Assessment of Coagulation Parameters in Women Aﬀected by Endometriosis: Validation Study and Systematic Review of the Literature
Jessica Ottolina, Ludovica Bartiromo, Carolina Dolci, Noemi Salmeri, Matteo Schimberni, Roberta Villanacci, Paola Viganò, and Massimo Candiani
Diagnostics 2020, 10, 567; doi:10.3390/diagnostics10080567
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.
Keywords: endometriosis; coagulation; thrombin time; activated partial thromboplastin time; platelet-to-lymphocyte ratio; neutrophil-to-lymphocyte ratio
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