AKUT DÖNEM İNTRASEREBRAL HEMORAJİLİ HASTALARDA PLATELET/LENFOSİT ORANININ MORTALİTE ÜZERİNE ETKİSİ

Amaç: Mortalite ve morbidite oranı oldukça yüksek olan intraserebral hemorajinin(İSH) prognozunda inflamatuarsüreç oldukça önemli bir yer tutar. İnflamatuar bir gösterge olarak kabul edilen platelet/lenfositoranının(PLO); son yapılan çalışmalarla özellikle akut koroner sendrom, kalp kapak hastalıkları, çeşitli onkolojikhastalıklar ve serebral infarktüste prognozla ilişkili olduğu ortaya konmuştur. Ancak akut dönem İSH’lihastaların prognozunu göstermedeki yeri henüz bilinmemektedir.Gereç ve Yöntemler: Çalışmamıza retrospekif olarak Ocak 2008- Haziran 2016 tarihleri arasında kliniğimizeşikayetlerinin başladığı ilk 24 saat içinde başvuran, İSH tanısı kesinleşmiş 296 hasta ile benzer yaş ve cinsiyetesahip 180 kontrol dahil edildi. 296 hastanın 120 tanesi 30 günlük hastane yatışı sırasında hayatınıkaybetmişti. Hastalarla kontrollerin ve ölenlerle sağ kalan hastaların nötrofil/lenfosit oranları(NLO) ile PLOdeğerleri karşılaştırılarak 30 günlük mortaliteyi saptamada NLO ve PLO’nun rolü değerlendirildi.Bulgular: Hasta grubu kontrollerle, ölen hastalar sağ kalan hastalarla kıyaslandığında nötrofil ve plateletsayıları ile NLO ve PLO değerleri hasta grubunda ve özellikle de ölen hastalarda daha yüksekti. Yapılantek ve çok değişkenli lojistik regresyon analizlerinde, NLO ve PLO değerlerindeki yüksekliğin akut dönemİSH’li hastalardaki kısa dönem mortaliteyi saptamada anlamlı bağımsız değişkenler olduğu saptandı(p=0.014,p=0.024).Ek olarak yapılan ROC analizi ile PLO için 261.7, NLO için ise 9.5 üzerindeki değerlerin İSH’yebağlı 30 günlük mortaliteyi saptamada kullanılabileceği gösterildi.Sonuç: Bu sonuçlarla akut dönem İSH’lı hastalarda NLO ve PLO değerlerinin arttığı ve mekanizması tam olarakbilinmese de NLO ve PLO değerlerindeki yüksekliğin İSH’li hastalarda kısa dönem mortalite ile yakındanilişkili olduğu söylenebilir.

The Effect of Platelet to Lymphocyte Ratio on Mortality in Patients with Acute Intracerebral Hemorrhage

Aim: Inflammation plays an important role in the prognosis of intracerebral hemorrhage(ICH), which has high mortality and morbidity rates. Platelet to lymphocyte ratio(PLR), which was accepted as an indicator of inflammation, have been increasingly demonstrated a prognostic factor, particularly in acute coronary syndrome, various oncological diseases, and in cerebral infarction in recent studies. Nonetheless, its significance regarding the determination of prognosis in patients with ICH has not yet been clarified. Materials and Methods: This is a retrospective study including 296 patients who presented to our clinic within 24 hours of the onset of symptoms and who were diagnosed with ICH between January 2008 and June 2016, along with 180 age and sex-matched controls. During their 30 day-hospitalization, 120 of these 296 patients died. Patients and controls were compared in terms of neutrophil to lymphocyte ratio(NLR) and PLR values; these were also compared between died and surviving patients. The significance of NLR and PLR in predicting mortality was also evaluated. Results: Patients had significantly higher neutrophil and platelet counts and NLR and PLR values than controls; these results were similar between died and surviving patients. Univariate and multivariate logistic regression analyses indicated that NLR and PLR were independent predictors of short term mortality in ICH (p= 0.014, p=0.024). In addition, ROC analysis showed that cut-off values of 261.7 for PLR and 9.5 for NLR may be used to determine 30-day mortality due to ICH. Conclusion: These results indicate that NLR and PLR can increase in patients with ICH, and that although the mechanism is unclear, the increase of NLR and PLR is closely associated with short term mortality in patients with ICH.

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