Tubo-Ovaryan Apse Tanılı Olgularda Tedavi Öncesi Nötrofil/Lenfosit ve Platelet/Lenfosit Oranları Medikal Tedavi Başarısını Predikte Eder mi?
GİRİŞ ve AMAÇ: Tubo-ovaryan apse (TOA) tanılı hastalarda enflamasyon belirteçlerinin medikal tedavi başarısındaki prediktif değerlerini analiz etmektir. YÖNTEM ve GEREÇLER: Tepecik Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde 2008- 2016 yılları arasında medikal ve cerrahi olarak tedavi edilmiş TOA tanılı 180 hasta retrospektif olarak değerlendirildi. Klinik, demografik, laboratuvar ve operasyon verileri hastaların tıbbi kayıtları incelenerek sağlandı. Medikal ve cerrahi tedavi uygulanan hastaların tedavi öncesi ve sonrası dönemde tam kan sayımı, C-reaktif protein (CRP) ve eritrosit sedimantasyon hızı (ESR) ölçümleri için kan örnekleri alınarak sonuçları karşılaştırıldı. Tam kan sayımı parametreleri olarak; lökosit sayısı, nötrofil, lenfosit, hemoglobin, hematokrit ve platelet değerleri ile nötrofil/lenfosit oranı (NLR) ve platelet/lenfosit oranları (PLR) incelendi. BULGULAR: Antibiyotik tedavisinin başarısız olmasından dolayı 99 (%55) hastaya cerrahi tedavi uygulandı. Hastaların ortalama yaşı, ortalama apse boyutu, tedavi öncesi ortalama lökosit sayısı, nötrofil sayısı, trombosit sayısı, NLR ve PLR oranları ile CRP değerleri cerrahi olarak tedavi edilen grupta daha yüksekti (p
Do Pre-treatment Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios Predict Success of Medical Treatment in Patients with Tubo-ovarian Abscess?
INTRODUCTION: To analyze the predictive value ofinflammatory markers for medical treatment success inpatients with tubo-ovarian abscess (TOA).METHODS: Patients with TOA between January 2008 andDecember 2016 were retrospectively reviewed at TepecikTraining and Research Hospital, Obstetrics and GynaecologyDepartment. A total of 180 patients were enrolled the study.Patients were compared on the basis of TOA size, demographiccharacteristics, and laboratory findings. As complete bloodcount parameters, white blood cell, neutrophil, lymphocyte,and platelet counts, hemoglobin, hematocrit,neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyteratio (PLR) were analysed.RESULTS: A total of 99 (55%) patients underwent surgicaltreatment due to unsuccessful medical treatment. Patients whorequired surgery had larger abscess size, higher mean age,higher mean white blood cell, neutrophil, lymphocyte, andplatelet counts, and higher mean C-reactive protein level, NLR,and PLR (p
___
- 1. Granberg S, Gjelland K, Ekerhovd E. The
management of pelvic abscess. Best Pract Res Clin
Obstet Gynaecol 2009; 23:667-8.
- 2. Chappell CA, Wiesenfeld HC. Pathogenesis,
diagnosis, and management of severe pelvic
inflammatory disease and tuboovarian abscess. Clin
Obstet Gynecol 2012;55:893–903.
- 3. Vermeeren J, Te Lınde Rw. Intraabdominal
rupture of pelvic abscesses. Am J Obstet Gynecol
1954; 68:402.
- 4. Pedowıtz P, Bloomfıeld Rd. Ruptured Adnexal
Abscess (Tuboovarıan)With Generalızed Perıtonıtıs.
Am J Obstet Gynecol 1964; 88:721.
- 5. Rosen M, Breitkopf D, Waud K. Tubo-ovarian
abscess management options for women who desire
fertility. Obstet Gynecol Surv 2009; 64:681.
- 6. Kinay T, Unlubilgin E, Cirik DA, et al. The value
of ultrasonograhic tubo-ovarian abscess morphology
in predicting whether patients will require surgical
treatment. Int J Gynaecol Obstet 2016;135:77–81.
- 7. Topcu HO, Kokanali K, Guzel AI, et al. Risk
factors for adverse clinical outcomes in patients with
tubo-ovarian abscess. J Obstet Gynaecol
2015;35:699–702.
- 8. Gungorduk K, Guzel E, Asicioglu O, et al.
Experience of tubo-ovarian abscess in western
Turkey. Int J Gynecol Obstet 2014;124:45–50.
- 9. Inal ZO, Inal HA, Gorkem U. Experience of
Tubo-Ovarian Abscess: A Retrospective Clinical
Analysis of 318 Patients in a Single Tertiary Center
in Middle Turkey. Surg Infect (Larchmt).
2018;19:54-60.
