Osman DOĞRU, Hasan KARA, Aysegül BAYIR, Ahmet AK, Mehmet Ertuğrul KAFALI, Selim DEĞİRMENCİ, Emet Ebru NAZİK, Ali DOĞRU

Diagnostic value of neutrophil-to-lymphocyte ratio in emergency department patients diagnosed with acute pancreatitis

Amaç: Artmış nötrofil sayısı ile birlikte azalmış lenfosit sayısı ağır sepsis, bakteremi ve cerrahi stres ile bağlantılıdır. Beyaz kan hücrelerinin bu farklı iki kompanentinin birbirine oranıyla bulunan nötrofil-lenfosit oranı (NLR), cerrahi ve inflamasyon durumlarını değerlendirmede kullanılmaktadır. Biz bu çalışmada akut pankreatit hastalarda, biliyer ve non-biliyer pankreatitli hastaların ayrımında NLR'nin prognostik değerini araştırmayı amaçladık. Gereç ve Yöntem: Ocak 2011 ve Temmuz 2014 tarihleri arasında akut pankreatit tanısı almış 18 yaşından büyük hastalar geriye dönük olarak değerlendirmeye alınmıştır. Hastalar etyolojik olarak biliyerpankreatit ve nonbiliyerpankreatit olarak ikiye ayrıldı. Bulgular: Çalışmaya 255 akut pankreatitli hastanın yaş ortalaması 59±18 yıl olup, 81 tanesi (%36) erkekti. Etiyolojik faktörlere bakıldığında biliyer pankreatitli hasta sayısı 144 (%64) non-biliyer pankreatitli hasta sayısı 81 (%36) idi. Hastaların fizik muayene ve laboratuar bulguları, pankreatit etyolojisine göre karşılaştırıldığında Beyaz kan hücreleri ve nötrofil değerlerinin non-biliyer pankreatit grubunda anlamlı olarak yüksek olduğu görüldü. Sonuç: Bulgularımıza göre NLR akut pankreatitte yüksek bulunmasına rağmen non-biliyer ve biliyer pankreatit arasında NLR değerinde istatiksel olarak anlamlı bir değişme olmamıştır.

Acil serviste akut pankreatit tanısı alan hastalarda nötrofil lenfosit oranının tanısal değeri

Purpose: Decreased lymphocyte count and increased neutrophil count may be associated with severe sepsis, bacteremia, and surgical stress. The neutrophil-tolymphocyte ratio (NLR) may be used to assess inflammatory conditions and surgery. We evaluated whether NLR may be useful in the differentiation between biliary and nonbiliary acute pancreatitis. Material and Methods: Data from patients aged > 18 years who were diagnosed with acute pancreatitis between January 2011 and July 2014 were evaluated retrospectively. Patients were grouped as having biliary or nonbiliary pancreatitis. The white blood cell, neutrophil, and lymphocyte counts and NLR were evaluated and compared between the 2 groups. Results: In the 225 patients with acute pancreatitis (mean age, 59±18 y; 81 male patients [36%]), most patients had biliary pancreatitis (biliary, 144 patients [64%]; nonbiliary, 81 patients [36%]). Frequency of hypertension and mean arterial pressure were lower in patients who had biliary than nonbiliary pancreatitis. The mean white blood cell, neutrophil, and platelet counts were greater in patients who had nonbiliary than biliary pancreatitis. Conclusions: Although the NLR was increased in acute pancreatitis, there were no differences in NLR between patients who had biliary or nonbiliary acute pancreatitis. Therefore, the NLR is not useful in differentiating biliary from nonbiliary acute pancreatitis.

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Sangrasi AK, Syed B, Memon AI, Laghari AA, Talpur KA, Qureshi JN. Laparoscopic cholecystectomy in acute gallstone pancreatitis in index hospital admission: feasibility and safety. Pak J Med Sci. 2014;30:601-5.
Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet. 2008;371:143-52.
Ponette J, Wilmer A. Update on the management of acute severe pancreatitis. Acta Clin Belg. 2001;56:135- 45.
Taguchi M, Kubo T, Yamamoto M, Muramatsu K, Yasunaga H, Horiguchi H et al. Body mass index influences the outcome of acute pancreatitis: an analysis based on the Japanese administrative database. Pancreas. 2014;43:863-6.
Barreto SG, Rodrigues J. Comparison of APACHE II and Imrie Scoring Systems in predicting the severity of acute pancreatitis. World J Emerg Surg. 2007;2:33.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102-11.
Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA et al. New diagnostic criteria of acute pancreatitis. J Hepatobiliary Pancreat Sci. 2010;17:24-36.
Suppiah A, Malde D, Arab T, Hamed M, Allgar V, Smith AM et al. The prognostic value of the neutrophil-lymphocyte ratio (NLR) in acute pancreatitis: identification of an optimal NLR. J Gastrointest Surg. 2013;17:675-81.
Pavlidis TE, Pavlidis ET, Sakantamis AK. Advances in prognostic factors in acute pancreatitis: a mini- review. Hepatobiliary Pancreat Dis Int. 2010;9:482-6.
Felderbauer P, Müller C, Bulut K, Belyaev O, Schmitz F, Uhl W et al. Pathophysiology and treatment of acute pancreatitis: new therapeutic targets - a ray of hope? Basic Clin Pharmacol Toxicol. 2005;97:342-50.
de Jager CP, van Wijk PT, Mathoera RB, de Jongh- Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14:R192.
Dundar ZD, Ergin M, Koylu R, Ozer R, Cander B, Gunaydin YK. Neutrophil-lymphocyte ratio in patients with pesticide poisoning. J Emerg Med. 2014;47:286-93.
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.
Ertaş G, Sonmez O, Turfan M, Kul S, Erdogan E, Tasal A et al. Neutrophil/lymphocyte ratio is associated with thromboembolic stroke in patients with non-valvular atrial fibrillation. J Neurol Sci. 2013;324:49-52.
de Jager CP, Wever PC, Gemen EF, Kusters R, van Gageldonk-Lafeber AB, van der Poll T et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One. 2012;7:e46561.
Gunay E, Ulaslı SS, Akar O, Ahsen A, Gunay S, Koyuncu T et al. Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study. Inflammation. 2014;37:374-80.
Ishizuka M, Shimizu T, Kubota K. Neutrophil-to- lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy. Int Surg. 2012;97:299-304.
Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A, Prasad KR, Toogood GJ et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol. 2008;34:55-60.
Pezzilli R, Billi P, Beltrandi E, Casadei Maldini M, Mancini R. Impaired lymphocyte proliferation in human acute pancreatitis. Digestion. 1997;58:431-6.
Azab B, Jaglall N, Atallah JP, Lamet A, Raja-Surya V, Farah B et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology. 2011;11:445-52.