Can the neutrophil to lymphocyte ratio, determined in the whole blood count, be used as a mortality marker in patients with pulmonary thromboembolism ?

Yıl 2020, Cilt: 10 Sayı: 3, 422 - 429, 15.09.2020

Fahrettin Turna Asim Enhoş

https://doi.org/10.31832/smj.747828

Cited By: 1

Öz

Objective: Acute pulmonary thromboembolism (APTE) is one of the life-threatening cardiovascular diseases. Following the diagnosis, it has a broad range of severity and a wide spectrum. Its mortality and morbidity vary depending on its clinical scope and the site of involvement. Neutrophil / lymphocyte ratio (NLR) has previously been studied in many cardiovascular disease processes as an indicator of inflammation and marker of mortality. The aim of our study is to determine the correlation between NLR and the 30-day mortality in APTE.
Materials and Methods: 160 APTE patients who applied to the emergency department of Bagcilar Education and Research Hospital between January 2011 and June 2013 were determined retrospectively and hemogram parameters at the time of application were recorded. It was ensured in the selection of patients that all patients had a final diagnosis supported by computed tomography. APTE patients; It was divided into two groups in terms of those who died (n:28) and survived (n:120) within 30 days. Low, medium and high risk APTE patients in both groups were compared in terms of NLR. The utility of NLR as a marker of mortality was investigated in patients with pulmonary embolism
Results: NLR was significantly higher in the deceased group (11.40 ± 4.24 vs 18.33 ± 9.06, p < 0.001). It had 57 % sensitivity and 89 % specificity for prediction of mortality (Area Under Curve: 0.736, 95% CI: 0.619–0.853, p < 0.001) in patients with pulmonary embolism. In the multivariate logistic regression analysis; NLR was found to be signifant independent predictor of the 30-day mortality (Odds: 1.132 (1.031-1.243, CI 95%), p=0.009).
Conclusion: NLR plays a strong role in determining 30-day mortality in APTE patients.
Key Words: Leukocyte Count; Pulmonary embolism; Mortality

Anahtar Kelimeler

Leukocyte Count;, Pulmonary embolism;, Mortality;

Tam kan sayımında belirlenen nötrofil/lenfosit oranı pulmoner tromboemboli hastalarında mortalite belirteci olarak kullanılabilir mi?

Öz

Amaç: Akut pulmoner tromboemboli (APTE) hayatı tehdit eden kardiyovasküler hastalıklardan biridir. Teşhisi takiben, geniş bir ciddiyet aralığı ve spektrumu vardır. Mortalitesi ve morbiditesi klinik kapsamına ve tutulum yerine bağlı olarak değişir. Nötrofil / lenfosit oranı (NLR) daha önce birçok kardiyovasküler hastalık sürecinde inflamasyon ve mortalite belirteci olarak incelenmiştir. Çalışmamızın amacı, APTE'de NLR ile 30 günlük mortalite arasındaki korelasyonu belirlemektir.
Gereç ve Yöntemler: Ocak 2011 - Haziran 2013 tarihleri arasında Bağcılar Eğitim ve Araştırma Hastanesi acil servisine başvuran hastalardan 160 APTE hastası retrospektif olarak saptandı ve başvuru sırasında hemogram parametreleri kaydedildi. Hasta seçiminde tüm hastaların bilgisayarlı tomografi ile desteklenen kesin tanı alması sağlandı. APTE hastaları; 30 gün içinde ölen (n: 28) ve hayatta kalan (n: 120) olarak iki gruba ayrıldı. Her iki gruptaki düşük, orta ve yüksek riskli APTE hastaları NLR açısından karşılaştırıldı. Pulmoner emboli hastalarında NLR'nin mortalite belirteci olarak kullanımı araştırıldı.
Bulgular: Ölen grupta NLR anlamlı olarak daha yüksekti (11.40 ± 4.24'e karşı 18.33 ± 9.06, p <0.001). Pulmoner emboli hastalarında NLR; mortalite tahmini için % 57 duyarlılığa ve % 89 özgüllüğe (Eğri altındaki alan: 0.736,% 95 CI: 0.619-0.853, p <0.001) sahipti. Çok değişkenli lojistik regresyon analizinde; NLR'nin 30 günlük mortalitenin anlamlı bağımsız prediktörü olduğu bulunmuştur (Odds Oranı: 1.132 (1.031-1.243, GA% 95), p = 0.009).
Sonuç: NLR, APTE hastalarında 30 günlük mortalitenin belirlenmesinde güçlü bir rol oynamaktadır.

