The Effects of NLR on the Diagnosis and Pharmacological Management of Brain Abscesses

Year 2021, Volume: 5 Issue: 3, 308 - 316, 31.12.2021

Tezcan Çalışkan , Ibrahim Yilmaz , Fatma Hacıoglu , Emel Ersoz Mustafa Doğan , Numan Karaarslan

https://doi.org/10.30565/medalanya.946066

Abstract

Aim: The present study aims to examine the effectiveness of the neutrophil-to-lymphocyte ratio in the treatment and diagnosis of patients with brain abscesses.

Method: In this retrospective study, radiological, neurological, and surgical data obtained from the medical records of healthy volunteers (n = 10) who presented to the hospital for check-ups and patients with brain abscesses who were treated (n = 10) were evaluated statistically. Alpha significance value was accepted as <0.05.

Results: Comparisons between groups revealed that the erythrocyte sedimentation rate, C-reactive protein, leukocyte, and neutrophil values were statistically significant (P <0.05) while lymphocyte value was not statistically significant (P >0.05). The preoperative neutrophil-to-lymphocyte ratio in cases diagnosed with brain abscesses showed statistical significance compared to that in the healthy volunteers (P <0.05) and the neutrophil-to-lymphocyte ratio increased 3.31-fold in the study group compared to the healthy volunteers.

Conclusion: A strong positive strong relationship between the neutrophil-to-lymphocyte ratio and abscess size (r = 0.662; P = 0.037) was observed. An increased neutrophil-to-lymphocyte ratio may serve as an early warning signal of brain abscesses.
Keywords: Antibiotic treatment; brain abscess; low-cost diagnosis method; magnetic resonance image; neutrophil-to-lymphocyte ratio.

Keywords

antibiyıtik tedavsi,, beyin absesi,, nötrofil-lenfosit oranı,

Supporting Institution

None

Project Number

-

Thanks

We, the authors, would like to thank Assist. Prof. M.D., Aysegul ISAL ARSLAN, Namik Kemal University School of Medicine, Department of Medical Pathology, who performed the histopathological assessment of the cases.

NLO’nun Beyin Apselerinin Tanı ve Farmakolojik Tedavi Yönetimine Etkileri

Abstract

Amaç: Bu makalede; beyin apsesi tanısı alan olgularda, nötrofil-lenfosit oranı (NLO)’nın, tanı ve tedavide önemli olup olmadığının incelenmesi amaçlandı.

Metod: Retrospektif dizayna sahip araştırmada, hastaneye kontrol için gelen sağlıklı bireyler (n=10) ile beyin apsesi olan ve tedavi edilen olgular (n=10)’dan elde edilen radyolojik, nörolojik ve cerrahi veriler istatistiksel olarak değerlendirmeye alındı. Alfa anlamlılık değeri <0,05 olarak kabul edildi.

Bulgular: Gruplar arası karşılaştırmalar sonucunda; eritrosit çökelme oranı (ESR), C-reaktif protein (CRP), lökosit (WBC) ve nötrofil (NEU) değerleri istatistiksel olarak anlamlı iken (P<0,05), lenfosit (LYMPH) değerinde istatistiksel olarak anlamlılık görülmedi (P>0,05). Sağlıklı bireylere oranla beyin apsesi tanısı alan olgulara ait preoperatif NLO değerlerinin istatistiksel olarak anlamlılık (P<0,05) gösterdiği ve NLO değerinin sağlıklı bireylere oranla yaklaşık 3,31 kat artış gösterdiği kaydedildi.

Sonuç: NLO oranı ile abse boyutu arasında (r=0,662; P=0,037) pozitif yönde kuvvetli ilişki bulunmaktadır. Artış gösteren NLO, beyin apsesinin tanısında erken uyarı sinyali olarak hizmet edebilir.

Keywords

Antibiyotik tedavisi, beyin apsesi, manyetik rezonans görüntüleme, düşük maliyetli tanı metodu, nötrofil-lenfosit oranı.

