The Determınant Effect of Novel Inflammatory Markers on Pressure Ulcer Formatıon and Progressıon of Its Stages

Öz

In this retrospective case-control study, the relationship between new inflammatory markers and the development and stage progression of pressure ulcers (PUs) was evaluated in 1246 patients followed up for pressure ulcers. Participants' sociodemographic characteristics, presence and stages of pressure ulcers, and neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and mean platelet volume (MPV) levels were examined. A significant correlation was found between pressure ulcer development and age, immobility, and immobilization duration; in addition, high CRP, low hemoglobin, high neutrophil count, and high NLR and PLR values were found to be associated with pressure ulcer development. A significant relationship was found between the stage of pressure ulcer and a body mass index above 30, immobility, and duration of immobility. It was found that, among the laboratory parameters, elevated CRP levels, elevated neutrophil and platelet counts, and a low MPV were significantly associated with the stage of pressure ulcers.The findings suggest that NLR and PLR may be potentially useful inflammatory markers in predicting ulcer development in patients at risk for pressure ulcers, while MPV may be useful in assessing stage progression in patients with existing pressure ulcers.

Anahtar Kelimeler

• immobility
• MPV
• NLR
• PLR
• Pressure Ulcer

Destekleyen Kurum

None

Proje Numarası

None

Etik Beyan

Ethical committee approval has been obtained from the Non-Interventional Ethics Committee of Kütahya Health Sciences University, dated 30 May 2023 and numbered 2023/07-28.

Teşekkür

None

Yeni İnflamatuvar Belirteçlerin Basınç Ülseri Oluşumu ve Evrelerinin İlerlemesi Üzerindeki Belirleyici Etkisi

Öz

Bu retrospektif vaka kontrol çalışmasında, basınç ülseri (BÜ) nedeniyle takip edilen 1246 hastada yeni inflamatuar belirteçler ile basınç ülseri gelişimi ve evre progresyonu arasındaki ilişki değerlendirildi. Katılımcıların sosyodemografik özellikleri, basınç ülseri varlığı ve evreleri ile nötrofil/lenfosit oranı (NLR), trombosit/lenfosit oranı (PLR) ve ortalama trombosit hacmi (MPV) düzeyleri incelendi. Basınç ülseri gelişimi ile yaş, hareketsizlik ve immobilizasyon süresi arasında anlamlı korelasyon saptandı; ayrıca yüksek CRP, düşük hemoglobin, yüksek nötrofil sayısı ile yüksek NLR ve PLR değerlerinin basınç ülseri gelişimiyle ilişkili olduğu görüldü. Basınç ülseri evresi ile vücut kitle indeksinin 30’un üzerinde olması, hareketsizlik ve hareketsiz kalma süresi arasında anlamlı ilişki bulundu. Laboratuvar parametrelerinden CRP yüksekliği, nötrofil ve trombosit yüksekliği ile MPV düşüklüğünün basınç ülseri evresi ile anlamlı bir ilişki gösterdiği belirlendi. Bulgular, NLR ve PLR’nin basınç ülseri riski taşıyan hastalarda ülser gelişimini öngörmede, MPV’nin ise basınç ülseri mevcut hastalarda evre progresyonunu değerlendirmede potansiyel olarak yararlı inflamatuar belirteçler olabileceğini düşündürmektedir.

Anahtar Kelimeler

• Basınç ülseri
• immobilite
• MPV
• NLR
• PLR

Destekleyen Kurum

yok

Proje Numarası

None

Etik Beyan

Kütahya Sağlık Bilimleri Üniversitesi Girişimşel Olmayan Etik Kurulundan 30.05.2023 tarih ve 2023/07-28 numaralı etik kurul izni alınmıştır.

