Nezir YILMAZ, Mevlüt DOĞUKAN, Cengiz GÜVEN

Stanford Tip A Aort Diseksiyon Cerrahisinde Ortalama Trombosit Hacmi, Trombosit Lenfosit Oranı ve Nötrofil Lenfosit Oranının Mortalite Üzerine Etkisi

Amaç: Bu çalışmanın amacı akut tip A aort disseksiyonu olgularında, nötrofil-lenfosit oranı (NLR), trombosit-lenfosit oranı (PLR) ve ortalama trombosit hacminin (MPV) mortalite üzerindeki etkilerini araştırmaktır. Materyal ve metod: Ocak 2013 ile Kasım 2020 tarihleri arasında Adıyaman Eğitim ve Araştırma Hastanesi’nde akut tip A aort disseksiyonu tanısı ile opere edilen hastaların dosyaları retrospektif olarak tarandı. Hastalar taburcu olanlar (Grup I) ve eksitus ile sonuçlanan (Grup II) olmak üzere ikiye ayrıldı. Hastaların demografik verileri, preoperatif kan testleri, operasyon süreleri ve mortalite durumu kaydedildi. Preoperatif olarak alınmış olan kan örneklerinde NLR, PLR ve MPV değerleri hesaplanarak kaydedildi. Bulunan veriler gruplar arasında kıyaslanarak verilerin mortalite ile ilişkisi incelendi. Bulgular: Çalışmadaki hastaların 23’ü erkek 9’u kadındı. Hastaların 22’si şifa ile taburcu olurken 10 hasta mortalite ile sonuçlanmıştır. EF, CRP ve kardiyopulmoner by-pass sürelerinde eksitus grubunda anlamlı farklılık bulundu (p<0.05). Eksitus ile sonuçlanan hastalarda MPV, NLR ve PLR düzeyleri daha yüksek tespit edildi. Fakat anlamlı farklılık tespit edilemedi (p>0.05). Sonuç: MPV, NLR ve PLR’nin akut tip A aort dissekiyonunda mortaliteyi tahmin etmede etkisi gösterilemedi.

Anahtar Kelimeler:

Akut tip A aort diseksiyonu, Ortalama trombosit hacmi, Nötrofil-lenfosit Oranı, Platelet-lenfosit oranı, Mortalite, Acute type A aortic dissection, Mean platelet volume, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio, Mortality

The Effect of Average Thrombocyte Volume, Thrombocyte Lymphocyte Ratio and Neutrophil Lymphocyte Ratio on Mortality in Stanford Type A Aortic Dissection Surgery

Background: It was aimed to investigate the effects of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and mean platelet volume (MPV) on mortality in cases of acute type A aortic dissection in this study.Materials and Methods: The files of patients who were operated on with the diagnosis of acute type A aortic dissection in Adıyaman Training and Research Hospital between January 2013 and November 2020 were reviewed retrospectively. The patients were divided into those who were discharged (Group I) and those who resulted in death (Group II). Demographic data, preoperative blood tests, operation times and mortality status of the patients were recorded. MPV, NLR and PLR were calcula-ted and recorded in blood samples taken preoperatively. The obtained data were compared between groups and the relationship of the data with mortality was examined.Results: 23 of the patients in the study were male and 9 were female. While 22 of the patients were discharged with cure, 10 patients resulted in mortality. A significant difference was found in the exit group in terms of EF, CRP and cardiopulmonary bypass times (p<0.05). MPV, NLR and PLR were found to be higher in patients who resulted in death. However, this difference was not statistically signifi-cant (p>0.05).Conclusions: MPV, NLR and PLR could not be shown to have an effect on predicting mortality in acute type A aortic dissection.

Keywords:

Acute type A aortic dissection, Mean platelet volume, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio, Mortality,

