PALYATİF BAKIM MERKEZİNDE YATAN KANSER HASTALARININ BESLENME NRS-2002 SKORLARI İNFLAMASYONLA İLİŞKİLİ MİDİR?

Amaç: Bu çalışmada, NRS-2002 tarama skorları ile hematolojik inflamasyon belirteçleri sayılan nötrofil/Lenfositoranı (NLR), platelet/lenfosit oranı (PLR) ve ortalama trombosit hacmi (MPV) arasındaki olası ilişkilerinortaya konulması amaçlandı.Gereç ve Yöntemler: Palyatif bakım merkezinde takip edilmiş olan çeşitli tanılardaki kanser hastalarının NRS-2002 skorları ile NLR, PLR ve MPV arasındaki olası korelasyonlar araştırıldı. Ayrıca, taburcu olanlar ve palyatifünitede ölen hastalar olmak iki grup oluşturuldu ve bu inflamatuvar belirteçler gruplararasında yönündende karşılaştırıldı.Bulgular: Toplam 64 hastanın yaş ortalamaları 66,5±13,1 yıldı. Hastaların NRS-2002 skorlarıyla NLR arasındapozitif yönde, hafif düzeyde, istatistiksel olarak anlamlı bir korelasyon vardı (r=383, p=0,002). HastalarınNRS-2002 skorlarıyla PLR arasında pozitif yönde, hafif düzeyde, istatistiksel olarak anlamlı bir korelasyonvardı (r=341, p=0,006). Hastaların palyatif bakım ünitesinden taburcu edildikten sonraki sağkalım süreleriile PLR arasında negatif yönde, orta düzeyde, istatistiksel olarak anlamlı bir korelasyon vardı (r=0,501, p=-0,021). Hastaların palyatif bakım ünitesine yattığı andan ölümüne kadar geçen süre ile MPV arasında negatifyönde, hafif düzeyde, istatistiksel olarak anlamlı bir korelasyon vardı (r=-285, p=0,029). Hastaların palyatifbakıma yattıktan sonraki sağkalımları ile (yatış günü 1.gün olarak kabul edildi) NLR arasında negatif yönde,hafif düzeyde, istatistiksel olarak anlamlı bir korelasyon vardı (r=-279, p=0,025).Sonuç: Bu çalışmanın sonuçlarına göre NLR ve PLR’nin NRS-2002 skorlarıyla korelasyon içerisinde olduğusöylenilebilir. Bu karşılaştırmalar palyatif bakım merkezleri özelinde ilk kez yapılmıştır.

Are the Nutritional Nrs-2002 Scores of Cancer Patients at the Palliative Care Center Related to Inflammation?

Objective: In this study, it was aimed to determine the possible relationships between the NRS-2002 screening scores and the neutrophil / lymphocyte ratio (NLR), platelet / lymphocyte ratio (PLR) and mean platelet volume (MPV), which are considered to be hematologic inflammation markers. Materials and methods: Possible correlations between NRS-2002 scores and NLR, PLR, and MPV were investigated in the various cancer patients followed up at the palliative care center. In addition, two groups of patients who were discharged and those who died in the palliative unit were formed and compared in terms of the groups of these inflammatory markers. Results: The mean age of 64 patients was 66.5 ± 13.1 years. There was a statistically significant correlation between the NRS-2002 scores of the patients and the NLR in the positive direction (r = 383, p = 0,002). There was a statistically significant correlation between the NRS-2002 scores of the patients and PLR in the positive direction (r = 341, p = 0.006). There was a moderate, statistically significant correlation between the survival times after discharge from the patients’ palliative care unit and PLR (r = 0,501, p = -0,021). There was a mild, statistically significant correlation between MPV and the time from the onset of death to the palliative care unit of the patients (r = -285, p = 0.029). There was a mild, statistically significant correlation (r = -279, p = 0.025) between the survival of the patients after palliative care and the NLR on the negative side (day 1 was accepted as the day of admission). Conclusion: According to the results of this study, it can be said that NLR and PLR are in correlation with NRS-2002 scores. These comparisons were made for the first time in the area of palliative care centers.

