore the predictive value of systemic immune-inflammation index (SII). This retrospective study included 109 adults newly diagnosed with primary ITP between January 2008 and December 2023. Demographic, clinical, and laboratory data were collected from patient records, and SII was calculated for each patient. Receiver operating characteristic (ROC) analysis determined the optimal SII cut-off for predicting treatment response, while logistic regression identified independent predictors of corticosteroid and IVIG resistance. The mean age was 51.48 ± 16.9 years, and 72.5% were female. All patients received systemic steroids, and 32.1% also received IVIG. The complete response rate to steroids was 50%, while 31.3% were non-responders; the IVIG non-response rate was 45.7%. ROC analysis identified an optimal SII cut-off of 48.33, with lower SII associated with significantly higher response rates to both steroids and IVIG (p < 0.05). Multivariate analysis confirmed low SII as an independent predictor of IVIG responsiveness (OR = 8.25, 95% CI 1.15–59.00; p = 0.036). In conclusion, SII at the time of diagnosis independently predicts response to first-line therapy, and early assessment may facilitate timely second-line interventions

Anahtar Kelimeler

• Primary immune thromboytopenia (ITP)
• Systemic immune inflammation index (SII)
• Intravenous immunoglobulin (IVIG)
• Corticosteroids

Kaynakça

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