Kaynakça

1. Adıyeke, E., & Adıyeke, L. (2020). Neutrophil to lymphocte ratio and mean platelet volume may predict the development of the pressure ulcers. Journal of Surgery and Medicine, 4(7), 578–581. https://doi.org/10.28982/josam.739227
2. Akboga, M. K., Canpolat, U., Balci, K. G., Akyel, A., Şen, F., Yayla, C., Çay, S., Aras, D., & Aydoğdu, S. (2016). Increased platelet-to-lymphocyte ratio is related to slow coronary flow. Angiology, 67(1), 21–26. https://doi.org/10.1177/0003319715585401
3. Akboga, M. K., Canpolat, U., Yüksel, M., et al. (2016). Platelet-to-lymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome: A single center large-scale study. Platelets, 27(2), 178–183. https://doi.org/10.3109/09537104.2015.1055943
4. Altunel, C. T., & Kartal, S. P. (2019). Dekübit ve bası ülserleri. In A. Akgül (Ed.), Gerontolojik/65+ deri ve sorunları (pp. 87–94). Türkiye Klinikleri.
5. Amir, Y., Lohrmann, C., Halfens, R. J. G., & Schols, J. M. G. A. (2017). Pressure ulcers in four Indonesian hospitals: Prevalence, patient characteristics, ulcer characteristics, prevention and treatment. International Wound Journal, 14(1), 184–193. https://doi.org/10.1111/iwj.12580
6. Capone, M., Giannarelli, D., Mallardo, D., et al. (2018). Baseline neutrophil-to-lymphocyte ratio (NLR) and derived NLR could predict overall survival in patients with advanced melanoma treated with nivolumab. Journal for ImmunoTherapy of Cancer, 6(1), 74. https://doi.org/10.1186/s40425-018-0383-9
7. Cunkus, N., Taşdemir Yiğitoğlu, G., & Akbaş, E. (2019). Ageing and social exclusion. Geriatrik Bilimler Dergisi (Journal of Geriatric Science), 2(2), 58–67.
8. Diakos, C. I., Charles, K. A., McMillan, D. C., & Clarke, S. J. (2014). Cancer-related inflammation and treatment effectiveness. The Lancet Oncology, 15. https://doi.org/10.1016/S1470-2045(14)70116-2

