Role of Neutrophil-to-Lymphocyte Ratio as a Predictor of Systemic Inflammatory Response Syndrome in Blunt Abdominal Trauma Following Emergency Laparotomy in Sanglah General Hospital, Denpasar

I Made Dwi Purnamantara; I Ketut Wiargitha; Tjok Gede Bagus Mahadewa

doi:10.3889/oamjms.2021.6699

Authors

I Made Dwi Purnamantara Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia https://orcid.org/0000-0003-1221-5546
I Ketut Wiargitha Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
Tjok Gede Bagus Mahadewa Department of Surgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.6699

Keywords:

Neutrophils-to-lymphocytes ratio, Systemic inflammatory response syndrome, Abdominal trauma, Predictor

Abstract

BACKGROUND: Abdominal trauma, both blunt and penetrating abdominal trauma, is the third most common trauma, which is about 10% after head trauma (30%) and chest trauma (20%). Trauma has an influence on the balance of the immune system. The excessive inflammatory response can trigger systemic inflammatory response syndrome (SIRS). The ratio of neutrophils to lymphocytes acts as a marker of the inflammatory response in both surgical and non-surgical patients.

AIM: The purpose of the study was to predict the incidence of SIRS using neutrophils-to-lymphocytes ratio (NLR) in patients with blunt abdominal trauma undergoing emergency laparotomy.

METHODS: This study is an observational analytic study with a prospective design which was carried out at the emergency room, intensive care unit, Sanglah Hospital, Denpasar, Surgery for 1 year from January 2019 to December 2019, involving 59 research subjects with the consecutive sampling method who is met the inclusion and exclusion criteria.

RESULTS: The area under the curve value obtained an NLR sensitivity of 87.1% with a cutoff point of 5.25. In the path analysis, it was found that NLR was the dominant factor and had a positive effect of 43.9% (p < 0.001) on SIRS.

CONCLUSION: NLR is expected to be used as a reference to predict the incidence of SIRS in blunt abdominal trauma following laparotomy emergency.

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References

El-Menyar A, Abdelrahman H, Al-Thani H, Zarour A, Parchani A, Peralta R, et al. Compartmental anatomical classification of traumatic abdominal injuries from the academic point of view and its potential clinical implication. J Trauma Manag Outcomes. 2014;8:14. https://doi.org/10.1186/1752-2897-8-14 PMid:25332723 DOI: https://doi.org/10.1186/1752-2897-8-14

Hazeldine J, Hampson P, Lord JM. The impact of trauma on neutrophil function. Injury. 2014;45(12):1824-33. https://doi.org/10.1016/j.injury.2014.06.021 PMid:25106876 DOI: https://doi.org/10.1016/j.injury.2014.06.021

Koirala U, Thapa PB, Joshi MR, Singh DR, Sharma SK. Systemic inflammatory response syndrome following gastrointestinal surgery. JNMA J Nepal Med Assoc. 2017;56(206):221-5. https://doi.org/10.31729/jnma.3144 PMid:28746319 DOI: https://doi.org/10.31729/jnma.3144

Nurdani A, Hadi U, Arfijanto M, Rusli M, Bramantono B, Miftahussurur M. Neutrophil-lymphocyte ratio and procalcitonin levels in sepsis patients. N Am Med J. 2019;13:48-54.

Shi J, Dong B, Mao Y, Guan W, Cao J, Zhu R, et al. Review: Traumatic brain injury and hyperglycemia, a potentially modifiable risk factor. Oncotarget. 2016;7(43):71052-61. https://doi.org/10.18632/oncotarget.11958 PMid:27626493 DOI: https://doi.org/10.18632/oncotarget.11958

Bar-Or D, Rael LT, Madayag RM, Banton KL, Tanner A, Acuna DL, et al. Stress hyperglycemia in critically Ill patients: Insight into possible molecular pathways. Front Med (Lausanne). 2019;6:54. https://doi.org/10.3389/fmed.2019.00054 PMid:30972338 DOI: https://doi.org/10.3389/fmed.2019.00054

Soop M, Duxbury H, Agwunobi AO, Gibson JM, Hopkins SJ, Childs C, et al. Euglycemic hyperinsulinemia augments the cytokine and endocrine responses to endotoxin in humans. Am J Physiol Endocrinol Metab. 2002;282(6):E1276-85. https://doi.org/10.1152/ajpendo.00535.2001 PMid:12006357 DOI: https://doi.org/10.1152/ajpendo.00535.2001

van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359-67. https://doi.org/10.1056/nejmoa011300 PMid:11794168 DOI: https://doi.org/10.1056/NEJMoa011300

