Assessment of the Relationship Between Leukocyte Count and Neutrophil-to-Lymphocyte Ratio and Clinical Course in Non-Variceal Upper Gastrointestinal System Bleeding

Yıl 2018, Cilt: 8 Sayı: 2, 320 - 326, 29.06.2018

Altay Kandemir , Mehmet Süle İrfan Yavaşoğlu , Mevlüt Türe , Adil Coşkun Abdülvahit Yükselen M. Hadi Yaşa

https://doi.org/10.31832/smj.414202

Cited By: 1

Öz

Objective: Nonvariceal
upper gastrointestinal system bleeding (NVUGIB) is a life-threatening condition
that can lead to mortality. It is
important to identify the risk factors in terms of prognosis and mortality in
patients with NVUGIB. In this
study, we assessed the relationship between leukocytosis and neutrophil-to-lymphocyte
ratio and the clinical course in patients with NVUGIB.

Materials and Methods:
We
included 156 patients who were diagnosed with NVUGIB between September 2013 and
March 2017 in our clinic. The
relationship between demographic data, endoscopic findings, need for
erythrocyte suspension, length of hospital stay, need for intensive care, need
for surgical intervention and mortality of the patients with the number of
leukocytes and neutrophil-to-lymphocyte ratio (NLR) was investigated.

Results:  Of the patients, 104 (66,7%) were male, 52 (33,3%) were female, and mean age was
63,8±17,6 years. According to endoscopic findings, the most common cause of the
bleeding was peptic ulcer (77,6%). There was no statistically significant
correlation between leukocyte count and NLR and need for intensive care, need
for surgical intervention and treatment outcome. However, there was a
statistically significant relationship between NLR and length of hospital stay
(p=0,02)

Conclusions: Evaluation
of the patients with NVUGIB timely through their findings detected at admission
and their laboratory results would make a positive contribution to treatment
planning and follow up of the patient. Leukocyte count alone or in combination
with other clinical and laboratory parameters can be a valuable marker in
measuring mortality potential of acutely hospitalized patients. In our study,
we found a significant relationship between NLR and the average length of
hospital stay, which should be encouraged for further studies investigating its
relation with the prognosis of the  disease.

Anahtar Kelimeler

Nonvariceal upper gastrointestinal bleeding, leukocytosis, neutrophil-to-lymphocyte ratio

Nonvarisial Üst Gastrointestinal Sistem Kanamalarında Klinik Gidiş ve Nötrofil-Lenfosit Oranı ve Lökosit Sayısı Arasındaki İlişkinin Değerlendirilmesi

Öz

Amaç: Nonvariseal
üst gastrointestinal sistem kanamaları (NVUGIB) kanamaları yaşamı tehdit eden
ve mortalite oluşturan kanamalardır. NVUGIB’li hastalarda prognoz ve  mortalite için risk faktörlerini belirlemek
önemlidir. Biz bu çalışmada, NVUGIB li hastalarda, lökositoz ve nötrofil-lenfosit oranının
hastalığın klinik seyiri ile ilişkisini değerlendirdik.

Gereç-Yöntemler: Kliniğimizde, Eylül 2013 – Mart
2017 tarihleri arasında
NVUGIB tanısı konulan 156 hasta çalışmaya alındı. Hastaların
demografik verileri, endoskopik bulguları, eritrosit süspansiyonu ihtiyacı,
hastanede yatış süresi, yoğun bakım ihtiyacı, cerrahi müdahaleye ihtiyaç, ölüm
ile lökosit sayısı ve nötrofil-lenfosit oranı (NLR) ilişkisi araştırılmıştır.

Results: Hastaların
103’ü (%66,7) erkek, 52’si (%33,3) kadın, yaş ortalamaları 63,8 ± 17,6
saptandı. Endoskopi bulgularına göre kanamanın 
en sık nedeni peptik ülserdir (%77,6). Hem lökosit sayısı hem de NLR ile
yoğun bakım ihtiyacı, cerrahi müdahaleye ihtiyaç ve tedavi sonucu arasında istatistiksel
olarak anlamlı bir ilişki bulunmadı. Ancak Hastaların NLR’a göre hastanede
yatış süre ortalaması arasında istatistiksel olarak anlamlı bir ilişki vardı
(p:0,02)

Sonuç: NVUGIB sahip hastaların hastaneye
başvurusu sırasında saptanan bulguları ve laboratuvar verileri çerçevesinde
önceden değerlendirebilmek hastanın takibine, tedavi planlamasına olumlu katkı
yapmaktadır. Lökosit tek başına ya da diğer klinik ve laboratuar parametrelerle
kombine edilerek, akut olarak hastaneye yatırılan hastalarda mortalite
potansiyelinin ölçülmesinde önemli bir marker olabilir. Çalışmamızda NLR ile hastanede
yatış süre ortalaması ile anlamlı ilişki saptanmış olup, hastalığın prognozu
ile ilişkisini gösteren daha ileri çalışmalar yapmak için teşvik edici
olmalıdır. 

