Admission Neutrophil To Lymphocyte Ratio Research Articles

Predictive value of neutrophil-to-lymphocyte ratio for adverse outcomes in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease: A retrospective study.

Chronic obstructive pulmonary disease (COPD) stands as one of the leading causes of mortality worldwide. Acute exacerbations of COPD (AECOPD) lead to rapid respiratory function decline and worsened disease status. Despite recent studies, the ability of the neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with COPD remains controversial. We investigated the predictive value of NLR for adverse outcomes in hospitalized patients with AECOPD. A retrospective study was conducted at the Department of Pulmonary Medicine, Cho Ray Hospital (Vietnam) from November 2019 to November 2021. The study extracted data from patients diagnosed with AECOPD at discharge and met the inclusion criteria. NLR is calculated by dividing the number of neutrophils by the number of lymphocytes in the peripheral blood test. Adverse outcomes are defined as invasive mechanical ventilation, admission to intensive care unit, or in-hospital mortality. Multivariable regression analysis was conducted to identify variables predicting adverse outcomes. The cutoff, sensitivity, specificity, area under the curve, and receiver operating characteristic of NLR were determined for predicting adverse outcomes. Two hundred eighty-seven patients with AECOPD were included in the final analysis, with a mean age of 70.9, and males comprising 92.7%. The rate of adverse outcomes was 15.7%. Multivariable logistic regression identified reduced consciousness at admission (adjusted odds ratio = 0.08, 95% confidence interval [CI]: 0.02-0.38, P = .001) and high NLR (adjusted odds ratio = 1.17, 95% CI: 1.10-1.24, P < .001) as predictors of adverse outcomes. The receiver operating characteristic of NLR's predictive value yielded an area under the curve of 0.877 (95% CI: 0.83-0.93). An NLR cutoff of 11.0 predicted adverse outcomes with a sensitivity of 80.0%, specificity of 77.7%, and an odds ratio of 13.9 (95% CI: 6.3-30.7), P < .001. NLR is a simple, routine, and cost-effective tool for predicting adverse outcomes in hospitalized patients with AECOPD. Future studies should evaluate the kinetics of NLR in predicting treatment response in patients with AECOPD.

Neutrophil to lymphocyte ratio and five-year mortality in patients with acute ischemic stroke

BackgroundPrevious studies linked neutrophil to lymphocyte ratio (NLR) with short-term mortality after acute ischemic stroke (AIS), but its relationship with long-term mortality remains unclear. This study investigates the association between NLR and five-year mortality in AIS patients. MethodWe analyzed 416 AIS patients from April 2012 to January 2016 at Zhangjiagang TCM Hospital. Admission NLR was divided into quartiles: Q1 (<2.00), Q2 (2.00–3.05), Q3 (3.06–5.46), and Q4 (≥5.46). We assessed 5-year all-cause and vascular mortality using Kaplan-Meier, Cox regression, and receiver operating characteristic (ROC) curve analyses. ResultsOver five years, 134 (32.2 %) all-cause deaths and 114 (27.4 %) vascular deaths occurred. Elevated NLR was significantly associated with increased risks of all-cause and vascular mortality. Multivariate Cox analysis identified stroke history (HR: 1.57, 95 % CI 1.08–2.30), baseline National Institutes of Health Stroke Scale (NIHSS) score (HR: 1.09, 95 % CI 1.05–1.12), and NLR (HR: 1.09, 95 % CI 1.05–1.12) as independent risk factors for all-cause mortality. These factors also predicted 5-year vascular mortality: stroke history (HR: 1.65, 95 % CI 1.10–2.49), NIHSS score (HR: 1.10, 95 % CI 1.06–1.13), and NLR (HR: 1.08, 95 % CI 1.05–1.10). NLR quartiles were significantly linked to both outcomes: all-cause mortality HRs were Q2 (1.87, 95 % CI 1.00–3.51), Q3 (2.40, 95 % CI 1.31–4.39), Q4 (2.77, 95 % CI 1.47–5.24), P for trend = 0.001; vascular mortality HRs were Q2 (1.76, 95 % CI 0.88–3.55), Q3 (2.34, 95 % CI 1.14–4.40), Q4 (2.57, 95 % CI 1.28–5.16), P for trend = 0.002. Kaplan-Meier survival analysis revealed significantly higher mortality rates in higher NLR quartiles (log-rank p < 0.001). ROC analysis identified optimal NLR cutoff values of 3.42 for predicting 5-year all-cause mortality (AUC 0.689) and 3.51 for vascular-cause mortality (AUC 0.700), with moderate sensitivity and specificity. ConclusionsHigher NLR at admission was linked with five-year all-cause mortality and mortality attributed explicitly to vascular causes in AIS patients.

