MEAN PLATELET VOLUME (MPV), PLATELET DISTRIBUTION WIDTH (PDW), NEUTROPHIL TO LYMPHOCYTE RATIO (NLR) AND EOSINOPHIL TO LYMPHOCYTE RATIO (ELR) AS MARKERS IN NASAL POLYPS AND AS PREDICTORS OF RECURRENCE.
Main Article Content
Keywords
Nasal polyps, MPV, NLR, PDW, ELR
Abstract
Background: Nasal polyps (NP) are benign protrusions of para-nasal sinus formed as a result of long standing mucosal changes due to allergy or infection. Treatment options include medically (oral or topical steroids) or surgically (Endoscopic sinus surgery).Novel inflammatory markers have been investigated in recent years for their levels in nasal polyps and as markers of recurrence.
Methodology: 37 patients (21 males and 15 females) with histopathologically confirmed nasal polyps (ethmoidal and antrochoanal), presenting in ENT OPD owere taken up for surgery (Endoscopic polypectomy/ FESS). All patients had their Complete blood count (CBC) performed with an automated blood cell counter. Preoperative nasal endoscopy and computed tomography (CT) scans were conducted on each patient. The following values were directly derived and tabulated from the CBC reports: Absolute neutrophil count (N), Absolute eosinophil count (E), absolute lymphocyte count (L), Mean platelet volume (MPV), Platelet distribution width (PDW). The Neutrophil to lymphocyte ratio and eosinophil to lymphocyte ratio were calculated and tabulated .CBC was repeated at 6 months and 12 months post-operative.
Results: All the parameters had a significant decrease in the post-operative period when comparing Baseline vs 6 months and 1 year values of. comparing recurrent( 9/ 37) vs non recurrent( 28/37) cases, there was highly significant difference(decrease) in all parameters (MPV-p=0.000 ; PDW-p=0.002; NLR-p=0.000 ; ELR-p=0.000).
Conclusion: MPV, PDW, NLR and ELR are simple and reproducible parameters in predicting recurrence in nasal polyps. They can be used with clinical observation and follow up of nasal polyp cases after FESS and predicting response to surgery
References
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40. Fatih Boztepe, Osman & Gün, Taylan & Demir, Meltem & Gür, Özer & Ozel, Deniz & Doğru, Harun. (2015). A novel predictive marker for the recurrence of nasal polyposis following endoscopic sinus surgery. Archives of Oto-Rhino-Laryngology. 273. . 10.1007/s00405-015-3753-z.
41. Jankowski R. Eosinophils in the pathophysiology of nasal polyposis. Acta Otolaryngol. 1996 Mar; 116(2):160-3.
42. Jeong WJ1, Lee CH, Cho SH, Rhee CS. Eosinophilic allergic polyp: a clinically oriented concept of nasal polyp. Otolaryngol Head Neck Surg. 2011 Feb; 144(2):241-6. doi: 10.1177/0194599810391738. Epub 2010 Dec 20
43. Eghtedari F1, Cheraghzadeh SR, Kashef MA, Monabati A, Kashef S. Agreement rate of skin prick test with tissue eosinophil count in patients with nasal polyps. Iran J Allergy Asthma Immunol. 2007 Jun;6(2):89-92
44. Yenigun A, Sezen S, Calim OF, Ozturan O. Evaluation of the eosinophil-to-lymphocyte ratio in pediatric patients with allergic rhinitis. Am J Rhinol Allergy. 2016 Mar-Apr; 30(2):e21-5. doi: 10.2500/ajra.2016.30.4296.
45. Schoene NW (1997) Design criteria: tests used toassess platelet function. Am J Clin Nutr 65: S1665-1685
46. Meloni F, Stomeo F, Teatini GP, et al. Post-operative recurrence of naso-sinus polyposis. Acta Otorhinolaryngol Ital. 1990; 10:173-179.
47. Allen JS, Eisma R, Leonard G, et al. Interleukin-3 interleukin-5, and granulocyte-macrophage colony-stimulating factor expression in nasal polyps. Am J Otolaryngol. 1997; 18:239-246.
48. .Ohori J, Ushikai M, Sun D, et al. TNF-alpha up regulates VCAM-1 and NF-kappaB in fibroblasts from nasal polyps. Auris Nasus Larynx. 2007; 34:177-183.
49. Parnes SM. The role of leukotriene inhibitors in patients with paranasal sinus disease. Curr Opin Otolaryngol Head Neck Surg. 2003; 11:184-191.
