Research Article
The role of systemic inflammatory markers in prediction of medical treatment failure in patients with tubo-ovarian abscess
Abstract
Aim: Aimed to evaluate the role of systemic inflammatory markers and Aspartate aminotransferase to Platelet Ratio Index (APRI) sore in predicting medical treatment failure in patients with Tubo-ovarian abscess (TOA).
Materials and Methods: Patients (n=240) hospitalized with a diagnosis of TOA between August 2016 - October 2020 were included in the study. Patients' demographic and clinical characteristics and mean C-Reactive protein (CRP) level, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and APRI score measured on admission were also recorded. The role of these parameters was investigated in predicting medical treatment failure in patients who only received medical treatment or who needed surgical treatment.
Results: The mean age (40.95 ± 6.96 vs. 38.09 ± 7.69), abscess size (67.57 ± 19.86 mm vs. 52.78 ± 16.63 mm), CRP level, (140.61 ± 110.88 vs. 75.24 ± 36.64 mg/L), white blood cell count (13818.86 ± 5445.80 and 11845.31 ± 4424.39 μL), neutrophil count (11146.81 ± 5284.83 and 9242.03 ± 4278.60 μL) and NLR (9.52 ± 6.88 and 6.64 ± 6.30) of patients who received surgical treatment were significantly higher than those who received only medical treatment. In receiver operating characteristics (ROC) analysis area under the curve (AUC) 0.607 was statistically significant for CRP with a cut-off value of 11.57 to predict medical treatment failure (95% 0.531-0.682, sensitivity 63.3%, specificity 55.4%).
Conclusion: NLR, PLR and APRI score are ineffective in predicting the need for surgical treatment. CRP could be used as a marker in predicting the need for surgical treatment in patients with TOA.
References
- Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol 2009; 23: 667-8.
- Lee NC, Rubin GL, Grimes DA. Measures of sexual behavior and the risk of pelvic inflammatory disease. Obstet Gynecol 1991; 77: 425-30.
- Weström L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol 1980; 138:880-92.
- Wiesenfeld HC, Sweet RL. Progress in the management of tuboovarian abscesses. Clin Obstet Gynecol 1993; 36: 433-44.
- Dewitt J, Reining A, Allsworth JE, Peipert JF. Tuboovarian abscesses: is size associated with duration of hospitalization & complications? Obstet Gynecol Int 2010; 2010:847041.
- Fouks Y, Cohen A, Shapira U, Solomon N, Almog B, Levin I. Surgical Intervention in Patients with Tubo-Ovarian Abscess: Clinical Predictors and a Simple Risk Score. J Minim Invasive Gynecol 2019; 26: 535-43.
- Yildirim M, Turkyilmaz E, Avsar A, F: Preoperative Neutrophil-to-Lymphocyte Ratio Has a Better Predictive Capacity in Diagnosing Tubo-Ovarian Abscess. Gynecol Obstet Invest 2015; 80: 234-9.
- Torun S, Tunc BD, Suvak B et al. Assessment of neutrophil‑lymphocyte ratio in ulcerative colitis: A promising marker in predicting disease severity. Clinics and Research in Hepatology and Gastroenterology 2012; 36: 491‑7.
- Lee J, Park J, Lee HJ et al. Original Articles Preoperative Hematological Parameters for Predicting Ovarian Torsion in Patients with Mature Cystic Teratoma. Int J Womens Health. 2021; 13: 317-26.
- Tolunay HE, Kahraman NÇ, Varlı EN et al. First-trimester aspartate aminotransferase to platelet ratio index in predicting intrahepatic cholestasis in pregnancy and its relationship with bile acids: A pilot study. Eur J Obstet Gynecol Reprod Biol. 2021;256:114-17.
- De Matteis C, Cariello M, Graziano G, et al. AST to Platelet Ratio Index (APRI) is an easy-to-use predictor score for cardiovascular risk in metabolic subjects. Sci Rep. 2021; 11 (1): 14834.