Anahtar Kelimeler

Nonvarisial üst gastrointestinal sistem kanaması, lökositoz, nötrofil-lenfosit oranı

Kaynakça

• Rotondano G. Epidemiology and diagnosis of acute nonvariceal upper gastrointestinal bleeding. Gastroenterology clinics of North America 2014; 43: 643-663.
• Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. The American journal of gastroenterology 1997; 92: 419-424.
• Tielleman T, Bujanda D, Cryer B. Epidemiology and Risk Factors for Upper Gastrointestinal Bleeding. Gastrointestinal endoscopy clinics of North America 2015; 25: 415-428.
• Coskun F, Topeli A, Sivri B. Patients admitted to the emergency room with upper gastrointestinal bleeding: factors influencing recurrence or death. Advances in therapy 2005; 22: 453-461.
• Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316-321.
• Kim JY, Park T, Jeong SH, Jeong CY, Ju YT, Lee YJ, et al. Prognostic importance of baseline neutrophil to lymphocyte ratio in patients with advanced papillary thyroid carcinomas. Endocrine 2014; 46: 526-531.
• Motomura T, Shirabe K, Mano Y, Muto J, Toshima T, Umemoto Y, et al. Neutrophil-lymphocyte ratio reflects hepatocellular carcinoma recurrence after liver transplantation via inflammatory microenvironment. Journal of hepatology 2013; 58: 58-64.
• Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. The American journal of cardiology 2008; 102: 653-657.
• Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. Journal of surgical oncology 2005; 91: 181-184.
• Chalasani N, Patel K, Clark WS, Wilcox CM. The prevalence and significance of leukocytosis in upper gastrointestinal bleeding. The American journal of the medical sciences 1998; 315: 233-236.
• Asadollahi K, Hastings IM, Beeching NJ, Gill GV. Laboratory risk factors for hospital mortality in acutely admitted patients. QJM : monthly journal of the Association of Physicians 2007; 100: 501-507.
• Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC research notes 2017; 10: 12.
• Ghassemi KA, Jensen DM. What Does Lesion Blood Flow Tell Us About Risk Stratification and Successful Management of Non-variceal UGI Bleeding? Current gastroenterology reports 2017; 19: 17.
• Laine L. CLINICAL PRACTICE. Upper Gastrointestinal Bleeding Due to a Peptic Ulcer. The New England journal of medicine 2016; 374: 2367-76.
• Kim JJ, Sheibani S, Park S, Buxbaum J, Laine L. Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. Journal of clinical gastroenterology 2014; 48: 113-118.
• Tomizawa M, Shinozaki F, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, et al. Laboratory test variables useful for distinguishing upper from lower gastrointestinal bleeding. World journal of gastroenterology 2015; 21: 6246-6251.
• Longo DL FA, Kasper DL, Hauser SL, Jameson J, Loscalzo J, et al. eds. . Gastrointestinal Bleeding. . In: Harrison’s Manual of Medicine, 18th ed. New York: McGraw-Hill, 2014; 1281-1286. ed.
• van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best practice & research Clinical gastroenterology 2008; 22: 209-224.
• Bor S, Dagli U, Sarer B, Gurel S, Tozun N, Sivri B, et al. A retrospective study demonstrating properties of nonvariceal upper gastrointestinal bleeding in Turkey. The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology 2011; 22: 249-254.
• Hay JA, Lyubashevsky E, Elashoff J, Maldonado L, Weingarten SR, Ellrodt AG. Upper gastrointestinal hemorrhage clinical--guideline determining the optimal hospital length of stay. The American journal of medicine 1996; 100: 313-22.
• Abramson N, Melton B. Leukocytosis: basics of clinical assessment. American family physician 2000; 62: 2053-2060.
• Barron HV, Harr SD, Radford MJ, Wang Y, Krumholz HM. The association between white blood cell count and acute myocardial infarction mortality in patients > or =65 years of age: findings from the cooperative cardiovascular project. Journal of the American College of Cardiology 2001; 38: 1654-1661.
• Kazmierski R, Guzik P, Ambrosius W, Kozubski W. [Leukocytosis in the first day of acute ischemic stroke as a prognostic factor of disease progression]. Wiadomosci lekarskie (Warsaw, Poland : 1960) 2001; 54: 143-151.
• Tatsukawa Y, Hsu WL, Yamada M, Cologne JB, Suzuki G, Yamamoto H, et al. White blood cell count, especially neutrophil count, as a predictor of hypertension in a Japanese population. Hypertension research : official journal of the Japanese Society of Hypertension 2008; 31: 1391-1397.
• Fritsche A, Haring H, Stumvoll M. [White blood cell count as a predictor of glucose tolerance and insulin sensitivity. The role of inflammation in the pathogenesis of type 2 diabetes mellitus]. Deutsche medizinische Wochenschrift (1946) 2004; 129: 244-8.
• de Labry LO, Campion EW, Glynn RJ, Vokonas PS. White blood cell count as a predictor of mortality: results over 18 years from the Normative Aging Study. Journal of clinical epidemiology 1990; 43: 153-157.
• Srygley FD, Gerardo CJ, Tran T, Fisher DA. Does this patient have a severe upper gastrointestinal bleed? Jama 2012; 307: 1072-1079.
• Park CH, Han DS, Jeong JY, Eun CS, Yoo KS, Jeon YC, et al. The Optimal Cut-Off Value of Neutrophil-to-Lymphocyte Ratio for Predicting Prognosis in Adult Patients with Henoch-Schonlein Purpura. PloS one 2016; 11: e0153238.
• Makay B, Gucenmez OA, Duman M, Unsal E. The relationship of neutrophil-to-lymphocyte ratio with gastrointestinal bleeding in Henoch-Schonlein purpura. Rheumatology international 2014; 34: 1323-1327.