Effect of Sleeve Gastrectomy on the Neutrophil-to-Lymphocyte Ratio, the Platelet-to-Lymphocyte Ratio, Platelet Counts, and Mean Platelet Volumes

Abstract

The correlation of obesity with chronic inflammation and thrombotic processes leads to morbidity and mortality. This risk is associated with platelet (PLT) hyperactivity, which increases platelet aggregation and adhesion to the vascular endothelium, thereby leading to a clotting condition. PLT activity is strongly related to the mean platelet volume (MPV). This study aims to investigate the effects of laparoscopic sleeve gastrectomy (LSG) on platelet count, MPV, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) in patients with morbid obesity. Our study included 252 patients who underwent LSG. The results of routine physical examination and laboratory parameters, which were performed prior to the surgery, were statistically compared with the same parameters at the end of the first year. The mean preoperative body mass index (BMI) of the patients was 46.00 ± 7.12 kg/m2, whereas the average BMI was 28.01 ± 6.43 kg/m2 in the first postoperative year. The mean platelet count decreased significantly (295.80 ± 68.51 vs. 269.70 ± 71.69 × 109/L; p < 0.001), whereas postoperative MPV increased significantly (9.19 ± 0.98 vs. 9.62 ± 1.14 fL; p < 0.001). NLR and PLR levels decreased significantly after LSG (2.49 ± 1.87 vs. 1.69 ± 0.71; p < 0.001 and 121.59 ± 46.52 vs. 105.39 ± 36.75; p = 0.001, respectively). Our results showed that platelet counts decreased significantly, as MPV levels increased significantly after LSG. In addition, NLR and PRL levels considerably decreased after LSG. There was a positive correlation between these results and changes in BMI.

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References

  1. 1.

    Blokhin IO, Lentz SR (2013) Mechanisms of thrombosis in obesity. Curr Opin Hematol 20(5):437–444

    CAS  Article  Google Scholar 

  2. 2.

    Morange PE, Alessi MC (2013) Thrombosis in central obesity and metabolic syndrome: mechanisms and epidemiology. Thromb Haemost 110(4):669–680

    CAS  Article  Google Scholar 

  3. 3.

    Vizioli L, Muscari S, Muscari A (2009) The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract 63(10):1509–1515

    CAS  Article  Google Scholar 

  4. 4.

    Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP (2003) Platelets as predictors of vascular risk: is there a practical index of platelet activity? Clin Appl Thromb Hemost 9(3):177–190

    CAS  Article  Google Scholar 

  5. 5.

    Siess W (1989) Molecular mechanisms of platelet activation. Physiol Rev 69(1):58–178

    CAS  Article  Google Scholar 

  6. 6.

    Nijhuis J, Rensen SS, Slaats Y, van Dielen FMH, Buurman WA, Greve JWM (2009) Neutrophil activation in morbid obesity, chronic activation of acute inflammation. Obesity (Silver Spring) 17(11):2014–2018

    CAS  Article  Google Scholar 

  7. 7.

    Monteiro R, Azevedo I (2010) Chronic inflammation in obesity and the metabolic syndrome. Mediat Inflamm 2010

  8. 8.

    Medzhitov R (2008) Origin and physiological roles of inflammation. Nature 454(7203):428–435

    CAS  Article  Google Scholar 

  9. 9.

    Mei Z, Shi L, Wang B, Yang J, Xiao Z, du P, Wang Q, Yang W (2017) Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: a systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev 58:1–13

    Article  Google Scholar 

  10. 10.

    Balta S, Ozturk C (2015) The platelet-lymphocyte ratio: a simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets 26(7):680–681

    CAS  Article  Google Scholar 

  11. 11.

    Davi G, Patrono C (2007) Platelet activation and atherothrombosis. N Engl J Med 357(24):2482–2494

    CAS  Article  Google Scholar 

  12. 12.

    Heneghan HM, Meron-Eldar S, Brethauer SA, Schauer PR, Young JB (2011) Effect of bariatric surgery on cardiovascular risk profile. Am J Cardiol 108(10):1499–1507

    Article  Google Scholar 

  13. 13.

    Himpens J, Dobbeleir J, Peeters G (2010) Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 252(2):319–324

    Article  Google Scholar 

  14. 14.

    Azevedo A, Santos AC, Ribeiro L, Azevedo I. The metabolic syndrome. In: Soares R, Costa C, eds. Oxidative Stress, Inflammation and Angiogenesis in the Metabolic Syndrome. Dordrecht: Springer Netherlands; 2009:1–19.

  15. 15.

    Anfossi G et al (2010) Adipocytokines in atherothrombosis: focus on platelets and vascular smooth muscle cells. Mediat Inflamm 2010:174341

    Article  Google Scholar 

  16. 16.

