Use of Inflammatory Markers in the Evaluation of Patients with Asymptomatic Microscopic Haematuria to Predict Malignancy.

Objectives: This study assessed the use of inflammatory biomarkers in the prediction of malignancy in patients with asymptomatic microscopic haematuria.

Methods: In this prospective study, patients between 18 and 65 years old with asymptomatic microscopic haematuria who presented at our urology clinic within 2 years were included. The patients had no urological complaints and had applied to other clinics for other reasons. Microscopic haematuria was detected, and the patients were referred to the urology clinic for investigation. The participants were included in a 6-month and 1-year follow-up protocol. All investigations and follow-ups were conducted by the same experienced doctor. The patients were divided into malignancy and non-malignant groups according to the definitive diagnosis after the necessary examinations (laboratory tests, medical imaging and pathological examination if necessary). Inflammatory parameters were compared statistically between the two groups. Receiver operating characteristic curve analysis was applied to inflammatory parameters to detect malignancy.

Results: Asymptomatic microscopic haematuria was detected in 294 patients (242 males, 52 females). Malignancies in 98 of 294 patients were determined with various imaging and laboratory methods. The detected malignancies were confirmed with pathological examination. In addition, 196 of 294 age-matched and gender-matched patients without malignancy but with haematuria were used as the non-malignant group. Red blood cell distribution width, neutrophil-to-lymphocyte ratio, mean platelet volume, serum C-reactive protein and erythrocyte sedimentation rate of patients in the non-malignant group were lower than those with malignancy. Receiver operating characteristic curve analysis suggested that the optimum red blood cell distribution width cut-off point for patients with malignancy was 14.45, with a sensitivity and a specificity of 75% and 65%, respectively.

Conclusions: Patients with high inflammatory biomarkers value, especially high red blood cell distribution width, should be evaluated in detail and carefully. Further large collective studies should be conducted to confirm the use of red blood cell distribution width in the prediction of malignancy in patients with asymptomatic microscopic haematuria. Patients with microscopic haematuria who have high erythrocyte sedimentation rate, neutrophil-to-lymphocyte ratio and C-reactive protein are at a high risk of malignancy and therefore should be followed up attentively.