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    Comparison of the effects of normal and cesarean delivery methods and general and spinal anesthesia techniques on the inflammatory response
    (Anaesthesia Pain & Intensive Care, 2024) Hazar, Egemen Umit; Altinisik, Hatice Betul
    Background: Childbirth induces an inflammatory response that varies with the delivery mode and anesthesia type. This study investigates how normal delivery (ND) versus cesarean section (CS) under spinal anesthesia (SA) or general anesthesia (GA) affects inflammatory markers, including mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Methods: This retrospective study included patients who underwent ND or CS at a tertiary care hospital in Turkey between 2013 and 2017. Patients with significant illnesses were excluded. Patients were categorized into three groups: CS-SA, CS-GA, and ND. Blood samples were taken preoperatively and 24 h postpartum to measure MPV, NLR, and PLR. Results: The mean age was 27.8 +/- 3.8 years. Hemoglobin and platelet counts decreased significantly in all groups, while NLR increased. PLR increased in the CS-SA and CS-GA groups but not in the ND group. MPV decreased significantly only in the CS-SA group. Postoperative NLR, PLR, and MPV showed significant differences between the groups, with the highest response in the CS-GA group. Conclusion: Cesarean section under general anesthesia is associated with a higher inflammatory response compared to spinal anesthesia or normal delivery. Normal vaginal delivery results in the lowest inflammatory response.
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    Neutrophil-platelet ratio as a predictor of acute kidney injury in severe COVID-19
    (Lippincott Williams & Wilkins, 2024) Sayan, Mihrican; Altinisik, Hatice Betul; Sayan, Ozan
    Acute kidney injury (AKI) is one of the most seen complications of coronavirus-2019 (COVID-19) infection. Patients with AKI caused by COVID-19 likely have higher neutrophil counts and lower platelet and lymphocyte levels. Therefore, the predictive value of many inflammation indexes calculated from the total blood count has been investigated to predict the AKI in COVID-19. According to our clinical experience, we thought that neutrophilia and thrombocytopenia may be more common in the development of AKI. For this reason, this study aimed to evaluate the predictive value of the neutrophil-to-platelet ratio (NPR) for AKI in severe COVID-19 patients. This retrospective study included 334 severe COVID-19 patients followed up in the intensive care unit (ICU). Predictive factors for AKI were analyzed. ROC curve analysis was performed to determine the inflammation indexes' cutoff values for the AKI prediction. Multivariate analyses were performed to determine correlations between the inflammation indexes and AKI. In this study, AKI was determined at the rate of 43% (n:145). Independent risk factors affecting AKI were determined to be age (HR = 1.047, 95% confidence interval [CI]: 1.021-1.072, P < .001), the need for invasive mechanical ventilation (HR = 3.003, 95% CI: 1.645-5.481, P = .001) and the need for vasopressor (HR = 8.111, 95% CI: 3.786-17.375, P < .001). The optimal cutoff values predicting AKI were determined to be 3.9 for the NPR (AUC = 0.679, 95% CI: 0.622-0.737, P < .001) with 71.7% sensitivity and 61.9% specificity, 16.1 for the neutrophil-to-lymphocyte ratio (NLR) (AUC = 0.634, 95% CI: 0.575-0.694, P < .001) with 65.5% sensitivity and 56.1% specificity, and 3872.5 x 10(9)L for the systemic inflammatory index (SII) (AUC = 0.566, 95% CI: 0.504-0.629, P = .038) with 60% sensitivity and 55.6% specificity. In the regression model, only NPR values above the cutoff were related to AKI (HR = 3.817, 95% CI: 1.782-8.177, P = .001). The NPR has more predictive value than the NLPR, NLR, and SII in developing AKI in severe COVID-19 patients in the ICU. NPR is a new helpful index that can help clinicians predict early AKI in critical COVID-19.