Admission Neutrophil-lymphocyte Ratio Research Articles

Neutrophil-to-lymphocyte ratio on admission predicts early perihematomal edema growth after intracerebral hemorrhage.

Poor functional outcome is associated with perihematomal edema (PHE) expansion after intracerebral hemorrhage (ICH). The inflammatory response is crucial for the onset and progression of PHE. This study aimed to determine the connection between admission neutrophil-lymphocyte ratio (NLR) and early PHE development. We retrospectively analyzed patients with ICH admitted to the Chaohu Affiliated Hospital of Anhui Medical University from January 2021 to December 2022. The primary outcome measure was absolute PHE, defined as the volume of the follow-up PHE minus admission PHE. A semiautomated measurement tool (3D Slicer) was used to calculate the volumes of cerebral hematoma and cerebral edema. Spearman's correlation analysis determined the relationship between NLR and absolute PHE. The multiple linear regression model was constructed to analyze the predictive relation of admission NLR on early PHE expansion. A total of 117 patients were included. The median hematoma and PHE volumes on admission were 9.38 mL (interquartile range [IQR], 4.53-19.54) and 3.54 mL (IQR, 1.33-7.1), respectively. The median absolute PHE was 2.26 mL (IQR, 1.25-4.23), and the median NLR was 3.10 (IQR, 2.26-3.86). Spearman's correlation test showed a positive correlation between admission NLR and absolute PHE (r = .548, P < .001). Multiple linear regression analyses suggested that for every 1-unit increase in admission NLR (B = .176, SE = .043, Beta = .275, P < .001), there was a 0.176 mL increase in absolute PHE. Admission neutrophil-to-lymphocyte ratio (NLR) significantly and positively predicted early perihematomal edema (PHE) expansion.

Role of Neutrophil-Lymphocyte Ratio in Predicting Severity of COVID-19

Background: Higher neutrophil-lymphocyte ratio (NLR) is considered as cardinal findings with prognostic potentials in identification of severe COVID-19 cases. However, whether baseline NLR could be a predictor of disease severity and outcome remained to be investigated. Hence, this study was conducted with an aim to evaluate the relation of NLR (on admission) with disease severity. Objective: The objective of the study was to estimate the neutrophil-lymphocyte ratio among COVID-19 patients and its role in predicting disease severity. Method: This cross-sectional study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2020 to June 2021. Ninety-four COVID-19 admitted patients were enrolled following inclusion &amp; exclusion criteria. Informed consent was taken from the subjects. Ethical clearance was obtained from institutional review board (IRB) of BSMMU. Complete blood count for N-L ratio was done by standard procedure on admission by SYSMEX XN-2000 haematology analyser. Clinical and laboratory information were recorded with a semi-structured questionnaire. After collection of all the required data, analysis was done by SPSS 24.0. Results: Mean age of the patients was 56.59±12.25 years, wherein maximum patients were male (67%), non-smoker (80.9%), and retired/current service holder (51.1%). Maximum patients were hypertensive (61.7%) and diabetic (56.4%). Besides, maximum study patients (64.9%) were in severe category of COVID-19, followed by moderate (20.2%) and mild (14.9%) category according to National Guidelines on Clinical Management of COVID-19 criteria. Mean NLR was 5.40±4.35 (SD), wherein on admission NLR was significantly higher among severe COVID-19 patients compared to mild/moderate category (6.90±4.64 vs 2.61±1.53, p &lt;0.05). 28-days hospital mortality was found to be significantly associated with NLR (p&lt;0.05). Receiver operator curve analysis found highly significant cut-off value for NLR (3.42) with 75.4% sensitivity and 75.8% specificity in predicting severe COVID-19 patients (AUC= 0.841, p value &lt;0.001). Multivariate logistic regression analysis found NLR as an independent predictor for severe COVID-19 (OR=4.68, 95% CI: 1.29-16.81, P=0.019). Pearson correlation analysis showed that NLR had significant positive correlation with CRP and D-dimer as p value &lt;0.05. Conclusion: NLR can predict the disease severity and outcome of hospitalized COVID-19 patients. However, further larger study is recommended.

Effect of inflammatory response before mechanical thrombectomy on prognosis in stroke patients.

