Ayse Ayzıt KILINÇ, Gulizar ALİSHBAYLİ, Nursena KOLOGLU, Haluk ÇOKUĞRAŞ

Nötrofil- lenfosit oranı ve trombosit- lenfosit oranlarının çocuklardaki kistik fibroz dışı bronşektazinin akut alevlenmesinde potansiyel biyolojik gösterge olarak değerlendirmesi

Özet Amaç: Kistik fibroz dışı bronsektazi (KFDBE) çocuklarda önemli morbiditeye yol açan kronik inflamatuar akciğer hastalığıdır. KFDBE'de alevlenme akciğer fonksiyonlarının kötüye gitmesi ile ilişkilidir. Nötrofil- lenfosit oranı (NLO), trombosit- lenfosit oranı (TLO) ve ortalama trombosit hacmi (OTH) gibi bazı laboratuar parametrelerinin çesitli kronik inflamatuar hastalıkları için bir gösterge olduğu öne sürülmüştür. Çalışmamızda, KFDBE’li çocuklardaki akut alevlenmede NLO, TLO ve OTH ölçümlerinin bir gösterge olarak değerlendirilmesini amaçladık. Gereç ve yöntem: Çalışmada, akut alevlenme ve stabil dönemdeki 55 KFDBE' li hastanın ve 79 sağlıklı kontrol grubunun NLO, TLO ve OTH değerleri analiz edildi. Bulgular: Çalışma ve kontrol grubundaki hastaların ortalama yaşları sırasıyla 13,62±3,5 ve 12,72±2,68 yıldı. Çalışma grubunun %64'ü ve kontrol grubunun %54'ü erkekti. Alevlenme dönemindeki grupta beyaz küre sayısı, nötrofil oranı ve NLO değerleri sağlıklı kontrol grubundan anlamlı olarak yüksekti (p<0,05). İki gruptaki TLO ve OTH değerleri arasında anlamli fark yoktu. Çalışma grubunun akut alevlenme ve stabil dönemleri arasında, sadece ilk bir saniyede zorlu ekspiryum hacmi (FEV1) ve c-reaktif protein (CRP) seviyeleri arasında anlamlı fark vardı (p<0,001). Sonuç: Her ne kadar KFDBE' li çocuklardaki NLO değeri sağlıklı kontrol grubundaki çocuklara göre anlamlı ölçüde yüksek olsa da hastalığın stabil durum ve akut alevlenme periyodu arasında NLO değeri farklılık göstermedi. TLO ve OTH değerleri, KFDBE'li çocuklardaki akut alevlenmelerde bir gösterge olarak kullanılamaz.

Anahtar Kelimeler:

Bronşektazi, kistik fibroz dışı bronşektazi, nötrofil-lenfosit oranı, trombosit-lenfosit oranı, ortalama trombosit hacmi

Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as potential biomarkers of acute exacerbation in children with non-cystic fibrosis bronchiectasis

