Çocuk hastalarda yılan sokması sonrası nötröfil lenfosit oranının klinik sonuçlarla ilişkisi

Amaç: Yılan zehirinin ciddi kardiyotoksik, nörotoksik, nefrotoksik etkileri  mevcuttur. Nötrofil-lenfosit oranı inflamasyonun tanınmasında ve progresyonunda kullanılabilen yeni bir biyomarkerdır. Biz burada yılan sokması nedeni ile izlediğimiz hastaların klinik sonuçları ve nötrofil-lenfosit oranları (NLO) arasındaki ilişkiyi incelemek istedik.Gereç ve Yönetem: Üçüncü basamak üniversite hastanesi ve bir çocuk hastanesinin çocuk acil ve çocuk yoğun bakım birimlerine, Temmuz 2012-Temmuz 2017 yılları arasında başvuran toplam 61 hastanın demografik özellikleri, klinik bulguları ve komplikasyonları, hastanede yatış süreleri retrospektif olarak tarandı. Başvurudaki (NLO1), 12.saatteki (NLO2), taburculuktaki (NLO3) nötrofil-lenfosit oranı ve mean platelet volüme (MPV) değerleri kaydedildi.Bulgular: Hastanede yatış süresi ile NLO1 arasında pozitif korelasyon saptandı. NLO1 arttıkça hastanede yatışın uzadığını  ve yılan sokmasının evresinin arttığını saptadık. Yılan sokmasının evresi arttıkça hastanede yatış süresinin uzadığını görülmüştür.Sonuç: Çalışmamız NLO ile hastalık ciddiyeti arasında pozitif korelasyon tespit etmiştir. Buradan yola çıkarak biz, başvuruda yüksek NLO değerleri olan yılan sokmalarında kötü klinik gidiş ve uzamış hastane yatışının öngörülebileceğini düşünmekteyiz. 

The relationship between neutrophil lymphocyte ratio and clinical outcomes after snakebite in pediatric patients

Purpose: Snake venom has serious cardiotoxic, neurotoxic, nephrotoxic effects. The neutrophil-to-lymphocyte ratio (NLR) is a new biomarker of inflammation and can be used as an indicator and prognositic marker of inflammation. In this study we aimed to analyze the association with clinical outcomes of pediatric patients with snakebite envenomation, and NLR.Materials and Methods: A total of 61 pediatric patients with snakebite who admitted to a tertiary university hospital and a children’s hospital between July 2012 and July 2017 were included in the study. Demographic features, clinical findings and complications of snakebite, length of stay in hospital, NLR at admission (NLR1), and NLR at the twelfth hour (NLR2) and NLR at the discharge (NLR3) and mean platelet volume (MPV) were retrospectively reviewed and recorded.Results: There was a positive correlation between NLR1 and the length of hospital stay. We found that as the level of NLR1 increased, the length of hospitalization was prolonged. NLR1 level increased as the disease stage progressed, but it was not statistically significant. Our study showed that when the severity of the illness increased, the length of hospital stay was significantly prolonged.Conclusion: The study revealed a positive correlation with NLR and severity of the illness. We claim that NLR at admission can be a useful marker for predicting severe clinical course and prolonged hospital length of stay for pediatric patients with snake envenomation.

Kaynakça

1. Kara ME, Ay MO, Seğmen S, Avcı A, İçme F, Gökel Y. Management of Snake Bites. Archives Medical Review Journal. 2014;23:272–92.

2. Karakus A, Zeren C, Celik MM, Arica S, Ozden R, Duru M, et al. A 5-year retrospective evaluation of snakebite cases in Hatay, Turkey. Toxicol Ind Health. 2015;31(2):188-92.

3. Gökel Y, Baslamıslı F, Kocak R. Çukurova region bites. Çukurova University School of Medicine Journal. 1997;22(3):184–8.

4. Sönmez BM, Yılmaz F, Yılmaz MS, Kavalcı C, Gökhan Ş, Akbulut AS, et al. Clinical aspects and emergent management of snake bites presented to emergency department. J Clin Anal Med. 2015;6:558–61.

5. Alan S, Tuna S, Turkoglu EB. The relation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume with the presence and severity of Behcet’s syndrome. Kaohsiung J Med Sci. 2015;31:626–31.

6. Duksal F, Alaygut D, Güven AS, Ekici M, Oflaz MB, Tuncer R, et al. Neutrophil-lymphocyte ratio in children with familial Mediterranean fever: Original article. Eur J Rheumatol. 2015;2(1):20-3.

7. Nacaroglu HT, Erdem SB, Karaman S, Yazici S, Can D. Can mean platelet volume and neutrophil-to-lymphocyte ratio be biomarkers of acute exacerbation of bronchiectasis in children? Cent Eur J Immunol. 2017;42(4):358-62.

