Akut skrotal ağrıda albüminin ve semptom süresinin tanısal değeri: testis torsiyonu ve epididimo-orşit
Abstract
Amaç: Bu çalışmanın amacı acil servise akut skrotal ağrı ile başvuran hastalarda testis torsiyonu (TT) ile epididimo-orşit arasındaki ayrımı yapmak amacıyla inflamatuar parametreleri değerlendirmektir.
Gereç ve Yöntem: Çalışmada, Ocak 2012 ile Aralık 2023 arasında üçüncü basamak bir hastanenin acil servisine akut skrotal ağrıyla gelen 241 yetişkin hasta analiz edildi.
Bulgular: Kohort, epididimo-orşitli 137 hastadan (%56,8) ve TT'li 104 hastadan (%43,2) oluşuyordu. Epididimo-orşit vakalarında medyan semptom süresi 24 saat (24-48 saat) iken torsiyon vakalarında 6 saat (4-10 saat) idi. Laboratuvar analizlerinde epididimo-orşitli hastalarda torsiyon olgularına göre monosit, kan üre azotu (BUN), BUN/Albümin oranı (BAR) ve monosit/lenfosit oranı (MLR) ortalama değerlerinin anlamlı derecede yüksek olduğu, hemoglobin ve albumin düzeylerinin ise anlamlı derecede düşük olduğu saptandı. Cox regresyon analizi sonucunda albumin, yaş ve vücut sıcaklığının tanının bağımsız öngörücüleri olduğu ortaya çıktı. Semptom süresi ile albumin düzeyleri arasında anlamlı ve orta derecede negatif korelasyon bulundu. Albüminin AUC değeri 0,842 idi ve testiküler torsiyon varlığını tahmin etme gücünde kesme değeri 4,05 mg/dl olarak alındığında duyarlılık %80,8 ve özgüllük %71,5 olarak bulundu.
Sonuç: Akut skrotal ağrısı olan hastalarda testis torsiyonunu epididimo-orşitten ayırmada, semptom süresi ile anlamlı ilişki gösteren albumin düzeyi değerli bir belirleyicidir.
References
- Lemini R, Guanà R, Tommasoni N, Mussa A, Di Rosa G, Schleef J. Predictivity of clinical findings and doppler ultrasound in pediatric acute scrotum. Urol J. 2016;13:2779-83.
- Mellick LB, Sinex JE, Gibson RW, Mears K. A systematic review of testicle survival time after a torsion event. Pediatr Emerg Care. 2019;35:821-25.
- Redshaw JD, Tran TL, Wallis MC, deVries CR. Epididymitis: a 21-year retrospective review of presentations to an outpatient urology clinic. J Urol. 2014;192:1203-7.
- Mellick LB. Torsion of the testicle: it is time to stop tossing the dice. Pediatr Emerg Care. 2012;28:80-6.
- Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician. 2009;79:583-7.
- Hamarat MB, Dönmez Mİ, Sezgin T, Unlu MZ, Kocaoglu C, Ozkent MS et al. Testicular volume loss in the long-term follow-up after surgical detorsion of the testis. Pediatr Surg Int. 2022;38:907-11.
- Hazeltine M, Panza A, Ellsworth P. Testicular Torsion: Current evaluation and management. Urol Nurs. 2017;37:61-71.
- Rebik K, Wagner JM, Middleton W. Scrotal Ultrasound. Radiol Clin North Am. 2019;57:635-48.
- Bitkin A, Aydın M, Ozgur BC, Irkilata L, Akgunes E, Keles M et al. Can hematologic parameters be used for differential diagnosis of testicular torsion and epididymitis? Andrologia. 2018;50.
- Peretti M, Zampieri N, Bertozzi M, Bianchi F, Patanè S, Spigo V et al. Mean platelet volume and testicular torsion: New Findings. Urol J. 2019;16:83-85.
- Zhu J, Song Y, Chen G, Hu R, Ou N, Zhang W et al. Predictive value of hematologic parameters in diagnosis of testicular torsion: Evidence from a systematic review and meta-analysis. Andrologia. 2020;52:e13490.
- Sugrue DD, O'Connor E, Davis N. Testicular torsion in Ireland: a 10-year analysis of incidence and risk of orchidectomy. Ir J Med Sci. 2022;191:2267-74.
- Smith G.I. Cellular changes from graded testicular ischemia. J Urol. 1955;73:355-62.
- Ralls PW, Jensen MC, Lee KP, Mayekawa DS, Johnson MB, Halls JM. Color doppler sonography in acute epididymitis and orchitis. J Clin Ultrasound. 1990;18:383-86.
- Burks DD, Markey BJ, Burkhard TK, Balsara ZN, Haluszka MM, Canning DA. Suspected testicular torsion and ischemia: evaluation with color doppler sonography. Radiology. 1990;175:815-21.
