Turgay DEMİR, Devrim SÖĞÜT, Mehmet Taylan PEKÖZ, Şebnem BIÇAKCI

Orta serebral arter enfarktlarında nötrofil/lenfosit oranı ve ortalama trombosit hacminin kısa dönem prognoza etkisi

Amaç: Bu çalışmada akut iskemik inme tanısı alan ve orta serebral arter (OSA) enfarktı saptanan hastalarda nötrofil/lenfosit oranı (NLR) ve ortalama trombosit hacminin (MPV) kısa dönem prognoz üzerine etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Bir üniversite hastanesi Nöroloji Yoğun Bakım ve İnme Ünitesine akut iskemik inme tanısıyla yatan ve OSA enfarktı saptanan hastalar alınmıştır. Kontrol grubu olarak Nöroloji polikliniğine başağrısı yakınmasıyla başvurmuş, inme öyküsü olmayan, bilinen sistemik hastalığı olmayan yaş ve cinsiyet dağılımı benzer hastalar bu çalışmaya alınmıştır. Hasta ve kontrol grubunun NLR ve MPV değerleri kaydedildi. Ayrıca hastaların yatış sırasında ve taburculuk sırasındaki NIHSS (National Institute of Health Stroke Scale) skoru, taburculuk sırasındaki modifiye Rankin skoru (mRS) kaydedildi. Bulgular: Çalışmaya dahil edilen 72 hastanın % 58,3’ü (n=42) erkekti. Hasta ve kontrol grubu NLR ve MPV ortalamaları açısından karşılaştırılmış ve her iki parametre de hasta grubunda kontrol grubuna göre daha yüksek bulunmuştur. NLR kötü prognoz grubunda iyi prognoz grubuna göre ve mortalite grubunda sağ kalım grubuna göre daha yüksek saptanmıştır. Sonuç: Klinisyenler OSA enfarktı olan hastalarda NLR ile kısa dönem prognoz tayininde kullanabilirler ve bu kolayca belirlenebilir ölçüm, objektif, basit ve kolay ulaşılabilirdir, aynı zamanda herhangi bir ek maliyete de yol açmaz.

Anahtar Kelimeler:

Akut iskemik inme, nötrofil/lenfosit oranı, orta serebral arter, ortalama trombosit hacmi, prognoz

The effect of neutrophyl/lymphocyte ratio and mean platelet volume on short-term prognosis in middle cerebral artery infarctions

Purpose: The aim of this study was to investigate the effect of neutrophil / lymphocyte ratio (NLR) and mean platelet volume (MPV) on short-term prognosis in patients with acute ischemic stroke who had middle cerebral artery (MCA) territory infarction. Materials and Methods: The study included patients who were admitted to a University Hospital Neurology Intensive Care and Stroke Unit with the diagnosis of acute ischemic stroke and had MCA territory infarction. The control group consisted of patients with similar age and gender distribution applied to the Neurology outpatient clinic with the complaint of headache, without history of stroke or systemic disease. NLR and MPV values of groups were recorded. In addition, the patients' NIHSS (National Institute of Health Stroke Scale) score at hospitalization and at discharge and the modified Rankin score (mRS) at discharge were recorded. Results: Of the 72 patients 58.3% (n = 42) included in the study were male. The patient and control groups were compared in terms of mean NLR and MPV values, and both parameters were higher in patient group than the control group. NLR was higher in poor prognosis group than the good prognosis group and in mortality group compared to the survival group. Conclusion: Physicians can use NLR for short-term prognosis in patients with MCA infarction, and this easily identifiable measurement is objective, simple and easily accessible, and does not cause any additional costs.

