Can Neutrophil Lymphocyte Ratio Predict the Thrombus Localization in Patient with Acute Pulmonary Embolism?

Öz

Objective: Acute pulmonary embolism (PE), often seen in the emergency department, is a life threatening disease. The aim of this study was to determine the associations of thrombus localization with white blood cell (WBC) subtypes, including the neutrophil lymphocyte ratio (NLR).

Material-Method:We retrospectively analysed the data of patients who were diagnosed with acute PE  admitted from 1 January 2017 to 30 June 2018. The accompanying disorders, risk factors, clinical, laboratory and radiological findings were retrospectively evaluated.

Results: The mean age of the patients was 63.40±17.11 years and 119 (53.1%) patients were female. The most frequent complaint was dyspnea (62.5%), most frequent coexisting disease was chronic obstructive pulmonary disease (30.4%), immobilization (21.4%) was the most frequently seen risk factor. Thrombus was mostly in bilateral pulmonary artery (PA) (45.9%). In 46.4% of the patients, the thrombus was localized to the lobar PA. The mean WBC, neutrophil,  platelet distribution width  and  NLR in the patients with thrombus in the main PA were higher than those in the patients with thrombus in more distal PA branches. The parameter with the highest sensitivity and specificity was found as NLR.

Conclusions: High NLR  is independently associated with proximally localized thrombus in patients with PE.

Anahtar Kelimeler

• Pulmonary embolism,neutrophil lymphocyte ratio

Can Neutrophil Lymphocyte Ratio Predict the Thrombus Localization in Patient with Acute Pulmonary Embolism?

Öz

Amaç: Acil serviste sıklıkla görülen akut pulmoner emboli (PE) hayatı tehdit edici bir hastalıktır. Bu çalışmanın amacı, nötrofil lenfosit oranı (NLR) dahil olmak üzere trombüs lokalizasyonunun beyaz kan hücresi (WBC) alt tipleri ile ilişkilerini belirlemektir.

Materyal-Metot: 1 Ocak 2017 - 30 Haziran 2018 tarihleri ​​arasında başvuran akut PE tanısı alan hastaların verilerini retrospektif olarak inceledik. Eşlik eden hastalıklar, risk faktörleri, klinik, laboratuvar ve radyolojik bulgular değerlendirildi.

Bulgular: Hastaların yaş ortalaması 63,40 ± 17,11 idi  ve hastların 119'u (% 53,1) kadındı. En sık görülen şikayet dispne (% 62,5), en sık eşlik eden hastalık kronik obstrüktif akciğer hastalığı (% 30,4) ve immobilizasyon (% 21,4) en sık görülen risk faktörü idi. Trombüs çoğunlukla bilateral pulmoner arterde (PA) (% 45,9) idi. Hastaların % 46,4'ünde trombüs, lober PA'da lokalize edildi. Ana PA'da trombüs olan hastalarda ortalama WBC, nötrofil, trombosit dağılım genişliği ve NLR, daha distal PA dallarında trombüs olanlara göre daha yüksekti. Hassasiyeti ve özgüllüğü en yüksek olan parametre NLR olarak bulundu.

Sonuç: Yüksek NLR, PE'li hastalarda proksimal lokalize trombüs ile bağımsız olarak ilişkilidir.

Anahtar Kelimeler

• Pulmoner emboli,nötrofil lenfosit oranı

Kaynakça

1. 1. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008; 29(18): 2276-315.
2. 2. Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. The Lancet. 2012; 379(9828): 1835-46.
3. 3. Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM. Epidemiology, pathophysiology, and natural history of pulmonary embolism. Semin Intervent Radiol. 2018; 35(2): 92-8.
4. 4. Korkmaz O, Yucel H, Zorlu A, Berkan O, Kaya H, Goksel S, et al. Elevated gamma glutamyl transferase levels are associated with the location of acute pulmonary embolism. Cross-sectional evaluation in hospital setting. Sao Paulo Med J. 2015; 133(6): 488-94.
5. 5. Ghanima W, Abdelnoor M, Holmen L, Nielssen B, Sandset P. The association between the proximal extension of the clot and the severity of pulmonary embolism (PE): a proposal for a new radiological score for PE. J Intern Med. 2007; 261(1): 74-81.
6. 6. Riva N, Donadini MP, Ageno W. Epidemiology and pathophysiology of venous thromboembolism: similarities with atherothrombosis and the role of inflammation. Thromb Haemost. 2015; 113(6): 1176-83.
7. 7. 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.
8. 8. Bedel C. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis. Turk J Clin Lab.2018; 9(4): 266-71.

9. 9. Soylu K, Gedikli Ö, Ekşi A, Avcıoğlu Y, Soylu A, Yüksel S, et al. Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism. Arch Med Sci. 2016; 12(1): 95.
10. 10. Kayrak M, Erdoğan Hİ, Solak Y, Akilli H, Gül EE, Yildirim O, et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a restrospective study. Heart Lung Circ. 2014; 23(1): 56-62.
11. 11. Bedel C, Yolcu S, Albayrak L, Çetin NG, Tomruk Ö. Investigation of a Possible Relationship Between Clinical and Laboratory Values of Acute Pulmonary Embolism and Thrombus Location. Kırıkkale Med J. 2017; 20(1): 41-50.
12. 12. Gülcü A, Akkoclu A, Yilmaz E, Öztürk B, Osma E, Sengün B. The comparison of the clinical probability with computed tomography pulmonary angiography findings for the pulmonary embolism (PE) diagnosis. Tuberk Toraks. 2007; 55(2): 174-81.
13. 13. Oser RF, Zuckerman DA, Gutierrez FR, Brink JA. Anatomic distribution of pulmonary emboli at pulmonary angiography: implications for cross-sectional imaging. Radiology. 1996; 199(1): 31-5.
14. 14. Sunnetcioglu A, Sertogullarindan B, Ozbay B, Asker S, Ekin S. Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism. Clinics (Sao Paulo). 2015; 70(6): 441-5.
15. 15. Şimşek A, Türkkan Ö, Melek K, Eyüboğlu FÖ. Assessment of Patients with Pulmonary Thromboembolism (PTE) Diagnosed in Our Clinic: 5 Years Experience. Tur Toraks Der. 2010; 11: 149-54.
16. 16. Duru S, Ergün R, Dilli A, Kaplan T, Kaplan B, Ardıç S. Pulmoner embolide klinik, laboratuvar ve bilgisayarlı tomografi pulmoner anjiyografi sonuçları: 205 hastanın retrospektif değerlendirmesi. Anadolu Kardiyol Derg. 2012; 12: 142-9.
17. 17. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 353(9162): 1386-9.
18. 18. Ghanima W, Abdelnoor M, Holmen L, Nielssen B, Ross S, Sandset P. D-dimer level is associated with the extent of pulmonary embolism. Thromb Res. 2007; 120(2): 281-8.