Neutrophil to Lymphocyte Ratio Values in Late Preterm and Term Patients with Evidence of Chorioamnionitis on Placental Histopathology: A Retrospective Cohort Study

Introduction: Neutrophil to lymphocyte ratio (NLR) is an inexpensive biomarker that may aid in the prediction of adverse pregnancy outcomes, though data remains sparse at this time. Previously published research regarding chorioamnionitis almost exclusively focuses on preterm labor and preterm prelabor rupture of membranes before 34 weeks of gestation and suggests an increase in NLR in those patients with chorioamnionitis identified on placental histopathologic examination. However, chorioamnionitis in the late preterm and term timeframe also represents a significant source of maternal and neonatal morbidity. Therefore, the primary aims of the study were to: 1) compare obstetric admission NLR values among those with and without evidence of histopathologic chorioamnionitis 2) evaluate the efficacy of NLR in identifying histopathologic chorioamnionitis and 3) compare NLR values pre- and postdelivery in the setting of a placental histopathologic chorioamnionitis diagnosis in patients beyond 34 weeks of gestation. Methods: A retrospective electronic chart review was performed at an American urban safety net hospital. Institutional review board approval was obtained (UMKC #2093657), and patient consent was waived due to the retrospective nature of the review. Obstetric encounters were included if a complete blood count (CBC) with differential was performed on admission and postpartum, the subject underwent a trial of labor, a placental histopathologic examination was performed, and delivery occurred beyond 34 0/7 weeks of gestation. Subjects were excluded if an extrauterine infection was present during the hospitalization or the subject received corticosteroids within two weeks of delivery. Postdelivery placentas were examined by the University’s pathology department. Statistical analyses were performed with receiver operator curves, Mann-Whitney U test, and Wilcoxon Signed-Rank Test where applicable, with a significance level p &lt; 0.05. Results: Three hundred seventy-nine patient encounters were reviewed, with only 30.1% of all encounters with placental histopathology available. A total of 58 subjects met the inclusion criteria and 14 additional subjects were excluded due to extrauterine infection (n=1), SARS-CoV-2 diagnosis (n=5), and late preterm steroids administration (n=8). There was no difference between those subjects with and without histopathologic chorioamnionitis in median gestational age at the time of delivery (39 0/7 versus 39 1/7 weeks of gestational, p=0.960), median time of admission CBC collection to delivery (0.98 versus 0.98 days, p=0.340), and timing of collection of postpartum CBC (1.0 versus 1.0 days postpartum, p=0.631). Predelivery neutrophil to lymphocyte ratio values were compared in subjects with and without histopathologic chorioamnionitis and there was no significant difference in median values (4.11 versus 4.52, p=0.683). The predelivery NLR predicted the presence of chorioamnionitis poorly (AUC 0.518, 95% CI [0.326, 0.711], p=0.843). The postdelivery NLR was a slightly better predictor of chorioamnionitis (AUC 0.634, 95% CI [0.454, 0.815], p=0.147), but did not reach statistical significance. Although there was no significant difference in postpartum NLR values in those with and without chorioamnionitis on final histopathology (6.73 versus 4.63, p=0.147), the value was notably higher in the former. When the antepartum and postpartum NLR were compared across individual subjects in a paired fashion, there was a significantly higher postpartum NLR in those subjects both with and without chorioamnionitis on final histopathology (with chorioamnionitis: antepartum median 4.52 versus postpartum 6.73, p=0.012, n=15; without chorioamnionitis: antepartum median 4.11 versus postpartum 4.63, p=0.043, n=29). Conclusion: Though predelivery NLR is a poor predictor of chorioamnionitis, significantly higher postpartum NLR values in the sample population suggest an increase in NLR for all laboring patients, but a more pronounced increase occurs in those with inflammatory placental findings. While the study is limited by a heterogeneous sample population, nonparametric evaluation, and small sample sizes, the data does add to the paucity of preexisting literature that seeks to utilize NLR in the prediction of chorioamnionitis during the labor course. Larger longitudinal studies may help better characterize the rising NLR values over the course of labor and delivery as seen in our study. Neutrophil to lymphocyte ratio values across the spectrum of disease states and gestational ages in pregnancy may help isolate other inflammatory processes that impact perinatal outcomes.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio predicting hospital length of stay and mortality in young COVID-19 patients: A retrospective study

