The Role of SII and SIRI Values in Predicting the Severity of CO Poisoning in the Emergency Department

Öz

Aim: In this study, the role of indices based on hematological parameters measured at admission in predicting the severity of carbon monoxide poisoning (COZ) was investigated. Methods: A total of 183 patients, who were diagnosed with COZ in the emergency department of a Training and Research hospital between 2018 and 2022 were retrospectively analyzed. COHb and lactate levels were used to determine the clinical severity of the patients. The patients were divided into two groups as mild-moderate carbon monoxide poisoning (mild-moderate COZ) and severe carbon monoxide poisoning (severe COZ). Two groups were compared for systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), aggregate index of systemic inflammation (AISI), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and monocyte/lymphocyte ratio (MLR). Results: There was a significant difference between groups with regard to SII, SIRI, AISI, NLR, PLR and MLR (p<0.001, for all). According to the ROC analysis in the estimation of severe COZ, when SII cut-off value was >1519.14, the sensitivity was 67.9% and the specificity was 63.7% (AUC: 0.708, p<0.001). When SIRI cut-off value was >4.955, the sensitivity was 60% and the specificity was 78.5% (AUC:0.746, p<0.001). According to logistic regression analysis, NLR, PLR, MLR, SII, SIRI and AISI values were independent predictors of severity of COZ. Conclusion: SII, SIRI, AISI, NLR, PLR and MLR levels measured at admission in COZ patients are associated with the severity of poisoning. These markers can be used to predict the severity of inflammation.

Anahtar Kelimeler

• carbon monoxide poisoning;
• systemic immune-inflammation index;
• systemic inflammatory response index;
• emergency department
• Karbonmonosit zehirlenmesi
• sistemik immün inflamasyon indeksi;
• sistemik inflamatuar cevap indeksi;
• acil servis

Acil Serviste SII ve SIRI değerlerinin CO Zehirlenmesinin Şiddetini Tahmin Etmedeki Rolü

Öz

Amaç: Bu çalışmada, başvuru sırasında ölçülen hematolojik parametrelere dayalı indeklerin karbonmonoksit zehirlenmesinin (COZ) şiddetini tahmin etmedeki rolü araştırıldı. Gereç ve yöntem: 2018 ve 2022 tarihleri arasında bir Eğitim ve Araştırma hastanesi acil servisinde COZ tanısı konulan toplam 183 hasta retrospektif olarak incelendi. Hastaların klinik şiddetini belirlemek için COHb ve laktat düzeyleri kullanıldı. Hastalar hafif-orta karbon monoksit zehirlenmesi (hafif-orta COZ) ve ciddi karbon monoksit zehirlenmesi (ciddi COZ) olarak iki gruba ayrıldı. Sistemik immün inflamasyon indeksi (SII), sistemik inflamatuar cevap indeksi (SIRI) ve sistemik inflamasyon toplam indeksi (AISI), nötrofil/lenfosit oranı (NLR), platelet/lenfosit oranı (PLR) ve monosit/lenfosit oranı (MLR) bu iki hasta grubu arasında karşılaştırıldı. Bulgular: SII, SIRI, AISI, NLR, PLR ve MLR açısından her iki grup arasında önemli farklılık vardı (p<0.001, hepsi için). Ciddi COZ tahmininde ROC analizine göre, SII cut-off değeri >1519.14 iken, sensitivite %67.9 ve spesifite %63.7 idi (AUC: 0.708, p<0.001). SIRI cut-off değeri >4.955 iken, sensitivite %60 ve spesifite %78.5 olarak bulundu (AUC:0.746, p<0.001). Lojistik regresyon analizine göre, COZ’un ciddiyet tahmininde NLR, PLR, MLR, SII, SIRI ve AISI değerleri bağımsız öngörücülerdi. Sonuç: COZ hastalarında başvuru anında ölçülen SII, SIRI, AISI, NLR, PLR ve MLR seviyeleri zehirlenmenin ciddiyeti ile ilişkilidir ve inflamasyonun şiddetini öngörmede kullanılabilecek belirteçlerdir.