- Lerner RM, Mevorach RA, Hulbert WC, Rabinowitz R. Color doppler US in the evaluation of acute scrotal disease. Radiology. 1990;176:355-58.
- Horstman WG, Middleton WD, Melson GL. Scrotal inflammatory disease: color Doppler US findings. Radiology. 1991;179:55-59.
- Jaison A, Mitra B, Cameron P, Sengupta S. Use of ultrasound and surgery in adults with acute scrotal pain. ANZ J Surg. 2011;81:366-70.
- Cicek T, Togan T, Akbaba K, Narci H, Aygun C. The value of serum mean platelet volume in testicular torsion. J Int Med Res. 2015;43:452-59.
- Yang C Jr, Song B, Liu X, Wei GH, Lin T, He DW. Acute scrotum in children: an 18-year retrospective study. Pediatr Emerg Care. 2011;27:270-74.
- Palmer JS, Cromie WJ, Plzak LF, Leff AR. A platelet activating factor antagonist attenuates the effects of testicular ischemia. J Urol. 1997;158:1186-90.
- Guneş M, Umul M, Altok M, Akyuz M, İşoğlu CS, Uruc F et al. Predictive role of hematologic parameters in testicular torsion. Korean J Urol. 2015;56:324-29.
- Yilmaz M, Sahin Y, Hacibey I, Ozkuvanci U, Suzan S, Muslumanoglu AY. Should haematological inflammatory markers be included as an adjuvant in the differential diagnosis of acute scrotal pathologies? Andrologia. 2022;54:e14374.
- Bieber K, Autenrieth SE. Insights how monocytes and dendritic cells contribute and regulate immune defense against microbial pathogens. Immunobiology. 2015;220:215-26.
- Haines RW, Zolfaghari P, Wan Y, Pearse RM, Puthucheary Z, Prowle JR. Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma. Intensive Care Med. 2019;45:1718-31.
- Qian H, Tang C, Yan G. Predictive value of blood urea nitrogen/creatinine ratio in the long-term prognosis of patients with acute myocardial infarction complicated with acute heart failure. Medicine (Baltimore). 2019;98:e14845.
- Arena S, Iacona R, Antonuccio P, Russo T, Salvo V, Gitto E et al. Medical perspective in testicular ischemia-reperfusion injury. Exp Ther Med. 2017;13:2115-22.
- Asadi N, Bahmani M, Kheradmand A, Rafieian-Kopaei M. The impact of oxidative stress on testicular function and the role of antioxidants in improving it: A Review. J Clin Diagn Res. 2017;11:IE01-IE05.
- Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340:448-54.
- Baumann H, Gauldie J. The acute phase response. Immunol Today. 1994;15:74-80.
- Vincent JL, Russell JA, Jacob M, Martin G, Guidet B, Wernerman J et al. Albumin administration in the acutely ill: what is new and where next? Crit Care. 2014;18:231.
- Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr. 2019;43:181-93.
- Cai S, Wang Q, Chen C, Guo C, Zheng L, Yuan M. Association between blood urea nitrogen to serum albumin ratio and in-hospital mortality of patients with sepsis in intensive care: a retrospective analysis of the fourth-generation medical information mart for intensive care database. Front Nutr. 2022;9:967332.
- Ryu S, Oh SK, Cho SU, You Y, Park JS, Min JH et al. Utility of the blood urea nitrogen to serum albumin ratio as a prognostic factor of mortality in aspiration pneumonia patients. Am J Emerg Med. 2021;43:175-79.
- Zeng Z, Ke X, Gong S, Huang X, Liu Q, Huang X et al. Blood urea nitrogen to serum albumin ratio: a good predictor of in-hospital and 90-day all-cause mortality in patients with acute exacerbations of chronic obstructive pulmonary disease. BMC Pulm Med. 2022;22:476.
- Balcik M, Satar S, Gulen M, Acehan S, Sevdimbas S, Acele A et al. BUN/albumin ratio predicts short-term mortality better than SYNTAX score in ST-elevation myocardial infarction patients. J Cardiovasc Med (Hagerstown). 2023;24:326-33.
- Sevdimbas S, Satar S, Gulen M, Acehan S, Acele A, Koksaldı Sahin G et al. Blood urea nitrogen/albumin ratio on admission predicts mortality in patients with non-ST segment elevation myocardial infarction. Scand J Clin Lab Invest. 2022;82:454-60.
- Lin Z, Zhao Y, Xiao L, Qi C, Chen Q, Li Y. Blood urea nitrogen to serum albumin ratio as a new prognostic indicator in critical patients with chronic heart failure. ESC Heart Fail. 2022;9:1360-9.