Background This study investigated the utility of platelet-to-lymphocyte ratio (PLR) and Neutrophil-to-Lymphocyte ratio (NLR) in patients with COVID-19 with respect to age, early (a week) vs. delayed recovery (&gt; a week) and mortality. Methods This was a retrospective study including 1,016 COVID-19 patients. The discriminatory power and multivariate logistic regression analysis were performed. Results The mean age of patients was 45 (± 13.9), and 75.7% were males. Older patients had elevated NLR, PLR, D-dimer, CRP, and Interleukin-6 levels and longer hospital stay than the younger group (p &lt; 0.001). In-hospital mortality was higher in older adults (26.9% vs. 6.6%, p =0.001). On-admission NLR (5.8 vs. 3.2; P= 0.001) and PLR (253.9±221.1 vs. 192.2±158.5; p = 0.004) were higher in the non-survivors than survivors. Both PLR and NLR displayed significant discriminatory ability for mortality. NLR had a higher AUC and specificity, while PLR exhibited slightly higher sensitivity. In individuals aged ≤55, NLR showed superior discrimination (AUC=0.717) compared to PLR (AUC=0.620). Conversely, for older adults, PLR displayed enhanced discrimination (AUC=0.710), while NLR showed AUC=0.693. Conclusion Higher admission NLR and PLR levels were associated with delayed recovery, whereas an enhanced NLR was associated with considerably higher mortality in older COVID-19 patients.

Muscle mass as a modifier of stress response in acute ischemic stroke patients

Stroke triggers a systemic inflammatory response over the ensuing days after the cerebral insult. The age and comorbidities of the stroke population make them a vulnerable population for low muscle mass and sarcopenia, the latter being another clinical condition that is closely associated with inflammation, as shown by increased levels of pro-inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR). In this study, we evaluated the relationship between post-stroke NLR changes and muscle mass in a prospective cohort of acute ischemic stroke patients (n = 102) enrolled in the Muscle Assessment in Stroke Study Turkey (MASS-TR). Admission lumbar computed tomography images were used to determine the cross-sectional muscle area of skeletal muscles at L3 vertebra level and calculate the skeletal muscle index (SMI). The median (IQR) SMI was 44.7 (39.1–52.5) cm2/m2, and the NLR at admission and follow-up were 4.2 (3.0–10.5) and 9.4 (5.7–16.2), respectively. While there was no relationship between SMI and admission NLR, a significant inverse correlation was observed between SMI and follow-up NLR (r = − 0.26; P = 0.007). Lower SMI remained significantly associated (P = 0.036) with higher follow-up NLR levels in multivariate analysis. Our findings highlight the importance of muscle mass as a novel factor related to the level of post-stroke stress response.

