Med Bull Sisli Etfal Hosp. 2023; 57(2): 250-256 | DOI: 10.14744/SEMB.2023.14306

The Role of Serum Inflammation-Based Scores in Diagnosis and Assessing Remission in Cushing’s Disease

Muhammed Masum Canat¹, Ceren Yarkutay Turkkan², Hazan Erhan², Feyza Yener Ozturk¹, Yuksel Altuntas^1
1Department of Endocrinology and Metabolism, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
²Department of Internal Medicine, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye

Objectives: Chronic hypercortisolism causes diverse alterations in the immune system and inflammatory disruptions. Serum inflammation-based scores (SIBS) are indicators of systemic inflammatory status. This study aims to determine the role of SIBS in the diagnosis and evaluation of remission in patients with Cushing’s disease (CD).
Methods: This retrospective cross-sectional study was conducted on 195 participants; 52 patients diagnosed and followed up after treatment with CD, 65 patients with subclinical Cushing’s syndrome (SCS), and 78 healthy individuals whose complete blood counts (CBC) were obtained for analysis. Participants with additional diseases or drug use that could affect CBC were excluded from the study. SIBS of the three groups were compared. Scores considered were neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The correlations between SIBS and initial diagnostic tests for hypercortisolism were analyzed. The SIBS of patients with CD at the diagnosis were compared with those after remission. In addition, receiver operator characteristic curve analyses were used to determine the diagnostic accuracy, specificity, and sensitivity of the scores significantly high in the CD group.
Results: MLR and SII values were significantly higher in CD patients than in the healthy group (p<0.01). NLR and SII were significantly higher in patients with CD than those with SCS (p<0.05). There were no significant differences between the SCS and the control groups in all SIBS. We determine significant, positive, and moderately correlated findings between SIBS and initial diagnostic tests for hypercortisolism in the CD group (0.30<r<0.70; p<0.05). All of the scores evaluated were significantly lower in the remission of the disease compared to the active period (p<0.001). An optimal cut-off MLR value of 0.20 showed the best diagnostic value (p=0.003; sensitivity, 78.4%; specificity, 51.4%), and an optimal cut-off SII value of 776.20 showed the best diagnostic value (p=0.017; sensitivity, 54.9%; specificity, 70.0%).
Conclusion: The SIBS, which can be easily calculated with the data obtained from CBC and do not have additional costs, can contribute to the diagnosis and assessment of remission in patients with CD.

Keywords: Cushing’s disease, monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, serum inflammation-based scores, systemic immune-inflammation index

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Cushing Hastalýðý Tanýsý ve Remisyon Deðerlendirilmesinde Serum Ýnflamasyon Temelli Skorlarýn Rolü

Muhammed Masum Canat¹, Ceren Yarkutay Turkkan², Hazan Erhan², Feyza Yener Ozturk¹, Yuksel Altuntas^1
1Türkiye Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Endokrinoloji ve Metabolizma Ana Bilim Dalý, Ýstanbul
²Türkiye Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Ýç Hastalýklarý Ana Bilim Dalý, Ýstanbul

Amaç: Kronik hiperkortizolizm, immün sitemde çeþitli deðiþikliklere ve enflamatuar bozulmalara neden olur. Serum inflamasyon temelli skorlar (SIBS) sistemik inflamatuar durumu yansýtýr. Bu çalýþma, Cushing hastalýðý (CH) olan hastalarda taný ve remisyon deðerlendirilmesinde SIBS'ýn rolünü araþtýrmayý amaçlamaktadýr.
Yöntem: Bu retrospektif kesitsel çalýþma 195 katýlýmcý ile yapýlmýþtýr. CH tanýsý alýp tedavi sonrasý takipli 52 hasta, subklinik Cushing sendromu (SCS) tanýlý 65 hasta ve tam kan sayýmý (TKS) tetkiki olan 78 saðlýklý birey çalýþmaya alýndý. TKS sonucunu etkileyebilecek ek hastalýðý veya ilaç kullanýmý olan katýlýmcýlar çalýþma dýþý býrakýldý. Gruplarýn SIBS deðerleri karþýlaþtýrýldý. Deðerlendirilen indeksler; nötrofil-lenfosit oraný (NLR), monosit-lenfosit oraný (MLR), trombosit-lenfosit oraný (PLR), ve sistemik immün-enflamasyon indeksidir (SII). SIBS deðerleri ile hiperkortizolizm için taný testleri arasýndaki korelasyonlar incelendi. CH tanýlý hastalarýn taný anýndaki indeksleri remisyondan sonrakilerle karþýlaþtýrýldý. Ek olarak, CH grubunda anlamlý derecede yüksek indekslerin tanýsal doðruluðunu, duyarlýlýðýný ve özgüllüðünü deðerlendirmek için ROC eðrisi analizleri kullanýldý.
Bulgular: CH tanýlý grubun MLR ve SII deðerleri saðlýklý gruba göre anlamlý düzeyde yüksek bulundu (p<0.01). CH tanýlý hastalarýn SCS tanýlý hastalara göre, NLR ve SII deðerlerinin yüksekliði anlamlý düzeyde bulundu (p<0.05). SCS grubu ile kontrol grubu arasýnda ise tüm SIBS deðerleri için belirgin farklýlýk saptanmadý. CH grubunda SIBS deðerleri ile hiperkortizolizm için yapýlan taný testleri arasýnda anlamlý, pozitif ve orta derecede iliþki belirlendi (0.30<r<0.70; p<0.05). Deðerlendirilen tüm skorlar, hastalýðýn remisyon döneminde aktif dönemle karþýlaþtýrýldýðýnda anlamlý olarak daha düþük bulundu (p<0.001). MLR için optimal tanýsal eþik deðer 0,20 (p=0,003; duyarlýlýk, %78,4; özgüllük, %51,4) ve SII için optimal tanýsal eþik deðer 776,20 olarak (p=0,017; duyarlýlýk, %54,9; özgüllük, %70,0) bulundu.
Sonuç: TKS tetkikinden elde edilen verilerle kolayca hesaplanabilen ve ek maliyet gerektirmeyen SIBS deðerleri, CH için taný ve remisyon kararýna katkýda bulunabilir. (SETB-2023-04-072)

Anahtar Kelimeler: Cushing hastalýðý, monosit-lenfosit oraný, nötrofil-lenfosit oraný, trombosit-lenfosit oraný, serum inflamasyon bazlý skorlar, sistemik immün-inflamasyon indeksi

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