Abstract
The presence of endometriosis determines an inflammatory response locally. The objective of this validation study and systematic review was to assess systemic levels of coagulation and inflammatory parameters in women with or without the disease. We conducted a retrospective analysis of a database prospectively collected from January 2017 to February 2020 including n = 572 women who underwent laparoscopic surgery for endometriosis (cases, n = 324) or other benign gynecologic diseases (controls, n = 248). Inflammatory markers and coagulation parameters were determined. An advanced systematic search of the literature on the same parameters was conducted up to April 2020. A significantly higher neutrophil count was found in endometriosis patients. Patients with endometriomas and stage III–IV disease had a significantly lower absolute lymphocyte count and shortened activated partial thromboplastin time (aPTT) values. In the final regression model, aPTT retained significant predictive value for stage III–IV endometriosis (odds ratio (OR) = 0.002, 95% confidence interval (CI) = 0.00–0.445; p = 0.024). Results from the n = 14 included studies in the systematic review are characterized by a high variability, but some consistency has been found for alterations in thrombin time, platelet-to-lymphocyte ratio, and neutrophil count associated with endometriosis. Modest systemic changes of some inflammatory and coagulation parameters are associated with endometriosis. Indeed, all the modifications detected are still within the normal reference intervals, explaining the high heterogeneity among studies.
Highlights
Endometriosis, defined as the presence of endometrial tissue and fibrosis located outside the uterine cavity, is a common chronic disease that affects around 10% of women of reproductive age and is associated with infertility and pelvic pain [1,2,3,4]
When we considered the various manifestations of endometriosis separately, we found that women with ovarian disease had a borderline significant lower absolute lymphocyte count in comparison with controls, superficial peritoneal endometriosis (SPE) group, and deep infiltrating endometriosis (DIE) group
We found no difference in neutrophil-to-lymphocyte ratio (NLR) between women with endometriosis and controls, when considering the various manifestations of endometriosis separately, a significant difference among groups emerged, as women with peritoneal lesions had lower NLR compared to patients without this form [14]
Summary
Endometriosis, defined as the presence of endometrial tissue and fibrosis located outside the uterine cavity, is a common chronic disease that affects around 10% of women of reproductive age and is associated with infertility and pelvic pain [1,2,3,4]. Macrophages infiltrating the ectopic lesions express typical markers of alternative activation, favoring the growth of the lesions and promoting their angiogenesis Some inflammatory parameters, such as the neutrophil-to-lymphocyte ratio (NLR), have been found elevated in the peripheral blood in patients with some forms of the disease [9,10]. In 2018, our group demonstrated that endometriosis patients had a significantly shorter aPTT than women not affected by the disease and, in the subgroup analysis, women with ovarian disease had significantly shortened aPTT values in comparison to women without this form Both platelet-to-lymphocyte ratio (PLR) and aPTT were shown to be altered in the less severe forms. Since endometriotic cells express tissue factor (TF), these alterations were suggested to represent the subtle manifestation of the activation of this factor in the lesions and were portrayed in the context of angiogenesis and, the development and progression of the disease [15]
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