<p>Mechanical thrombectomy is the most important treatment modality in acute stroke; despite successful thrombectomy, good functional outcome is not achieved in a significant proportion of patients. This study examined the effect of neutrophil lymphocyte ratio (NLR) values at admission on functional outcomes in successfully recanalized patients.</p>. <p>Patients who underwent mechanical thrombectomy due to anterior system major vessel occlusion were retrospectively analyzed and compared with the admission NLR values and 3-month clinical modified Rankin Scale (mRS) scores of successfully recanalized patients.</p>. <p>Of a total of 126 patients who underwent thrombectomy within the specified period, 97 patients with successful recanalization were included in the study. The overall successful recanalization rate was calculated as 77%. The mean NLR of patients with mRS &le;2 (n=65) was found to be significantly lower than patients with mRS&ge;3 (n=32) (p&lt;0.001). A weak and significant correlation was found between National Institutes of Health Stroke Scale (NIHSS) value and NLR (r= 0.315, p=.002).</p>. <p>NLR value has been found to be associated with futile recanalization in me&shy;chanical thrombectomy patients. There&shy;fore, we think that suppression of inflammation before thrombectomy will increase the chan&shy;ce of successful thrombectomy.</p>.

Neutrophil-to-lymphocyte ratio predicted cerebral infarction and poor discharge functional outcome in aneurysmal subarachnoid hemorrhage: A propensity score matching analysis

Background:Neutrophil-lymphocyte-ratio (NLR) and platelet-lymphocyte-ratio (PLR) have emerged as potential biomarkers in predicting the outcomes of aneurysmal subarachnoid hemorrhage (aSAH). Since a study was never conducted on the Southeast Asian and Indonesian population, we designed the present study to evaluate the potential of NLR and PLR in predicting cerebral infarction and functional outcomes and find the optimal cutoff value.Methods:We retrospectively reviewed patients admitted for aSAH in our hospital between 2017 and 2021. The diagnosis was made using a computed tomography (CT) scan or magnetic resonance imaging and CT angiography. Association between admission NLR and PLR and the outcomes were analyzed using a multivariable regression model. A receiver operating characteristic (ROC) analysis was done to identify the optimal cutoff value. A propensity score matching (PSM) was then carried out to reduce the imbalance between the two groups before comparison.Results:Sixty-three patients were included in the study. NLR was independently associated with cerebral infarction (odds ratio, OR 1.197 [95% confidence interval, CI 1.027–1.395] per 1-point increment;P= 0.021) and poor discharge functional outcome (OR 1.175 [95% CI 1.036–1.334] per 1-point increment;P= 0.012). PLR did not significantly correlate with the outcomes. ROC analysis identified 7.09 as the cutoff for cerebral infarction and 7.50 for discharge functional outcome. Dichotomizing and performing PSM revealed that patients with NLR above the identified cutoff value significantly had more cerebral infarction and poor discharge functional outcome.Conclusion:NLR demonstrated a good prognostic capability in Indonesian aSAH patients. More studies should be conducted to find the optimal cutoff value for each population.

Neutrophil Lymphocyte Ratio: A Prognostic Indicator of Limb Survival in CLI Patients

Aims and Objectives: This study was designed to evaluate the admission neutrophil-lymphocyte ratio in predicting the risk of amputation in critical limb ischemia patients who could not get surgical or radiological (percutaneous transluminal angioplasty) revascularization. Methods: A total of 150 patients who presented with CLI to our hospital between June 2017 and June 2018 and who could not have radiological or surgical revascularization are included in the study. Critical limb ischemia patients are those with is defined with ischemic rest pain and/or skin ulceration/gangrene in accordance with current guidelines reflecting patients with Fontaine class 3 and 4. This is a comparative study, 75 with CLI and rest pain and 75 without rest pain, so the NLR was significant in the rest pain group substantiated with the p-value thus proving a a vascular endpoint. An optimal cut-off value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our study occurrence of CLI significantly increased with an increase in NLR. A P value &lt;0.05 was considered statistically significant and the CI was 95%. Analyses were performed using SPSS software. Results: Using an NLR cutoff of ≥3.2, the area under the receiver–operating characteristic curve was 0.71 (95% CI 0.54-0.78). Overall, there were a total of 9 (0.06%) deaths and 135(90%) amputations. The amputations were above the ankle in 103 (77%) and below the ankle in 32 (23%). Conclusion: The neutrophil-lymphocyte ratio is an independent predictive factor for amputation in critical limb ischemia patients. An increased NLR is significantly associated with patients at high risk for CLI and other vascular endpoints. Stratification of patients with CLI according to admission NLR should be considered in the limb survival analyses of future adjuvant and neoadjuvant trials to validate these findings.

