http://orcid.org/0000-0003-2794-0062
Acute mesenteric ischemia is a rather uncommon condition where the blood flow of the intestine is compromised due to various known as well as unknown reasons. The resultant devascularization of the bowel results in a myriad of presenting symptoms varying from abdomen pain and distension to frank bleeding through the anal canal. In spite of the advances in medical technology, which have resulted in earlier detection, as well as the newer therapeutic modalities like imaging-guided embolization, the morbidity and mortality associated with this condition is still high, to the range 50–70% [Citation1].
Computed tomography angiography (CTA) is the gold standard investigation in acute mesenteric ischemia and is recommended to be done at the earliest in any patient with a clinical suspicion of this entity [Citation2]. CT angiography specifically allows to differentiate the occlusive from non-occlusive form of acute mesenteric ischemia as well as to evaluate the condition of the bowel walls. This can dictate the appropriate planning of treatment: that is, revascularization versus non-vascular management. CT angiography does have a distinct disadvantage in that it often requires skilled radiologists to interpret the findings, especially for an early diagnosis in its non-occlusive form.
Neutrophil–lymphocyte ratio and platelet–lymphocyte ratio are two parameters calculated from the blood values of platelets and leucocytes. These markers have been shown to reflect the presence of ongoing inflammatory as well as neoplastic processes within the body [Citation3]. The common effect on both cancerous and inflammatory pathologies can be explained by the fact that inflammation plays a crucial role in most steps of cancer right from its initiation to progression and even metastases [Citation4]. Of late, studies have revealed that platelet–lymphocyte ratio and neutrophil–lymphocyte ratio could be used as indicators predictive of advanced stage of presentation, presence of lymphatic metastasis, response to treatment, and even prognosis in various types of malignancies [Citation5,Citation6]. As these ratios can be calculated by using only simple blood routine analysis, they have the distinct advantages of being frequently repeatable and highly cost-effective.
The current study being reviewed was a retrospective case-controlled study which tried to analyze whether blood parameters including neutrophil-lymphocyte ratio and platelet-lymphocyte ratio can be used in the diagnosis of acute mesenteric ischemia [Citation7]. For a period of 10 months, they studied all patients who were clinically diagnosed as acute mesenteric ischemia. Stratification into cases and controls was done intra-operatively, based on the presence and absence of mesenteric ischemia, respectively. The venous blood parameters were calculated for these patients including the platelet count, total leucocyte count, neutrophil count, lymphocyte count, red cell distribution width, platelet distribution width, and so on. From these values, the neutrophil–lymphocyte ratio and platelet–lymphocyte ratio values were calculated.
At the end of the study, they had 125 cases and 13 controls. After statistical analysis with logistic regression model and receiver operating characteristic, they found platelet–lymphocyte ratio and platelet distribution width to be significantly associated with a diagnosis of acute mesenteric ischemia. Their study substantiates the findings from a similar case-controlled study which looked at the ability of hematologic markers in predicting acute mesenteric ischemia and found a positive correlation [Citation8]. Another retrospective cohort study similarly done on patients with acute mesenteric ischemia also brought out the diagnostic efficacy of neutrophil–lymphocyte ratio, apart from other inflammatory markers [Citation9].
The present study does have its own set of limitations. The major issue is regarding the retrospective study design, which attenuates the statistical significance of the study results.
Another drawback of the study is the lower number of patients in the control group which again exaggerates the bias in analysis. Nevertheless, the strong association between the diagnosis and the study parameters that they were able to detect, brings out the relevance of the study. To conclude from the study findings, platelet–lymphocyte ratio as well as neutrophil–lymphocyte ratio can be used as serum makers for supporting the diagnosis in patients with suspected mesenteric ischemia.
Declaration of interest
The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.
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