How well does peripheral blood neutrophil-to-lymphocyte ratio predict the severity and prognosis of hemorrhagic Stroke

ObjectiveWe explored the blood neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker and its relation with mortality and Modified Rankin Scale (mRS) score at discharge and at 3 months following ICH and also compared NLR with intracerebral hemorrhage (ICH) score, Sequential Organ Failure Assessment (SOFA) score and National Institutes of Health Stroke Scale (NIHSS) score. MethodsThe investigators calculated the NIHSS score, SOFA score, ICH score and NLR of 90 adult patients within 3 days of onset of stroke with evidence of hemorrhagic stroke in brain imaging and correlated it with in-hospital mortality, 3-month mortality and mRS at 3 months following stroke using regression analysis. ResultsOut of 90 individuals, there were 54 (60%) males and 36 (40%) females. The mRS score at 3 months significantly related to the admission NLR ratio >7 and SOFA score. Similarly, the in-hospital death and 3-month mortality was related to the admission NLR ratio >7 and ICH score. However, at a cut off value of NLR>3 for assessing the prognosis of the patients, we did not get significant results for mRS at 3 months following stroke and for in-hospital and 3-month mortality. ConclusionA high NLR ratio >7 predicted worse outcomes in terms of mortality and morbidity at 3-months following haemorrhagic stroke. Hence, like ICH score, NLR can predict 3-month mortality following an acute haemorrhagic stroke and can also predict morbidity following 3 months of brain haemorrhage.

Abstract WMP8: Tenecteplase vs Alteplase: is Pro-Inflammatory and Procoagulant Response Any Different in Acute Ischemic Stroke?

Introduction: Thrombolysis in acute ischemic stroke (AIS) using Tenecteplase (TNK) is gaining popularity compared to Alteplase (ALT) for its practical advantages. At our center, we observed an improvement in clinical outcome in TNK treated patients compared to ALT. Hence, we aimed to study the pro-inflammatory and procoagulant responses post-thrombolysis and their contributory role in clinical outcome. Methods: This is a single-center retrospective study of ALT or TNK treated AIS patients admitted to a comprehensive stroke center over a 3-year period. Non-parametric tests were used to compare differences between the ALT and TNK cohorts. Peripheral blood indices, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), and mean platelet volume to platelet count ratio (MPV:PLT), were calculated. Their rise from pre-thrombolysis baseline during the first 48 hours was used to define a systemic inflammatory and procoagulant response. A p-value of &lt;0.05 was considered statistically significant. Results: During the study period, 165 and 64 patients were treated with ALT and TNK respectively. The baseline demographics, vascular risk factors, and admission stroke severity were similar. Admission NLR, PLR, MLR, and MPV:PLT were not statistically different. Clinical outcome at 3 months assessed using median modified Rankin Scale (mRS) was better with TNK (2.0 [IQR, 1.0, 4.0] vs 3.0 [IQR, 2.0, 5.0]; p = 0.0007). Rise in NLR was significantly higher in the ALT cohort compared to TNK on day 1 (2.25 [IQR, 0.0, 5.77] vs. 0.49 [IQR, -0.48, 3.91], p = 0.01) and day 2 (1.58 [IQR, -0.09, 5.68] vs. 0.39 [IQR, -0.96, 2.91], p = 0.045). Similarly, MLR on day 2 in the ALT cohort (0.16 [IQR, 0.05, 0.49] vs. 0.12 [IQR, -0.05, 0.22], p = 0.038) and MPV:PLT on day 1 (0.61 [IQR, 0.16, 1.35] vs. 0.32 [IQR, 0.003, 0.68], p = 0.002) and day 2 (0.83 [IQR, -0.35, 1.90] vs. 0.36 [IQR, -0.12, 1.21], p = 0.004) were higher. Conclusions: Patients treated with TNK had better mRS scores compared to ALT in our study. This was associated with significantly less inflammatory and procoagulant response during the first 48 hours of AIS in the TNK group. The etiology for such an association is speculative and needs confirmation using more specific biomarkers.

Postoperative neutrophil-to-lymphocyte ratio predicts malignant cerebral edema following endovascular treatment for acute ischemic stroke.