- Polyzos S.A, Goulis DG, Kountouras J, et al. Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: assessment of non-invasive indices predicting hepatic steatosis and fibrosis. Hormones 2014; 13: 519–31
- Centers For Disease Control and Prevention, Sexually Transmitted Disease Infectious Treatment Guidelines, 2021 (cited 2021 July 22) Available from: https://www.cdc.gov/std/treatment-guidelines/toc.htm
- Protopapas AG, Diakomanolis ES, Milingos SD, et al. Tubo-ovarian abscesses in postmenopausal women: gynecological malignancy until proven otherwise? Eur J Obstet Gynecol Reprod Biol 2004; 114:203.
- Chan GMF, Fong YF, Ng KL. Tubo-ovarian abscesses: epidemiology and predictors for failed response to medical management in an Asian population. Inf D Obstet Gynecol 2019:4161394.
- DeWitt J, Reining A, Allsworth EJ, Peipert FJ. Tuboovarian abscesses: ıs size associated with duration of hospitalization and complications? Obstetr Gynecol Int 2010: 847041
- Farid H, Lau TC, Karmon AE, Styer AK. Clinical characteristics associated with antibiotic treatment failure for Tuboovarian abscesses. Infect Dis Obstet Gynecol 2016; 5120293.
- Fouks Y, Cohen A, Shapira U, Solomon N, Almog B, Levin I. Surgical Intervention in Patients with Tubo-Ovarian Abscess: Clinical Predictors and a Simple Risk Score. J Minim Invasive Gynecol. 2019; 26 (3): 535-43.
- Gözüküçük, M., Yıldız, E.G. Is it possible to estimate the need for surgical management in patients with a tubo-ovarian abscess at admission? A retrospective long-term analysis. Gynecol Surg 2021; 18: 14
- Güngördük K, Guzel E, Asicioğlu O et al. Experience of tubo-ovarian abscess in western Turkey. Int J Gynaecol Obstet. 2014; 124: 45–50.
- Akkurt MÖ, Yalçın SE, Akkurt İ, et al. The evaluation of risk factors for failed response to conservative treatment in tubo-ovarian abscesses. J Turk Ger Gynecol Assoc. 2015; 16 (4): 226-30.
- Topçu HO, Kokanalı K, Güzel AI et al. Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess, Journal of Obstetrics and Gynaecology. 2015; 35: (7): 699-702
- Uyar I, Gulhan I, Sipahi M, Cetin F, Hanhan HM, Ozeren M. Risk factors for surgery in patients with tuba-ovarian abscess. Arch Gynecol Obstet 2012; 286, 973–5
- Karaca K, Ozkaya E, Kurek Eken M et al. Serum procalcitonin levels together with clinical features and inflammatory markers in women with tubo-ovarian abscess for discriminating requirements for surgery for full recovery, J of Obstet and Gyn, 2018; 38: 6, 818-21
- Ata N, Kulhan M, Kulhan NG, Turkler C. Can neutrophil-lymphocyte and platelet-lymphocyte ratios predict threatened abortion and early pregnancy loss? Ginekol Pol 2020; 91 (4); 210–5
- Kang Q, Li W, Yu N, et al. Predictive role of neutrophil-to-lymphocyte ratio in preeclampsia: A metaanalysis including 3982 patients. Pregnancy Hypertension 2020; 20: 111-8
- Caglayan EK, Engin-Ustun Y, Gocmen AY et al. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? J of Perinat Med. 2016; 44 (3): 315-20.
- Topcu HO, Guzel AI, Ozer I et al. Comparison of neutrophil/lymphocyte and platelet/ lymphocyte ratios for predicting malignant potential of suspicious ovarian masses in gynecology practice. Asian Pac J Cancer Prev, 2014; 15, 6239-41.