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1. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A et al. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association. Stroke. 2013;44:2064-89.
2. Chamorro A, Hallenbeck J. The harms and benefits of inflamatory and immune responses in vascular disease. Stroke. 2006;37:291-3.
3. Worthmann H, Tryc AB, Deb M, Goldbecker A, Ma YT, Tountopoulou A et al. Linking infection and inflammation in acute ischemic stroke. Ann N Y Acad Sci. 2010;1207:116-22.
4. Buck BH, Liebeskind DS, Saver JL, Bang OY, Yun SW, Starkman S et al. Early neutrophilia is associated with volume of ischemic tissue in acute stroke. Stroke. 2008;39:355-60.
5. Xue J, Huang W, Chen X, Li Q, Cai Z, Yu T, Shao B. Neutrophil-to-Lymphocyte Ratio Is a Prognostic Marker in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2017;26:650-7.
6. Greisenegger S, Endler G, Hsieh K, Tentschert C, Mannhalter C, Lalouschek W et al. Is elevated mean platelet volume associated with a worse outcome in patients with acute ischemic cerebrovascular events? Stroke. 2004;34:1688-91.
7. Mayda-Domaç F, Misirli H, Yilmaz M. Prognostic role of mean platelet volume and platelet count in ischemic and hemorrhagic stroke. J Stroke Cerebrovasc Dis. 2010;19:66-72.
8. Bath PM, Butterworth RJ. Platelet size: Measurement, physiology and vascular disease. Blood Coagul Fibrinolysis. 1996;7:157-61.
9. Tscoepe D, Roesen P, Esser J, Schwippert B, Nieuwenhuis HK, Kehrel B et al. Large platelets circulate in an activated state in diabetes mellitus. Semin Thromb Hemost. 1991;17:433-9.
10. Kurabayashi H, Tamura J, Naruse T, Kubota K. Possible existence of platelet activation before onset of cerebral infarction. Atherosclerosis. 2000;153:203- 7.
11. O’Brien JR. The role of platelets in the thrombotic diasthesis. Blood Vessels. 1980;11:1-15.
12. Halbmayer WM, Haushofer A, Radek J, Schön R, Deutsch M, Fischer M. Platelet size, fibrinogen and lipoprotein (a) in coronary heart disease. Coron Artery Dis. 1995;6:397-402.
13. Muscari A, Puddu GM, Cenni A, Silvestri MG, Giuzio R, Rosati M et al. Mean platelet volume (MPV) increase during acute non-lacunar ischemic strokes. Thromb Res. 2009;123:587-91.
14. Butterworth R, Bath P. The relationship between mean platelet volume, stroke subtype and clinical outcome. Platelets. 1998;9:359-64.
15. O’Malley T, Langhorne P, Elton RA, Stewart C. Platelet size in stroke patients. Stroke. 1995;26:995-9.
16. D’Erasmo E, Aliberti G, Celi F. Platelet count, mean platelet volume and their relation to prognosis in cerebral infarction. J Intern Med. 1990;227:11-4.
17. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20:864-70.
18. Zhao H, Collier JM, Quah DM, Purvis T, Bernhardt J. The modified Rankin Scale in acute stroke has good inter-rater-reliability but questionable validity. Cerebrovasc Dis. 2010;29:188-93.
19. Kim JY, Park J, Chang JY, Kim SH, Lee JE. Inflammation after ischemic stroke: the role of leukocytes and glial cells. Exp Neurobiol. 2016; 25:241–51.
20. Lakhan SE, Kirchgessner A, Hofer M. Inflammatory mechanisms in ischemic stroke: therapeutic approaches. J Transl Med. 2009;7:97.
21. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol. 2006;97:993–6.
22. Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G et al. Preoperative neutrophil- lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154:995–1002.
23. Horne BD, Anderson JL, John JM, Weaver A, Blair TL, Jensen KR et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45:1638–43.
24. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil- lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta. 2008;395:27–31.
25. Zhang RL, Chopp M, Chen H, Garcia JH. Temporal profile of ischemic tissue damage, neutrophil response, and vascular plugging following permanent and transient (2H) middle cerebral artery occlusion in the rat. J Neurol Sci. 1994;125:3–10.
26. Davies CA, Loddick SA, Stroemer RP, Hunt J, Rothwell NJ. An integrated analysis of the progression of cell responses induced by permanent focal middle cerebral artery occlusion in the rat. Exp Neurol. 1998;154:199–212.
27. Huang J, Upadhyay UM, Tamargo RJ. Inflammation in stroke and focal cerebral ischemia. Surg Neurol. 2006;66:232–45.
28. Bowes MP, Rothlein R, Fagan SC, Zivin JA. Monoclonal antibodies preventing leukocyte activation reduce experimental neurologic injury and enhance efficacy of thrombolytic therapy. Neurology. 1995;45:815–9.
29. Chopp M, Li Y, Jiang N, Zhang RL, Prostak J. Antibodies against adhesion molecules reduce apoptosis after transient middle cerebral artery occlusion in rat brain. J Cereb Blood Flow Metab. 1995;16:578–84.
30. Garau A, Bertini R, Colotta F, Casilli F, Bigini P, Cagnotto A et al. Neuroprotection with the CXCL8 inhibitor repertaxin in transient brain ischemia. Cytokine. 2005;30:125–31.
31. Gokhan S, Ozhasenekler A, Mansur Durgun H, Akil E, Ustundag M et al. Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack. Eur Rev Med Pharmacol Sci. 2013;17:653–7.
32. Kocatürk O, Beşli F, Güngören F, Kocatürk M, Tanrıverdi Z. The relationship among neutrophil to lymphocyte ratio, stroke territory, and 3-month mortality in patients with acute ischemic stroke. Neurol Sci. 2019;40:139-46.
33. Qun S, Tang Y, Sun J, Liu Z, Wu J, Zhang J. Neutrophil-to-lymphocyte ratio predicts 3-month outcome of acute ischemic stroke. Neurotox Res. 2017;31:444-52.
34. Aytaç E, Akpınar ÇK, Gürkaş E. Neutrophil to lymphocyte ratio: A simple and readily available independent marker of mortality in acute ischemic stroke. Firat Med J. 2017;22:192-6.
35. Martin JF, Shaw T, Heggie J, Penington DG. Measurement of the density of platelets and its relationship to volume. Br J Haematol. 1983;54:337- 52.
36. 36.Chen Y, Xiao Y, Lin Z, Xiao X, He C, Bihl JC et al. The role of circulating platelets microparticles and platelet parameters in acute ischemic stroke patients. J Stroke Cerebrovasc Dis. 2015;24:2313-20.
37. 37.Staszewski J, Pogoda A, Data K, Walczak K, Nowocień M, Frankowska E et al. The mean platelet volume on admission predicts unfavorable stroke outcomes in patients treated with IV thrombolysis. Clin Interv Aging. 2019;14:493-503.