Associations of Neutrophil-Lymphocyte Ratios with Reperfusion and Functional Outcomes in Ischemic Stroke after Endovascular Therapy

ObjectivesTreatment of ischemic stroke with endovascular thrombectomy (EVT) leads to improved outcomes compared to IV tPA. The neutrophil-lymphocyte ratio (NLR), a marker of inflammation, has been proposed to predict outcomes in ischemic stroke patients and may be used to identify patients at risk for poor outcomes after EVT. Materials and MethodsThis was a retrospective study of adult ischemic stroke patients undergoing EVT between 1/1/2018 and 12/31/2020. Outcomes were successful reperfusion (TICI score ≥2B), favorable discharge NIHSS (≤4), favorable discharge and 3-month mRS (≤2), and symptomatic intracranial hemorrhage (sICH). The primary exposure was NLR, measured pre- and post-EVT. Other variables collected included demographics and timing of stroke onset, arrival, groin puncture, tPA, and recanalization. ResultsA total of 592 patients were included. The most common vessel involved was the middle cerebral artery (73%). Lower admission NLR was associated with favorable discharge NIHSS and favorable discharge and 3-month mRS (all P < 0.01). NLRs measured after EVT were associated with all the primary outcomes. Improvements in NLR after EVT were associated with favorable discharge (P = 0.02) and 3-month mRS (P = 0.02) and lower incidence of sICH (P = 0.01). ConclusionsBecause of the long-term functional deficits that can persist after ischemic stroke, it is vital to identify patients with higher probability for these outcomes. The results from this study showed that favorable NLR measures, as well as favorable trends in NLR over time, are associated with improved outcomes, indicating that NLR is a useful marker to identify patients at risk for poor functional outcomes.

Süleyman Demirel Üniversitesi Hastanesi acil servisine başvuran pankreatit hastalarının demografik verilerinin analizi, nötrofil/lenfosit oranı ile sonlanımın ilişkisi

Purpose: The aim of this study is to investigate the demographic data of the patients diagnosed with acute pancreatitis (AP), find out etiological factors and relation of labortaory data with the outcome in the emergency department. Materials and methods: The data of patients diagnosed with AP in the Emergency Department of Suleyman Demirel University, between 2013 and 2017 were analyzed retrospectively. The patients' demographic, laboratory and imaging findings were noted. Patients’ outcomes were evaluated in terms of hospitalization and in-hospital mortality.Results: Of the 603 patients in the study, 290 (48.1%) were female and 313 (51.9%) were male. The mean age of the patients was 59.49±18.73 years. The most applications were in the winter (n=161 [26.7%]) and the least in the spring (n=143 [23.7%]). The neutrophil counts of the discharged patients were lower than the patients hospitalized in the ward and intensive care unit. Primary etiology of the pancreatitis was biliary. The neutrophil/lymphocyte ratio (NLR) was significantly higher in the patients hospitalized or died in the intensive care unit, and the glucose and lactate dehydrogenase values are higher in the patients hospitalized in the intensive care unit. In-hospital mortality was 6.5%.Conclusion: Biliary pancreatitis is the main cause of pancreatitis. Mortality in AP is 6.5%. The admission NLR value is increased significantly in patients who need intensive care and in cases with in-hospital mortality.

Role of Neutrophil-Lymphocyte Ratio in the Prognosis of Acute Ischaemic Stroke After Reperfusion Therapy: A Systematic Review and Meta-analysis.

