Skip to main content Skip to main navigation menu Skip to site footer

The association between neutrophil to lymphocyte ratio (NLR) with mortality in patients with perforated peptic ulcer at Dr. Soetomo Hospital in Surabaya, Indonesia

  • Arifin Perdana Istimansyah ,
  • Denny Septarendra ,
  • Marjono Dwi Wibowo ,

Abstract

Background: Perforated peptic ulcer is the most dangerous complication of peptic ulcer.  Neutrophils and lymphocytes are crucial in the inflammatory process. A simple and effective biomarker to assess systemic inflammation is the neutrophil-lymphocyte ratio (NLR). This study aims to ascertain the connection between NLR and mortality in peptic ulcer patients.

Methods: This study was a cross-sectional observational analytic study. Data were obtained from medical records in Dr. Soetomo General Hospital from January 2018 to December 2022. The dependent variable was patient mortality, while NLR value served as the independent variable. NLR cutoff value calculated using the Receiver Operating Characteristic (ROC) curve. The collected data was tested using the Chi-square test and the Spearman rank correlation test integrated in the SPSS software.

Results: There were 109 patients, consisting of 74 male and 35 female patients. There were 29 patients with the Boey Score category 1, 54 patients with the Boey score category 2, and 25 patients with the Boey score 3. Using a cutoff of 15.60, the NLR values were separated into low and high NLR groups. There were 56 patients with high scores and 53 patients with low scores. A significant relationship was found between NLR values and mortality (p <0.0001). The results of Spearman's analysis revealed a strong correlation between the incidence of mortality and an increase in the NLR value (p<0.0001; r = 0.500).

Conclusion: There is a significant relationship between NLR and mortality in patients with perforated peptic ulcers.

