Şahin KAHRAMANCA, Gülay ÖZGEHAN, Oskay KAYA, Tevfik Hadi KÜÇÜKPINAR, Hülagü KARGICI, Mehmet Fatih AVŞAR

Platelet Lenfosit Oranı ve Akut Apandisit

Amaç: Akut apandisit (AA) genel cerrahi pratiğinde sık karşılaşılan bir durumdur. Ancak doğru tanıya ulaşmada bazen zorluklar olabilmektedir. Bu çalışmanın amacı AA tanısında platelet lenfosit oranının (PLO) belirleyiciliğini araştırmaktır. Materyal ve Metot: Akut apandisit tanısı ile ameliyat edilmiş 569 hastaya ait hastane kayıtları geriye dönük olarak incelendi. Postoperatif histopatolojik inceleme sonuçlarına göre hastalar iki gruba ayrıldı: Akut apandisit grubu (G1) ve normal appendiks grubu (G2). Gruplar arasında demografik analizler ve PLO hesaplamaları karşılaştırıldı. Bulgular: G1 de 475, G2 de 94 hasta vardı. AA tanısında PLO için sınır değer 136,5 (p=0,036) olarak hesaplandı. Duyarlılık ve seçicilik sırası ile %56,3 ve %55,3 idi. Pozitif prediktif ve negatif prediktif değerler sırası ile %86,2 ve %19,6 olarak bulundu. Sonuç: AA tanısında ve tedavinin yönlendirilmesinde PLO değerli bir ölçüt olabilir.

Anahtar Kelimeler:

akut apandisit, platelet lenfosit oranı

Platelet to Lymphocyte Ratio and Acute Appendicitis

Aim: Acute appendicitis (AA) is a frequent condition for general surgery practice. However, sometimes there may be difficulties in accurate diagnosis. The aim of this study is to research the predictive value of platelet to lymphocyte ratio (PLR) in diagnosis of AA. Material and Method: Hospital records were investigated retrospectively for 569 patients who underwent operation for AA diagnosis. According to postoperative histopathological examination of specimens, patients were divided into two groups: acute appendicitis group (G1) and normal appendix group (G2). Demographic analyses and PLR calculations on hospital admission were compared intergroup. Results: There were 475 patients in G1 whereas 94 in G2. The cut-off value of PLR for diagnosis of AA was 136.5 (p=0.036). The sensitivity and specificity were 56.3% and 55.3% respectively. Positive predictive value and negative predictive value were found as 86.2% and 19.6% respectively. Conclusion: PLR may be a valuable parameter supporting clinical evaluation for diagnosis and management of AA.

Keywords:

acute appendicitis, platelet to lymphocyte ratio,

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1. Fitz RH. Perforating inflammation of the vermiform appendix, with special reference to its early diagnosis and treatment. Trans Assoc Am Physicians 1886;1:107–44.
2. Andersson RE. The role of antibiotic therapy in management of acute appendicitis. Curr Infect Dis Rep 2013;15(1):10–3.
3. Maa J, Kirkwood KS. The appendix. In: Townsend CM (ed). Sabiston Textbook of Surgery 19th edition, Sounders Elsevier Inc. Philadelphia 2012:1279–93.
4. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15(5):557–64.
5. Lintula H, Kokki H, Pulkkinen J, Kettunen R, Gröhn O, Eskelinen M. Diagnostic score in acute appendicitis. Validation of a diagnostic score (Lintula score) for adults with suspected appendicitis. Langenbecks Arch Surg 2010;395:495–500.
6. Eskelinen M, Ikonen J, Lipponen P. Sex-specific diagnostic scores for acute appendicitis. Scand J Gastroenterol 1994;29(1):59–66.
7. Markar SR, Karthikesalingman A, Falzon A, Kan Y. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg 2010;110(5):543–7.
8. Yazici M, Ozkisacik S, Oztan OM, Gursoy H. Neutrophil/ lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 2010;52:400–3.
9. Lee JH, Park YS, Choi JS. The epidemiolog y of appendicitis and appendectomy in South Korea: National registry data. J Epidemiol 2010;20(2):97–105.
10. Dunn EL, Moore EE, Elerding SC, Murphy JR. The unnecessary laparotomy for appendicitis-can it be decreased? Am Surg 1982;48:320–3.
11. Kahramanca Ş, Özgehan G, Şeker D, Gökce EI, Seker G, Tunç G, et al. Neutrophil to lymphocyte ratio as a predictor of acute appendicitis? Ulus Travma Acil Cerrahi Derg 2014;20(1):19–22.
12. Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaiprachoroen S, Thavaramara T. Platelet to lyphpcyte ratio as aprognostic factor for epithelial ovarian cancer. J Gynecol Oncol 2012;23(4):265–73.
13. Seretis C, Seretis F, Lagoudianakis E, Politou M, Gemenetzis G, Salemis NS. Enhancing the accuracy of platelet to lymphocyte ratio after adjustment for large platelet count: a pilot study in breast cancer patients. Int J Surgl Oncol 2012; Article ID 653608.
14. Lee S, Oh SY, Kim SH, Lee JH, Kim MC, Kim KH, et al. Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer 2013;13(1):350.
15. Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, et al. Clinical significance of preoperative neutrophil-lympocyte versus platelet-lympocyte ratio in patients with operable colorectal cancer. Biomarkers 2012;17(3):216–22.
16. Hailiang L, Xiaohuri DU, Peiming S, Chunhong X, Yingxin X, Rong L. Preoperative platelet-lympocyte ratio is an independent prognostic factor for resectable colorectal cancer. J South Med Univ 2013;33(1):70–3.
17. He W, Yin C, Guo G, Jiang C, Wang F, Qiu H, et al. Initial neutrophil lymphocyte ratia is superior to platelet lymphocyte ratio as an adverse prognostic and predictive factor in metastatic colorectal cancer. Med Oncol 2013;30(1):439.
18. Simith RA, Bosonnet L, Ghaneh P, Sutton R, Evans J, Healey P, et al. The platelet-lymphocyte ratio improves the predictive value of serum CA 19–9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer. Surg 2008;143(5):658–66.
19. Bhatti I, Peacock O, Lloyd G, Larvin M, Hall RI. Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil- lymphocyte versus platelet-lymphocyte ratio. Am J Surg 2010;200(2):197–203.
20. Azab B, Shah N, Radbel J, Tan P, BhattV, Vonfrolio S, et al. Pretreatment neutrophil/lymphocyte ratio is superior to platelet lymphocyte ratio as a predictor of long-term mortality in breast cancer patients. Med Oncol 2013;30(1):432.
21. Wang D, Yang JX, Cao DY, Wan XR, Feng FZ, Huang HF, et al. Preoperative neutrophil-lymphocyte and platelet-lympocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometroid adenocarcinoma. Onco Targ Ther 2013;6:211–6.
22. Azab B, Shah N, Akerman M, McGinn JT Jr. Value of platelet/ lymphocyte ratio as apredictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis 2012;34(3):326–34.
23. Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Platelet-to-lymphocyte ratio: A novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. Plos One (www. plosone. org )2013;8(7): e67688.
24. Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int 2013;17(3):391–6.