Med Bull Sisli Etfal Hosp. 2022; 56(1): 77-83 | DOI: 10.14744/SEMB.2021.58219

Lymphocyte to Monocyte Ratio and C-Reactive Protein Combination as the Best Simple Predictor of Treatment Response in Cirrhotic Patients with Culture Negative Neutrocytic Ascites

Sezgin Barutcu¹, Abdullah Emre Yildirim¹, Ahmet Sahin², Murat Taner Gulsen^1
1Division of Gastroenterology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
²Department of Infectious Disease and Clinical Microbiology, Health Sciences University, Mehmet Akif Inan Research and Training Hospital, Þanlýurfa, Turkey

Objectives: The aim of this study was to evaluate the most ideal inflammatory markers for treatment response and to determine a cutoff value that could predict response to treatment for culture negative neutrocytic ascite (CNNA) patients.
Methods: This is a retrospective cross-sectional case-controlled study. Patients with CNNA were evaluated by taking ascites fluid sampling at the beginning and on the 5th day of treatment. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-monocyte ratio were calculated.
Results: Of the 123 cases with cirrhotic ascites disease, 59 were CCNA and 64 were the control group without ascite-fluid infection. There were statistically significant differences for blood monocyte count, NLR (p<0.01), LMR, and C-reactive protein (CRP) (p<0.001) between two groups. Patients in the CNNA group were compared before and after treatment among themselves for the treatment response. There was statistically significant difference in mean platelet volume, monocyte, LMR, and CRP (p<0.05) between two groups. After receiver operator characteristics curve analysis, the best cutoff value for monocyte was <0.64 × 10³/µL (sensitivity 49.2%, specificity 74.6%, positive predictive value [PPV] 65.9%, and negative predictive value [NPV] 59.5%) (p<0.01), for LMR was ≥1.7 (sensitivity 76.3%, specificity 78%, PPV 77.6%, and NPV 76.7%), and for CRP was ≤18 mg/L (sensitivity 91.5% specificity 57.6%, PPV 68.4%, and NPV 87.2%) (p<0.001). When LMR and CRP were used together, sensitivity (86.5%), specificity (83.1%), PPV (83.6%), and NPV (86%) were found to be statistically significantly higher (p<0.001).
Conclusion: Our results showed that in cirrhotic patients with CNNA, combined LMR + CRP can be used as a novel, low cost and non-invasive test to predict treatment response.

Keywords: Ascitic fluid infection, cirrhosis, c-reactive protein, culture negative neutrocytic ascites, lymphocyte to monocyte ratio

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Kültür Negatif Nötrositik Asitli Sirotik Hastalarda Tedavi Yanýtýnýn En Basit Prediktörü Olarak Lenfosit-Monosit Oraný ve C-Reaktif Protein Kombinasyonu

Sezgin Barutcu¹, Abdullah Emre Yildirim¹, Ahmet Sahin², Murat Taner Gulsen^1
1Gaziantep Üniversitesi Týp Fakültesi, Gastroenteroloji Anabilim Dalý, Gaziantep
²Saðlýk Bilimleri Üniversitesi Mehmet Akif Ýnan Eðitim ve Araþtýrma Hastanesi Enfeksiyon Hastalýklarý ve Klinik Mikrobiyoloji Anabilim Dalý, Þanlýurfa

Amaç: Bu çalýþmanýn amacý, kültür negatif nötrositik asitli (KNNA) siroz hastalarýnda tedavi yanýtý için en ideal inflamatuar belirteçleri deðerlendirmek ve tedaviye yanýtý öngörebilecek bir kesme deðeri belirlemekti.
Metod: Bu çalýþma, retrospektif, kesitsel, vaka kontrollü bir çalýþmadýr. KNNA olan hastalar tedavinin baþlangýcýnda ve 5. gününde asit sývý örneði alýnarak deðerlendirildi. Nötrofil-lenfosit oraný (NLR), lenfosit-monosit oraný (LMR) ve nötrofil-monosit oraný hesaplandý.
Bulgular: Sirotik asit hastalýðý olan 123 vakanýn 59'u KNNA, 64'ü asit-sývý enfeksiyonu olmayan kontrol grubuydu. Ýki grup arasýnda kan monosit sayýsý, NLR (p <0,01), LMR ve C-reaktif protein (CRP) (p <0,001) açýsýndan istatistiksel olarak anlamlý fark vardý. KNNA grubundaki hastalar tedavi yanýtý için tedavi öncesi ve sonrasý kendi aralarýnda karþýlaþtýrýldý. Ýki grup arasýnda ortalama trombosit hacmi (MPV), monosit, LMR ve CRP (p <0.05) açýsýndan istatistiksel olarak anlamlý fark vardý. ROC eðrisi analizinden sonra, monosit için en iyi kesme deðeri <0,64 10³ / µL idi (duyarlýlýk%49,2, özgüllük%74,6, PPV %65,9, NPV %59,5) (p <0,01) LMR için ≥1,7 (duyarlýlýk %76,3, özgüllük %78, PPV %77,6, NPV %76,7) ve CRP için 18 mg / L (duyarlýlýk %91,5 özgüllük 57,6 %, PPV %68,4, NPV %87,2) (p<0,001). Hem LMR hem de CRP birlikte birleþtirildiðinde duyarlýlýk (%86,5), özgüllük (%83,1), PPV (%83,6) ve NPV (%86) istatistiksel olarak anlamlý derecede yüksek bulundu (p <0,001).
Sonuç: Sonuçlarýmýz, KNNA'li sirotik hastalarda, kombine LMR + CRP'nin tedavi yanýtýný tahmin etmek için yeni, düþük maliyetli ve invazif olmayan bir test olarak kullanýlabileceðini gösterdi. (SETB-2021-02-050)

Anahtar Kelimeler: Kültür negatif nötrositik asit, lenfosit-monosit oraný; C-reakif protein; siroz; asit sývý enfeksiyonu

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