Yıl: 2014 Cilt: 44 Sayı: 1 Sayfa Aralığı: 50 - 55 Metin Dili: İngilizce

Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism

Öz:
Aim: Preliminary evidence suggests that inflammation plays a role in the development and prognosis of pulmonary embolism (PE). We used the neutrophil/lymphocyte ratio (NLR) as a measure of systemic inflammation and investigated its association with PE. Materials and methods: A total of 266 patients who were diagnosed with PE and a control group of 124 age- and sex-matched healthy subjects were included in this study. We further classified the PE patients into 2 groups: those who survived and those who died in the first 30 days. Baseline NLR was measured by dividing neutrophil count to lymphocyte count and was compared between the groups. Results: Median NLR was significantly higher among patients with PE compared to the healthy control group (3.9 (interquartile range (IQR): 5.0) vs. 1.9 (IQR: 0.6), P < 0.001). Of the 266 patients with PE, 16 (6%) died within 1 month. Median NLR was significantly higher among PE patients who died compared to those who survived, as well (3.7 (IQR: 4.3) vs. 9.0 (IQR: 7.9), P < 0.001). The optimal cut-off values, sensitivities, and specificities of NLR for predicting PE and in-hospital mortality of PE were >2.565 and >5.465, 70.3% and 75.0%, and 92.7% and 67.6%, respectively. Multiple logistic regression analysis showed that NLR values of >5.465 could define those patients with a mortal clinical course independently (odds ratio: 13.446, 95% confidence interval: 3.141 57.566, P < 0.001). Conclusion: A higher NLR, as an emerging marker of inflammation, may be beneficial in determining prognosis in PE patients.
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  • 1. Varol A, Köktürk N, Kılıç H, Aydoğdu M, Ekim NN. The role of quantitative D-dimer levels in the follow-up and differential diagnosis of pulmonary thromboembolism and communityacquired pneumonia. Turk J Med Sci 2012; 42: 639–47.
  • 2. Mehta J, Dinerman J, Mehta P, Saldeen TG, Lawson D, Donnelly WH, Wallin R. Neutrophil function in ischemic heart disease. Circulation 1989; 79: 549–56.
  • 3. Shen XH, Chen Q, Shi Y, Li HW. Association of neutrophil/ lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Chin Med J (Engl) 2010; 123: 3438–43.
  • 4. Downing LJ, Strieter RM, Kadell AM, Wilke CA, Brown SL, Wrobleski SK, Burdick MD, Hulin MS, Fowlkes JB, Greenfield LJ et al. Neutrophils are the initial cell type identified in deep venous thrombosis induced vein wall inflammation. ASAIO J 1996; 42: M677–82.
  • 5. Wakefield TW, Strieter RM, Downing LJ, Kadell AM, Wilke CA, Burdick MD, Wrobleski SK, Phillips ML, Paulson JC, Anderson DC et al. P-Selectin and TNF inhibition reduce venous thrombosis inflammation. J Surg Res 1996; 64: 26–31.
  • 6. Eagleton MJ, Henke PK, Luke CE, Hawley AE, Bedi A, Knipp BS, Wakefield TW, Greenfield LJ. Southern Association for Vascular Surgery William J. von Leibig Award. Inflammation and intimal hyperplasia associated with experimental pulmonary embolism. J Vasc Surg 2002; 36: 581–8.
  • 7. Watts JA, Zagorski J, Gellar MA, Stevinson BG, Kline JA. Cardiac inflammation contributes to right ventricular dysfunction following experimental pulmonary embolism in rats. J Mol Cell Cardiol 2006; 41: 296–307.
  • 8. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, Renlund DG, Muhlestein JB; Intermountain Heart Collaborative Study Group. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005; 45: 1638–43.
  • 9. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008; 102: 653–7.
  • 10. Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, Capodilupo R. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011; 107: 433–8.
  • 11. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008; 395: 27–31.
  • 12. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 2006; 97: 993–6.
  • 13. Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CG, Thomson SP, Gibbons RJ. Predictive power of the relative lymphocyte concentration in patients with advanced heart failure. Circulation 1998; 97: 19–22.
  • 14. Tsujimura A, Kawamura N, Ichimura T, Honda K, Ishiko O, Ogita S. Telomerase activity in needle-biopsied uterine myoma-like tumors: differential diagnosis between uterine sarcomas and leiomyomas. Int J Oncol 2002; 20: 361–5.
  • 15. Blake-Mortimer JS, Sephton SE, Carlson RW, Stites D, Spiegel D. Cytotoxic T lymphocyte count and survival time in women with metastatic breast cancer. Breast J 2004; 10: 195–9.
  • 16. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005, 91: 181–4.
  • 17. Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A, Prasad KR, Toogood GJ, Lodge JP. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 2008; 34: 55– 60.
  • 18. Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A, Prasad KR, Toogood GJ, Lodgen JP. Negative impact of neutrophillymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Ann Surg 2009; 250: 141–51.
  • 19. Sarraf KM, Belcher E, Raevsky E, Nicholson AG, Goldstraw P, Lim E. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg 2009; 137: 425–8.
  • 20. Colotta F, Sciacca FL, Sironi M, Luini W, Rabiet MJ, Mantovani A. Expression of monocyte chemotactic protein-1 by monocytes and endothelial cells exposed to thrombin. Am J Pathol 1994; 144: 975–85.
  • 21. Watts JA, Gellar MA, Stuart LK, Obraztsova M, Kline JA. Proinflammatory events in right ventricular damage during pulmonary embolism: effects of treatment with ketorolac in rats. J Cardiovasc Pharmacol 2009; 54: 246–52.
  • 22. Fraser RS, Müller NL, Colman N. Thrombosis and thromboembolism. In: Fraser RS, Müller NL, Colman N, Pare PD, editors. Diagnosis of Diseases of the Chest. 4th ed. Philadelphia: WB Saunders Company; 1999. pp. 1773–843.
  • 23. Kniffin WD Jr, Baron JA, Barrett J, Birkmeyer JD, Anderson FA Jr. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arc Intern Med 1994; 154: 861–6.
  • 24. Galle C, Papazyan JP, Miron MJ, Slosman D, Bounameaux H, Perrier A. Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound. Thromb Haemost 2001; 86: 1156–60.
  • 25. Fishman A. Fishman’s Pulmonary Disease and Disorders. 4th ed., Vol. 2. New York: McGraw-Hill; 2009. pp. 1423–47.
APA ÇAVUŞ U, YILDIRIM S, SÖNMEZ E, ERTAN Ç, ÖZEKE Ö (2014). Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. , 50 - 55.
Chicago ÇAVUŞ Umut Yücel,YILDIRIM SİNAN,SÖNMEZ ERTAN,ERTAN Çağatay,ÖZEKE ÖZCAN Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. (2014): 50 - 55.
MLA ÇAVUŞ Umut Yücel,YILDIRIM SİNAN,SÖNMEZ ERTAN,ERTAN Çağatay,ÖZEKE ÖZCAN Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. , 2014, ss.50 - 55.
AMA ÇAVUŞ U,YILDIRIM S,SÖNMEZ E,ERTAN Ç,ÖZEKE Ö Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. . 2014; 50 - 55.
Vancouver ÇAVUŞ U,YILDIRIM S,SÖNMEZ E,ERTAN Ç,ÖZEKE Ö Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. . 2014; 50 - 55.
IEEE ÇAVUŞ U,YILDIRIM S,SÖNMEZ E,ERTAN Ç,ÖZEKE Ö "Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism." , ss.50 - 55, 2014.
ISNAD ÇAVUŞ, Umut Yücel vd. "Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism". (2014), 50-55.
APA ÇAVUŞ U, YILDIRIM S, SÖNMEZ E, ERTAN Ç, ÖZEKE Ö (2014). Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. Turkish Journal of Medical Sciences, 44(1), 50 - 55.
Chicago ÇAVUŞ Umut Yücel,YILDIRIM SİNAN,SÖNMEZ ERTAN,ERTAN Çağatay,ÖZEKE ÖZCAN Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. Turkish Journal of Medical Sciences 44, no.1 (2014): 50 - 55.
MLA ÇAVUŞ Umut Yücel,YILDIRIM SİNAN,SÖNMEZ ERTAN,ERTAN Çağatay,ÖZEKE ÖZCAN Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. Turkish Journal of Medical Sciences, vol.44, no.1, 2014, ss.50 - 55.
AMA ÇAVUŞ U,YILDIRIM S,SÖNMEZ E,ERTAN Ç,ÖZEKE Ö Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. Turkish Journal of Medical Sciences. 2014; 44(1): 50 - 55.
Vancouver ÇAVUŞ U,YILDIRIM S,SÖNMEZ E,ERTAN Ç,ÖZEKE Ö Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. Turkish Journal of Medical Sciences. 2014; 44(1): 50 - 55.
IEEE ÇAVUŞ U,YILDIRIM S,SÖNMEZ E,ERTAN Ç,ÖZEKE Ö "Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism." Turkish Journal of Medical Sciences, 44, ss.50 - 55, 2014.
ISNAD ÇAVUŞ, Umut Yücel vd. "Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism". Turkish Journal of Medical Sciences 44/1 (2014), 50-55.