Author + information
- Eftal Murat Bakirci1,
- Selim Topcu2,
- Kamuran Kalkan2,
- Ibrahim Halil Tanboga2,
- Abdurrezzak Borekci3,
- Serdar Sevimli2 and
- Mahmut Acikel2
The aim of this study was to investigate the relationship between the anatomic extent of venous thromboembolism (VTE) and nonspecific inflammatory markers such as Neutrophil to lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hs-CRP).
We retrospectively enrolled 77 patients with VTE (Distal deep vein thrombosis (DVT) (n=19), proximal DVT (n=32) and pulmonary thomboembolism (PTE) (n=26)) and 34 healthy controls. Distal and proximal DVT was diagnosed by using peripheral vascular duplex ultrasonography. Proximal DVT was defined as thrombosis at the level of the popliteal veins or above. Distal DVT was defined as thrombosis occurring within the calf veins. The diagnosis of PTE was confirmed in all cases by computed tomography. Total and differential leukocyte count and hs-CRP were determined by standard laboratory.
It was detected in patients with VTE that WBC (8.5±0.26 vs 6.5±0.95, p<0.001), NLR (3.41±1.41 vs 1.80±0.70, p<0.001) and hs-CRP(2.00±2.68 mg/L vs 0.68±0.35 mg/L, p=0.005) levels were significantly higher in comparison with the healthy control group. According to the analysis made by ANOVA, the levels of WBC, NLR and hs-CRP were clearly different among the groups (control, distal and proximal DVT and PTE) (p<0.001). According to ANOVA test with LSD as a post-hoc test performed to find the source of the difference between the groups, only hs-CRP was found high in PTE group in comparison with the other groups; and no difference was detected between the other groups. A significant increase from the control group to DVT and PTE was observed in the analysis made for NLR. In the analysis for WBC, while there was no difference between the control group and distal DVT, it was found significantly higher in the proximal DVT and PTE (Table 1). ROC curve analysis was performed in order to find the best cut-off values of these variables in predicting VTE. AUC:0.849, p<0.001 was detected for NLR>1.84. For this value, sensitivity as 88.2% and specifity as 67.6% was determined. AUC:0.741, p<0.001 was detected for Hs-CRP>1.17. For this value, sensitivity as 45.6% and specifity as 94.1% was determined. For WBC>7.7, AUC:0.761, p<0.001 was detected. For this value, sensitivity as 57.4% and specifity as 91.2% was determined. ROC curve-AUC values of each three variables were compared. While there was no significant difference between hs-CRP and WBC (p=0.742), it was observed that there was a clear difference between both NLR and WBC (p=0.078), and NLR and hs-CRP (p=0.044) (Figure 1).
These findings suggest that the inflammatory process might have an important role in the prothrombotic state in patients with VTE. Also, NLR may be effective in determining the anatomic extent of VTE. NLR is inexpensive and readily available markers that may be useful for risk stratification in patients with VTE.
|Kontrol||Distal VTE||Proksimal VTE||PTE||P value|
The distribution of NLR, WBC and hs-CRP values between the control group and the sub-groups of VTE. Abbreviations: NLR, neutrophil to lymphocyte ratio; WBC, white blood cell; hs-CRP, high-sensitivity C-reactive protein.