    Ballantyne GH, Gumbs A, Modlin IM (2005) Changes in insulin resistance following bariatric surgery and the adipoinsular axis: role of the adipocytokines, leptin, adiponectin and resistin. Obes Surg 15(5):692–699

    Article  Google Scholar 

  17. 17.

    Adler BJ, Kaushansky K, Rubin CT (2014) Obesity-driven disruption of haematopoiesis and the bone marrow niche. Nat Rev Endocrinol 10(12):737–748

    CAS  Article  Google Scholar 

  18. 18.

    Raoux L, Moszkowicz D, Vychnevskaia K, Poghosyan T, Beauchet A, Clauser S, Bretault M, Czernichow S, Carette C, Bouillot JL (2017) Effect of bariatric surgery-induced weight loss on platelet count and mean platelet volume: a 12-month follow-up study. Obes Surg 27(2):387–393

    Article  Google Scholar 

  19. 19.

    Elbatarny HS, Netherton SJ, Ovens JD, Ferguson AV, Maurice DH (2007) Adiponectin, ghrelin, and leptin differentially influence human platelet and human vascular endothelial cell functions: implication in obesity-associated cardiovascular diseases. Eur J Pharmacol 558(1–3):7–13

    CAS  Article  Google Scholar 

  20. 20.

    Chu SG et al (2010) Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost 8(1):148–156

    CAS  Article  Google Scholar 

  21. 21.

    Kutluturk F, Ozsoy Z (2018) Effect of sleeve gastrectomy on platelet counts and mean platelet volumes. Obes Surg 28(10):3159–3164

    Article  Google Scholar 

  22. 22.

    Coban E, Yilmaz A, Sari R (2007) The effect of weight loss on the mean platelet volume in obese patients. Platelets 18(3):212–216

    CAS  Article  Google Scholar 

  23. 23.

    Altin C et al (2018) Effects of significant weight loss following bariatric surgery on red cell distribution width and mean platelet volume. Medeniyet Med J 33(4):278–284

    Google Scholar 

  24. 24.

    Yilmaz H, Ucan B, Sayki M, Unsal I, Sahin M, Ozbek M, Delibasi T (2015) Usefulness of the neutrophil-to-lymphocyte ratio to prediction of type 2 diabetes mellitus in morbid obesity. Diabetes Metab Syndr 9(4):299–304

    CAS  Article  Google Scholar 

  25. 25.

    Furuncuoglu Y et al (2016) How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study. Eur Rev Med Pharmacol Sci 20(7):1300–1306

    CAS  PubMed  Google Scholar 

  26. 26.

    Wang Y, Peng C, Cheng Z, Wang X, Wu L, Li J, Huang C, Guo Q, Cai H (2018) The prognostic significance of preoperative neutrophil-lymphocyte ratio in patients with hepatocellular carcinoma receiving hepatectomy: a systematic review and meta-analysis. Int J Surg 55:73–80

    Article  Google Scholar 

  27. 27.

    Galliazzo S, Nigro O, Bertù L, Guasti L, Grandi AM, Ageno W, Dentali F (2018) Prognostic role of neutrophils to lymphocytes ratio in patients with acute pulmonary embolism: a systematic review and meta-analysis of the literature. Intern Emerg Med 13(4):603–608

    Article  Google Scholar 

  28. 28.

    Kaur R, Kaur M, Singh J (2018) Endothelial dysfunction and platelet hyperactivity in type 2 diabetes mellitus: molecular insights and therapeutic strategies. Cardiovasc Diabetol 17(1):121

    CAS  Article  Google Scholar 

  29. 29.

    Ertugrul I, Kuzu F (2019) The impact of bariatric surgery on hematological inflammatory parameters. Ann Med Res 26(10):2250. https://doi.org/10.5455/annalsmedres.2019.10.633

    Article  Google Scholar 

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Correspondence to Muhammed Rasid Aykota.

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The study protocol was approved by the Clinical Research Ethics Committee of the Faculty of Medicine, University of Pamukkale (ethics committee approval number, 60116787-020/28616). The study was conducted in accordance with the 1964 principles of the declaration of Helsinki.

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The authors declare that they have no conflict of interest.

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Aykota, M.R., Yilmaz, S., Atabey, M. et al. Effect of Sleeve Gastrectomy on the Neutrophil-to-Lymphocyte Ratio, the Platelet-to-Lymphocyte Ratio, Platelet Counts, and Mean Platelet Volumes. Indian J Surg (2020). https://doi.org/10.1007/s12262-020-02497-0

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Keywords

  • Obesity
  • Sleeve gastrectomy
  • Platelet
  • Mean platelet volume
  • The neutrophil-to-lymphocyte ratio
  • The platelet-to-lymphocyte ratio
  • Chronic inflammation