BackgroundInflammation may mediate response to acute reperfusion therapy (RT) in acute cerebral ischaemia. Neutrophil-lymphocyte ratio (NLR), an inflammatory biomarker, may play an important role in acute ischaemic stroke (AIS) prognostication.ObjectiveThis meta-analysis sought to examine the effect of NLR on functional outcomes, mortality and adverse outcomes in AIS patients receiving RT.MethodsIndividual studies were retrieved from PubMed/Medline, EMBASE and Cochrane databases. Data were extracted using a standardised data sheet and meta-analysis on association of admission (pre-RT) or delayed (post-RT) NLR with clinical/safety outcomes after RT was conducted.ResultsThirty-five studies (n = 10 308) were identified for the systematic review with 27 (n = 8537) included in the meta-analyses. Lower admission NLR was associated with good functional outcomes (GFOs), defined as 3-month modified Rankin scale (mRS) 0–2 (SMD = −.46; 95% CI = −.62 to −.29; P < .0001), mRS 0–1 (SMD = −.44; 95% CI = −.66 to −.22; P < .0001) and early neurological improvement (ENI) (SMD = −.55; 95 %CI = −.84 to −.25; P < .0001). Lower delayed admission NLR was also associated with GFOs (SMD = −.80; 95%CI = −.91 to −.68; P < .0001). Higher admission NLR was significantly associated with mortality (SMD = .49; 95%CI = .12 to .85; P = .009), intracerebral haemorrhage (ICH) (SMD = .34; 95% CI = .09 to .59; P = .007), symptomatic ICH (sICH) (SMD = .48; 95% CI = .07 to .90; P = .022) and stroke-associated infection or pneumonia (SMD = .85; 95% CI = .50, 1.19; P < .0001). Higher delayed NLR was significantly associated with sICH (SMD = 1.40; 95% CI = .60 to 2.19; P = .001), ICH (SMD = .94; 95% CI = .41 to 1.46; P < .0001) and mortality (SMD = 1.12; 95% CI = .57 to 1.67; P < .0001). There were variations in outcomes across RT groups.ConclusionHigher admission or delayed NLR is significantly associated with worse morbidity, mortality and safety outcomes in AIS patients receiving RT.

Abstract TP117: NLR Does Not Predict The Development Of Delirium In AIS Stroke Patients With Higher Rates Of Reperfusion Therapies.

Introduction: Stroke patients who develop delirium after their stroke can have worse cognitive and functional outcomes. Prior studies suggest that admission Neutrophil Lymphocyte ratio (NLR) is associated with the development of delirium in both ischemic (AIS) and hemorrhagic stroke geriatric patients. In this study we examine AIS patients for laboratory predictors of delirium. Methods: Between September 2019 and June 2021, patients diagnosed with AIS, within 48 hrs of last seen normal or time of onset and had expected mortality &gt;1 month were prospectively evaluated for delirium using the Confusion Assessment Method (CAM)-ICU daily for the first 8 days of their hospital stay and at discharge. NLR ratio was derived from patients’ admission blood panel and were both evaluated as continuous variables and in quartiles. Results: During the study period, 213 patients were screened for delirium. Of these, 18 patients could not be evaluated by the CAM-ICU at any point during the first eight days and 99(50.5%) screened positive for delirium. Our patient population was younger and had higher rates of endovascular and thrombolytic therapy than prior studies. Similar to other studies, patients with delirium had more severe NIHSS score (Table 1), longer lengths of stay, were more likely to be discharged to inpatient rehab than home, and trended to higher inpatient mortality. However, there was no apparent association between NLR and the development of delirium. Conclusion: In our patient population of younger patients who were more likely to receive reperfusion therapies, we did not find that NLR is associated with delirium. These results warrant additional study, specifically if reperfusion therapies such as thrombectomy and thrombolysis change how the nature of delirium and its predictive variables.

The Relationship between Admission Neutrophil-Lymphocyte Ratio and 90d Outcome after Endovascular Therapy in Patients with Acute Large Artery Occlusion

The Relationship between Admission Neutrophil-Lymphocyte Ratio and 90d Outcome after Endovascular Therapy in Patients with Acute Large Artery Occlusion

Predictive value of neutrophil-lymphocyte ratio on admission and before discharge for long-term all-cause death in hospitalized heart failure patients with reduced ejection fraction

Objective: To evaluate the predictive value of neutrophil-lymphocyte ratio (NLR) on admission and before discharge for long-term all-cause death (ACD) in patients hospitalized with heart failure with reduced ejection fraction (HFrEF). Methods: Patients hospitalized and discharged from hospital alive with the clinical diagnosis of HFrEF in cardiac care unit (CCU) of TEDA International Cardiovascular Hospital from January 2013 to December 2017 were consecutively enrolled. NLR, which was defined as neutrophil counts divided by lymphocyte counts, was measured 1 day within admission and 3 days before discharge to evaluate the prognostic value of admission NLR in combination with discharge NLR for the ACD after discharge by using of multivariate Cox regression analysis. Patients were followed-up until December 2020 or ACD. Results: A total of 368 patients hospitalized with HFrEF were enrolled with an age of (54±14) years, including 79 females (21.5%). During the median (inter-quartile range, IQR) duration of follow-up after discharge of 30 (10, 60) months, 95 patients died, thus, the rate of ACD was 25.8%. Multivariate Cox regression analysis showed that the NLR level before discharge was an independent predictor of ACD after discharge [hazard ratio (HR)=1.143, 95% confidence interval (CI) 1.048-1.248, P=0.003] after adjusting for other parameters such as systolic blood pressure on admission and at discharge, left ventricular end-diastolic diameter on admission, and usage of aldosterone receptor blockers at discharge. Moreover, compared to those with NLR level at admission ≤2.25 and ≤2.00 before discharge, the long-term risk of ACD after discharge was nearly doubled for patients with NLR level at admission>2.25 and>2.00 before discharge (adjusted HR=1.968, 95%CI 1.198-3.234, P=0.008). Conclusions: The NLR level before discharge was an independent predictor of ACD after discharge for patients hospitalized with HFrEF. Combining NLR levels at admission and before discharge help to better predictive the risk of long-term ACD after discharge.