- Covali R, Socolov D, Pavaleanu I, Carauleanu A,Socolov R. Platelet Indices in Uterine Leiomyoma Compared with other Major Gynecological Diseases. J Adv Med Med Res 2020; 32 (24), 164-76.
- Cakmak B, Gulucu S, Aliyev N, Ozsoy Z, Nacar M, Koseoglu D. Neutrophil-lymphocyte and platelet-lymphocyte ratios in endometrial hyperplasia. Obstet Gynecol Sci. 2015; 58 (2): 157-61.
- Aydın F, Biler A, Taner CE, Ertaş İE. Tubo-ovaryan apse tanılı olgularda tedavi öncesi nötrofil/lenfosit ve platelet/lenfosit oranları medikal tedavi başarısını predikte eder mi? Kocaeli Tıp Dergisi. 2018; 7: 165–71.
- Çoşkun B, Şimşir C. Evaluation of risk factors predicting surgical treatment in tuboovarian abscess cases. Medical Science and Discovery, 2019; 6 (10): 235-40.
- Alay I, Kaya C, Karaca I, et al. The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo-ovarian abscess. J Obstet Gynaecol Res 2019; 45: 1183–9.
- Akselim B, Karaşin SS, Demirci A, Üstünyurt E. Can antibiotic treatment failure in tubo-ovarian abscess be predictable? Eur J Obstet Gynecol Reprod Biol. 2021; 258; 253-57
- Inal ZO, Inal HA, Gorkem, U. Experience of Tubo-ovarian abscess: a retrospective clinical analysis of 318 patients in a single tertiary Center in Middle Turkey. Surg infect, 2018; 19 (1): 54-60.
Tuboovaryan apseli hastalarda sistemik inflamatuvar belirteçlerin medikal tedavi başarısızlığını öngörmedeki yeri
Abstract
Amaç: Tuboovaryan apse (TAO) olgularında sistemik inflamatuar belirteçler ve Aspartate aminotransferaz/Platelet Index (APRİ) skorun medikal tedavi başarısızlığını öngörmede yeri olup olmadığı araştırıldı.
Gereç ve Yöntem: Ağustos 2016 – Ekim 2020 tarihleri arasında TOA tanısı ile yatırılarak tedavi edilen 240 hasta çalışmaya dâhil edildi. Hastaların demografik ve klinik özellikleri, tanı anında bakılan C- Reaktif protein (CRP), Nötrofil lenfosit oranı (NLR), Platelet lenfosit oranı (PLR) ve APRI skoru dosya kayıtlarından elde edildi. Sadece medikal (n=74) tedavi alan veya cerrahi tedavi gereken hastalarda (n=166) bu parametrelerin medikal tedavi başarısızlığını öngörmedeki yerleri araştırıldı.
Bulgular: Cerrahi tedavi alan hastaların sadece medikal tedavi alanlara göre ortalama yaşı (40,95 ± 6,96 ve (38,09 ± 7,69), apse boyutu (67,57 ± 19,86 mm ve 52,78 ± 16,63 mm), CRP değeri (140,61 ± 110,88 ve 75,24 ± 36,64 mg/L), beyaz küre (13818,86 ± 5445,80 ve 11845,31 ± 4424,39 μL), nötrofil (11146,81 ± 5284,83 ve 9242,03 ± 4278,60 μL) ve NLR değeri (9.52 ± 6.88 ve 6.64 ± 6.30) anlamlı olarak daha yüksek bulundu. Receiver Operating Characteristics (ROC) eğrisi analizi (95% 0,531-0,682) ile CRP’nin >11,57 olmasının %63,3 sensitivite, %55,4 spesifite ile medikal tedavi başarısızlığını öngördüğü saptandı.
Sonuç: NLR, PLR ve APRI skoru cerrahi tedavi gereksinimini öngörmede etkisizdir. CRP başvuru anında cerrahi tedavi gereksinimini belirlemek adına kullanılabilecek bir belirteçtir.