8. Nacaroglu HT, Bahceci Erdem S, Durgun E, Karaman S, Baris Erdur C, Unsal Karkmer CS, et al. Markers of inflammation and tolerance development in allergic proctocolitis. Arch Argent Pediatr. 2018;116(1):e1-e7.

9. Dogru M, Citli R. The neutrophil-lymphocyte ratio in children with atopic dermatitis: a case-control study. Clin Ter. 2017;168(4):e262-e65.

10. Demir F, Karadeniz C, Özdemir R, Yozgat Y, Çelegen K, Karaaslan U, et al. Usefulness of Neutrophil to Lymphocyte Ratio in Prediction of Coronary Artery Lesions in Patients with Kawasaki Disease. Balkan Med J. 2015;32(4):371-6.

11. Shrestha BM. Outcomes of snakebite envenomation in children. J Nepal Paediatr Soc. 2011;31(3):192-7.

12. Saborio P, Gonzalez M, Cambronero M. Snakebite accidents in children in Costa Rica: epidemiology and determination of risk factors in the development of abscess and necrosis. Toxicon. 1998;36(2):359-66.

13. Warrel DA. The clinical management of snakebite in south-east Asian region. South-East Asian J Trop Med Pub Health. 1999;30:1-84.

14. Ertem M, Esenkaya I, Kaygusuz MA and Turan C. Clinical experience in the treatment of snake envenomation (our clinical experience in the treatment of snakebites). Acta Orthopaedica et Traumatologica Turcica Journal. 2005;39(2): 54–8.

15. Satar S, Karcıoglu O, Sebe A. An usual localization of snakebite antivenin Treated without: a case report. The Mount Sinai Journal of Medicine. 2005;72:116–9.

16. Guti errez JM, Lomonte B, Leon G, et al. Trends in snakebite envenomation therapy: scientific, technological and public health considerations. Curr Pharm Des. 2007;13:2935–50.

17. Clark RF, McKinney PE, Chase PB, Walter FG. Immediate and delayed allergic reactions to Crotalidae polyvalent immune Fab (ovine) antivenom. Ann Emerg Med. 2002;39(6):671–76.

18. Ahsen A, Ulu MS, Yuksel S, Demir K, Uysal M, Erdogan M, et al. As a new inflammatory marker for familial Mediterranean fever: Neutrophil-to-lymphocyte ratio. Inflammation. 2013;36:1357–62.

19. Yilmaz E, Bayram KA, Bozpolat A, Zararsiz G, Gorkem BS, Karakukcu M, et al. The relationship between hematological parameters and prognosis of children with acute ischemic stroke. Childs Nerv Syst. 2018;34(4):655-61.

20. Basaran O, Uncu N, Celikel BA, Aydın F, Cakar N. Assessment of neutrophil to lymphocyte ratio and mean platelet volume in pediatric familial Mediterranean fever patients J Res Med Sci. 2017;15:22-35.

21. Bhat T, Teli S, Rijal J, Raza M, Khoueiry G, Meghani M, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: A review. Expert Rev Cardiovasc Ther. 2013;11(1):55-9.

22. Sonmez, O, Ertas, G, Bacaksız A, Tasal A, Erdogan E, Asoglu E, et al. Relation of neutrophil-tolymphocyte ratio with the presence and complexity of coronary artery disease: an observational study. Anadolu Kardiyol Derg. 2013;13:662–67.

23. Rifaioglu EN, Sen B, Ekiz O, Dogramaci A. Neutrophil to lymphocyte ratio in Behcet’s disease as a marker of disease activity. Acta Dermatovenerol Alp Panonica Adriat. 2014;23:65–7.

24. 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. Am J Cardiol. 2008;10:653–57.

25. Elbey B, Baykal B, Yazgan ÜC, Zengin Y. The prognostic value of the neutrophil/lymphocyte ratio in patients with snake bites for clinical outcomes and complications. Saudi J Biol Sci. 2017;24(2):362-66.

26. Aktar F, Tekin R. Mean platelet volume, neutrophil to lymphocyte ratio in determining the diagnosis or outcome in children with snakebite. Arch Argent Pediatr. 2017;115(6):576-80.

27. Erdoğan S, Oto A, Boşnak M. The relation between mean platelet volume and mortality in critical pediatric patients. Turk J Pediatr. 2015;57(6):605-10.

28. Golwala ZM, Shah H, Gupta N, Sreenivas V, Puliyel JM. Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study. Afr Health Sci. 2016;16(2):356-62.

29. Omran A, Maaroof A, Saleh MH, Abdelwahab A. Salivary C-reactive protein, mean platelet volume and neutrophil lymphocyte ratio as diagnostic markers for neonatal sepsis. J Pediatr (Rio J). 2018;94(1):82-7.