Neutrophil Lymphocyte Ratio In Predicting Severity Of Injury, Complications And Mortality In Caustic Ingestion Cases

Karaali̇ Rezan¹, Topal Firdevs², Payza Umut¹, Akyol Pınar Yeşim¹, Kavalci Cemil³, Karakaya Zeynep¹, Topal Fatih Esad¹

¹Izmir KatipÇelebi University Atatürk Research and Training Hospital Emergency Department, Izmir/Turkey - ²Izmir Katip Celebi University Atatürk Research and Training Hospital Gastroenterology Department, Izmir/Turkey - ³Ankara Baskent University Hospital Emergency Department, Ankara/Turkey

Background: Caustic ingestion is still a life-threatening condition. In this study, we investigated the significance of the neutrophil lymphocyte ratio (NLR) in predicting the severity of the injury, complications and mortality at an early stage in the emergency department. 

Material and methods: 133 patients included in the study. Endoscopic findings and Complete Blood Count (CBC) parameters were retrieved from hospital files. The data were divided into two groups Zargar grade 0, 1and 2A as Group1, 2B, 3A and 3B as Group 2. The Zargar scores and the laboratory values were evaluated with Spearman's Correlation.

Results: We found that NLR and White Blood Cells (WBC) values of Group 1 cases were statistically significant and lower than NLR and WBC values of Group 2 cases (p<0,05). Values in Group 2 patients showed that AUC value for the 6.99 cut-off value of the NLR was 0.913 sensitivity 100% and specificity was 78,3% (p <0.05). The 0,801 AUC for the 11.9 value of the WBC, sensitivity 66,7 and specificity 84.4 were found to be statistically significant (p <0,05). NLR> 7,33 AUC 0,915 (p<0.05) and AUC value for WBC> 11,9 was found to be 0,870 (p <0.05) for the patients with late complications. Interms of mortality no statistical relationship was found (p> 0,05).

Conclusion: Endoscopy (EGD) is the valid gold standard method to determine the injury. In the literature, which patient groups should undergo endoscopy is also unclear. In addition, performing endoscopy in each patient will increase both the cost and the possibility of endoscopy-related complications. In our study NLR was statistically significant in predicting the severity of injury and possibility of complications in corrosive ingestion. Moreover, it can be obtain through affordable and routine blood count.