References
- Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol 2009; 23: 667-8.
- Lee NC, Rubin GL, Grimes DA. Measures of sexual behavior and the risk of pelvic inflammatory disease. Obstet Gynecol 1991; 77: 425-30.
- Weström L. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. Am J Obstet Gynecol 1980; 138:880-92.
- Wiesenfeld HC, Sweet RL. Progress in the management of tuboovarian abscesses. Clin Obstet Gynecol 1993; 36: 433-44.
- Dewitt J, Reining A, Allsworth JE, Peipert JF. Tuboovarian abscesses: is size associated with duration of hospitalization & complications? Obstet Gynecol Int 2010; 2010:847041.
- Fouks Y, Cohen A, Shapira U, Solomon N, Almog B, Levin I. Surgical Intervention in Patients with Tubo-Ovarian Abscess: Clinical Predictors and a Simple Risk Score. J Minim Invasive Gynecol 2019; 26: 535-43.
- Yildirim M, Turkyilmaz E, Avsar A, F: Preoperative Neutrophil-to-Lymphocyte Ratio Has a Better Predictive Capacity in Diagnosing Tubo-Ovarian Abscess. Gynecol Obstet Invest 2015; 80: 234-9.
- Torun S, Tunc BD, Suvak B et al. Assessment of neutrophil‑lymphocyte ratio in ulcerative colitis: A promising marker in predicting disease severity. Clinics and Research in Hepatology and Gastroenterology 2012; 36: 491‑7.
- Lee J, Park J, Lee HJ et al. Original Articles Preoperative Hematological Parameters for Predicting Ovarian Torsion in Patients with Mature Cystic Teratoma. Int J Womens Health. 2021; 13: 317-26.
- Tolunay HE, Kahraman NÇ, Varlı EN et al. First-trimester aspartate aminotransferase to platelet ratio index in predicting intrahepatic cholestasis in pregnancy and its relationship with bile acids: A pilot study. Eur J Obstet Gynecol Reprod Biol. 2021;256:114-17.
- De Matteis C, Cariello M, Graziano G, et al. AST to Platelet Ratio Index (APRI) is an easy-to-use predictor score for cardiovascular risk in metabolic subjects. Sci Rep. 2021; 11 (1): 14834.
- Polyzos S.A, Goulis DG, Kountouras J, et al. Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: assessment of non-invasive indices predicting hepatic steatosis and fibrosis. Hormones 2014; 13: 519–31
- Centers For Disease Control and Prevention, Sexually Transmitted Disease Infectious Treatment Guidelines, 2021 (cited 2021 July 22) Available from: https://www.cdc.gov/std/treatment-guidelines/toc.htm
- Protopapas AG, Diakomanolis ES, Milingos SD, et al. Tubo-ovarian abscesses in postmenopausal women: gynecological malignancy until proven otherwise? Eur J Obstet Gynecol Reprod Biol 2004; 114:203.
- Chan GMF, Fong YF, Ng KL. Tubo-ovarian abscesses: epidemiology and predictors for failed response to medical management in an Asian population. Inf D Obstet Gynecol 2019:4161394.
- DeWitt J, Reining A, Allsworth EJ, Peipert FJ. Tuboovarian abscesses: ıs size associated with duration of hospitalization and complications? Obstetr Gynecol Int 2010: 847041
- Farid H, Lau TC, Karmon AE, Styer AK. Clinical characteristics associated with antibiotic treatment failure for Tuboovarian abscesses. Infect Dis Obstet Gynecol 2016; 5120293.
- Fouks Y, Cohen A, Shapira U, Solomon N, Almog B, Levin I. Surgical Intervention in Patients with Tubo-Ovarian Abscess: Clinical Predictors and a Simple Risk Score. J Minim Invasive Gynecol. 2019; 26 (3): 535-43.