Requirement of respiratory support in acute bronchiolitis in infants is linked to endothelial and neutrophil activation.

Evidence shows that activation of pulmonary vascular endothelium and neutrophils are involved in the pathophysiology of acute bronchiolitis. We hypothesized that levels of markers of endothelial activation and leukocyte counts are associated with requirement and duration of respiratory support. Thirty-four infants with bronchiolitis and eight controls were included. Nasopharyngeal swabs and blood samples were taken at admission. Serum levels of Angiopoietin (Ang)-1, Ang-2, sP-selectin, sE-selectin, vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1), and leukocyte counts were measured. For univariate analysis, bronchiolitis cases were grouped into two groups, namely those not requiring and those requiring any form of respiratory support. To control for known risk factors for poor outcome (i.e., age, prematurity, and congenital heart disease), and for days post symptom onset, linear regression analysis was performed with duration of any type of respiratory support in days. Ang-2 levels, Ang-2/Ang-1 ratios, sE-selectin levels, immature neutrophil count, and neutrophil/lymphocyte ratio (NLR) were higher in acute bronchiolitis versus controls. Ang-2, and NLR levels were significantly higher, and lymphocyte counts significantly lower, in infants that required respiratory support versus those that did not. Ang-2 levels (β: .32, 95% confidence interval [CI]: 0.19-1.19) and NLR (β: .68, 95% CI: 0.17-1.19) were positive predictors for the duration of respiratory support. Markers of endothelial and neutrophil activation are associated with respiratory support for acute bronchiolitis. Admission Ang-2 levels and NLR may be promising markers to determine requirement of respiratory support and deserve further study.

Prognostic value of neutrophil-lymphocyte ratio in cardiogenic shock complicating acute myocardial infarction: A cohort study.

Cardiogenic shock (CS) is the most severe complication after acute myocardial infarction (AMI) with mortality above 50%. Inflammatory response is involved in the pathology of CS and AMI. In this study, we aimed to evaluate the prognostic value of admission neutrophil-lymphocyte ratio (NLR) in patients with CS complicating AMI. Two hundred and seventeen consecutive patients with CS after AMI were divided into two groups according to the admission NLR cut-off value ≤7.3 and >7.3. The primary outcome was 30-day all-cause mortality and the secondary end-point was the composite events of major adverse cardiovascular events (MACE), including all-cause mortality, ventricular tachycardia/ventricular fibrillation, atrioventricular block, gastrointestinal haemorrhage and non-fatal stroke. Cox proportional hazard models were performed to analyse the association of NLR with the outcome. NLR cut-off value was determined by Youden index. Patients with NLR > 7.3 were older and presented with lower lymphocyte count, higher admission heart rate, B-type natriuretic peptide, leucocyte, neutrophil and creatinine (all P<.05). During a period of 30-day follow-up after admission, mortality in patients with NLR > 7.3 was significantly higher than in patients with NLR ≤ 7.3 (73.7% vs. 26.3%, P<.001). The incidence of MACE was also remarkably higher in patients with NLR > 7.3 (87.9% vs. 53.4%, P<.001). After multivariable adjustment, NLR > 7.3 remained an independent predictor for higher risk of 30-day mortality (HR 2.806; 95%CI 1.784, 4.415, P<.001) and MACE (HR 2.545; 95%CI 1.791, 3.617, P<.001). Admission NLR could be used as an important tool for short-term prognostic evaluation in patients with CS complicating AMI and higher NLR is an independent predictor for increased 30-day all-cause mortality and MACE.

First Admission Neutrophil-Lymphocyte Ratio May Indicate Acute Prognosis of Ischemic Stroke.