Malignant cerebral edema (MCE) is one of serious complications with high mortality following endovascular treatment (EVT) for acute ischemic stroke (AIS) with large vessel occlusion. We aimed to investigate the relationship between postoperative neutrophil-to-lymphocyte ratio (NLR) and MCE after EVT. The clinical and imaging data of 175 patients with AIS of anterior circulation after EVT were studied. Admission and postoperative NLR were determined. The presence of MCE was evaluated on the computed tomography performed 24 h following EVT. The clinical outcomes were measured using the modified Rankin Scale (mRS) at 90-day after onset. Univariate and multivariate regression analyses were used to analyze the relationship between postoperative NLR and MCE. Optimal cutoff values of postoperative NLR to predict MCE were defined using receiver operating characteristic analysis. MCE was observed in 24% of the patients who underwent EVT and was associated with a lower rate of favorable clinical outcomes at 90-day. Multivariate logistic regression analysis demonstrated that baseline Alberta Stroke Program Early CT Score (ASPECT) score (OR = 0.614, 95% CI 0.502-0.750, p = 0.001), serum glucose (OR = 1.181, 95% CI 1.015-1.374, p = 0.031), and postoperative NLR (OR = 1.043, 95% CI 1.002-1.086, p = 0.041) were independently associated with MCE following EVT for AIS with large vessel occlusion. Postoperative NLR had an area under the receiver operating characteristic curve of 0.743 for prediction MCE, and the optimal cutoff value was 6.15, with a sensitivity and specificity of 86.8% and 55%. Elevated postoperative NLR is independently associated with malignant brain edema following EVT for AIS with large vessel occlusion, and may serve as an early predictive indicator for MCE after EVT.

Pericardial effusion in patients with chronic kidney disease: A two-center study.

Pericardial effusion (PE) is a prevalent form of pericardial involvement in chronic kidney disease (CKD). This study aims to investigate the clinical and laboratory features associated with PE severity in patients with CKD. In this cross-sectional study, we examined the medical records of patients admitted to tertiary hospitals with International Classification of Diseases 10th Revision (ICD-10) codes associated with CKD and PE. We included 112 CKD patients in stage 4 and 5 non-dialysis (ND) with PE for assessing the clinical and laboratory features of severity. Patients were divided into two categories based on the severity of PE. Seventy-two patients had mild and 40 had moderate and severe PE. Univariate analysis of demographic and laboratory features on the date of admission demonstrated that chest pain, dyspnea, serum albumin, and neutrophil-to-lymphocyte ratio (NLR) are associated with the severity of PE. The univariate analysis on the date of echocardiography showed significantly higher white blood cell count (WBC), neutrophil count (percentage and absolute count), and NLR, along with significantly lower lymphocyte percentage and serum albumin among patients with moderate and severe PE. In the multivariable analysis of laboratory features, on admission hypoalbuminemia (p-value = 0.014, OR = 4.03, CI: 1.32-12.25) and NLR greater than 5.5 (p-value = 0.015, OR = 4.22, CI: 1.32-13.50) were significantly associated with moderate and severe PE. In a parallel matter, at the time of echocardiography hypoalbuminemia (p-value = 0.004, OR = 5.38, CI: 1.74-16.65) and neutrophilia (p-value = 0.005, OR = 7.94, CI: 1.89-33.44) were significantly associated with moderate and severe PE. Despite advancements in the diagnosis and treatment of CKD, PE is still a concerning issue in these patients. This study revealed that hypoalbuminemia, neutrophilia, and NLR greater than 5.5 could be predictive factors of moderate and severe PE in CKD patients with PE. Further prospective study with larger sample size is needed to confirm these results.

Admission Inflammation Markers Influence Long-term Mortality in Elderly Patients Undergoing Hip Fracture Surgery: A Retrospective Cohort Study.

Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture. We reports on a retrospective study of elderly hip fracture patients admitted to a hospital in China between January 2015 and December 2019. A total of 1085 patients were included in the study, and their demographic and pre-operative characteristics were analyzed. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by receiver operating characteristics (ROC) curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression. The 30-day, 1-year, 2-year, and 4-year mortality were 1.6%, 11.5%, 21.4% and 48.9%, respectively. The optimal cut-off values of admission NLR, MLR and CAR for 1-year mortality were 7.28, 0.76, and 1.36. After adjusting the covariates, preoperative NLR ≥ 7.28 (HR = 1.419, 95% CI: 1.080-1.864, p = 0.012) were found to be only independent risk factors with 4-year all-cause mortality, the preoperative CAR ≥ 1.36 was independently associated with 1-year (HR = 1.700, 95% CI: 1.173-2.465, p = 0.005), 2 year (HR = 1.464, 95% CI: 1.107-1.936, p = 0.008), and 4-year (HR = 1.341, 95% CI: 1.057-1.700, p = 0.016) all-cause mortality, While age, CCI score, and low hemoglobin at admission were also risk factors for postoperative all-cause mortality. Admission CAR and NLR may be useful indicators for predicting the long-term mortality of elderly patients undergoing hip fracture surgery, and that more research is needed to validate these findings.

Evaluation of the role of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) time series as predictors of diagnosis and prognosis of hemotoxic snakebite

BackgroundThis study aimed to assess the predictive value of NLR, PLR, and MPV time series for diagnosis and prognosis of hemotoxic snakebite envenomation.MethodsThis is a prospective study among snakebite patients admitted to the Poison Control Center of Ain Shams University Hospitals and Assiut University Hospitals from the beginning of July 2019 to the end of October 2021. Patients were classified according to their clinical severity into three groups: mild, moderate, and severe.ResultsThe maximum incidence of snakebite was found in males (95%) from rural areas (80%); at lower limbs (70%); at night (51%); and during the autumn season (43.3%). The admission NLR and PLR can predict hemotoxic snakebite envenomation with an AUC of 0.940 and 0.569. The combination of NLR with PLR can develop a more predominant prediction of snakebite envenomation with an area under the curve (AUC) of 0.979. Furthermore, higher admission NLR and PLR levels are associated with prolonged hospital stays.ConclusionWhile NLR and PLR levels may be helpful in the diagnosis of snakebite, MPV plays no part in the prognosis of snakebite patients. Serial NLR, PLR initially, at 24 hours, and predischarge can be used to evaluate the early treatment response.

Neutrophil to lymphocyte ratio and antidepressant treatment response in patients with major depressive disorder: Effect of sex and hippocampal volume

Several factors may affect response to treatment in Major Depressive Disorder (MDD) including immune/inflammatory alterations and regional brain volumes, particularly in hippocampal regions which have shown to be influenced by inflammatory status. Neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker found to be elevated in depressed women in large population studies. Here we investigate the effect of NLR on treatment response in MDD patients, and the role of sex and hippocampal volume on influencing this relationship. A sample of 124 MDD depressed inpatients (F = 80) underwent MRI acquisition, admission NLR was calculated by dividing absolute neutrophil by absolute lymphocyte counts and depression severity was assessed at admission and discharge via the Hamilton Depression Rating Scale (HDRS). As a measure of treatment response, delta HDRS was calculated. We found a significant moderation effect of sex on the relationship between NLR and Delta HDRS: a negative relation was found in females and a positive one in males. NLR was found to negatively affect hippocampal volumes in females. Both left and right hippocampal volume positively associated with Delta HDRS. Finally, left hippocampal volume mediated the effect of NLR on Delta HDRS in females. Sex moderated the relation between inflammation and treatment response in line with previous reports linking inflammation to hampered antidepressant effect in females. Further, this effect is partially mediated by hippocampal volume, suggesting that antidepressant response may be hampered by the detrimental effect of inflammation on the brain.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios and prognosis after aneurysmal subarachnoid hemorrhage: a cohort study.

