Can neutrophil-lymphocyte ratio predict mortality in acute non-variceal upper gastrointestinal bleeding?

BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is one of the common gastrointestinal problems and has a high mortality, especially in patients with poor hemodynamics. Therefore, treatment and follow-up should be managed dy-namically. Neutrophil-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are fast workable, cheap, and easy to calculate he-matological parameters. We need easily accessible parameters as well as routine classifications such as Rockall score in the treatment and follow-up of NVUGIB patients, whose hemodynamics are unstable and progress with high mortality. In this study, we planned to evaluate NLR and PLR levels in patients with NVUGIB in the treatment follow-up with other scoring systems and their relationship with mortality in these patients.
METHODS: Two hundred and forty-nine patients who were admitted to our clinic between January 2015 and January 2017 diag-nosed with NVUGIB, and who underwent necessary examinations and follow-ups, were included in the study. The patients’ Glasgow Blacthford, Rockall Score, NLR, and PLR levels were calculated at the first admission.
RESULTS: One hundred and fifty-six of the patients were male (70.6%) and the mean age of all patients was 64.5±18.0 years. After follow-up and treatment, 28 (11.2%) patients died due to bleeding. High NLR and tachycardia at the time of admission and high patient age were found to be independent risk factors affecting the long of hospital stay. High Rockall score, high NLR at admission, and hy-potension at admission were shown to be independent risk factors affecting mortality.
CONCLUSION: Besides the use of various scoring systems in patients with NVUGIB, we think that the use of simple hematological parameters may be appropriate and the use of these hematological parameters may be useful in the management of patients with unstable hemodynamics.

Nötrofil lenfosit oraný akut varis dýþý üst gastrointestinal kanamada mortaliteyi öngörebilir mi?

AMAÇ: Akut non varisiyel üst gastrointestinal kanama (NVUGIB) sýk görülen gastrointestinal problemlerden biridir ve mortalitesi özellikle hemodi-namisi kötü olan hastalarda yüksek seyretmektedir. Bu nedenle tedavi ve takibinin dinamik olarak yönetilmesi gerekmektedir. Nötrofil-lenfosit oraný (NLR), trombosit lenfosit oraný (PLR) hýzlý çalýþýlabilir, ucuz ve hesaplanmasý kolay hematolojik paremetrelerdir. Özellikle hemodinamisi stabil olma-yan ve yüksek mortalite ile seyreden NVUGIB hastalarýnýn tedavi-takibinde Rockall score gibi rutin kullanýlan sýnýflamalar yanýn da kolay ulaþýlabilir parametrelere ihtiyacýmýz vardýr. Biz bu çalýþmamýz da NLR ve PLR düzeylerinin NVUGIB olan hastalarýn tedavi-takibinde diðer skorlama sistemleri ile ve bu hastalardaki mortalite ile olan iliþkisini deðerlendirmeyi planladýk.
GEREÇ VE YÖNTEM: Kliniðimiz de Ocak 2015–Ocak 2017 tarihleri arasýnda baþvuran, NVUGIB tanýsý konan, gerekli tetkik ve takipleri yapýlan 249 hasta çalýþmaya alýndý. Hastalarýn ilk baþvuru anýndaki Glasgow Blacthford, Rockall score, NLR ve PLR düzeyleri hesaplandý.
BULGULAR: Hastalarýn 156’sý erkek (%70.6) olup tüm hastalarýn ortalama yaþý 64.5±18.0 yýl idi. Takip ve tedavi sonrasýnda sonrasýnda kanamaya baðlý 28 (%11.2) hasta öldü. Baþvuru anýnda NLR oranýn yüksek olmasý, baþvuru anýnda taþikardi olmasý ve hasta yaþýnýn fazla olmasý hastane yatýþ süresinin uzun olmasýný etkileyen baðýmsýz risk faktörleri olarak saptandý. Rockall skorunun yüksek olmasý, baþvuru anýnda NLR yüksek olmasý, baþ-vuru anýnda hipotansiyon varlýðýný mortaliteyi etkileyen baðýmsýz risk faktörleri olduðu gösterildi.
TARTIÞMA: Sonuç olarak NVUGIB olan hastalarda çeþitli skorlama sistemlerinin kullanýmý yanýnda basit hematolojik paremetrelerin kullanýmýnýn uygun olabileceðini ve hemodinamisi stabil olmayan hastalarýn tedavi yönetiminde bu hematolojik parametrelerin kullanýmýnýn yararlý olabileceðini düþünüyoruz.