2. Sagit M, Korkmaz F, Kavugudurmaz M, Somdas MA.Impact of septoplasty on mean platelet volume levels in patients with marked nasal septal deviation. J Craniofac Surg. 2012 Jul; 23(4):974-6. doi: 10.1097/SCS.0b013e31824e2c08.
3. Ulu S, Ulu MS, Bucak A, Kahveci OK, Yucedag F, Aycicek A.Evaluating the relationship between nasal obstruction and mean platelet volume by using acoustic rhinometry in patients with septum deviation. Rhinology. 2013 Sep; 51(3):249-52. doi: 10.4193/Rhino12.169.
4. Unlu I, Kesici GG2, Oneç B3, Yaman H4, Guclu E5.The effect of duration of nasal obstruction on mean platelet volume in patients with marked nasal septal deviation. Eur Arch Otorhinolaryngol. 2016 Feb; 273(2):401-5. doi: 10.1007/s00405-015-3580-2. Epub 2015 Mar 4.
5. Kucur C, Kulekci S, Zorlu A, Savran B, Oghan F, Yildirim N.Mean platelet volume levels in children with adenoid hypertrophy. J Craniofac Surg. 2014 Jan; 25(1):e29-31. doi: 10.1097/SCS.0b013e3182a2eddd
6. Eyibilen A., Aladağ İ., Gürbüzler L., Koç S., Ekinci A., Yamanoğlu M. Mean Platelet Volume İn Patients With Nasal Polyposis Ana Sayfa » Yayın Arşivi » Türk Otorinolarengoloji XXXIII Ulusal Kongre Özetleri » 2011 » Mean Platelet Volume İn Patients With Nasal Polyposis
7. Ferit Akil, Umur Yollu, Fatih Turgut and Muhammed Ayral.The Relationship Between Nasal Polyps, Mean Platelet Volume,Neutrophile/Lymphocyte Ratio and Platelet Count.Otolaryngology online journal. Volume 6 Issue 4: 140 2016
8. E Vagdatli, E Gounari, E Lazaridou, E Katsibourlia, F Tsikopoulou, I Labrianou.Platelet distribution width: a simple, practical and specific marker of activation of coagulation.Hippokratia. 2010 Jan-Mar; 14(1): 28–32
9. Fan Z, Pan J, Zhang Y, Wang Z, Zhu M, Yang B, Shi L, Jing H.Mean Platelet Volume and Platelet Distribution Width as Markers in the Diagnosis of Acute Gangrenous Appendicitis. 2015; 2015:542013. doi: 10.1155/2015/542013. Epub 2015 Nov 25.
10. Hedman J, Kaprio J, Poussa T, et al. Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol. 1999; 28:717–22.
11. Hellquist HB..Nasal polyps update. Histopathology. Allergy Asthma Proc. 1996 Sep-Oct; 17(5):237-42.
12. Bachert C, Gevaert P, Holappels G, et al. Total and specific IgE in nasal polyps is related to local eosinophilic inflammation. J Allergy Clin Immunol. 2001; 107:607–14.
13. Jankowski R.Eosinophils in the pathophysiology of nasal polyposis. Acta Otolaryngol. 1996 Mar;116(2):160-3
14. Ikeda K1, Shiozawa A, Ono N, Kusunoki T, Hirotsu M, Homma H, Saitoh T, Murata J.Subclassification of chronic rhinosinusitis with nasal polyp based on eosinophil and neutrophil. Laryngoscope. 2013 Nov; 123(11):E1-9. doi: 10.1002/lary.24154. Epub 2013 May 13.
15. Wen W1, Liu W, Zhang L, Bai J, Fan Y, Xia W, Luo Q, Zheng J, Wang H, Li Z, Xia J, Jiang H, Liu Z, Shi J, Li H, Xu G.Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy. J Allergy Clin Immunol. 2012 Jun; 129(6):1522-8.e5. doi: 10.1016/j.jaci.2012.01.079. Epub 2012 Mar 27.
16. Fairweather D, Frisancho-Kiss S. Mast cells and inflammatory heart disease: potential drug targets. Cardiovasc Hematol Disord Drug Targets 2008; 8: 80-90.
17. Cingi C1, Demirbas D, Ural A.Nasal polyposis: an overview of differential diagnosis and treatment. Recent Pat Inflamm Allergy Drug Discov. 2011 Sep; 5(3):241-52.
