Does neutrophil/lymphocyte, monocyte/lymphocyte,platelet/lymphocyte ratio affect prognosis and stage in femoral head avascular necrosis?

Avascular necrosis of the femoral head (AVNFH) is a type of osteonecrosis that occurs due to ischemia and death of osteocytes due to traumatic or non-traumatic causes that cause impaired blood flow to the proximal femur.The exact pathomechanism of AVNFH is still unclear.The underlying conditions that cause AVNFH include environmental or genetic factors that cause the osteocyte mechanism to change, and these factors affect vascularization.The most common etiological factors are corticosteroid therapy, alcohol, fractures and joint dislocations. Untreated FBAN leads to secondary hip arthritis requiring hip arthroplasty. Early diagnosis is important for correct conservative or surgical treatment. Achieving a complete blood count (CBC) in the clinic is more economical and more practical.The amounts of neutrophils, lymphocytes, monocytes, and platelets measured by complete blood count and their ratios have recently been used as an easily accessible and reliable immune response marker against various infectious and non-infectious stimuli in almost all medical disciplines.Although Neutrophil/Lymphocyte (NL), Monocyte/Lymphocyte (ML), Platelet/Lymphocyte (PL) ratios are generally investigated in malignancy, rheumatological diseases, COPD and many other autoimmune diseases, there is no study on AVNFH in the literature.In this thesis, our aim is to examine the effects of NL, ML, PL ratios according to prognosis and stage in patients with a diagnosis of AVNFH. 106 patients (30 females; 76 males) diagnosed with femoral avascular necrosis between 2012-2022 in Gaziantep University Şahinbey Practice and Research Hospital polyclinic were collected retrospectively from the hospital registry system. A healthy control group whose demographic characteristics matched the study group was formed. Laboratory findings, Pelvis X-ray and MR images were obtained from the Gaziantep University Sahinbey Resarch and Practise Hospital Information system. The individuals included in the study group were divided into 3 groups as Stage I, II and III according to the Ficat-Arlet classification. The study group and the control group were compared in terms of neutrophil, lymphocyte, monocytes, platelet counts and NL, ML, PL ratios. No significant difference was found between the mean values of lymphocytes, monocytes, and platelets compared between the groups (p>0.05). When the neutrophil values of the study and control groups were examined, the neutrophil value in the study group was 4.94 ± 1.89; In the control group, it was measured as 4.21 ± 1.17, there was a statistically significant difference between the measurements (p<0.05). When the Neutrophil/Lymphocyte Ratio was examined, it was observed that there was a significant difference between the groups. Neutrophil-lymphocyte ratio was higher in the study group (2.11 ± 0.85) than in the control group (1.75 ± 0.44). The cut-off value for the NL ratio was determined as 2.13 according to the ROC analysis (sensitivity 47.17% (95% CI (37.4-57.1)); Specificity=84.91 95% CI (76.6-91.1) ). The sensitivity and specificity of the cut-off value were found to be statistically significant. There was no difference between the groups formed according to Ficat-Arlet in terms of hemogram parameters. The NL ratio can give information aboutAVNFH, but it is thought that other parameters may be insufficient to form an independent determinant inAVNFH due to the inability to create an adequate immune response.Further studies with larger samples should be planned with methods that allow standard and multidimensional analysis.