References

  1. Agustin ED, Putro MD, Purbayu H. Characteristic of Patients with Gastric Perforation due to Peptic Ulcer in Dr. Soetomo General Hospital Surabaya in the Period of January - December 2016. JBN (Jurnal Bedah Nasional). 2019;3(2):45. Available from: http://dx.doi.org/10.24843/jbn.2019.v03.i02.p04
  2. Koto K, Asrul A, A M. Characteristic of Gastric Perforation Type and The Histopathology at Haji Adam Malik General Hospital Medan-Indonesia. Bali Med J. 2016;5(1):186. Available from: http://dx.doi.org/10.15562/bmj.v5i1.325
  3. Budipramana VS. Lactate Level as a Prediction Factor of Reperforation after Repairing Gastric Perforation. Folia Medica Indones. 2019;55(1):43. Available from: http://dx.doi.org/10.20473/fmi.v55i1.12556
  4. Menekse E, Kocer B, Topcu R, Olmez A, Tez M, Kayaalp C. A practical scoring system to predict mortality in patients with perforated peptic ulcer. World J Emerg Surg. 2015;10:7. Available from: https://pubmed.ncbi.nlm.nih.gov/25722739
  5. Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratislava Med J. 2021;122(07):474–88. Available from: http://dx.doi.org/10.4149/bll_2021_078
  6. Kelana S, Susilo DH, Sahudi. The performance of various laboratory parameters to differentiate follicular thyroid carcinoma and follicular thyroid adenoma. Bali Med J. 2022;11(3):1461–7. Available from: http://dx.doi.org/10.15562/bmj.v11i3.3521
  7. Sakarozi R, Susilo DH, Wibowo MD. The use of Neutrophil – Lymphocyte Ratio (NLR) as a potential biomarker to predict the prognosis of Ludwig’s angina patients. Bali Med J. 2022;11(3):1553–8. Available from: http://dx.doi.org/10.15562/bmj.v11i3.3612
  8. Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Patients with Sepsis: A Prospective Observational Study. Mediators Inflamm. 2016/03/24. 2016;2016:8191254. Available from: https://pubmed.ncbi.nlm.nih.gov/27110067
  9. Song M, Graubard BI, Rabkin CS, Engels EA. Neutrophil-to-lymphocyte ratio and mortality in the United States general population. Sci Rep. 2021;11(1):464. Available from: https://pubmed.ncbi.nlm.nih.gov/33431958
  10. Sudiartha IPG, Wiargitha IK, Mahadewa TGB. Perbedaan nilai Neutrophil Lymphocyte Ratio (NLR) terhadap pemeriksaan kultur darah dalam mendiagnosis sepsis pada pasien peritonitis di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis. 2020;11(1):165–71. Available from: http://dx.doi.org/10.15562/ism.v11i1.571
  11. Saputra HM, Hakim L. The Prognostic Role of Neutrophil-to-Lymphocyte Ratio (NLR) in Testicular Germ Cell Tumor (GCT). Folia Medica Indones. 2022;58(1):39. Available from: http://dx.doi.org/10.20473/fmi.v58i1.32599
  12. Iskandar HR, Pudjiadi A, Mulyo D, Pratiwi A, Suryatin Y. Sensitifitas dan Spesifisitas Pemeriksaan Procalcitonin, C-Reactive Protein (CRP), dan Hitung Leukosit untuk Memprediksi Infeksi Bakterial pada Sindrom Syok Dengue di Pediatric Intensive Care Unit. Sari Pediatr. 2016;12(4):233. Available from: http://dx.doi.org/10.14238/sp12.4.2010.233-40
  13. Boey J, Wong J, Ong GB. A prospective study of operative risk factors in perforated duodenal ulcers. Ann Surg. 1982;195(3):265–9. Available from: https://pubmed.ncbi.nlm.nih.gov/7059238
  14. Nuzulistina E. Profile of Perforated Peptic Ulcer Based on Prognosis Score at Dr. Soetomo Hospital in 2016. Thesis. Universitas Airlangga.
  15. Thorsen K, Søreide JA, Søreide K. What is the best predictor of mortality in perforated peptic ulcer disease? A population-based, multivariable regression analysis including three clinical scoring systems. J Gastrointest Surg. 2014/03/08. 2014;18(7):1261–8. Available from: https://pubmed.ncbi.nlm.nih.gov/24610235
  16. Tanrikulu Y, Sen Tanrikulu C, Sabuncuoglu MZ, Kokturk F, Temi V, Bicakci E. Is the neutrophil-to-lymphocyte ratio a potential diagnostic marker for peptic ulcer perforation? A retrospective cohort study. Am J Emerg Med. 2016;34(3):403–6. Available from: http://dx.doi.org/10.1016/j.ajem.2015.11.009
  17. Zahorec R, Hulin I, Zahorec P. Rationale Use of Neutrophil-to-lymphocyte ratio for early diagnosis and stratification of COVID-19. Bratislava Med J. 2020;121(07):466–70. Available from: http://dx.doi.org/10.4149/bll_2020_077
  18. Faria SS, Fernandes Jr PC, Silva MJB, Lima VC, Fontes W, Freitas-Junior R, et al. The neutrophil-to-lymphocyte ratio: a narrative review. Ecancermedicalscience. 2016;10:702. Available from: https://pubmed.ncbi.nlm.nih.gov/28105073
  19. Liu S, Li Y, She F, Zhao X, Yao Y. Predictive value of immune cell counts and neutrophil-to-lymphocyte ratio for 28-day mortality in patients with sepsis caused by intra-abdominal infection. Burn trauma. 2021;9:tkaa040–tkaa040. Available from: https://pubmed.ncbi.nlm.nih.gov/33768121
  20. Thorsen K, Søreide JA, Søreide K. Scoring systems for outcome prediction in patients with perforated peptic ulcer. Scand J Trauma Resusc Emerg Med. 2013;21:25. Available from: https://pubmed.ncbi.nlm.nih.gov/23574922
  21. Fadhila H. Boey and Peptic Ulcer Perforation (PULP) Score Accuracy as a Mortality Prediction Factor in Perforated Peptic Ulcer Patients at H. Adam Malik General Hospital Medan. 2018.
  22. Meidiansyah NS, Efman EU, Manawan F, Legiran S. Comparison of the Accuracy of Boey Score and PULP Score in Prediction of Gastric Perforation Mortality at Dr. Mohammad Hoesin General Hospital Palembang. Sriwijaya Journal of Surgery. 2012;5(1):448-496. Available from: https://doi.org/10.37275/sjs.v5i1.73
  23. Wardhana AA, Lesmana T. Neutrophil Lymphocyte Ratio (NLR) as a predictive factor radiological response of Neoadjuvant Chemotherapy (NAC) in Locally Advanced Rectal Cancer (LARC). Bali Med J. 2021;10(2):717–23. Available from: http://dx.doi.org/10.15562/bmj.v10i2.2483

How to Cite

Istimansyah, A. P., Septarendra, D. ., & Wibowo, M. D. . (2023). The association between neutrophil to lymphocyte ratio (NLR) with mortality in patients with perforated peptic ulcer at Dr. Soetomo Hospital in Surabaya, Indonesia . Bali Medical Journal, 12(1), 976–982. https://doi.org/10.15562/bmj.v12i1.4046

HTML
4

Total
3

Share

Search Panel

Arifin Perdana Istimansyah
Google Scholar
Pubmed
BMJ Journal


Denny Septarendra
Google Scholar
Pubmed
BMJ Journal


Marjono Dwi Wibowo
Google Scholar
Pubmed
BMJ Journal