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1. Pacini D, Di Marco L, Fortuna D, Belotti LMB, Gabbieri D, Zussa C, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol . 2013; 167(6): 2806–12.
2. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies: Part I: From etiology to diagnostic strategies. Circulation. 2003; 108(5): 628–35.
3. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B. Mean platelet volume as a predictor of cardiovascular risk: a systemic review and meta-analysis. J Thromb Haemost. 2010; 8: 148–56.
4. Yuri Gasparyan A, Ayvazyan L, P. Mikhailidis D, D. Kitas G. Mean platelet volume: A link between thrombosis and inflammation? Curr Pharm Des. 2011; 17(1): 47–58.
5. Zhang J, Jiang Y, Gao C, Feng J, Wang A. Risk factors for hospital death in patients with acute aortic dissection. Heart Lung Circ. 2015; 24(4): 348–53
6. Balta S. Mean platelet volume, neutrophil-lymphocyte ratio, and long-term major cardiovascular events. Angiology. 2019; 70(4): 289–90.
7. Elsayed RS, Cohen RG, Fleischman F, Bowdish ME. Acute type A aortic dissection. Cardiol Clin. 2017; 35(3): 331–45.
8. Wu Y, Jiang R, Xu P, Wang G, Wang J, Yang S. Perioperative results and risk factors for in-hospital mortality in patients with Stanford type A aortic dissection undergoing Sun’s procedure - A single center study. Heart Surg Forum. 2018; 21(6): E432–7
9. Zhang Y, Chen T, Chen Q, Min H, Nan J, Guo Z. Development and evaluation of an early death risk prediction model after acute type A aortic dissection. Ann Transl Med. 2021; 9(18): 1442.
10. Lin C-Y, Lee K-T, Ni M-Y, Tseng C-N, Lee H-A, Su I-L, et al. Impact of reduced left ventricular function on repairing acute type A aortic dissection: Outcome and risk factors analysis from a single institutional experience. Medicine (Baltimore) 2018; 97(35): e12165.
11. Dobrilovic N, Singh AK, Fingleton JG, Maslow A, Machan J, Feng J, et al. Surgical outcomes for type-A aortic dissection in septuagenarians and octogenarians. J Surg Res 2012; 172(2): 278.
12. Wen D, Wu H-Y, Jiang X-J, Zhang H-M, Zhou X-L, Li J-J, et al. Role of plasma C-reactive protein and white blood cell count in predicting in-hospital clinical events of acute type A aortic dissection. Chin Med J (Engl). 2011; 124(17): 2678–82.
13. Li M, Xu S, Yan Y, Wang H, Zheng J, Li Y, et al. Association of biomarkers related to preoperative inflammatory and coagulation with postoperative in-hospital deaths in patients with type A acute aortic dissection. Sci Rep. 2021; 11(1): 18775.
14. Liu H, Li D, Jia Y, Zeng R. Predictive value of white blood cells, neutrophils, platelets, platelet to lymphocyte and neutrophil to lymphocyte ratios in patients with acute aortic dissection. Braz J Cardiovasc Surg. 2020; 35(6): 1031–3.
15. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012; 5(1): 2.
16. Erdolu B, As AK. C-reactive protein and neutrophil to lymphocyte ratio values in predicting inhospital death in patients with Stanford type A acute aortic dissection. Heart Surg Forum 2020; 23(4):E488–92.
17. Vrsalović M, Vrsalović Presečki A. Admission C-reactive protein and outcomes in acute aortic dissection: a systematic review. Croat Med J. 2019; 60(4):309–15. 18. Djordjevic D, Rondovic G, Surbatovic M, Stanojevic I, Udovicic I, Andjelic T, et al. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injured patients: Which ratio to choose to predict outcome and nature of bacteremia? Mediators Inflamm. 2018; 3758068.
19. Stojkovic Lalosevic M, Pavlovic Markovic A, Stankovic S, Stojkovic M, Dimitrijevic I, Radoman Vujacic I, et al. Combined diagnostic efficacy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as biomarkers of systemic inflammation in the diagnosis of colorectal cancer. Dis Markers. 2019: 6036979.
20. Ko DE, Yoon HJ, Nam SB, Song SW, Lee G, Ham SY. Preoperative neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and mean platelet volume as predictors of 1-year mortality in patients undergoing an open repair of abdominal aortic aneurysms: A retrospective study. J Clin Med. 2021; 10(22):5410.
21. Bedel C, Selvi F. Association of platelet to lymphocyte and neutrophil to lymphocyte ratios with in-hospital mortality in patients with type A acute aortic dissection. Braz J Cardiovasc Surg. 2019; 34(6):694–8.
22. Sansanayudh N, Anothaisintawee T, Muntham D, McEvoy M, Attia J, Thakkinstian A. Mean platelet volume and coronary artery disease: a systematic review and meta-analysis. Int J Cardiol. 2014; 175(3):433–40.