PLATELET TO LYMPHOCYTE RATIO (PLR) AND NEUTROPHIL TO LYMPHOCYTE RATIO (NLR) – PREDICTOR OF MORTALITY IN PEPTIC ULCER PERFORATION PATIENTS

  • Nirmal thakur NSCB Medical College Jabalpur
  • Dileep Thakur NSCB Medical College Jabalpur
  • Uday somashekar NSCB Medical College Jabalpur
  • amrendra verma NSCB Medical College Jabalpur
  • Reena kothari NSCB Medical College Jabalpur
  • Dhananjay sharma NSCB Medical College Jabalpur
Keywords: Peptic Ulcer Perforation (PUP), Platelet to Lymphocyte Ratio (PLR), Neutrophil to Lymphocyte ratio (NLR), Receiver Operating Characteristic (ROC)

Abstract

 

Peptic ulcer perforation (PUP) and peritonitis is a high-risk acute abdomen event that constitutes 5% of all abdominal emergencies. Despite the best surgical treatment, there is high rates of morbidity and mortality. Multiple factors and scoring systems are in system to identify patients at high risk of mortality 1-3. Still the clinicians and intensivist are motivated to search for new laboratory markers that is simple, routinely available and is cost effective to predict morbidity and mortality in preop and post op settings4-5. This study aimed to evaluate and establish the role of two such markers - PLR and NLR.

Methods: This study is an observational prospective study which was conducted in the Department of Surgery, NSCB Medical college Jabalpur from December 2018 to September 2020. Data of 400 patients with PUP collected at time of admission and were managed surgically for Peptic Ulcer Perforation. Patient were followed for outcomes post-surgery. The PLR, NLR was calculated for each Patient. The predictive power of these values and their differences were studied using the area under the receiver-operator characteristic (ROC) curve and regression analysis.

Result: The analysis was made by comparing the values of PLR and NLR in different groups of patients i.e., between Gender, Age and Duration of hospital stay. ROC curve analysis found that the value of PLR ≥ 216.1 and NLR ≥ 10.68 could have diagnostic value in predicting the mortality in Peptic Ulcer Perforation patients.

Conclusion: In this study, it was concluded that there is a significant correlation of PLR and  NLR to mortality of patients following management of PUP and hence can be used as an effective independent single variable for this.

Keywords: 

References

[1] K Søreide, K Thorsen, J Søreide., “Strategies to improve the outcome of emergency surgery for perforated peptic ulcer” Br J Surg 2014;101: e51– e64.
[2] K Thorsen, JA Søreide, JT Kvaløy, et al., “Epidemiology of perforated peptic ulcer: Age- and gender-adjusted analysis of incidence and mortality”. World J Gastroenterol 2013;19: 347.
[3] Y Tanrikulu, CS Tanrikulu, MZ Sabuncuoglu, et al., “Is the neutrophil-to- lymphocyte ratio a potential diagnostic marker for peptic ulcer perforation? A retrospective cohort studies” Ann J Emerg Med 2016; 34:403–406.
[4] MJ Proctor, DS Morrison, D Talwar, et al., “A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer.” 2011; 47:2633–2641.
[5] M Hermansson, CS von Holstein, T Zilling., “Surgical ap- proach and prognostic factors after peptic ulcer perforation.” Eur J Surg 1999; 165:566–572.
[6] Y Ma, Y Mao, X He, et al., “The values of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting 30-day mortality in patients with acute pulmonary embolism.” BMC Cardiovascular Disorder 2016; 16:123
[7] F Pehlivanlı, O Aydin., “Factors affecting mortality in Fournier gangrene: A single center experience.” Surg Infect 2019; 20:78-78.
[8] CP de Jager, PT van Wijk, RB Mathoera, et al., “Lympho- cytopenia and neutrophil to lymphocyte count ratio predict”
[9] R Zahorec., “Ratio of neutrophil to lymphocyte counts— Rapid and simple parameter of systemic inflammation and stress in critically ill.” Bratislavske Lekarske Listy 2001; 102:5–14.
[10] S Balta, S Demırkol, U Kucuk., “The platelet lymphocyte ratio may be useful inflammatory indicator in clinical practice.” Hemodial Int 2013; 17:668–669.
[11] M Ishizuka, T Shimizu, K Kubota., “Neutrophil-to- lymphocyte ratio has a close association with gangrenous appendicitis in patients undergoing appendectomy.” Int Surg 2013; 97:299–304.
[12] R Aktimur, S Cetinkunar, K Yildirim, et al., “Neutrophil-to- lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia.” Eur J Trauma Emerg Surg 2016; 42:363–368.
[13] A Mishra, D Sharma, VK Raina., “A simplified prognostic scoring system for peptic ulcer perforation in developing countries.” Indian J Gastroenterol. 2003;22(2):49-53.
[14] C Suriya, N Kasatpibal, W Kunaviktikul, T Kayee., “Diagnostic indicators for peptic ulcer perforation at a tertiary care hospital in Thailand.” Clin Exp Gastroenterol 2011;4: 283.
[15] O Aydin, F Pehlivanlı., “Is the Platelet to Lymphocyte Ratio a Potential Biomarker for Predicting Mortality in Peptic Ulcer Perforation?” Surg Infect 2019 May/Jun;20(4):326-331.
Published
2022-05-02
How to Cite
[1]
N. thakur, D. Thakur, U. somashekar, amrendra verma, R. kothari, and D. sharma, “PLATELET TO LYMPHOCYTE RATIO (PLR) AND NEUTROPHIL TO LYMPHOCYTE RATIO (NLR) – PREDICTOR OF MORTALITY IN PEPTIC ULCER PERFORATION PATIENTS”, JSS, vol. 9, no. 1, May 2022.