The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo‐ovarian abscess

Alay, Ismail; Kaya, Cihan; Karaca, İbrahim; Eren, Ecem; Hoşgören, Murat; Aslanova, Fidan; Cengiz, Hüseyin; Ekin, Murat; Yaşar, Levent

doi:10.1111/jog.13946

Cited by 20 publications

(22 citation statements)

References 22 publications

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“…Early surgical intervention can reduce morbidity and mortality in TOA patients who do not respond to antibiotics. Several studies of demographic and clinical characteristics associated with antibiotic treatment failure in TOA patients have shown that the TOA size and age of the patient are signi cantly related and proportional to the need for surgical treatment (6)(7)(8)(9)(10)(11). Early recognition of a patient's risk of antibiotic treatment failure alerts clinicians to the need to change the treatment strategy, thereby reducing acute and longterm complications of TOA.…”

Section: Discussionmentioning

confidence: 99%

The prediction of surgical intervention in patients with tubo-ovarian abscess

Hwang

Kim

et al. 2021

Journal of Obstetrics and Gynaecology

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Background: The prediction of antibiotic treatment failure is helpful to identify patients with a high likelihood of needing surgical treatment early in patients diagnosed with tubo-ovarian abscess (TOA). The aim of this study was to compare the clinical characteristics of patients with TOA) who responded to medical treatment and those who underwent surgical intervention due to medical treatment failure. Material and Methods: Electronic medical records were evaluated retrospectively to identify patients who were diagnosed with TOA and hospitalized in our obstetrics and gynecology department between March 2014 and June 2019. Demographic, clinical, and laboratory data including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were compared between the medical treatment group and the surgical intervention group. Logistic regression was used to determine the independent predictors of treatment failure. Results: Patient age, TOA diameter, WBC count, CRP, and ESR were signi cantly different between the groups. On multiple regression analysis, signi cant correlations were identi ed between age (p = 0.001), ESR (p = 0.045), and failure of medical treatment. TOA diameter (p = 0.065) showed a borderline association with surgical intervention. The risk group was de ned as the combination of factors producing a risk score > 2. The area under the curve (AUC) for the risk group (age >34.3 years, ESR > 45 mm/h, and TOA size > 5.9 cm) was 0.844.

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Section: Discussionmentioning

confidence: 99%

The prediction of surgical intervention in patients with tubo-ovarian abscess

Hwang

Kim

et al. 2021

Journal of Obstetrics and Gynaecology

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show abstract

“…Early surgical intervention can reduce morbidity and mortality in TOA patients who do not respond to antibiotics. Several studies of demographic and clinical characteristics associated with antibiotic treatment failure in TOA patients have shown that the TOA size and age of the patient are significantly related and proportional to the need for surgical treatment (6)(7)(8)(9)(10)(11). Early recognition of a patient's risk of antibiotic treatment failure alerts clinicians to the need to change the treatment strategy, thereby reducing acute and long-term complications of TOA.…”

Section: Discussionmentioning

confidence: 99%

“…Yildirim et al reported that WBCs and neutrophils were elevated in TOA patients, and neutrophils were elevated even when the WBC count was normal (13); they also found that lymphocytes were relatively decreased, resulting in an increase in the neutrophilto-lymphocyte ratio (NLR). Alay et al reported that neutrophil counts were significantly higher in TOA patients with no response to medication and that the NLR could be used to predict non-response to medication in TOA patients (10).…”

Section: Discussionmentioning

confidence: 99%

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The prediction of surgical intervention in patients with tubo-ovarian abscess

Hwang

Kim

2020

Preprint

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Background: The prediction of antibiotic treatment failure is helpful to identify patients with a high likelihood of needing surgical treatment early in patients diagnosed with tubo-ovarian abscess (TOA). The aim of this study was to compare the clinical characteristics of patients with TOA) who responded to medical treatment and those who underwent surgical intervention due to medical treatment failure. Material and Methods: Electronic medical records were evaluated retrospectively to identify patients who were diagnosed with TOA and hospitalized in our obstetrics and gynecology department between March 2014 and June 2019. Demographic, clinical, and laboratory data including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were compared between the medical treatment group and the surgical intervention group. Logistic regression was used to determine the independent predictors of treatment failure. Results: Patient age, TOA diameter, WBC count, CRP, and ESR were significantly different between the groups. On multiple regression analysis, significant correlations were identified between age ( p = 0.001), ESR ( p = 0.045), and failure of medical treatment. TOA diameter ( p = 0.065) showed a borderline association with surgical intervention. The risk group was defined as the combination of factors producing a risk score > 2. The area under the curve (AUC) for the risk group (age >34.3 years, ESR > 45 mm/h, and TOA size > 5.9 cm) was 0.844. The sensitivity, specificity, accuracy, PPV, and NPV were 93.8%, 75%, 83.3%, 75%, and 93.8%, respectively. Conclusions: The risk of needing surgical intervention in TOA patients can be predicted using ESR in addition to age and TOA size as risk factors.

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“…42 It has been found that elevated ca125 is related with failure of conservative parenteral antibiotic therapy for TOA, but further prospective studies are necessary to evaluate this finding. Last year Alay et al 43 presented the neutrophil-to-lymphocyte ratio (NLR) and age as significant indicators in the prediction of medical treatment failure in TOA patients. Unfortunately, to now, there are not enough data to suggest an accurate scoring system which could guide the clinicians to choose the better approach for each different case.…”

Section: Prognosismentioning

confidence: 99%

Tubo-ovarian abscess: Exploring optimal treatment options based on current evidence

Gkrozou

Tsonis

Daniilidis

et al. 2020

Journal of Endometriosis and Pelvic Pain Disorders

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Purpose: Tubo-ovarian abscess (TOA) and pelvic abscess are characterized by an inflammatory pelvic mass. In the majority of cases, this condition involves the ovaries, the fallopian tubes and/or any other adjacent tissue. TOA is considered a severe complication of PID and can cause severe sepsis. The main risk factors for women’s health are the size of the abscess, the initial amount of white blood cells (WBC), patients’ age as well as, any co-existing comorbidities. Methods: This study provides a review of the current literature regarding the management of TOA and the different criteria used in order to establish the optimal therapeutic approach or to predict outcome by individualizing cases. Four major search engines, MEDLINE, Google Scholar, PubMed and EMBASE, up to February 2020 were explored, focusing in epidemiology and risk factors, pathogenesis, diagnosis and treatment. Results: Our review suggests that there are no clear guidelines for best practice, in case of TOA, but it appears that intravenous antibiotics combined with interventional radiology have good results for TOA <5 cm. When TOA is >5 cm, laparoscopic approach is indicated. Further studies are needed in order to evaluate the best treatment for women with TOA. Conclusions: More prospective studies on large-series of patients are in need, in order to determine a clear pathway and to suggest specific criteria, which can guide clinicians to choose optimal approach in a timely manner.

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The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo‐ovarian abscess

Cited by 20 publications

References 22 publications

The prediction of surgical intervention in patients with tubo-ovarian abscess

The prediction of surgical intervention in patients with tubo-ovarian abscess

The prediction of surgical intervention in patients with tubo-ovarian abscess

Tubo-ovarian abscess: Exploring optimal treatment options based on current evidence

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