9. Diegelmann, R. F. (2003). Excessive neutrophils characterize chronic pressure ulcers. Wound Repair and Regeneration, 11(6), 490–495. https://doi.org/10.1046/j.1524-475X.2003.11604.x
10. Duchesne, G. A., Waller, J. L., Baer, S. L., et al. (2023). Pressure ulcer diagnosis is associated with increased mortality in patients with end-stage renal disease: A retrospective study. Life, 13(8), 1713. https://doi.org/10.3390/life13081713
11. Durmaz, A., & Yılmaz, M. (2023). Changes in hemoglobin, mean thrombocid volume and neutrophil-lymphocyte ratio in COVID-19 infection. Sakarya University Journal of Holistic Health, 6(1), 44–52. https://doi.org/10.54803/sauhsd.1138532
12. Gasparyan, A. Y., Ayvazyan, L., Mukanova, U., et al. (2019). The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Annals of Laboratory Medicine, 39(4), 345–357. https://doi.org/10.3343/alm.2019.39.4.345
13. Gong, Z., Xin, R., Li, L., et al. (2022). Platelet-to-lymphocyte ratio associated with the clinicopathological features and prognostic value of breast cancer: A meta-analysis. International Journal of Biological Markers, 37(4), 339–348. https://doi.org/10.1177/17246008221116321
14. Gosain, A., & DiPietro, L. A. (2004). Aging and wound healing. World Journal of Surgery, 28(3), 321–326. https://doi.org/10.1007/s00268-003-7398-z
15. Gül, Y. G., Köprülü, A. Ş., Haspolat, A., Uzman, S., Toptaş, M., & Kurtuluş, İ. (2016). Is Braden Scale reliable and sufficient to evaluate the risk of pressure ulcer occurrence in level 3 intensive care unit patients. Journal of Academic Research in Medicine, 6(2), https://doi.org/98-104. 0.5152/jarem.2016.9699
16. Huang, Z., Fu, Z., Huang, W., & Huang, K. (2020). Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. American Journal of Emergency Medicine, 38(3), 641–647. https://doi.org/10.1016/j.ajem.2019.10.055
17. Hyun, S., Li, X., Vermillion, B., et al. (2014). Body mass index and pressure ulcers: Improved predictability of pressure ulcers in intensive care patients. American Journal of Critical Care, 23(6), 494–501. https://doi.org/10.4037/ajcc2014543
18. Jenkins, M. L., & O’Neal, E. (2010). Pressure ulcer prevalence and incidence in acute care. Advances in Skin & Wound Care, 23(12), 556–559. https://doi.org/10.1097/01.ASW.0000386075.92785.a0
19. Kaya, H., Ertaş, F., İslamoğlu, Y., et al. (2012). Association between neutrophil-to-lymphocyte ratio and severity of coronary artery disease. Clinical and Applied Thrombosis/Hemostasis, 20(1), 50–54.
20. Kıraner, E., Terzi, B., & Ekinci, A. (2016). Yoğun bakım ünitemizdeki basınç yarası insidansı. Journal of Intensive Care Nursing, 20(2).
21. Korniluk, A., Koper-Lenkiewicz, O. M., Kamińska, J., Kemona, H., & Dymicka-Piekarska, V. (2019). Mean platelet volume (MPV): New perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediators of Inflammation, 2019, 9213074. https://doi.org/10.1155/2019/9213074
22. Kurz, K., Lanser, L., Seifert, M., et al. (2020). Anaemia, iron status, and gender predict the outcome in patients with chronic heart failure. ESC Heart Failure, 7(4), e00705. https://doi.org/10.1002/ehf2.13005
23. Lattanzi, S., Brigo, F., Trinka, E., et al. (2019). Neutrophil-to-lymphocyte ratio in acute cerebral hemorrhage: A systematic review. Translational Stroke Research, 10(2), 137–145.
24. Lee S, Kim S, Jeon K, et al. Department of Materials Science and Engineering, Yonsei University, Seoul, Korea. Scientific Reports. 2023;13:5773.
25. Moore, Z. E., & Patton, D. (2019). Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews, 1(1). https://doi.org/10.1002/14651858.CD006471.pub4
26. Nassaji, M., Askari, Z., & Ghorbani, R. (2014). Cigarette smoking and risk of pressure ulcer in adult intensive care unit patients. International Journal of Nursing Practice, 20(4), 418–423. https://doi.org/10.1111/ijn.12138
27. Öztürk, İ., & Öztin, H. (2020). Dekübit ülser enfeksiyonunda etken ve antibiyotik direnç dağılımı. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 7(1), 1–5.
28. Spite, M., Norling, L. V., Summers, L., et al. (2009). Resolvin D2 is a potent regulator of leukocytes and controls microbial sepsis. Nature, 461, 1287–1291. https://doi.org/10.1038/nature08541
29. Tsai, Y. J., Lin, C. H., Yen, Y. H., et al. (2023). Risk factors for pressure ulcer recurrence following surgical reconstruction: A cross-sectional retrospective analysis. Frontiers in Surgery, 10, 970681. https://doi.org/10.3389/fsurg.2023.970681
30. Theilla, M., Schwartz, B., Zimra, Y., Shapiro, H., Anbar, R., Rabizadeh, E., Cohen, J., & Singer, P. (2012). Enteral n-3 fatty acids and micronutrients enhance percentage of positive neutrophil and lymphocyte adhesion molecules: a potential mediator of pressure ulcer healing in critically ill patients. The British journal of nutrition, 107(7), 1056–1061. https://doi.org/10.1017/S0007114511004004
31. Toplak, H., & Wascher, T. C. (1994). Influence of weight reduction on platelet volume: Different effects of a hypocaloric diet and a very low calorie diet. European Journal of Clinical Investigation, 24(11), 778–780. https://doi.org/10.1111/j.1365-2362.1994.tb01076.x
32. Vanderwee, K., Clark, M., Dealey, C., et al. (2007). Pressure ulcer prevalence in Europe: A pilot study. Journal of Evaluation in Clinical Practice, 13(2), 227–235.
33. VanGilder, C., MacFarlane, G., Meyer, S., & Lachenbruch, C. (2009). Body mass index, weight, and pressure ulcer prevalence: An analysis of the 2006–2007 International Pressure Ulcer Prevalence Surveys. Journal of Nursing Care Quality, 24(2), 127–135. https://doi.org/10.1097/NCQ.0b013e31819e785b
34. Yager, D. R., Zhang, L. Y., Liang, H. X., et al. (1996). Wound fluids from human pressure ulcers contain elevated matrix metalloproteinase levels and activity compared to surgical wound fluids. Journal of Investigative Dermatology, 107(5), 743–748. https://doi.org/10.1111/j.1523-1747.1996.tb00284.x