- Gözüküçük, M., Yıldız, E.G. Is it possible to estimate the need for surgical management in patients with a tubo-ovarian abscess at admission? A retrospective long-term analysis. Gynecol Surg 2021; 18: 14
- Güngördük K, Guzel E, Asicioğlu O et al. Experience of tubo-ovarian abscess in western Turkey. Int J Gynaecol Obstet. 2014; 124: 45–50.
- Akkurt MÖ, Yalçın SE, Akkurt İ, et al. The evaluation of risk factors for failed response to conservative treatment in tubo-ovarian abscesses. J Turk Ger Gynecol Assoc. 2015; 16 (4): 226-30.
- Topçu HO, Kokanalı K, Güzel AI et al. Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess, Journal of Obstetrics and Gynaecology. 2015; 35: (7): 699-702
- Uyar I, Gulhan I, Sipahi M, Cetin F, Hanhan HM, Ozeren M. Risk factors for surgery in patients with tuba-ovarian abscess. Arch Gynecol Obstet 2012; 286, 973–5
- Karaca K, Ozkaya E, Kurek Eken M et al. Serum procalcitonin levels together with clinical features and inflammatory markers in women with tubo-ovarian abscess for discriminating requirements for surgery for full recovery, J of Obstet and Gyn, 2018; 38: 6, 818-21
- Ata N, Kulhan M, Kulhan NG, Turkler C. Can neutrophil-lymphocyte and platelet-lymphocyte ratios predict threatened abortion and early pregnancy loss? Ginekol Pol 2020; 91 (4); 210–5
- Kang Q, Li W, Yu N, et al. Predictive role of neutrophil-to-lymphocyte ratio in preeclampsia: A metaanalysis including 3982 patients. Pregnancy Hypertension 2020; 20: 111-8
- Caglayan EK, Engin-Ustun Y, Gocmen AY et al. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? J of Perinat Med. 2016; 44 (3): 315-20.
- Topcu HO, Guzel AI, Ozer I et al. Comparison of neutrophil/lymphocyte and platelet/ lymphocyte ratios for predicting malignant potential of suspicious ovarian masses in gynecology practice. Asian Pac J Cancer Prev, 2014; 15, 6239-41.
- Covali R, Socolov D, Pavaleanu I, Carauleanu A,Socolov R. Platelet Indices in Uterine Leiomyoma Compared with other Major Gynecological Diseases. J Adv Med Med Res 2020; 32 (24), 164-76.
- Cakmak B, Gulucu S, Aliyev N, Ozsoy Z, Nacar M, Koseoglu D. Neutrophil-lymphocyte and platelet-lymphocyte ratios in endometrial hyperplasia. Obstet Gynecol Sci. 2015; 58 (2): 157-61.
- Aydın F, Biler A, Taner CE, Ertaş İE. Tubo-ovaryan apse tanılı olgularda tedavi öncesi nötrofil/lenfosit ve platelet/lenfosit oranları medikal tedavi başarısını predikte eder mi? Kocaeli Tıp Dergisi. 2018; 7: 165–71.
- Çoşkun B, Şimşir C. Evaluation of risk factors predicting surgical treatment in tuboovarian abscess cases. Medical Science and Discovery, 2019; 6 (10): 235-40.
- Alay I, Kaya C, Karaca I, et al. The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo-ovarian abscess. J Obstet Gynaecol Res 2019; 45: 1183–9.
- Akselim B, Karaşin SS, Demirci A, Üstünyurt E. Can antibiotic treatment failure in tubo-ovarian abscess be predictable? Eur J Obstet Gynecol Reprod Biol. 2021; 258; 253-57
- Inal ZO, Inal HA, Gorkem, U. Experience of Tubo-ovarian abscess: a retrospective clinical analysis of 318 patients in a single tertiary Center in Middle Turkey. Surg infect, 2018; 19 (1): 54-60.
There are 35 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 13, 2022 |
| Submission Date | August 20, 2021 |
| Published in Issue | Year 2022 |