- 10. Oktem O., The Ovary Anatomy and Function
throughout Human Life, Ann. N.Y. Acad. Sci. 1127:
1–9 (2008). New York Academy of Sciences.doi:
10.1196/annals.1434.009.
- 11. Saladin K., Human Anatomy, Second Edition,
ISBN 978–0–07–294368–9, MHID 0–07–294368–
8,2008,S:736-767.
- 12. Yildirim M, Turkyilmaz E, Avsar AF.
Preoperative Neutrophil-to-Lymphocyte Ratio Has a
Better Predictive Capacity in Diagnosing Tubo-
Ovarian Abscess. Gynecol Obstet Invest.
2015;80:234-9.
- 13. Bolat D, Topcu YK, Aydogdu O, et al. Neutrophil
to Lymphocyte Ratio as a predictor of early penile
prosthesis implant infection. Int Urol Nephrol
2017;49:947–53.
- 14. Zahorec R: Ratio of neutrophil to lymphocyte
counts rapid and simple parameter of systemic
inflammation and stress in critically ill. Bratisl Lek
Listy 2001; 102: 5–14.
- 15. Kurtipek E, Bekci TT, Kesli R, et al. The role of
neutrophil-lymphocyte ratio and plateletlymmphocyte
ratio in exacerbation of chronic
obstructive pulmonary disease. J Pak Med Assoc
2015;65:1283-7.
- 16. Ertas IE, Gungorduk K, Akman L, et al. Eur J
Obstet Gynecol Reprod Biol. 2013 Nov;171(1):138-
4.
- 17. Gungorduk K, Ertaş IE, Ozdemir A, et al.
Prognostic Significance of Retroperitoneal
Lymphadenectomy, Preoperative Neutrophil
Lymphocyte Ratio and Platelet Lymphocyte Ratio in
Primary Fallopian Tube Carcinoma: A Multicenter
Study. Cancer Res Treat. 2015;47(3):480-8.
- 18. Paramanathan A, Saxena A, Morris DL: A
systematic review and meta-analysis on the impact
of pre-operative neutrophil lymphocyte ratio on long
term outcomes after curative intent resection of solid
tumours. Surg Oncol 2014; 23: 31–9.
- 19. Williams KA, Labidi-Galy SI, Terry KL, et al.
Prognostic significance and predictors of the
neutrophil-to-lymphocyte ratio in ovarian cancer.
Gynecol Oncol 2014; 132: 542–50.
- 20. Chappell CA, Wiesenfeld HC. Pathogenesis,
d,agnosis, and management of severe pelvic
inflammatory diease and tuboovarian abcess. Clin
Obster Gynecol 2012;55(4):893-903.
- 21. Varras M, Polyzos D, Perouli E, et al. Tuboovarian
abscesses:spectrum of sonographic findings
with surgical and pathological correlations: Clin Exp
Obstet Gynecol 2003;30(2-3):117-21.
- 22. Seshadri S, Kirwan J, Neal T:
Perimenopausal pneumococcal tubo-ovarian abscess
– a case report and review. Infect Dis Obstet Gynecol
2004; 12: 27–30.
- 23. Topcu HO, Kokanali K, Guzel AI, et al. Risk
factors for adverse clinical outcomes in patients with
tubo-ovarian abscess. J Obstet Gynaecol
2015;35:699–702.
- 24. Reed SD, Landers DV, Sweet RL (1991)
Antibiotic treatment of tuboovarian abscess:
comparison of broad-spectrum β-lactam agents
versus clindamycin-containing regimens. Am J
Obstet Gynecol 164:1556–62.
- 25. Doganay M, Iskender C, Kilic S, et al.
Treatment approaches in tubo-ovarian abscesses
according to scoring system. Bratisl Lek Listy.
2011;112(4):200-3.
- 26. Dewitt J, Reining A, Allsworth JE, et al.
Tuboovarian abscesses: is size associated with
duration of hospitalization & complications? Obstet
Gynecol Int. 2010;2010:847041.
- 27. Akkurt MO, Yalcin SE, Akkurt I, et al. The
evaluation of risk factors for failed response to
conservative treatment in tubo-ovarian abscesses. J
Turk Ger Gynecol Assoc 2015; 16:226–30.
- 28. Ear T, McDonald PP. Cytokine generation,
promoter activation, and oxidant-independent NFkappaB
activation in a transfectable human
neutrophilic cellular model. BMC Immunol.
2008;9:14.
- 29. Kolaczkowska E, Kubes P. Neutrophil
recruitment and function in health and inflammation.
Nat Rev Immunol. 2013;13:159-75.
- 30. Klinger Mh, Jelkman W. Role of blood
platelets in infection and. İnflamation. J Interferon
Cytokine Res. 2002;22:913-22.