Anahtar Kelimeler

• Karbonmonosit zehirlenmesi
• sistemik immün inflamasyon indeksi;
• sistemik inflamatuar cevap indeksi;
• acil servis

Kaynakça

1. Shahin MM, Allam AA, Elkholy RA, Lashin HI. Hematological parameters as early predictors of delayed neurological sequelae in acute carbon monoxide poisoning. Ain Shams Journal of Forensic Medicine and Clinical Toxicology. 2020;35:61-72. doi: 10.21608/AJFM.2020.104446
2. Bağci Z, Arslan A, Neşelioğlu S. Pediatric Carbon Monoxide Poisoning: Effects of Hyperbaric Oxygen Therapy on Thiol/Disulfide Balance. Pediatr Emerg Care. 2022;38(3):104-107. doi: 10.1097/PEC.0000000000002619.
3. Moon JM, Chun BJ, Cho YS. The predictive value of scores based on peripheral complete blood cell count for long-term neurological outcome in acute carbon monoxide intoxication. Basic Clin Pharmacol Toxicol. 2019;124:500-10. doi: 10.1111/bcpt.13157.
4. Çelik B, Nalçacıoğlu H, Özçatal M, Altuner Torun Y. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg. 2019;25:222-228. doi: 10.5505/tjtes.2018.06709.
5. Ertekin B, Yortanlı M, Özelbaykal O, Doğru A, Girişgin AS, Acar T. The Relationship between Routine Blood Parameters and the Prognosis of COVID-19 Patients in the Emergency Department. Emerg Med Int. 2021;2021:7489675. doi: 10.1155/2021/7489675.
6. Smith TL, Weyrich AS. Platelets as central mediators of systemic inflammatory responses. Thromb Res. 2011;127:391–4. doi: 10.1016/j.thromres.2010.10.013.
7. Halaseh SA, Kostalas M, Kopec CA, Nimer A. Single-Center Retrospective Analysis of Neutrophil, Monocyte, and Platelet to Lymphocyte Ratios as Predictors of Complicated Appendicitis. Cureus. 2022;14(9):e29177. doi: 10.7759/cureus.29177.
8. Bağcı Z, Arslan A, Arslan D. The Value of Neutrophil:Lymphocyte Ratio and Platelet:Lymphocyte Ratio in Predicting Clinical Severity in Children with Carbon Monoxide Poisoning. Indian J Pediatr. 2021;88(11):1121-1126. doi: 10.1007/s12098-021-03704-w.