Diagnostic value of albumin and symptom duration in acute scrotal pain: testicular torsion vs. epididymo-orchitis
Abstract
Purpose: The aim of this study was to evaluate inflammatory parameters to differentiate between testicular torsion (TT) and epididymo-orchitis in patients presenting to the emergency department with acute scrotal pain.
Materials and Methods: The study analyzed 241 adult patients who were presented with acute scrotal pain at a tertiary hospital's ED between January 2012 and December 2023.
Results: The cohort comprised 137 patients (56.8%) with epididymo-orchitis and 104 (43.2%) with TT. Median symptom duration was 24 hours (24–48 hours) for epididymo-orchitis cases versus 6 hours (4–10 hours) for torsion cases. Laboratory analysis revealed significantly elevated mean values of monocytes, blood urea nitrogen (BUN), BUN/Albumin ratio (BAR), and Monocyte/Lymphocyte Ratio (MLR) in epididymo-orchitis patients compared to torsion cases, while hemoglobin and albumin levels were significantly lower. As a result of the cox regression analysis revealed that albumin, age and body temperature were independent predictors of the diagnosis. A significant and moderately negative correlation was found between symptom duration and albumin levels. The AUC value of albümin was 0.842 and sensitivity was 80.8% and specificity was 71.5% when the cut-off value was taken as 4.05 mg/dl in the power to predict the presence of testiculer torsion.
Conclusion: Albumin level, significantly associated with symptom duration, is a valuable predictor in distinguishing testicular torsion from epididymo-orchitis in patients with acute scrotal pain.
Ethical Statement
This retrospective observational case series spanned twelve years, conducted following approval from local ethics committee (Decision No: 3220, Meeting No: 148; March 14, 2024). All research procedures adhered to the principles of the Declaration of Helsinki and good clinical practice guidelines
Supporting Institution
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
Thanks
No
References
- Lemini R, Guanà R, Tommasoni N, Mussa A, Di Rosa G, Schleef J. Predictivity of clinical findings and doppler ultrasound in pediatric acute scrotum. Urol J. 2016;13:2779-83.
- Mellick LB, Sinex JE, Gibson RW, Mears K. A systematic review of testicle survival time after a torsion event. Pediatr Emerg Care. 2019;35:821-25.
- Redshaw JD, Tran TL, Wallis MC, deVries CR. Epididymitis: a 21-year retrospective review of presentations to an outpatient urology clinic. J Urol. 2014;192:1203-7.
- Mellick LB. Torsion of the testicle: it is time to stop tossing the dice. Pediatr Emerg Care. 2012;28:80-6.
- Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician. 2009;79:583-7.
- Hamarat MB, Dönmez Mİ, Sezgin T, Unlu MZ, Kocaoglu C, Ozkent MS et al. Testicular volume loss in the long-term follow-up after surgical detorsion of the testis. Pediatr Surg Int. 2022;38:907-11.
- Hazeltine M, Panza A, Ellsworth P. Testicular Torsion: Current evaluation and management. Urol Nurs. 2017;37:61-71.
- Rebik K, Wagner JM, Middleton W. Scrotal Ultrasound. Radiol Clin North Am. 2019;57:635-48.
- Bitkin A, Aydın M, Ozgur BC, Irkilata L, Akgunes E, Keles M et al. Can hematologic parameters be used for differential diagnosis of testicular torsion and epididymitis? Andrologia. 2018;50.
- Peretti M, Zampieri N, Bertozzi M, Bianchi F, Patanè S, Spigo V et al. Mean platelet volume and testicular torsion: New Findings. Urol J. 2019;16:83-85.
- Zhu J, Song Y, Chen G, Hu R, Ou N, Zhang W et al. Predictive value of hematologic parameters in diagnosis of testicular torsion: Evidence from a systematic review and meta-analysis. Andrologia. 2020;52:e13490.
- Sugrue DD, O'Connor E, Davis N. Testicular torsion in Ireland: a 10-year analysis of incidence and risk of orchidectomy. Ir J Med Sci. 2022;191:2267-74.
- Smith G.I. Cellular changes from graded testicular ischemia. J Urol. 1955;73:355-62.
- Ralls PW, Jensen MC, Lee KP, Mayekawa DS, Johnson MB, Halls JM. Color doppler sonography in acute epididymitis and orchitis. J Clin Ultrasound. 1990;18:383-86.
- Burks DD, Markey BJ, Burkhard TK, Balsara ZN, Haluszka MM, Canning DA. Suspected testicular torsion and ischemia: evaluation with color doppler sonography. Radiology. 1990;175:815-21.
- Lerner RM, Mevorach RA, Hulbert WC, Rabinowitz R. Color doppler US in the evaluation of acute scrotal disease. Radiology. 1990;176:355-58.
- Horstman WG, Middleton WD, Melson GL. Scrotal inflammatory disease: color Doppler US findings. Radiology. 1991;179:55-59.
- Jaison A, Mitra B, Cameron P, Sengupta S. Use of ultrasound and surgery in adults with acute scrotal pain. ANZ J Surg. 2011;81:366-70.
- Cicek T, Togan T, Akbaba K, Narci H, Aygun C. The value of serum mean platelet volume in testicular torsion. J Int Med Res. 2015;43:452-59.
- Yang C Jr, Song B, Liu X, Wei GH, Lin T, He DW. Acute scrotum in children: an 18-year retrospective study. Pediatr Emerg Care. 2011;27:270-74.
- Palmer JS, Cromie WJ, Plzak LF, Leff AR. A platelet activating factor antagonist attenuates the effects of testicular ischemia. J Urol. 1997;158:1186-90.
- Guneş M, Umul M, Altok M, Akyuz M, İşoğlu CS, Uruc F et al. Predictive role of hematologic parameters in testicular torsion. Korean J Urol. 2015;56:324-29.
- Yilmaz M, Sahin Y, Hacibey I, Ozkuvanci U, Suzan S, Muslumanoglu AY. Should haematological inflammatory markers be included as an adjuvant in the differential diagnosis of acute scrotal pathologies? Andrologia. 2022;54:e14374.
- Bieber K, Autenrieth SE. Insights how monocytes and dendritic cells contribute and regulate immune defense against microbial pathogens. Immunobiology. 2015;220:215-26.
- Haines RW, Zolfaghari P, Wan Y, Pearse RM, Puthucheary Z, Prowle JR. Elevated urea-to-creatinine ratio provides a biochemical signature of muscle catabolism and persistent critical illness after major trauma. Intensive Care Med. 2019;45:1718-31.
- Qian H, Tang C, Yan G. Predictive value of blood urea nitrogen/creatinine ratio in the long-term prognosis of patients with acute myocardial infarction complicated with acute heart failure. Medicine (Baltimore). 2019;98:e14845.
- Arena S, Iacona R, Antonuccio P, Russo T, Salvo V, Gitto E et al. Medical perspective in testicular ischemia-reperfusion injury. Exp Ther Med. 2017;13:2115-22.
- Asadi N, Bahmani M, Kheradmand A, Rafieian-Kopaei M. The impact of oxidative stress on testicular function and the role of antioxidants in improving it: A Review. J Clin Diagn Res. 2017;11:IE01-IE05.
- Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340:448-54.
- Baumann H, Gauldie J. The acute phase response. Immunol Today. 1994;15:74-80.
- Vincent JL, Russell JA, Jacob M, Martin G, Guidet B, Wernerman J et al. Albumin administration in the acutely ill: what is new and where next? Crit Care. 2014;18:231.
- Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr. 2019;43:181-93.
- Cai S, Wang Q, Chen C, Guo C, Zheng L, Yuan M. Association between blood urea nitrogen to serum albumin ratio and in-hospital mortality of patients with sepsis in intensive care: a retrospective analysis of the fourth-generation medical information mart for intensive care database. Front Nutr. 2022;9:967332.
- Ryu S, Oh SK, Cho SU, You Y, Park JS, Min JH et al. Utility of the blood urea nitrogen to serum albumin ratio as a prognostic factor of mortality in aspiration pneumonia patients. Am J Emerg Med. 2021;43:175-79.
- Zeng Z, Ke X, Gong S, Huang X, Liu Q, Huang X et al. Blood urea nitrogen to serum albumin ratio: a good predictor of in-hospital and 90-day all-cause mortality in patients with acute exacerbations of chronic obstructive pulmonary disease. BMC Pulm Med. 2022;22:476.
- Balcik M, Satar S, Gulen M, Acehan S, Sevdimbas S, Acele A et al. BUN/albumin ratio predicts short-term mortality better than SYNTAX score in ST-elevation myocardial infarction patients. J Cardiovasc Med (Hagerstown). 2023;24:326-33.
- Sevdimbas S, Satar S, Gulen M, Acehan S, Acele A, Koksaldı Sahin G et al. Blood urea nitrogen/albumin ratio on admission predicts mortality in patients with non-ST segment elevation myocardial infarction. Scand J Clin Lab Invest. 2022;82:454-60.
- Lin Z, Zhao Y, Xiao L, Qi C, Chen Q, Li Y. Blood urea nitrogen to serum albumin ratio as a new prognostic indicator in critical patients with chronic heart failure. ESC Heart Fail. 2022;9:1360-9.
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine, Urology |
| Journal Section | Research |
| Authors | |
| Publication Date | June 30, 2025 |
| Submission Date | February 21, 2025 |
| Acceptance Date | May 23, 2025 |
| Published in Issue | Year 2025 |