ObjectivesOur study aimed to determine the relationship between serum periostin levels, and the neutrophil–lymphocyte ratio (NLR) with ischemic stroke subtypes, clinical stroke scales, and acute prognosis in patients with acute ischemic stroke.Materials and MethodsForty-two ischemic stroke patients and 39 age- and sex-matched healthy volunteers were included in our study. Demographic characteristics including age and gender were recorded. Blood serum periostin and NLR values were evaluated in the first 24 hours after admission. Serum periostin levels were compared with healthy controls of similar age and sex. Lesion localization was determined by cranial CT or diffusion MRI of the patients. Stroke scales were recorded on days 1 and 7 of hospitalization in the study group.ResultsThe mean serum periostin levels were higher than in the control group, but no statistically significant difference was found. There was no correlation between serum periostin levels and prognosis of stroke. First admission NLRs were statistically higher than in the control group. The first admission NLRs were positively correlated with the first admission National Institute of Health Stroke Scale score and the day 7 modified Rankin score.ConclusionOur study is the first study to evaluate both NLR and serum periostin levels in all types of acute ischemic stroke. While our study did not show that first admission serum periostin levels can be used as a biomarker in ischemic stroke, it did indicate that the first admission NLR can be used for acute prognosis of ischemic stroke.

NEUTROPHIL-LYMPHOCYTE RATIO PREDICTS SHORT-TERM MORTALITY IN PATIENTS HOSPITALIZED FOR ACUTE DECOMPENSATION OF CIRRHOSIS.

Individuals with cirrhosis have a chronic systemic inflammation associated with an immune dysfunction, affecting the progression of the liver disease. The neutrophil-lymphocyte ratio (NLR) was proposed as a marker of systemic inflammatory response and survival in patients with cirrhosis. Evaluate the prognostic role of NLR in cirrhotic patients and its relation with inflammatory cytokines(IL-6, IL-10 and IL-17). In this prospective study two groups were evaluated: 1) Stable cirrhotic in outpatient follow-up (n=193); 2) Hospitalized cirrhotic for acute decompensation for at least 48 hours (n=334) with admission and 48 hours tests evaluation. Circulating inflammatory cytokines were available for 130 hospitalized patients. In outpatients with stable cirrhosis, NLR correlated with MELD score and other variables associated with severity of disease. However, after a median of 32 months of follow up NLR was not associated with mortality (HR 1.058, 95%CI 0.900-1.243; P=0.495). In hospitalized patients, NLR at 48-hour after admission was independently associated with 90-day survival (HR 1.061, 95%CI 1.020-1.103; P=0.003) in multivariate Cox-regression analysis. The 90-day Kaplan-Meier survival probability was 87% for patients with a 48-hour NLR <3.6 and 62% for NLR ≥3.6 (P<0.001). Elevation of NLR in the first 48 hours was also independently associated with mortality (HR 2.038, 95%CI 1295-3207; P=0.002). The 90-day Kaplan-Meier survival probability was 83% when NLR did not increase and 62% when NLR increased (P<0.001). IL-6, IL-10 and IL-17 at admission were positively correlated with both admission and 48-hour NLR. Lower levels of baseline IL-10 were associated with NLR increase during first 48-hour. NLR evaluated at 48 hours of hospitalization and its early increase after admission were independently associated with short-term mortality in patients hospitalized for acute decompensation of cirrhosis.

A High Neutrophil-Lymphocyte Ratio Is Associated With Increased Morbidity and Mortality in Patients With Coronavirus Disease 2019.

The neutrophil-lymphocyte ratio is an inexpensive and simple inflammatory marker. A higher ratio, indicative of an acute hyperinflammatory response or diminished overall physiologic health status, has been associated with poor prognoses. This study aimed to evaluate the prognostic potential of admission neutrophil-lymphocyte ratio in patients admitted to the medical ICU with coronavirus disease 2019. Retrospective review of prospectively collected data. Medical ICU from a large medical center. 2,071 consecutive patients admitted to the medical ICU with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 between March 15, 2020, and December 30, 2020, were grouped by neutrophil-lymphocyte ratio above or below the median (7.45) at the time of hospital admission. Complete blood count with differential at the time of hospital admission. A neutrophil-lymphocyte ratio above 7.45 at the time of hospital admission was associated with increased need for mechanical ventilation (45.8% vs 38.0%, p < 0.0001), vasopressor therapy (55.6% vs 48.2%, p = 0.001), and decreased survival through 180 days (54.8% vs 67.0%, p < 0.0001). Patients with a high neutrophil-lymphocyte ratio exhibited a 1.32 (95% CI, 1.14-1.54) times greater risk of mortality than those with a low neutrophil-lymphocyte ratio. The neutrophil-lymphocyte ratio at the time of hospital admission is an independent risk factor for morbidity and mortality. This prognostic indicator may assist clinicians appropriately identify patients at heightened risk for a severe disease course and tailor treatment accordingly.

