Diagnostic utility of simple hematologic markers in acute gastroenteritis patients admitted to the emergency department

The contributions of hematologic parameters to the inflammatory response via different leukocyte and platelet pathways are well known. However, the diagnostic yield of these parameters in acute gastroenteritis (AGE) is not yet well understood. This study was planned to investigate the diagnostic value of simple hematological markers, including mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), platelet distribution width (PDW), and platelet-to-lymphocyte ratio (PLR), in patients with AGE admitted to the emergency department. A total of 57 patients with AGE of either viral or bacterial origin and 69 age and sexmatched control subjects were studied. NLR, PLR, MPV, PDW, and RDW values in all patients were calculated and recorded from complete blood cell counts. A total of 126 patients (57 men [45.2%] and 69 women [54.8%]) were included in the study. The mean NLR and PLR values of AGE patients were significantly higher than those of health controls (NLR = 4.44 ± 4.1 for AGE patients and 2.22 ± 1.2 for controls [P < 0.001]; PLR = 160.4 ± 102.4 for AGE patients and 113.8 ± 42.6 for controls [P = 0.02]. ROC curve analysis suggested that the optimum NLR cut-off point for AGE was 2.08, with a sensitivity, specificity, PPV, and NPV of 70%, 65%, 62%, and 72%, respectively (AUC = 0.704). The optimum PLR cut-off point for AGE was 105.55, with sensitivity, specificity, PPV, and NPV of 71%, 50%, 54%, and 68%, respectively (AUC = 0.648). We demonstrated that NLR and PLR levels are elevated in AGE patients. Thus, NLR and PLR levels can be considered a valuable tool to differentiate acute gastroenteritis from other non-inflammatory emergent conditions.

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1. Chow CM, Leung AK, Hon KL. Acute gastroenteritis: from guidelines to real life. Clin Exp Gastroenterol. 2010;3:97-112.

2. Dalby-Payne J, Elliott E. Gastroenteritis in children. Clin Evid. 2005;13:343- 53.

3. Degerli V. Diagnostic value of haematological parameters in differentiation between acute appendicitis and acute gastroenteritis. Med J Izmir Hospital. 2018;22:171-7.

4. Reust CE, Williams A. Acute abdominal pain in children. Am Fam Physician. 2016;93:830-6.

5. Beyazit F, Ozturk FH, Pek E, et al. Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study. Ginekol Pol. 2017;88:315-9.

6. Wu M, Zhou L, Zhu D, et al. Hematological indices as simple, inexpensive and practical severity markers of obstructive sleep apnea syndrome: a metaanalysis. J Thorac Dis. 2018;10:6509-21.

7. 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

8. Purnak T, Olmez S, Torun S, et al. Mean platelet volume is increased in chronic hepatitis C patients with advanced fibrosis. Clin Res Hepatol Gastroenterol. 2013;37:41-6.

9. Suvak B, Torun S, Tas A, et al. Mean platelet volume is a useful indicator of systemic inflammation in cirrhotic patients with ascitic fluid infection. Ann Hepatol. 2013;12:294–300.

10. Akbas EM, Demirtas L, Ozcicek A, et al. Association of epicardial adipose tissue, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic nephropathy. Int J Clin Exp Med. 2014;7:1794–801.

11. Torun S, Tunc BD, Suvak B, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012;36:491–7.

12. Beyazit Y, Sayilir A, Torun S, et al. Mean platelet volume as an indicator of disease severity in patients with acute pancreatitis. Clin Res Hepatol Gastroenterol. 2012;36:162-8.

13. Mete E, Akelma AZ, Cizmeci MN, et al. Decreased mean platelet volume in children with acute rotavirus gastroenteritis. Platelets. 2014;25:51-4.

14. Tanju C, Ekrem G, Berksoy Emel A, et al. Mean platelet volume as a negative marker of inflammation in children with rotavirus gastroenteritis. Iran J Pediatr. 2014;24:617-22.

15. Boshnak N, Boshnaq M, Elgohary H. Evaluation of platelet indices and red cell distribution width as new biomarkers for the diagnosis of acute appendicitis. J Invest Surg. 2018;31:121-9.

16. Matowicka-Karna J, Panasiuk A. Does anti-parasitic treatment normalize platelets morphology in patients infested with Entamoeba histolytica? Rocz Akad Med Bialymst. 1996;41:258-67.

17. Çelik T, Güler E, Berksoy EA, et al. Mean platelet volume in children with acute gastroenteritis caused by entamoeba histolytica. Turk. Parazit Derg. 2015;39:205-8.

18. Sitotaw C, Asrie F, Melku M. Evaluation of platelet and white cell parameters among pregnant women with Preeclampsia in Gondar, Northwest Ethiopia: A comparative cross-sectional study. Pregnancy Hypertens. 2018;13:242-7.

19. Yang SW, Cho SH, Kwon HS, et al. Significance of the platelet distribution width as a severity marker for the development of preeclampsia. Eur J Obstet Gynecol Reprod Biol. 2014;175:107-11.

20. Boshnak N, Boshnaq M, Elgohary H. Evaluation of platelet indices and red cell distribution width as new biomarkers for the diagnosis of acute appendicitis. J Invest Surg. 2018;31:121-9.

21. Liang QC, Jin D, Li Y, et al. Mean platelet volume and platelet distribution width in vascular dementia and Alzheimer’s disease. Platelets. 2014;25:433-8.

22. Mete Ural U, Bayoglu Tekin Y, Balik G, et al. Could platelet distribution width be a predictive marker for unexplained recurrent miscarriage? Arch Gynecol Obstet. 2014;290:233-6.

23. Budak YU, Polat M, Huysal K. The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency nontraumatic abdominal surgery: a systematic review. Biochem Med (Zagreb). 2016;26:178-93.

24. Mukker P, Haridas A, Kallinkeel N, et al. Comparative study of platelet indices in cirrhosis, cirrhosis with sepsis and normal population. Int J Res Med Sci. 2016;4:1423-8.

25. Halazun KJ, Aldoori A, Malik HZ, 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.

26. Kishi Y, Kopetz S, Chun YS, et al. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol. 2009;16:614-22.

27. Tamhane UU, Aneja S, Montgomery D, et al. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008;102:653-7.

28. Markar SR, Karthikesalingam A, Falzon A, et al. The diagnostic value of neutrophil: lymphocyte ratio in adults with suspected acute appendicitis. Acta Chir Belg. 2010;110:543-7.

29. Kawamura Y, Takeshita S, Kanai T, et al. The combined usefulness of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in predicting intravenous immunoglobulin resistance with Kawasaki disease. J Pediatr. 2016;178:281-4.

30. Cinar H, Aygun A, Derebey M, et al. Significance of hemogram on diagnosis of acute appendicitis during pregnancy. Ulus Travma Acil Cerrahi Derg. 2018;24:423-8.

31. Akpinar MY, Ozin YO, Kaplan M, et al. Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio predict mucosal disease severity in ulcerative colitis. J Med Biochem. 2018;37:155-62.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )