Validity of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in the Diagnosis of Pulmonary Embolism in Patients with Renal Disorder/Renal Fonksiyon Bozuklugu Olan Hastalarda Notrofil/Lenfosit ve Platelet/Lenfosit Oranlarinin Pulmoner Emboli Tanisinda Kullanilabilirligi

• Published in: Istanbul medical journal Vol. 22; no. 4; p. 280
• Main Authors: Turkoglu, Ezgi, Piskinpasa, Mehmet Emin
• Format: Journal Article
• Language: English; Turkish
• Published: Galenos Yayinevi Tic. Ltd 01.11.2021
• Subjects: Care and treatment; Chronic kidney failure; Comorbidity; CT imaging; Diagnostic imaging; Health aspects; Pulmonary embolism; Thromboembolism
• ISSN: 2619-9793; 1304-8503
• DOI: 10.4274/imj.galenos.2021.79989

Introduction: Acute pulmonary embolism (APE) is a common and sometimes fatal form of venous thromboembolism. The fact that patients do not consult with a specific clinical picture and accompanying comorbid conditions make the diagnosis difficult. Chronic renal failure is one of the comorbid conditions with increased susceptibility to thrombosis. Due to clinical presentation variabilities, the limited use of the d-dimer test in patients with renal dysfunction, and the limitation of use of computed tomography (CT) angiography due to potential renal side effects, an easily accessible, inexpensive, sensitive and specific guide laboratory parameter within acceptable limits is needed in the diagnosis of patients with impaired renal function. In this study, neutrophil/lymphocyte ratios (NLR) and platelet/lymphocyte ratios (PLR) will be compared between two patient groups with and without renal dysfunction and APE attack. It is aimed to demonstrate the usability of these rates together with clinical, laboratory and radiological evaluations in the diagnosis of pulmonary embolism. Methods: In the selection of patient groups, the retrospective files of patients with chronic renal failure who applied to the emergency service of our hospital between January 2015 and 2019 and then were diagnosed with APE were examined. The control group consist of the patients with chronic renal failure who applied to the nephrology and internal medicine outpatient clinic without any additional pathology. Information such as gender, age, existing diseases, laboratory tests such as hemogram, D-dimer, troponin, creatinine glomerular filtration rate, lower extremity venous Doppler ultrasonography and thorax CT angiography results of the patients were recorded. NLR and PLR ratios were calculated in all groups. The results were evaluated with SPSS. Results: NLR and PLR values were found to be significantly higher in the case group diagnosed with pulmonary embolism (p=0.000). At NLR 3.50 cut-off value, sensitivity was 70.6%, positive prediction was 84.6%, specificity was 86.8%, and negative prediction was 74.2%. Sensitivity was 68.8%, positive prediction was 67.0%, specificity was 65.1%, negative prediction was 67% at PLR 125 cut-off value. Conclusion: NLR and PLR values can be used in addition to clinical, laboratory and imaging methods in the diagnosis of APE in patients with chronic renal failure and can give results that may help the clinician. However, more comprehensive studies should be conducted with larger case groups. Keywords: Acute pulmonary embolism, chronic renal failure, NLR, PLR Amac: Akut pulmoner emboli (APE); yaygin ve bazen olumcul olan bir venoz tromboemboli seklidir. Hastalarin spesifik bir klinik tabloyla basvurmamalari ve eslik eden komorbid durumlar taniyi guclestirir. Kronik bobrek yetmezligi de tromboza yatkinligin arttigi komorbid durumlardandir. Klinik prezantasyon degiskenlikleri, D-dimer testinin renal disfonksiyonlu hastalarda kullanim kisitliligi, bilgisayarli tomografi (BT) anjiyografinin olasi renal yan etkilerinden dolayi kullanim kisiti nedeniyle renal fonksiyonlari bozuk hastalarin tanisinda, kolay ulasilabilir, ucuz, kabul edilebilir sinirlarda sensitif ve spesifik bir kilavuz laboratuvar parametresine ihtiyac duyulmaktadir. Bu calismada renal fonksiyon bozuklugu mevcut ve APE atagi geciren ve gecirmeyen iki hasta grubu arasinda notrofil/lenfosit oranlari (NLR) ve platelet/lenfosit oranlari (PLR) karsilastirilacaktir. Bu oranlarin pulmoner emboli tanisindaki klinik, laboratuvar ve radyolojik degerlendirmelerle birlikte kullanilabilirliginin gosterilmesi amaclanmistir. Yontemler: Hasta gruplarinin seciminde Ocak 2015-2019 tarihleri arasinda hastanemiz acil servisine basvurarak APE tanisi almis, kronik bobrek yetmezligi olan hastalarin geriye donuk dosyalari incelenmistir. Kontrol grubu olarak ise ek patolojisi olmayan, nefroloji ve dahiliye poliklinigine basvurmus, kronik renal yetmezligi bulunan hastalar alinmistir. Hastalarin cinsiyet, yas, mevcut hastaliklari, laboratuvar tetkiklerinden hemogram, D-dimer, troponin, kreatinin glomeruler filtrasyon hizi, alt ekstremite venoz Doppler ultrasonografi ve toraks BT anjiyografi sonuclari kaydedilmistir. Tum gruplarda NLR ve PLR oranlari hesaplanmistir. Sonuclar SPSS ile degerlendirilmistir. Bulgular: Pulmoner emboli tanili olgu grubunda NLR ve PLR degerleri anlamli olarak daha yuksek bulunmustur (p=0,000). NLR 3,50 cut-off degerinde duyarlik %70,6, pozitif kestirim %84,6, ozgulluk %86,8, negatif kestirim %74,2 olarak bulunmustur. PLR 125 cut-off degerinde duyarlik %68,8, pozitif kestirim %67,0, ozgulluk %65,1, negatif kestirim %67 olarak saptanmistir. Sonuc: Kronik bobrek yetmezlikli hastalarda, APE tanisinda NLR ve PLR degerleri klinik, laboratuvar ve goruntuleme yontemlerinin yaninda kullanilabilir ve klinisyene yardimci olabilecek sonuclar verebilir. Fakat daha genis olgu gruplariyla daha kapsamli calismalar yapilmalidir. Anahtar Kelimeler: Akut pulmoner emboli, kronik renal yetmezlik, NLR, PLR