Purpose: Non- cyctic fibrosis bronchiectasis (non-CFBE) is a chronic inflammatory lung disease which causes significant morbidity in children. Exacerbations in non-CFBE are associated with worsening lung function. Several laboratory parameters such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) have been suggested to be as an indicator in various chronic inflammatory diseases. We aimed to asses the value of the NLR, PLR and MPV as markers of acute exacerbation in pediatric patients with non-CFBE. Methods: The NLR, PLR, and MPV values of 55 non-CFBE patients (during exacerbation and stable state periods) and 79 healthy control subjects were analyzed. Results: The mean ages for the patient and control group were 13.62±3.5 and 12.72±2.68 years, respectively. 64% of patients and 54% of control subjects were male. The white blood cell count, absolute neutrophil count, and NLR values were significantly higher in the exacerbation group than in the healthy control group (p<0.05). MPV and PLR values were not significantly different between the two groups. Only forced expiratory volume in one second (FEV1) and C-reactive protein level were significantly different (p<0.001) between the acute exacerbation and stable state periods in the Purpose: Non- cyctic fibrosis bronchiectasis (non-CFBE) is a chronic inflammatory lung disease which causes significant morbidity in children. Exacerbations in non-CFBE are associated with worsening lung function. Several laboratory parameters such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) have been suggested to be as an indicator in various chronic inflammatory diseases. We aimed to asses the value of the NLR, PLR and MPV as markers of acute exacerbation in pediatric patients with non-CFBE.Methods: The NLR, PLR, and MPV values of 55 non-CFBE patients (during exacerbation and stable state periods) and 79 healthy control subjects were analyzed. Results: The mean ages for the patient and control group were 13.62±3.5 and 12.72±2.68 years, respectively. 64% of patients and 54% of control subjects were male. The white blood cell count, absolute neutrophil count, and NLR values were significantly higher in the exacerbation group than in the healthy control group (p<0.05). MPV and PLR values were not significantly different between the two groups. Only forced expiratory volume in one second (FEV1) and C-reactive protein level were significantly different (p<0.001) between the acute exacerbation and stable state periods in the patient group. Conclusion: Despite the NLR value being significantly higher in children with non-CFBE than in healthy control subjects, it did not differentiate between the steady-state and acute exacerbations periods of the disease. PLR and MPV values also cannot be used as markers of acute exacerbation in children with non-CFBE.

Keywords:

Bronchiectasis, non-cystic fibrosis bronchiectasis, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume,

