Validity of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in the Diagnosis of Pulmonary Embolism in Patients with Renal Disorder

Abstract

Introduction:Acute pulmonary embolism (APE) is a common and sometimes fatal form of venous thromboembolism. The fact that patients do not consult with a specific clinical picture and accompanying comorbid conditions make the diagnosis difficult. Chronic renal failure is one of the comorbid conditions with increased susceptibility to thrombosis. Due to clinical presentation variabilities, the limited use of the d-dimer test in patients with renal dysfunction, and the limitation of use of computed tomography (CT) angiography due to potential renal side effects, an easily accessible, inexpensive, sensitive and specific guide laboratory parameter within acceptable limits is needed in the diagnosis of patients with impaired renal function. In this study, neutrophil/lymphocyte ratios (NLR) and platelet/lymphocyte ratios (PLR) will be compared between two patient groups with and without renal dysfunction and APE attack. It is aimed to demonstrate the usability of these rates together with clinical, laboratory and radiological evaluations in the diagnosis of pulmonary embolism.Methods:In the selection of patient groups, the retrospective files of patients with chronic renal failure who applied to the emergency service of our hospital between January 2015 and 2019 and then were diagnosed with APE were examined. The control group consist of the patients with chronic renal failure who applied to the nephrology and internal medicine outpatient clinic without any additional pathology. Information such as gender, age, existing diseases, laboratory tests such as hemogram, D-dimer, troponin, creatinine glomerular filtration rate, lower extremity venous Doppler ultrasonography and thorax CT angiography results of the patients were recorded. NLR and PLR ratios were calculated in all groups. The results were evaluated with SPSS.Results:NLR and PLR values were found to be significantly higher in the case group diagnosed with pulmonary embolism (p=0.000). At NLR 3.50 cut-off value, sensitivity was 70.6%, positive prediction was 84.6%, specificity was 86.8%, and negative prediction was 74.2%. Sensitivity was 68.8%, positive prediction was 67.0%, specificity was 65.1%, negative prediction was 67% at PLR 125 cut-off value.Conclusion:NLR and PLR values can be used in addition to clinical, laboratory and imaging methods in the diagnosis of APE in patients with chronic renal failure and can give results that may help the clinician. However, more comprehensive studies should be conducted with larger case groups

Keywords

• acute pulmonary embolism
• chronic renal failure
• nlr
• plr