PDF

___

1. Gültekin M, Özgül N, Olcato E, Tuncer M, Türkiye’de palyatif bakım hizmetlerinin mevcut durumu. Türk Jinekolojik Onkoloji Dergisi 2010;1:1-6
2. http://www.who.int/cancer/palliative/definition/en/
3. Bechard LJ, Duggan, C, Touger-Decker R, Parrott JS, Rothpletz- Puglia P, Byham-Gray L, et al. Nutritional status based on Body Mass Index is associated with morbidity and mortality in mechanically ventilated critically ill children in the PICU. Critical Care Medicine. 2016;44(8):1530–7.
4. Pasinato VF, Berbigier MC, Rubin B de A, Castro K, Moraes RB, Perry IDS. Enteral nutritional therapy in septic patients in the intensive care unit: compliance with nutritional guidelines for critically ill patients. Revista Brasileira de Terapia Intensiva. 2013;25(1):17–24.
5. Özbilgin Ş, Hancı V, Ömür D, Özbilgin M, Tosun M, Yurtlu S,et al. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit. Medicine. 2016;95(40), e5038.
6. Dizdar OS, Baspınar O, Kocer D, Dursun ZB, Avcı D, Karakükcü C, et al. Nutritional Risk, Micronutrient Status and Clinical Outcomes: A Prospective Observational Study in an Infectious Disease Clinic. Nutrients. 2016;8(3), 124.
7. Westergren A, Norberg E, Hagell P. Diagnostic performance of the Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients - a cross-sectional study. BMC Nursing. 2011;10(1):24.
8. Borek P, Chmielewski, M, Małgorzewicz S, Dębska Ślizień A. Analysis of Outcomes of the NRS 2002 in Patients Hospitalized in Nephrology Wards. Nutrients. 2017;9(3):287.
9. Arslan M, Soylu M, Kaner G, İnanç N, Başmısırlı E. Evaluation of malnutrition detected with the Nutritional Risk Screening 2002 (NRS-2002) and the quality of life in hospitalized patients with chronic obstructive pulmonary disease. Hippokratia. 2016; 20(2): 147–52.
10. Avci A, Avci D, Erden F, Ragip E., Cetinkaya A, Ozyurt K, Atasoy M. Can we use the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume values for the diagnosis of anterior uveitis in patients with Behcet’s disease? Therapeutics and Clinical Risk Management. 2017;13:881–886.
11. Aksu E, Avcı D, Cıkım G. The relationship between neutrophil to lymphocyte ratio and myocardial bridge. International Journal of Research in Medical Sciences. 2016; 4(10):4530-4.
12. Toprak, E., Bozkurt, M., Dinçgez Çakmak, B., Özçimen, E. E., Silahlı, M., Ender Yumru, A., & Çalışkan, E. Platelet-to-lymphocyte ratio: A new inflammatory marker for the diagnosis of preterm premature rupture of membranes. Journal of the Turkish German Gynecological Association. 2017;18(3):122–6.
13. Liu C, Li L, Lu W, Du H, Yan L, Yang J, et al. Neutrophil-lymphocyte Ratio Plus Prognostic Nutritional Index Predicts the Outcomes of Patients with Unresectable Hepatocellular Carcinoma After Transarterial Chemoembolization. Scientific Reports. 2017;7(2):13873.
14. Sato Y, Gonda K, Harada M, Tanisaka Y, Arai S, Mashimo Y, et al. Increased neutrophil-to-lymphocyte ratio is a novel marker for nutrition, inflammation and chemotherapy outcome in patients with locally advanced and metastatic esophageal squamous cell carcinoma. Biomedical Reports. 2017;7(1):79–84.
15. Piciucchi M, Stigliano S, Archibugi L, Zerboni G, Valente R, Delle Fave G, Capurso G. 44 Elevated Neutrophil-Lymphocyte Ratio at Diagnosis Is Associated With Worse Nutritional Status and Survival, Irrespective of Stage in Pancreatic Cancer. Gastroenterology. 2015;148(4):13.
16. Dogan M, Algin E, Guven ZT, Baykara M, Kos TF, Bal O, Zengin N. Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, neutrophilplatelet score and prognostic nutritional index: do they have prognostic significance in metastatic pancreas cancer? Curr Med Res Opin. 2017;15:1-7
17. Liaw FY, Huang CF, Chen WL, Wu LW, Peng TC, Chang YW, Kao TW. Higher Platelet-to-Lymphocyte Ratio Increased the Risk of Sarcopenia in the Community-Dwelling Older Adults. Scientific Reports. 2017; 7(8):16609.
18. Li JY, Li Y, Jiang Z, Wang RT, Wang XS. Elevated mean platelet volume is associated with presence of colon cancer. Asian Pac J Cancer Prev. 2014;15(23):10501-4.
19. Krashin E, Cohen O, Pereg D, Lishner M, Leader A. Mean platelet volume and risk of thrombotic and bleeding complications in patients with Philadelphia chromosome negative myeloproliferative neoplasms. Blood Coagul Fibrinolysis. 2018; 29(3):288-93.
20. Gao L, Zhang H, Zhang B, Zhang L, Wang C. Prognostic value of combination of preoperative platelet count and mean platelet volume in patients with resectable non-small cell lung cancer. Oncotarget. 2017;8(9):15632–41.