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1. Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Pediatric bronchiectasis: No longer an orphan disease. Pediatr Pulmonol 2016;51:450-469. https://doi: 10.1002/ppul.23380.
2. Bell SC, Elborn JS, Byrnes CA. Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention. Respirology 2018;23:1006-1022. https://doi:10.1111/resp.13398.
3. Kapur N, Masters IB, Morris PS, Galligan J, Ware R, Chang AB. Defining pulmonary exacerbation in children with non-cystic fibrosis bronchiectasis. Pediatr Pulmonol 2011;47:68-75. https://doi:10.1002/ppul.21518.
4. Abd El Khalek KA, El Seify MY, Youssef OI, Badr MM. Diagnostic value of exhaled carbon monoxide as an early marker of exacerbation in children with chronic lung diseases. ISRN Pediatr 2012;2012:859873. https://doi: 10.5402/2012/859873.
5. Lee SJ, Lee HR, Lee TW, et al. Usefulness of neutrophil to lymphocyte ratio in patients with chronic obstructive pulmonary disease: A prospective observational study. Korean J Intern Med 2016;31:891‐898. https://doi:10.3904/kjim.2015.084.
6. Ye Z, Ai X, Liao Z, You C, Cheng Y. The prognostic values of neutrophil to lymphocyte ratio for outcomes in chronic obstructive pulmonary disease. Medicine 2019;98:e16371. https:// doi:10.1097/md.0000000000016371.
7. Dogru M, Yesiltepe Mutlu RG. The evaluation of neutrophil–lymphocyte ratio in children with asthma. Allergol Immunopat 2016;44:292–296. https://doi:10.1016/j.aller.2015.09.005.
8. O'Brien CE, Price ET. The blood neutrophil to lymphocyte ratio correlates with clinical status in children with cystic fibrosis: A retrospective study. PLoS One 2013;8:e77420. https://doi:10.1371/journal.pone.0077420.
9. Şahin F, Koşar AF, Aslan AF, Yiğitbaş B, Uslu B. Serum biomarkers in patients with stable and acute exacerbation of chronic obstructive pulmonary disease: A comparative study. J Med Biochem 2019;38:503‐511. https://doi:10.2478/jomb-2018-0050.
10. Karadag B, Karakoc F, Ersu R, Kut A, Bakac S, Dagli E. Non-cystic-fibrosis bronchiectasis in children: A persisting problem in developing countries. Respiration 2005;72:233–238. https://doi:10.1159/000085362.
11. Ethier J, Desautels D, Templeton A, Shah PS, Amir E. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: A systematic review and meta-analysis. Breast Cancer Res 2017;19:2. https://doi:10.1186/s13058-016-0794-1.
12. Qin B, Ma N, Tang Q, et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 2016;26:372-376. https://doi:10.3109/14397595.2015.1091136.
13. Hwang SY, Shin TG, Jo IJ, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med 2017;35:234-239. https://doi:10.1016/j.ajem.2016.10.055.
14. Dogru M, Evcimik MF, Cirik AA. Is neutrophil-lymphocyte ratio associated with the severity of allergic rhinitis in children?. Eur Arch Otorhinolaryngol 2016;273:3175-3178. https://doi:10.1007/s00405-015-3819.
15. Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: A review. Expert Rev Cardiovasc Ther 2013;11:55–59. https://doi:10.1586/erc.12.159.
16. Coban H, Gungen AC. Is there a correlation between new scoring systems and systemic inflammation in stable bronchiectasis? Can Respir J 2017;2017:9874068. https://doi: 10.1155/2017/9874068.
17. In E, Kuluozturk M, Oner O, Deveci F. The importance of neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease. Turk Thorac J 2016;17:41-46. https://doi: 10.5578/ttj.17.2.009.
18. Günay E, Sarιnç Ulaşlι S, Akar O, et al. Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: A retrospective study. Inflammation 2014;37:374-380. https://doi: 10.1007/s10753-013-9749-1.
19. Nacaroglu HT, Erdem SB, Karaman S, Yazıcı S, Can D. Can mean platelet volume and neutrophil-to-lymphocyte ratio be biomarkers of acute exacerbation of bronchiectasis in children? Centr Eur J Immunol 2017;42:358–362. https://doi: 10.5114/ceji.2017.72808.
20. Wang R, Li J-Y, Cao Z, Li Y. Mean platelet volume is decreased during an acute exacerbation of chronic obstructive pulmonary disease. Respirology 2013;18:1244-1248. https://doi:10.1111/resp.12143.
21. Wedzicha JA, Syndercombe-Court D, Tan KC. Increased platelet aggregate formation in patients with chronic airflow obstruction and hypoxaemia. Thorax 1991;46:504–507. https://doi: 10.1136/thx.46.7.504.
22. Ye G, Chen Q, Chen X, et al. The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: A cohort study. Sci Rep 2019;9:10639. https://doi:10.1038/s41598-019-47143-2.
23. Uysal P, Tuncel T, Erge DO, Hocaoglu AB, Karaman O, Uzuner N. Does mean platelet volume in children with bronchiectasis predict exacerbations? UHOD 2020;30:54-59.
24. Lee YSG, Bradi A, Peverelle M, et al. Usefulness of platelet-to-lymphocyte ratio to predict long-term all-cause mortality in patients at high risk of coronary artery disease who underwent coronary angiography. Am J Cardiol 2018;121:1021–1026. https://doi: 10.1016/j.amjcard.2018.01.018.
25. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets 2014;26:680-681. https://doi:10.3109/09537104.2014.979340.
26. Azab B, Shah N, Akerman M, McGinn JT. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis 2012;34:326-334. https://doi: 10.1007/s11239-012-0718-6.
27. Karadeniz G, Aktoğu S, Erer OF, et al. Predictive value of platelet-to-lymphocyte ratio in exacerbation of chronic obstructive pulmonary disease. Biomark Med 2016;10:701-710. https://doi:10.2217/bmm-2016-0046.
28. Uysal P, Tuncel T, Olmez D, Babayigit A, Karaman O, Uzuner N. The role of mean platelet volume predicting acute exacerbations of cystic fibrosis in children. Ann Thorac Med 2011;6:227‐230. https:// doi:10.4103/1817-1737.84778.