The role of the mean platelet volume and neutrophil-to-lymphocyte ratio in peritonsillar abscesses / O papel do volume plaquetário médio e a relação neutrófilos/linfócitos em abscesso periamigdaliano

Abstract Introduction: Peritonsillar abscess is a serious infectious disease of the tonsillar tissue. Treatment generally requires both medical and surgical approaches to relieve the symptoms. Recently, in addition to clinical follow-up, some inflammatory markers, such as the mean platelet volume and neutrophil-to-lymphocyte ratio, have been considered to be additional inflammatory monitoring markers in inflammatory diseases. Objective: The aim of this study was to describe the role of mean platelet volume and neutrophil-to-lymphocyte ratio in patients with peritonsillar abscess. Methods: A retrospective study was conducted in 88 patients with peritonsillar abscess and 88 healthy individuals. We analyzed the white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, mean platelet volume and neutrophil-to-lymphocyte ratio values and compared them among the patient and control groups. Results: The mean platelet volume levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess posttreatment group and the control group. A mean platelet volume value of 8.7 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 75%, 65.9%, 68% and 72%, respectively. The neutrophil-to-lymphocyte ratio levels were significantly higher in the peritonsillar abscess pretreatment group than in the peritonsillar abscess post-treatment group and the control group. A neutrophil-to-lymphocyte ratio value of 3.08 was the optimal cut-off value for evaluating the sensitivity, specificity, positive predictive value and negative predictive value of 90.9%, 90.9%, 90.9% and 90.9%, respectively. While the white blood cell count, neutrophil count, lymphocyte count and C-reactive protein values were significantly different among the patient and control groups (p < 0.05), the platelet count was not significantly different among the patient and control groups (p > 0.05). Conclusion: The mean platelet volume and neutrophil-to-lymphocyte ratio values made us think that these parameters were quick, inexpensive and reliable inflammatory follow-up parameters and could be easily integrated into daily practice for peritonsillar abscess treatment except platelet count.

Resumo Introdução: O abscesso periamigdaliano (APA) é uma doença infecciosa grave do tecido tonsilar. O seu tratamento geralmente requer uma abordagem medicamentosa e cirúrgica para o alívio dos sintomas. Recentemente, além do acompanhamento clínico, alguns marcadores inflamatórios, como o volume plaquetário médio (VPM) e a relação neutrófilos/linfócitos (RN/L), foram considerados marcadores de monitoramento adicionais em doenças inflamatórias. Objetivo: O objetivo deste estudo foi descrever o papel os VPM e a RN/L em pacientes com APA. Método: Estudo retrospectivo realizado com 88 pacientes com ATP e 88 indivíduos saudáveis. Analisamos a contagem de leucócitos, neutrófilos, linfócitos, plaquetas, proteína C-reativa (PCR), VPM e RN/L e a comparamos os valores entre o grupo de pacientes e grupo controle. Resultados: Os níveis de VPM eram significativamente maiores no grupo APA pré-tratamento que no grupo APA pós-tratamento e no grupo controle. Um valor de corte de 8,7 para o VPM foi considerado ideal para avaliar sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 75, 65,9, 68 e 72%, respectivamente. Os níveis da RN/L eram significantemente maiores no grupo APA pré-tratamento que no grupo APA pós-tratamento e no grupo controle. Um valor de 3,08 para a RN/L foi o valor de corte ideal para avaliar sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 90,9, 90,9, 90,9 e 90,9%, respectivamente. Enquanto a contagem dos valores de leucócitos, neutrófilos, linfócitos e PCR foi significantemente diferente entre os grupos de pacientes e controle (p<0,05), a contagem de plaquetas não foi (p>0,05). Conclusão: Os valores de VPM e RN/L sugerem que estes são parâmetros inflamatórios de acompanhamento rápido, barato e confiável, e que podem ser facilmente integrados à prática diária para o tratamento de APA, exceto pela contagem de plaquetas.

retrospective study of peritonsillar abscess in riyadh medical complex toward setting up treatment protocol

To investigate and study the management pattern of peritonsillar abscess, the male to female ratio and incidence. Also, to evaluate the causative organism isolated from abscess and reported by culture/sensitivity [C/S]. This study has been designed as a single centered retrospective hospital based study. We carried out this study in the Department of ENT, Riyadh Medical Complex, Saudi Arabia from 2000 to 2004. We gathered the data via survey [5 years]. There were 81 patients admitted for the management of peritonsillar abscess. Mean age of patients was 22 years [range 10 to 60 years; 44 male, 37 female]. The hospital stay varies from 1-8 days with a mean of 4 days. The left side is more involved. Treatment consisted mainly incision/drainage under local anesthetic in 47 patients [58%], while 5 cases [6%] were carried out under general anesthetic. Aspiration and conservative treatment was noted in 25 [31%] cases, abscess tonsillectomy was carried out in 3 [4%] cases. The most common microorganisms isolated from C/S is Group A beta hemolytic streptococcus [17/81 [21%]]. Penicillin G + Flagyl [49/81 [60%]] were the most common antibiotics used. No case of bilateral peritonsillar abscess was found and there is no consensus regarding the best technique. Options include needle aspiration, incision and drainage and immediate tonsillectomy. Peritonsillar abscess remain one of the acute admission in the Department of Otolaryngology at Riyadh Medical Complex, Riyadh. Incision/drainage remains the gold standard treatment, Penicillin G + Flagyl combinations are the cornerstones