Project Number

-

References

• 1. Feraco P, Donner D, Gagliardo C, Leonardi I, Piccinini S, Del Poggio A, et al., Cerebral abscesses imaging: A practical approach. J Popul Ther Clin Pharmacol. 2020;27(3):e11-e24. doi: 10.15586/jptcp.v27i3.688.
• 2. LaPenna PA, Roos KL. Bacterial Infections of the Central Nervous System. Semin Neurol. 2019;39(3):334-42. doi: 10.1055/s-0039-1693159.
• 3. Yang TP, Chang WN, Lu CH, Lien CY. Klebsiella pneumoniae brain abscesses in an elderly patient without clinically evident neurological signs and symptoms. Acta Neurol Taiwan. 2019;28(1):12-16. PMID: 31321760.
• 4. Han S. Brain abscess: All you need to know. https://www.medicalnewstoday.com/articles/185619 Accessed on 03/05/2021.
• 5. Tattevin P; ESCMID Study Group for Infectious Diseases of the Brain (ESGIB). An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect. 2017;23(9):614-20. doi: 10.1016/j.cmi.2017.05.004.
• 6. Karaarslan N, Yilmaz I, Akgun FS, Caliskan T, Dogan M, Bilir B, et al., Evaluation of neutrophil-to-lymphocyte ratio as a marker of inflammatory response in spondylodiscitis. Ann Med Res. 2018;25(2):252-257. doi: 10.5455/jtomc.2018.02.036.
• 7. Bilir B, Isyar M, Yilmaz I, Saracoglu GV, Cakmak S, Dogan M, et al., Evaluation of neutrophil-to-lymphocyte ratio as a marker of inflammatory response in septic arthritis. Eur J Inflam. 2015;13(3):196-203. doi: 10.1177/1721727X15607369.
• 8. Chen M, Low DCY, Low SYY, Muzumdar D, Seow WT. Management of brain abscesses: where are we now? Childs Nerv Syst. 2018;34(10):1871-80. doi: 10.1007/s00381-018-3886-7.
• 9. Brouwer MC, van de Beek D. Epidemiology, diagnosis, and treatment of brain abscesses. Curr Opin Infect Dis. 2017;30(1):129-34. doi: 10.1097/QCO.0000000000000334.
• 10. Umeda S, Fujikawa A, Tsuchiya K. [Brain Abscess]. No Shinkei Geka. 2021;49(2):368-74. doi: 10.11477/mf.1436204400.
• 11. Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther. 2016;14(5):573-7. doi: 10.1586/14779072.2016.1154788.
• 12. Nicolosi A, Hauser WA, Musicco M, Kurland LT. Incidence and prognosis of brain abscess in a defined population: Olmsted County, Minnesota, 1935-1981. Neuroepidemiology. 1991;10(3):122-31. doi: 10.1159/000110257.
• 13. Tunkel AR. Brain abscess. In: Bennett JE, Dolin R, Blaser M, editors. Principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier; 2015. pp. 1265–72.
• 14. Helweg-Larsen J, Astradsson A, Richhall H, Erdal J, Laursen A, Brennum J. Pyogenic brain abscess, a 15 year survey. BMC Infect Dis. 2012;12:332. doi: 10.1186/1471-2334-12-332.
• 15. Rath TJ, Hughes M, Arabi M, Shah GV. Imaging of cerebritis, encephalitis, and brain abscess. Neuroimaging Clin N Am. 2012;22(4):585-607. doi: 10.1016/j.nic.2012.04.002.
• 16. Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. Radiographics. 2007;27(2):525-551. doi: 10.1148/rg.272065155.
• 17. Mishra AM, Gupta RK, Saksena S, Prasad KN, Pandey CM, Rathore D, et al., Biological correlates of diffusivity in brain abscess. Magn Reson Med. 2005;54(4):878-85. doi: 10.1002/mrm.20645.
• 18. Nath K, Agarwal M, Ramola M, Husain M, Prasad KN, Rathore RK, et al., Role of diffusion tensor imaging metrics and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of cystic intracranial mass lesions. Magn Reson Imaging. 2009;27(2):198-206. doi: 10.1016/j.mri.2008.06.006.
• 19. Brouwer MC, Tunkel AR, McKhann GM 2nd, van de Beek D. Brain abscess. N Engl J Med. 2014;371(5):447-56. doi: 10.1056/NEJMra1301635.
• 20. Buonsenso D, Serranti D, Valentini P. Management of central nervous system tuberculosis in children: light and shade. Eur Rev Med Pharmacol Sci. 2010;14(10):845-53. PMID: 21222370.
• 21. Sheron MW, Holt SL, Ingram CW. Mycobacterium bovis Cerebellar Abscess Following Treatment With Bacillus Calmette-Guérin. J Pharm Pract. 2017;30(3):378-80. doi: 10.1177/0897190016636533.
• 22. Spinner CD, Barton J, Biever P, Klein M, Rieg S, Schneider J, et al., Steroide in der Infektionsmedizin [Steroids in infection medicine]. Dtsch Med Wochenschr. 2021;146(3):162-6. doi: 10.1055/a-1302-3530.
• 23. Xia C, Jiang X, Niu C. May short-course intravenous antimicrobial administration be as a standard therapy for bacterial brain abscess treated surgically? Neurol Res. 2016;38(5):414-9. doi: 10.1080/01616412.2016.1177928.
• 24. Zhou W, Shao X, Jiang X. A Clinical Report of Two Cases of Cryptogenic Brain Abscess and a Relevant Literature Review. Front Neurosci. 2019;12:1054. doi: 10.3389/fnins.2018.01054.
• 25. Siddiqui H, Vakil S, Hassan M. Diagnostic Accuracy of Echo-planar Diffusion-weighted Imaging in the Diagnosis of Intra-cerebral Abscess by Taking Histopathological Findings as the Gold Standard. Cureus. 2019;11(5):e4677. doi: 10.7759/cureus.4677.
• 26. Ahmet A. [Systematic Reviews and Meta-Analyses]. Acta Med. Alanya 2018;2(2):62-63. DOI: 10.30565/medalanya.439541
• 27. Aslan A. [Evidence Based Medicine and Clinical Practise Guidlines]. Acta Med. Alanya 2018;1(1):1-2. DOI: 10.30565/medalanya.405333