Assessing the Diagnostic Value of the Red Blood Cell Distribution-To- Platelet Ratio in Acute Leg Embolism Requiring Emergent Surgical Intervention

Year 2023, , 608 - 613, 25.10.2023

Ömer Faruk Çiçek , Ataberk Atalay Recep Çelik Mehmet Özdil Fatih Boncuk Adeviye Ünlü Nisa Nur Babadağ Şükran Aybike Ayyıldız , Farid Salehi Emre Coşkuner Elif Yıldırım Zülal Ceylan

https://doi.org/10.54005/geneltip.1354789

Abstract

Background: The objective of this study was to evaluate the significance of the red blood cell distribution-to-platelet ratio (RPR) as a diagnostic indicator, derived from the initial hemogram measurements of patients who underwent emergent surgical treatment for acute leg embolism, by comparing it to a control group of healthy individuals.
Methods: The study included 48 patients who underwent femoral embolectomy for acute lower limb ischemia, while an additional 49 individuals were enrolled as a control group. Demographic, clinical, and laboratory data were compared between the two groups. Using the receiver operating characteristic curve to determine the RPR cutoff value, the area under the curve, sensitivity, and specificity were calculated.
Results: The age and gender distribution of both groups were comparable. The admission RPR values of patients who underwent surgery for acute embolism were statistically higher compared to healthy individuals (0.0677 (IQR: 0.0547-0.0803) vs. 0.0504 (IQR: 0.0441-0.0572), p<0.001). The area under the curve for acute extremity embolism was determined to be 0.832, and the RPR cut-off value of 0.566 was found to predict acute extremity embolism with a sensitivity of 72.9% and a specificity of 73.5% (p<0.001).
Conclusion: Our findings provide preliminary evidence that RPR can be used as a novel diagnostic indicator for acute leg embolism. Rather than being used diagnostically alone, it is thought that a comprehensive evaluation of this ratio, when combined with the patient's medical history and other clinical findings, has the potential to expedite diagnostic process, particularly in healthcare settings with limited access to imaging resources.

Keywords

acute leg ischemia, hemogram, platelet, red blood cell distribution

Acil Cerrahi Müdahale Gerektiren Akut Bacak Embolisinde Kırmızı Kan Hücresi Dağılımı-Trombosit Oranının Tanısal Değerinin Değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı, akut bacak embolisi nedeniyle acil cerrahi tedavi uygulanan hastaların başvuru hemogram ölçümlerinden elde edilen kırmızı kan hücresi dağılımı-trombosit oranının (RPR) tanısal bir gösterge olarak önemini, sağlıklı bireylerden oluşan bir kontrol grubuyla karşılaştırarak değerlendirmektir.
Yöntemler: Çalışmaya akut alt ekstremite iskemisi nedeniyle femoral embolektomi yapılan 48 hasta dahil edilirken, 49 kişi de kontrol grubu olarak kaydedilmiştir. Demografik, klinik ve laboratuvar verileri iki grup arasında karşılaştırılmıştır. RPR kesme değerini belirlemek için receiver operating characteristic eğrisi kullanılarak eğri altında kalan alan, duyarlılık ve özgüllük hesaplanmıştır.
Bulgular: Her iki grubun yaş ve cinsiyet dağılımı benzerdi. Akut emboli nedeniyle ameliyat edilen hastaların başvuru RPR değerleri sağlıklı bireylere kıyasla istatistiksel olarak daha yüksekti (0,0677 (IQR: 0,0547-0,0803) vs. 0,0504 (IQR: 0,0441-0,0572), p<0,001). Akut ekstremite embolisi için eğri altında kalan alan 0,832 olarak belirlenmiş ve 0,566 RPR kesim değerinin akut ekstremite embolisini %72,9 duyarlılık ve %73,5 özgüllükle öngördüğü bulunmuştur (p<0,001).
Sonuç: Bulgularımız, RPR'nin akut bacak embolisi için yeni bir tanısal gösterge olarak kullanılabileceğine dair ön kanıtlar sunmaktadır. Bu oranın tek başına tanısal olarak kullanılmasından ziyade, hastanın tıbbi geçmişi ve diğer klinik bulgularla birleştirildiğinde kapsamlı bir değerlendirmesinin, özellikle görüntüleme kaynaklarına sınırlı erişimi olan sağlık hizmeti ortamlarında tanısal süreci hızlandırma potansiyeline sahip olduğu düşünülmektedir.

