Akut Kolesistit Tanısında İnflamasyon Belirteçlerinden Nötrofillenfosit ve Trombosit-lenfosit Oranlarının C-reaktif protein Düzeyine Üstünlüğü Var mı?
Amaç: Akut kolesistit acil servis ve genel cerrahi polikliniklerinde sık tanı alan hastalıklardandır. İnflamasyon derecesi hastalığın morbidite ve mortalitesi üzerine etkilidir. Bu çalışmada inflamasyon derecesini ölçmede; nötrofil-lenfosit oranı, trombosit-lenfosit oranı ve ortalama trombosit hacmi düzeyini klasik inflamasyon belirteçleriyle karşılaştırmak ve hangi değerlerin daha anlamlı olduğunu değerlendirmek istedik. Yöntemler: Kliniğimizde Haziran 2012 ve Aralık 2017 tarihleri arasında yapılan kolesistektomi olguları retrospektif olarak incelendi. Çalışmaya alınan olgular; patoloji sonuçlarına göre akut kolesistit olan olgular grup 1, akut kolesistit olmayan olgular ise grup 2 olarak ayrıldı. Çalışmada gruplar arası yatış süreleri, C-Reaktif Protein (CRP), lökosit değerleri, nötrofil-lenfosit oranı (NLO), trombosit-lenfosit oranı (PLO), kırmızı kan hücre dağılımı (RDW) ve ortalama trombosit hacmi düzeyleri (MPV) karşılaştırıldı. Bulgular: Grup 1 deki olguların hastanede yatış süresi grup 2 ye göre istatistiksel açıdan anlamlı düzeyde daha uzundu (p
Is C-reactive Protein a Superior Marker of Inflammation over the Neutrophil/Lymphocyte Ratio or Platelet/Lymphocyte Ratio in Acute Cholecystitis?
Objective: Acute cholecystitis is one of the common conditions encountered in emergency services and general surgery outpatient clinics. Survival and mortality rates positively correlate with the severity of inflammation. In this study, we aimed to compare established markers of inflammation to the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and the mean platelet volume and to assess which were the most clinically relevant. Methods: Patients who underwent cholecystectomy in our clinic between June 2012 and June 2017 were retrospectively reviewed. Study subjects were classified into two groups: Group 1, patients with acute cholecystitis and Group 2, patients without acute cholecystitis. Two groups were compared to each other in the length of hospital stay, CRP concentrations, leukocyte counts, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), red blood cell distribution width, and the mean platelet volume. Results: The length of hospital stay was significantly longer in the Group 1 compared to the Group 2 (p
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- 1. Peery AF, Crockett SD, Barritt AS, et al. Burden of
gastrointestinal, liver, and pancreatic diseases in the
United States. Gastroenterology 2015; 149: 1731–41.
- 2. Andrei M. Beliaev, M.D., Neville Angelo, Michael Booth,
Colleen Bergin. Evaluation of neutrophil-to-lymphocyte
ratio as a potential biomarker for acute cholecystitis.
Journal of Surgical Research 2017 Mar; 209: 93-101
Doi: 10.1016/j.jss.2016.09.034
- 3. Kimura Y, Takada T, Strasberg SM, et al. TG13 current
terminology, etiology, and epidemiology of acute
cholangitis and cholecystitis. J Hepatobiliary Pancreat
Sci. [Review]. 2013 Jan; 20: 8-23.
- 4. Papadakis M, Ambe PC, Zirngibl H. Critically ill patients
with acute cholecystitis are at increased risk for
extensive gallbladder inflammation. World J Emerg
Surg. 2015; 10: 59.
- 5. Lee SW, Yang SS, Chang CS, Yeh HJ. Impact of the Tokyo
guidelines on the management of patients with acute
calculous cholecystitis. J Gastroenterol Hepatol. 2009
Dec; 24: 1857-61.
- 6. Satoa N, Kinoshitaa A, Imaia N, et al. Inflammationbased prognostic scores predict disease severity in
patients with acute cholecystitis. European Journal of
Gastroenterology & Hepatology 2018 Apr; 30: 484-9.
Doi: 0.1097/MEG.0000000000001063
- 7. Balta S, Demirkol S, Unlu M, Arslan Z, Celik T.
Neutrophil to lymphocyte ratio may be predict of
mortality in all conditions. Br J Cancer 2013; 109:
3125-6.
- 8. Nazik H, Nazik S, Çoban F. nötrofil lenfosit ve platelet
lenfosit oranlarının aktif behçet hastalarındaki önemi.
Bozok Tıp Derg 2016; 6: 33-6.
- 9. Kanat BH, Yur M, Girgin M, et al. The Results of Early
Cholecystectomy in Acute Cholecystitis. KocaeliMJ.
2013; 2: 21-4.
- 10. Sözen S, Emir S, Bali İ. Laparoskopik
Kolesistektomiden Açık Ameliyata Geçme Nedenleri.
Int J Basic Clin Med 2014; 2: 8-13.
- 11. Ertok İ, Karakayalı O, Kocasaban D. Clinical
Importance of Neutrophil/Lymphocyte Ratio in
Differential Diagnosis of Acute Cholecystitis and
Cholelithiasis. Kocaeli Medical J 2016; 5; 3: 6-11.
- 12. Gurusamy KS, Samraj K, Fusai G, Davidson BR. Early
versus delayed laparoscopic cholecystectomy for
biliary colic. Cochrane Database Syst Rev
2008;CD007196.
- 13. Yazıcı P, Demir U, Bozdağ E, et al. What is the effect of
treatment modality on red blood cell distribution width
in patients with acute cholecystitis? Ulusal Cer Derg
2015; 31: 1-4. Doi: 10.5152/UCD.2015.2803.
- 14. Sayit AT, Gunbey PH, Terzi Y. Is the Mean Platelet
Volume in Patients with Acute Cholecystitis an
Inflammatory Marker? J Clin Diagn Res. 2015 Jun; 9:
TC05-7. doi: 10.7860/JCDR/2015/12028.6061.
- 15. Arer İM, Yabanoğlu H, Çalışkan K. Can red cell
distribution width be used as a predictor of acute
cholecystitis? Turk J Surg. 2017 Jun 1; 33: 76-9. doi:
10.5152/turkjsurg.2017; 3392.
- 16. Ishizuka M, Shimizu T, Kubota K. Neutrophil-toLymphocyte Ratio Has a Close Association With
Gangrenous Appendicitis in Patients Undergoing
Appendectomy. Int Surg 2012; 97: 299–304.
- 17. Celikbilek M, Dogan S, Ozbakır O. Neutrophil–
Lymphocyte Ratio as a Predictor of Disease Severity in
Ulcerative Colitis. Journal of Clinical Laboratory
Analysis. 2013; 27: 72–6.
- 18. Wongrakpanich S, George G, Chaiwatcharayut W, et
al. The prognostic significance of neutrophil-tolymphocyte and platelet-to-lymphocyte ratios in
patients with multiple myeloma. J Clin Lab Anal. 2016;
30: 1208–13.
- 19. Zheng J, Cai J, Li H, et al. Neutrophil to Lymphocyte
Ratio and Platelet to Lymphocyte Ratio as Prognostic
Predictors for Hepatocellular Carcinoma Patients with
Various Treatments: a Meta-Analysis and Systematic
Review. Cell Physiol Biochem 2017; 44: 967-981. doi:
10.1159/000485396.