18. Sharma M, Raman S, Ray B, Bagga RV, Sahu RK, De S. Study the relationship between nasal polyps, platelet count, mean platelet volume,neutrophil/lymphocyte ratio in patients attending otolaryngology OPD in a tertiary care teaching hospital,West Bengal. Int J Otorhinolaryngol Head Neck Surg 2017; 3:228-33.
19. Sagit M, Cetinkaya S, Dogan M, Bayram A,Vurdem UE, et al. Mean platelet volume in patients with nasal polyposis. B-ENT. 2012; 8:269-72.
20. Akil F, Yollu U, Turgut F, Ayral1 M. The Relationship between Nasal Polyps, Mean Platelet Volume, Neutrophile/Lymphocyte Ratio and Platelet Count. Otolaryngol. 2016;6(4):140
21. Tayfun Apuhan and Gulali Aktas.Association between nasal polyps and novel inflammatory parameters. ISSN: 0970-938X (Print) | 0976-1683 (Electronic)
22. Aktas G, Sit M, Tekce H, Alcelik A, Savli H, Simsek T, et al. Mean platelet volume in nasal polyps. West Indian Med J. 2013; 62(6):515-8.
23. Cengiz C, Erhan Y, Murat T, Ercan A, Ibrahim S, Ihsan G, et al. Values of mean platelet volume in patients with chronic tonsillitis and adenoid hypertrophy. Pak J Med Sci. 2013;29:569-72
24. Sayit, Asli & Terzi, Yuksel. (2016). Platelet Count and Mean Platelet Volume in Patients with Nasal Polyposis. Journal of Clinical and Analytical Medicine. 7. 10.4328/JCAM.2703.
25. Zahorec R. Bratisl Lek Listy. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill.2001; 102(1):5-14.
26. Bhat T1, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, Meghani M, Akhtar M, Costantino T.Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013 Jan;11(1):55-9. doi: 10.1586/erc.12.159.
27. Duan H, Zhang X, Wang F-X, et al. Prognostic role of neutrophil-lymphocyte ratio in operable esophageal squamous cell carcinoma. World Journal of Gastroenterology : WJG. 2015;21(18):5591-5597. doi:10.3748/wjg.v21.i18.5591.
28. Bowen RC, Little NAB, Harmer JR, et al. Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis. Oncotarget. 2017;8(19):32171-32189. doi:10.18632/oncotarget.16291.
29. Wei B, Yao M, Xing C, et al. The neutrophil lymphocyte ratio is associated with breast cancer prognosis: an updated systematic review and meta-analysis. OncoTargets and therapy. 2016;9:5567-5575. doi:10.2147/OTT.S108419.
30. Atan D, İkincioğulları A, Köseoğlu S, et al. New Predictive Parameters of Bell’s Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio. Balkan Medical Journal. 2015;32(2):167-170. doi:10.5152/balkanmedj.2015.15456.
31. Joong Seob Lee, Sung Kwang Hong, Dong Hyun Kim, Ju Han Lee, Hyo-Jeong Lee, Bumjung Park, Hyo Geun Choi, Il Gyu Kong, Hong Ji Song &Hung-Jong Kim .The neutrophil-to-lymphocyte ratio in children with sudden sensor neural hearing loss: a retrospective study. Acta Oto-Laryngologica Vol. 137, Iss. 1,2017
32. O’Brien CE, Price ET (2013) The Blood Neutrophil to Lymphocyte Ratio Correlates with Clinical Status in Children with Cystic Fibrosis: A Retrospective Study. PLoS ONE8(10): e77420. https://doi.org/10.1371/journal.pone.0077420
33. Yorulmaz MA, Tüz M, Yasan H, Okur E, Sivrice ME. Comparison of Neutrophil/Lymphocyte Ratio and Trombocyte/Lymphocyte Ratio Values between Tonsillectomy and a Control Group. J Clin Anal Med 2017;8(4): 280-3.
34. Yang D-H, Qian M-Z, Wei M-M, et al. The correlation of neutrophil-to-lymphocyte ratio with the presence and activity of myasthenia gravis. Oncotarget. 2017;8(44):76099-76107. doi:10.18632/oncotarget.18546.
35. Fu, Haitao & Qin, Baodong & Hu, Zhi-De & Ma, Ning & Yang, Min & Wei, Tingting & Tang, Qingqing & Huang, Yuanlan & Huang, Fenglou & Liang, Yan & Yang, Zaixing & Zhong, Renqian. (2015). Neutrophil- and Platelet-to-Lymphocyte Ratios are Correlated with Disease Activity in Rheumatoid Arthritis. Clinical laboratory. 61. 269-73. 10.7754/Clin.Lab.2014.140927.