Arumugam S, Al-Hassani A, El-Menyar A, Abdelrahman H, Parchani A, Peralta R, et al. Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis. J Emerg Trauma Shock. 2015;8(4):193-8. https://doi.org/10.4103/0974-2700.166590 PMid:26604524 DOI: https://doi.org/10.4103/0974-2700.166590

Trancă SD, Petrişor CL, Hagău N. Biomarkers in polytrauma induced systemic inflammatory response syndrome and sepsis-a narrative review. Rom J Anaesth Intensive Care. 2014;21(2):118-22. PMid:28913443

Mohr NM, Vakkalanka JP, Faine BA, Skow B, Harland KK, Dick- Perez R, et al. Serum anion gap predicts lactate poorly, but may be used to identify sepsis patients at risk for death: A cohort study. J Crit Care. 2018;44:223-8. https://doi.org/10.1016/j.jcrc.2017.10.043 PMid:29175046 DOI: https://doi.org/10.1016/j.jcrc.2017.10.043

Berkman M, Ufberg J, Nathanson LA, Shapiro NI. Anion gap as a screening tool for elevated lactate in patients with an increased risk of developing sepsis in the emergency department. J Emerg Med. 2009;36(4):391-4. https://doi.org/10.1016/j.jemermed.2007.12.020 PMid:18815002 DOI: https://doi.org/10.1016/j.jemermed.2007.12.020

Arif SK, Rukka ABS, Wahyuni S. Comparison of neutrophils-lymphocytes ratio and procalcitonin parameters in sepsis patient treated in Intensive Care Unit Dr. Wahidin Hospital, Makassar, Indonesia. J Med Sci. 2017;17(1):17-21. https://doi.org/10.3923/jms.2017.17.21 DOI: https://doi.org/10.3923/jms.2017.17.21

Mathews S, Rajan A, Soans S. Prognostic value of rise in neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting the mortality in paediatric intensive care. Int J Contemp Pediatr. 2019;6(3):1052-8. https://doi.org/10.18203/2349-3291.ijcp20191044 DOI: https://doi.org/10.18203/2349-3291.ijcp20191044

Darwis I, Probosuseno P. The relationship between neutrophil-lymphocyte ratio and sepsis outcome in geriatric patients. JK Unila. 2019;3(1):147-53.

Kaushik R, Gupta M, Sharma M, Jash D, Jain N, Sinha N, et al. Diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in early and late phase of sepsis. Indian J Crit Care Med. 2018;22(9):660-3. https://doi.org/10.4103/ijccm.ijccm_59_18 PMid:30294133 DOI: https://doi.org/10.4103/ijccm.IJCCM_59_18

Martins EC, Da Fe Silveira L, Viegas K, Beck AD, Fioravantti G Jr., Cremonese RV, et al. Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: A case-control study. Rev Bras Ter Intensiva. 2019;31(1):64-70. https://doi.org/10.5935/0103-507x.20190010 PMid:30916236 DOI: https://doi.org/10.5935/0103-507X.20190010

Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: A prospective observational study. Mediators Inflamm. 2016;2016:8191254. https://doi.org/10.1155/2016/8191254 PMid:27110067 DOI: https://doi.org/10.1155/2016/8191254

Ni J, Wang H, Li Y, Shu Y, Liu Y. Neutrophil to lymphocyte ratio (NLR) as a prognostic marker for in-hospital mortality of patients with sepsis: A secondary analysis based on a single-center, retrospective, cohort study. Medicine (Baltimore). 2019;98(46):e18029. https://doi.org/10.1097/md.0000000000018029 PMid:31725679 DOI: https://doi.org/10.1097/MD.0000000000018029

Marik PE, Flemmer M. The immune response to surgery and trauma: Implications for treatment. J Trauma Acute Care Surg. 2012;73(4):801-8. https://doi.org/10.1097/ta.0b013e318265cf87 PMid:22976420 DOI: https://doi.org/10.1097/TA.0b013e318265cf87

Lord JM, Midwinter MJ, Chen YF, Belli A, Brohi K, Kovacs EJ, et al. The systemic immune response to trauma: An overview of pathophysiology and treatment. Lancet. 2014;384(9952):1455-65. https://doi.org/10.1016/s0140-6736(14)60687-5 PMid:25390327 DOI: https://doi.org/10.1016/S0140-6736(14)60687-5

Menges P, Kessler W, Kloecker C, Feuerherd M, Gaubert S, Diedrich S, et al. Surgical trauma and postoperative immune dysfunction. Eur Surg Res. 2012;48(4):180-6. https://doi.org/10.1159/000338196 PMid:22653168 DOI: https://doi.org/10.1159/000338196