9. Dundar ZD, Ergin M, Koylu R, Ozer R, Cander B, Gunaydin YK. Neutrophil-lymphocyte ratio in patients with pesticide poisoning. J Emerg Med. 2014;47:286-93. doi: 10.1016/j.jemermed.2014.01.034.
10. Ertekin B, Koçak S, Acar T, Öztürk E, Demir L.S. Role of whole blood markers in carbon monoxide poisoning. Cukurova Med J. 2019;44(Suppl 1):197-201. doi: 10.17826/cumj.553701.
11. Cakcak İE, Türkyılmaz Z, Demirel T. Relationship between SIRI, SII values, and Alvarado score with complications of acute appendicitis during the COVID-19 pandemic. Ulus Travma Acil Cerrahi Derg. 2022;28(6):751-755. doi: 10.14744/tjtes.2021.94580.
12. Zinellu A, Collu C, Nasser M, Paliogiannis P, Mellino S, Zinellu E, et al. The Aggregate Index of Systemic Inflammation (AISI): A Novel Prognostic Biomarker in Idiopathic Pulmonary Fibrosis. J Clin Med. 2021;10(18):4134. doi: 10.3390/jcm10184134.
13. Mannaioni PF, Vannacci A, Masini E. Carbon monoxide: the bad and the good side of the coin, from neuronal death to anti-inflammatory activity. Inflamm Res. 2006;55(7):261-73. doi: 10.1007/s00011-006-0084-y.
14. Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, et al. Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. Am J Respir Crit Care Med. 2017;195(5):596-606. doi: 10.1164/rccm.201606-1275CI.
15. Coşkun A, Eren FA, Eren ŞH, Korkmaz İ. Predicting of neuropsychosis in carbon monoxide poisoning according to the plasma troponin, COHb, RDW and MPV levels Neuropsychoses in carbon monoxide poisoning. Am J Emerg Med. 2019;37(7):1254-1259. doi: 10.1016/j.ajem.2018.09.017.
16. Vezzani G, Socias S, Bianco A, Paoli A, Caberti L, Antadori L, et al. Inflammatory mediators and other biomarkers in co-intoxicated patients after hyperbaric oxygen therapy (Hbo2). Acta Medica Mediterranea. 2016;32:189. doi: 10.19193/0393-6384_2016_1_29.
17. Gozubuyuk AA, Dag H, Kacar A, Karakurt Y, Arica V. Epidemiology, pathophysiology, clinical evaluation, and treatment of carbon monoxide poisoning in child, infant, and fetüs. North Clin Istanb. 2017;4(1):100-107. doi: 10.14744/nci.2017.49368.
18. Emektar E, Dağar S, Çorbacıoğlu ŞK, Tandoğan M, Katırcı Y, Çevik Y. Evaluatıon Of Systemıc Inflammatory Parameters In Carbon Monoxıde Poısonıng. KÜ Tıp Fak Derg. 2019;21(1):1-8. doi: 10.24938/kutfd.429395.
19. Karabacak M, Turkdogan KA, Coskun A, Akpinar O, Duman A, Kapci M, et al. Detection of neutrophil–lymphocyte ratio as a serum marker associated with inflammations by acute carbon monoxide poisoning. Journal of Acute Disease. 2015;4(4):305-308. doi: 10.1016/j.joad.2015.06.009.
20. Thom SR, Bhopale VM, Han ST, Clark JM, Hardy KR. Intravascular neutrophil activation due to carbonmonoxide poisoning. Am J Respir Crit Care Med. 2006;174(11):1239–48. doi: 10.1164/rccm.200604-557OC.
21. Thom SR. Leukocytes in carbon monoxide-mediated brain oxidative injury. Toxicol Appl Pharmacol. 1993;123(2):234-47. doi: 10.1006/taap.1993.1242.
22. Gao H, Sun L, Wu H, Chen J, Cheng Y, Zhang Y. The predictive value of neutrophil–lymphocyte ratio at presentation for delayed neurological sequelae in carbon monoxide poisoning. Inhal Toxicol. 2021;33(4):121-127. doi: 10.1080/08958378.2021.1887410.
23. Güden M, Karaman ST, Basat O. Evaluation of the relationship between the level of addiction and exhaled carbon monoxide levels with neutrophil-tolymphocyte and platelet-to-lymphocyte ratios in smokers. Tob Induc Dis. 2022;20:52. doi: 10.18332/tid/149227.
24. Moon JM, Chun BJ, Cho YS, Lee SM. Diagnostic Value of Parameters Related to White Blood Cell Counts for Troponin I Elevation in CO Poisoning. Cardiovasc Toxicol. 2019;19(4):334-343. doi: 10.1007/s12012-018-09501-w.
25. Akin F, Yorulmaz A, Yazar A, Ture E, Erdemir E, Ertekin B, et al. Prognostic Importance of Thrombocyte Indices in Children with Carbon Monoxide Poisoning. Selcuk Med J. 2019;35(3): 180-187. doi: 10.30733/std.2019.01119.
26. Karabacak M, Varol E, Türkdogan KA, Duman A, Akpinar O, Karabacak P. Mean Platelet Volume in Patients With Carbon Monoxide Poisoning. Angiology. 2014;65(3):252-6. doi: 10.1177/0003319713497422.
27. Karaman K, Armagan HH. Predictive value of platelet lymphocyte ratio in carbon monoxide poisoning. Ann Med Res. 2021;28(9):1754-7. doi: 10.5455/annalsmedres.2020.12.1175.
28. Tanacan E, Dincer D, Erdogan FG, Gurler A. A cutoff value for the Systemic Immune-Inflammation Index in determining activity of Behçet disease. Clin Exp Dermatol. 2021;46(2):286-91. doi: 10.1111/ced.14432.
29. Erdogan T. Role of systemic immune-inflammation index in asthma and NSAID-exacerbated respiratory disease. Clin Respir J. 2021;15(4):400-5. doi: 10.1111/crj.13314.
30. Wang X, Ni Q, Wang J, Wu S, Chen P, Xing D. Systemic Inflammation Response Index Is a Promising Prognostic Marker in Elderly Patients With Heart Failure: A Retrospective Cohort Study. Front Cardiovasc Med. 2022;9:871031. doi: 10.3389/fcvm.2022.871031.
31. Zhang Y, Xing Z, Zhou K, Jiang S. The predictive role of systemic inflammation response index (SIRI) in the prognosis of stroke patients. Clin Interv Aging. 2021;16:1997–2007. doi: 10.2147/CIA.S339221.
32. Fois AG, Paliogiannis P, Scano V, Cau S, Babudieri S, Perra R, et al. The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients. Molecules. 2020;25(23):5725. doi: 10.3390/molecules25235725.
33. Biyik M, Biyik Z, Asil M, Keskin M. Systemic Inflammation Response Index and Systemic Immune Inflammation Index Are Associated with Clinical Outcomes in Patients with Acute Pancreatitis? J Invest Surg. 2022;35(8):1613-1620. doi: 10.1080/08941939.2022.2084187.