Keywords

akut bacak iskemisi, hemogram, kırmızı kan hücresi dağılımı, trombosit

References

• Becquemin JP, Kovarsky S. Arterial emboli of the lower limbs: analysis of risk factors for mortality and amputation. Association Universitaire de Recherche en Chirurgie. Ann Vasc Surg 1995;9 Suppl:S32-S38.
• Hu HD, Chang Q, Chen Z, Liu C, Ren YY, Cai YC, et al. Management and prognosis of acute arterial embolism: a multivariable analysis of 346 patients. Zhonghua Yi Xue Za Zhi 2011;91:2923-2926.
• Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997;26:517-538.
• Karapolat S, Dag O, Abanoz M, Aslan M. Arterial Embolectomy: A Retrospective Evaluation of 730 Cases over 20 Years. Surg Today 2006;36(5):416-419.
• Dentali F, Nigro O, Squizzato A, Gianni M, Zuretti F, Grandi AM, et al. Impact of neutrophils to lymphocytes ratio on major clinical outcomes in patients with acute coronary syndromes: A systematic review and meta-analysis of the literature. Int J Cardiol 2018;266:31-37.
• Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2015;52(2):86-105.
• Liu J, Huang X, Yue S, Wang J, Ye E, Huang J, et al. Association of Red Cell Distribution Width-to-Platelet Ratio and Mortality in Patients with Sepsis. Mediators Inflamm 2022;2022:4915887.
• Vazquez-Garza E, Jerjes-Sanchez C, Navarrete A, Joya-Harrison J, Rodriguez D. Venous thromboembolism: thrombosis, inflammation, and immunothrombosis for clinicians. J Thromb Thrombolysis 2017;44(3):377-385.
• Chen B, Ye B, Zhang J, Ying L, Chen Y. RDW to platelet ratio: a novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B. PLoS One 2013;8(7):e68780.
• Kubat E, Erol G, Akyol FB, Karabacak K, Kadan M, Dogancı S, et al. Comparison of embolectomy outcomes for acute lower limb ischemia between patients aged ≥80 years and <80 years. Turk J Vasc Surg 2020;29(2):84-89.
• Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009;133(4):628-632.
• Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009;169(5):515-523.
• Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011;17(1):47-58.
• Cil H, Yavuz C, Islamoglu Y, Tekbas EÖ, Demirtas S, Atilgan ZA, et al. Platelet count and mean platelet volume in patients with in-hospital deep venous thrombosis. Clin Appl Thromb Hemost 2012;18:650-653.
• Akbal E, Demirci S, Koçak E, Köklü S, Başar O, Tuna Y. Alterations of platelet function and coagulation parameters during acute pancreatitis. Blood Coagul Fibrinolysis 2013;24(3):243–246.
• Xi Y, Bai Y. Diagnostic value of red blood cell distribution width, platelet distribution width, and red blood cell distribution width to platelet ratio in children with hemophagocytic lymphohistiocytosis. J Clin Lab Anal 2021;35(9):e23909.
• Wu J, Huang L, He H, Zhao Y, Niu D, Lyu J. Red Cell Distribution Width to Platelet Ratio Is Associated with Increasing In-Hospital Mortality in Critically Ill Patients with Acute Kidney Injury. Dis Markers 2022;2022:4802702.
• Dervišević A, Muhić A, Začiragić A, Fajkić A, Dervišević L, Hasanbegović I, et al. Red blood cell distribution width-to-platelet ratio inversely correlates with indicators of disease activity status in rheumatoid arthritis patients. Rom J Intern Med 2021;59(2):180-186.
• Cetinkaya E, Senol K, Saylam B, Tez M. Red cell distribution width to platelet ratio: new and promising prognostic marker in acute pancreatitis. World J Gastroenterol 2014;20(39):14450-14454.
• Cocoi AF, Pop D, Cocoi M, Serban AM, Vida-Simiti LA. Involvement of inflammatory markers in pathogenesis of venous thromboembolism. Rev Rom Med Lab 2017;25(3):227-236.
• Qiu L, Chen C, Li SJ, Wang C, Guo F, Peszel A, et al. Prognostic values of red blood cell distribution width, platelet count, and red cell distribution width-to-platelet ratio for severe burn injury. Sci Rep 2017;7(1):13720.
• Jiang M, Shen J, Muhammad B, Geng D. Red blood cell distribution width to platelet ratio predicts early neurological deterioration in acute ischemic stroke patients receiving intravenous thrombolysis. J Stroke Cerebrovasc Dis 2023;32(7):107146.
• Arafa O, Tabl M, Elnagar A, Saleh M. Red cell distribution width to platelet ratio as a predictor of no-reflow phenomenon in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Benha J App Sci 2021;6(4):305-310.