Anahtar Kelimeler

Lökosit Sayısı;, Pulmoner Emboli;, Mortalite;

Kaynakça

• 1) 1) Yamada N, Nakamura M, Ito M. Current status and trends of right ventricular disfunction of acute pulmonary thromboembolism. Circ J. 2011;75(12):2731-8.
• 2) Konstantinides SV, Barco S, Rosenkranz S, Lankeit M, Held M, Gerhardt F, et al. Late outcomes after acute pulmonary embolism: rationale and design of FOCUS. a prospective observational multicenter cohort study. J Thromb Thrombolysis.2016; 42(4):600-609.
• 3) Becattini C, Agnelli G, Prandoni P, Silingardi M, Salvi R, Taliani MR et al. A prospective study on cardiovascular events after acute pulmonary embolism. Eur Heart J. 2005 Jan;26(1):77-83.
• 4) Sørensen HT, Horvath-Puho E, Pedersen L, Baron JA, Prandoni P. Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events: a 20-year cohort study. Lancet. 2007 Nov 24;370(9601):1773-9.
• 5) Bagot CN, Arya R. Virchow and his triad: a question of attribution. Br J Haematol. 2008 Oct;143(2):180-90.
• 6) Monreal M, Trujillo-Santos J. Lessons from VTE registries: the RIETE experience. Best Pract Res Clin Haematol. 2009 Mar;22(1):25-33.
• 7) Zahorec R. Ratio neutrophil to lymphocyte counts- rapid and simple parameter of systemic inflammation and stres in critically ill. Bratisl Lek Listy 2001; 102(1):5-14
• 8) Adam Torbicki, Chairperson (Poland),Arnaud Perrier (Switzerland), Stavros Konstantinides (Germany), Giancarlo Agnelli (Italy), Nazzareno Galie` (Italy), Piotr Pruszczyk (Poland), et al. Guidelines on the diagnosis and management of acute pulmonary embolism, European Heart Journal (2008) 29, 2276-2315.
• 9) Kayrak M, Erdoğan HI, Solak Y, Akilli H, Gül EE, Yildirim O, et al. Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a retrospective study. Heart Lung Circ. 2014 Jan;23(1):56-62.
• 10) Farah R, Nseir W, Kagansky D, Khamisy-Farah R, et al. The role of neuthrophil-lymphocyte ratio, and mean platelet volume in detecting patients with acute venous thromboembolism. J Clin Lab Anal. 2020 Jan;34(1):e23010.
• 11) Ma Y, Mao Y, He X, Sun Y, Huang S, Qiu J, et al. The values of neuthrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting 30 day mortality in patients with acute pulmonary embolism. BMC Cardiovasc Disord. 2016 Jun 4;16:123.
• 12) Soylu K, Gedikli Ö, Ekşi A, Avcıoğlu Y, Soylu Aİ, Yüksel S, et al. Neuthyrophil to lymphocyte ratio fort he assessment of hospital mortality in patients with acute pulmonary embolism. Arch Med Sci. 2016 Feb 1;12(1):95-100.
• 13) Gotto AM Jr. Role of C-reactive protein in coronary risk reduction: focus on primary prevention. Am J Cardiol. 2007 Mar 1;99(5):718-25.
• 14) Furman MI, Becker RC, Yarzebski J, Savegeau J, Gore JM, Goldberg RJ. Effect of elevated leukocyte count on in-hospital mortality following acute myocardial infarction. Am J Cardiol. 1996 Oct 15;78(8):945-8.
• 15) Kirtane AJ, Bui A, Murphy SA, Barron HV, Gibson CM. Association of peripheral neutrophilia with adverse angiographicoutcomes in ST-elevation myocardial infarction. Am J Cardiol. 2004 Mar 1;93(5):532-6.
• 16) Omar M, Tanrıverdi O, Cokmert S, Oktay E, Yersal O, Pilancı KN, et al. Role of increased mean platelet volume (MPV) and decreased MPV/platelet count ratio as poor prognostic factors in lung cancer. Clin Respir J. 2018 Mar;12(3):922-929.
• 17) Thomson SP, Gibbons RJ, Smars PA, V J Suman, R V Pierre, P J Santrach, et al. Incremental value of the leukocyte differentialand the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction. Ann Intern Med. 1995 Mar 1;122(5):335-41.
• 18) Gibson PH, Cuthbertson BH, Croal BL, Rae D, El-Shafei H, Gibson G, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 2010 Jan 15;105(2):186-91.
• 19) Kalay N, Dogdu O, Koc F, Yarlioglues M, Ardic I, Akpek M, et al. Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology. 2012 Apr;63(3):213-7.
• 20) Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol. 2012 Sep 1;110(5):621-7