Is there a predictive value of the preoperative neutrophil-lymphocyte ratio in terms of intensive care need in geriatric patients who underwent pertrochanteric fracture surgery?

Pertrochanteric fractures are serious health problem with an ever-increasing prevalence in elderly population. Potential post-operative intensive care need leads to delays in the timing of surgery due to the referral of patients to better equipped hospitals as well as the inability to arrange a reserved intensive care bed. The purpose of this study is to investigate whether pre-op-erative neutrophillymphocyte ratio (NLR) has predictive value in terms of post-operative intensive care need in geriatric patients who underwent surgery following pertrochanteric fractures. A total of 535 patients aged 65 years and above with hip fractures who presented to the emergency service between 2017 and 2020 were retrospectively screened. Out of 535 patients, 317 patients who met the inclusion and exclusion criteria were included in the study. The screened patient population was divided into two groups as those followed in the post-operative intensive care unit (ICU) and those followed in the orthopedic ward. There were 190 patients (59.9%) who were followed in the orthopedic ward postoperatively and 127 (40.1%) patients followed in the ICU postoperatively. While the mean pre-operative NLR value of all patients was 6.57, the mean pre-operative NLR of the patients who were followed up postoperatively in the orthopedic ward was 5.85, and the mean NLR of those who were followed up in the ICU was 7.65. It was found that the admission NLR values of the ICU group patients were significantly higher compared to those of the orthopedic ward group (p<0.001) and also the cutoff value of NLR was calculated as 6.14. We believe that this objective, simple, cost-effective, and rapid marker can be used in combination with other parameters to predict ICU need to prevent surgical delays due to the lack of a reserved intensive care bed in the ASA 3 geriatric patient group with pertrochanteric fractures, whose intensive care need cannot be clarified, thereby reducing mortality and morbidity.

ASSOCIATION OF NEUTROPHIL-LYMPHOCYTE RATIO AND ACUTE KIDNEY INJURY IN SEPTIC PATIENTS IN THE ICU

SESSION TITLE: Advances in Critical Care Practice SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Acute Kidney injury (AKI) is a common complication among patients with sepsis and conveys increased morbidity and mortality. Neutrophil-lymphocyte ratio (NLR) is a marker of inflammation and has been described to reflect severity of the infectious processes. We investigated the association between admission NLR and the development of AKI in septic patients admitted to the Intensive Care Unit (ICU). METHODS: Patients directly admitted to the ICU from the Emergency Department with a diagnosis of severe sepsis and septic shock between 2012-2014 at a large tertiary care center were included. Baseline demographics and laboratory values were collected retrospectively. The first absolute neutrophil and lymphocyte count of the hospital admission was used to calculate the NLR. Patients were classified into groups based on the degree of NLR elevation. The severe NLR group was defined as NLR greater than 18. The primary outcome was the development of AKI during ICU stay. Multivariate logistic regression was performed to determine predictors of AKI. RESULTS: A total of 125 patients were included in the study. There was a predominance of males (62%) and African Americans (53%). Mean (± SD) age was 54 ± 13 years and overall hospital mortality was 45%. 85 patients (68%) developed AKI during ICU stay. The median NLR in the AKI group was significantly higher than the non-AKI group: 14.14 (IQR 7.30-30.13) vs 8.64 (IQR 3.76-16.8) , p=0.012. The severe NLR group had a median NLR of 32.6 (IQR 24.5-45.7) and included a total of 46 patients (37%). In the univariate analysis, the severe NLR group was significantly associated with longer ICU stay (4 days in the severe NLR group vs 2 days in the non-severe NLR group, p=0.038) and development of AKI (p=0.023). On multivariate analysis, development of AKI was independently associated with severe NLR [adjusted Odds Ratio (OR)= 2.75, 95% Confidence Interval [CI] (1.03-7.39); p=0.044], creatinine level at admission (OR= 1.74, 95% CI 1.13-2.68, p=0.012) and Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR= 1.10, 95% CI 1.03-1.16, p=0.002). Chloride levels at 24 hours from admission was insignificant predictor of AKI in the model (OR= 1.05, 95% CI 0.97-1.13, p=0.229). CONCLUSIONS: Severe elevation of NLR was significantly associated with longer ICU stay and was independently associated with development of AKI in patients with severe sepsis and septic shock even after adjustment for SOFA scores. NLR is a simple laboratory parameter that can be easily obtained to predict kidney dysfunction in septic patients. CLINICAL IMPLICATIONS: AKI in the ICU is independently associated with adverse outcomes. Predictors of AKI may be helpful for early detection of patients at risk of kidney dysfunction and guide management for prevention of the same. DISCLOSURES: No relevant relationships by Afsana Asharaf, source=Web Response No relevant relationships by Rabab Nasim, source=Web Response No relevant relationships by Avantika Nathani, source=Web Response No relevant relationships by Prince Ntiamoah, source=Web Response No relevant relationships by VICTOR PRADO, source=Web Response No relevant relationships by Christian Trujillo, source=Web Response No relevant relationships by Connor Wakefield, source=Web Response

