Venöz Tromboembolizmde Enflamatuar Biyobelirteçler: Proksimal ve Distal DVT Alt Tiplerini Ayırt Etme ve Pulmoner Emboli Riskini Değerlendirme

Öz

Özet Arka plan: Derin ven trombozu (DVT), dünya çapında morbidite ve mortalitenin önemli bir nedenidir. Proksimal DVT, pulmoner emboli (PE) riski daha yüksektir; ancak, proksimal ve distal DVT'nin farklı inflamatuar profilleri hala belirsizdir. Amaçlar: Bu çalışmanın amacı, yeni nesil sistemik inflamatuar indekslerin (SII, SIRI, AISI, NLR, PLR, MLR) ve geleneksel biyobelirteçlerin (CRP, D-dimer) dağılımını karşılaştırmak ve bu parametrelerin PE'yi öngörmedeki tanısal ve prognostik değerini değerlendirmektir. Ek olarak, gruplar arasındaki demografik ve etiyolojik farklılıkların sistemik inflamatuar yanıt üzerindeki etkileri analiz edildi ve bulgular, bağımsız prediktif belirteçleri tanımlamak için lojistik regresyon modelleri ve ROC eğrisi metrikleri kullanılarak doğrulandı. Yöntemler: Bu retrospektif vaka kontrol çalışmasında, alt ekstremite DVT şüphesi olan 750 hasta (2019–2025) proksimal DVT (n=250), distal DVT (n=250) ve Doppler negatif kontrol (n=250) gruplarına sınıflandırılmıştır. Enflamatuar indeksler (SII, SIRI, AISI, NLR, PLR ve MLR), konvansiyonel biyobelirteçler (CRP ve D-dimer) ve biyokimyasal parametreler değerlendirildi. Grup farklılıkları ANOVA/Kruskal–Wallis kullanılarak test edilirken, proksimal DVT ve PE'nin öngörücüleri belirlemek için lojistik regresyon ve ROC analizleri kullanıldı. Sonuçlar: Proksimal DVT'li hastalar, distal DVT'li hastalar ve kontrollere göre anlamlı olarak daha yüksek inflamatuar belirteçler, CRP ve D-dimer düzeylerine sahipti (tümü p < 0,001). Distal DVT, yüksek SIRI (p<0,001) dışında kontrollere göre anlamlı bir fark göstermedi. Proksimal DVT ayrıca daha yüksek kreatinin ve LDH (laktat dehidrojenaz) ve daha düşük sodyum düzeyleri ile ilişkiliydi (tümü p<0,001). Çok değişkenli regresyonda, NLR (OR 1,24, p=0,042) ve D-dimer (OR 1,43, p<0,001) proksimal DVT'yi bağımsız olarak öngördü. PE için, D-dimer en yüksek doğruluğu gösterdi (AUC 0,827, duyarlılık %95,6, özgüllük %61,8), NLR ise orta düzeyde ayırt edici güç gösterdi (AUC 0,669).

Anahtar Kelimeler

• deriven trombozu
• pulmoner emboli
• inflamatuar indeksler
• D-dimer
• NLR

Inflammatory Biomarkers in Venous Thromboembolism: Distinguishing Proximal and Distal DVT Subtypes and Assessing Pulmonary Embolism Risk

Öz

Abstract Background: Deep vein thrombosis (DVT) is a major cause of morbidity and mortality. Proximal DVT carries a higher risk of pulmonary embolism (PE), but the distinct inflammatory profiles of proximal and distal DVT remain unclear. Objectives: This study aims to compare the distribution of next-generation systemic inflammatory indices (SII, SIRI, AISI, NLR, PLR, MLR) and conventional biomarkers (CRP, D-dimer) and to evaluate the diagnostic and prognostic value of these parameters in predicting PE. Additionally, the effects of demographic and etiological differences between groups on the systemic inflammatory response were analyzed; the findings were validated using logistic regression models and ROC curve metrics to identify independent predictive markers. Methods: In this retrospective case-control study, 750 patients (2019–2025) with suspected lower extremity DVT were classified into proximal DVT (n=250), distal DVT (n=250), and Doppler-negative control group (n=250). Inflammatory indices [SII, SIRI, AISI, NLR, PLR, MLR], conventional biomarkers (CRP, D-dimer), and biochemical parameters were evaluated. Group differences were tested using ANOVA/Kruskal–Wallis, while logistic regression and ROC analyses identified predictors of proximal DVT and PE. Results: Patients with proximal DVT had significantly higher inflammatory indices, CRP, and D-dimer values compared to those with distal DVT and controls (all p<0.001). Distal DVT showed no significant difference from controls except for high SIRI (p<0.001). Proximal DVT was also associated with higher creatinine and LDH (Lactate Dehydrogenase) and lower sodium levels (all p<0.001). In multivariate regression, NLR (aOR 1.24, p=0.042) and D-dimer (aOR 1.43, p<0.001) independently predicted proximal DVT. For PE, D-dimer showed the highest accuracy (AUC 0.827, sensitivity 95.6%, specificity 61.8%), while NLR provided moderate discriminatory power (AUC 0.669).

Anahtar Kelimeler

• deep vein thrombosis
• pulmonary embolism
• inflammatory indices
• D-dimer
• NLR

Kaynakça

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