36. Atan, Dogan & Murat Özcan, Kürşat & Koseoglu, Sabri & İkincioğulları, Aykut & Ali Çetin, Mehmet & Ensari, Serdar & Dere, Hüseyin. (2015). [New predictive parameters of nasal polyposis: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio]. Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat. 25. 97-101. 10.5606/kbbihtisas.2015.01947.
37. Alper Yenigün . Assessment of patients with nasal polyposis by the neutrophil-to-lymphocyte ratio and eosinophil-to-lymphocyte ratio. Ear Nose Bogaz Ihtis Derg. 2015; 25 (4): 193-19
38. Brescia G, Barion U, Zanotti C, Parrino D, Marioni G. Allergy Asthma Proc. 2017 Sep 1;38(5):64-69. doi: 10.2500/aap.2017.38.4068.
39. Forget P, Khalifa C, Defour J-P, Latinne D, Van Pel M-C, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Research Notes. 2017; 10:12. Doi: 10.1186/s13104-016-2335-5.
40. Fatih Boztepe, Osman & Gün, Taylan & Demir, Meltem & Gür, Özer & Ozel, Deniz & Doğru, Harun. (2015). A novel predictive marker for the recurrence of nasal polyposis following endoscopic sinus surgery. Archives of Oto-Rhino-Laryngology. 273. . 10.1007/s00405-015-3753-z.
41. Jankowski R. Eosinophils in the pathophysiology of nasal polyposis. Acta Otolaryngol. 1996 Mar; 116(2):160-3.
42. Jeong WJ1, Lee CH, Cho SH, Rhee CS. Eosinophilic allergic polyp: a clinically oriented concept of nasal polyp. Otolaryngol Head Neck Surg. 2011 Feb; 144(2):241-6. doi: 10.1177/0194599810391738. Epub 2010 Dec 20
43. Eghtedari F1, Cheraghzadeh SR, Kashef MA, Monabati A, Kashef S. Agreement rate of skin prick test with tissue eosinophil count in patients with nasal polyps. Iran J Allergy Asthma Immunol. 2007 Jun;6(2):89-92
44. Yenigun A, Sezen S, Calim OF, Ozturan O. Evaluation of the eosinophil-to-lymphocyte ratio in pediatric patients with allergic rhinitis. Am J Rhinol Allergy. 2016 Mar-Apr; 30(2):e21-5. doi: 10.2500/ajra.2016.30.4296.
45. Schoene NW (1997) Design criteria: tests used toassess platelet function. Am J Clin Nutr 65: S1665-1685
46. Meloni F, Stomeo F, Teatini GP, et al. Post-operative recurrence of naso-sinus polyposis. Acta Otorhinolaryngol Ital. 1990; 10:173-179.
47. Allen JS, Eisma R, Leonard G, et al. Interleukin-3 interleukin-5, and granulocyte-macrophage colony-stimulating factor expression in nasal polyps. Am J Otolaryngol. 1997; 18:239-246.
48. .Ohori J, Ushikai M, Sun D, et al. TNF-alpha up regulates VCAM-1 and NF-kappaB in fibroblasts from nasal polyps. Auris Nasus Larynx. 2007; 34:177-183.
49. Parnes SM. The role of leukotriene inhibitors in patients with paranasal sinus disease. Curr Opin Otolaryngol Head Neck Surg. 2003; 11:184-191.
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Dr. Nilamadhaba Prusty, & Dr. Siddharth Panditray. (2022). MEAN PLATELET VOLUME (MPV), PLATELET DISTRIBUTION WIDTH (PDW), NEUTROPHIL TO LYMPHOCYTE RATIO (NLR) AND EOSINOPHIL TO LYMPHOCYTE RATIO (ELR) AS MARKERS IN NASAL POLYPS AND AS PREDICTORS OF RECURRENCE. Journal of Population Therapeutics and Clinical Pharmacology, 29(03), 254–261. https://doi.org/10.53555/jptcp.v29i03.2764
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Author Biographies
Dr. Nilamadhaba Prusty
Assistant Professor, Dept of ENT, FM MCH, Balasore
Dr. Siddharth Panditray
Consultant, ENT & Head and Neck Surgery, AHPGIC, Cuttack