Prognostic implications of neutrophil-lymphocyte ratio in COVID-19.

The clinical presentation of COVID-19 ranges from a mild, self-limiting disease, to multiple organ failure and death. Most severe COVID-19 cases present low lymphocytes counts and high leukocytes counts, and accumulated evidence suggests that in a subgroup of patients presenting severe COVID-19, there may be a hyperinflammatory response driving a severe hypercytokinaemia which may be, at least in part, signalling the presence of an underlying endothelial dysfunction. In this context, available data suggest a prognostic role of neutrophil-lymphocyte ratio (NLR) in various inflammatory diseases and oncological processes. Following this rationale, we hypothesized that NLR, as a marker of endothelial dysfunction, may be useful in identifying patients with a poor prognosis in hospitalized COVID-19 cases. A retrospective observational study performed at Hospital Universitario HM Puerta del Sur, Madrid, Spain, which included 119 patients with COVID-19 from 1 March to 31 March 2020. Patients were categorized according to WHO R&D Expert Group. Forty-five (12.1%) patients experienced severe acute respiratory failure requiring respiratory support. Forty-seven (12.6%) patients died. Those with worse outcomes were older (P=.002) and presented significantly higher NLR at admission (P=.001), greater increase in Peak NLR (P<.001) and higher increasing speed of NLR (P=.003) compared with follow-up patients. In a multivariable logistic regression, age, cardiovascular disease and C-reactive protein at admission and Peak NLR were significantly associated with death. NLR is an easily measurable, available, cost-effective and reliable parameter, which continuous monitoring could be useful for the diagnosis and treatment of COVID-19.

Admission Neutrophil-Lymphocyte Ratio (NLR) Predicts Survival in Patients with Extensive Burns

BackgroundExtensive burns is one of the most common severe injuries, with a high annual death rate. Previous studies showed that the neutrophil to lymphocyte ratio (NLR) is a prognostic factor for some inflammatory diseases. However, until now, no study has evaluated the clinical prognostic value of NLR in extensively burned patients. The aim of this study was to investigate the prognostic value of NLR in this medical condition to provide clinical guidance. Methods271 patients diagnosed with extensive burns were analysed retrospectively between 2005 and 2018 in the Department of Burn Surgery of Changhai Hospital. NLR cut-off values at the first 3 days of hospitalization were calculated by the ROC analysis. ResultsOf the 271 patients in this study, the majority (82.3%) were injured by flame. The median total body surface area (TBSA) was 55% (IQR, 40% to 85%) and the median full thickness burn (FTB) was 20% (IQR, 3%–44%). The patients’ NLR declined within the first 3 days after admission, and we found that NLR was negatively correlated with the ventilator-free days at day 28 (r = -0.127, P = 0.048). In a multivariate logistic regression analysis, higher admission NLR was independently predictive of higher mortality. According to the ROC curve, the best cut-off values for day 1 (or admission day), day 2 and day 3 NLR were 14, 13 and 7.5, respectively. We then performed a survival analysis, finding that those NLR above the cut-off point had decreased overall survival compared to those with NLR below the cut-off point (p = 0.023, 0.045 and 0.019 for day 1, 2, and 3, respectively). ConclusionsNLR continuously decreased in the first 3 days of hospitalization. Admission NLR above 14 is associated with a decreased survival in patients with extensive burns. These findings demonstrate that NLR has prognostic value in these patients.