Subarachnoid hemorrhage (SAH) prognosis remains poor. Vasospasm mechanism might be associated with inflammation. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as inflammation markers and prognostic predictors. We aimed to investigate NLR and PLR in admission as predictors of angiographic vasospasm and functional outcome at 6 months. This cohort study included consecutive aneurysmal SAH patients admitted to a tertiary center. Complete blood count was recorded at admission before treatment. White blood cell count, neutrophil count, lymphocyte count, platelet count, NLR, and PLR were collected as independent variables. Vasospasm occurrence-modified Rankin scale (mRS), Glasgow outcome scale (GOS), and Hunt-Hess score at admission and at 6 months were recorded as dependent variables. Multivariable logistic regression models were used to adjust for potential confounding and to assess the independent prognostic value of NLR and PLR at admission. A total of 74.1% of the patients were female, with mean age of 55.6 ± 12.4 years. At admission, the median Hunt-Hess score was 2 (interquartile range [IQR] 1), and the median mFisher was 3 (IQR 1). Microsurgical clipping was the treatment for 66.2% of the patients. Angiographic vasospasm incidence was 16.5%. At 6 months, the median GOS was 4 (IQR 0.75), and the median mRS was 3 (IQR 1.5). Twenty-one patients (15.1%) died. Neutrophil-to-lymphocyte ratio and PLR levels did not differ between favorable and unfavorable (mRS > 2 or GOS < 4) functional outcomes. No variables were significantly associated with angiographic vasospasm. Admission NLR and PLR presented no value for prediction of functional outcome or angiographic vasospasm risk. Further research is needed in this field.

Risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns

Objective: To analyze the risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns. Methods: A retrospective case series study was conducted. From January 2018 to August 2022, 361 patients with extensive burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 231 males and 130 females, aged 50 (36, 58) years, with total burn area of 45% (35%, 60%) total body surface area. According to the highest level of creatine kinase isoenzyme-MB (CK-MB) within 72 h post injury, the patients were divided into early myocardial injury group (CK-MB≥75 U/L, 182 patients) and non-early myocardial injury group (CK-MB<75 U/L, 179 patients). The following data of patients in the 2 groups were collected and analyzed, including gender, age, total burn area, admission time post injury, combination with shock on admission, combination with inhalation injury on admission; the main blood test indexes such as myocardial enzyme spectrum, blood routine, liver and kidney function, and electrolytes within 72 h post injury; and treatment outcomes and fatality rate. Data were statistically analyzed with chi-square test, independent sample t test, or Mann-Whitney U test. The multivariate logistic regression analysis was conducted to screen the independent risk factors for early myocardial injury and for death in patients with extensive burns. Results: There were statistically significant differences in gender, combination with shock on admission, total burn area, and admission time post injury of patients between the two groups (with χ2 values of 6.40 and 6.10, Z values of 5.41 and 3.03, respectively, P<0.05). There were no statistically significant differences in age, combination with inhalation injury on admission of patients between the two groups (P>0.05). The CK-MB, creatine kinase, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase, white blood cell count, neutrophil-to-lymphocyte ratio (NLR), alanine aminotransferase (ALT), aspartate aminotransferase, potassium, and hemoglobin within 72 h post injury were significantly higher than those in non-early myocardial injury group (with Z values of 15.40, 6.26, 7.59, 7.02, 2.64, 4.53, 4.07, 6.32, and 4.12, t=2.34, respectively, P<0.05), while the level of calcium was significantly lower than that in non-early myocardial injury group (Z=2.72, P<0.05). There were no statistically significant differences in other blood test indexes of patients between the two groups (P>0.05). The total burn area, admission time post injury, NLR and ALT within 72 h post injury were the independent risk factors for early myocardial injury in patients with extensive burns (with odds ratios of 1.03, 1.07, 1.04, and 1.02, 95% confidence intervals of 1.02-1.05, 1.00-1.11, 1.02-1.07, and 1.00-1.03, respectively, P<0.05). The fatality rate of patients in early myocardial injury group was 8.8% (16/182), which was significantly higher than 2.8% (5/179) in non-early myocardial injury group (χ2 =5.93, P<0.05). Early myocardial injury, age, combination with shock on admission, and combination with inhalation injury on admission were the independent risk factors for death in patients with extensive burns (with odds ratios of 3.60, 1.04, 6.53, and 3.14, 95% confidence intervals of 1.17-11.05, 1.01-1.07, 1.39-30.68, and 1.15-8.56, respectively, P<0.05). Conclusions: The total burn area, admission time post injury, NLR and ALT within 72 h post injury were the independent risk factors for early myocardial injury in patients with extensive burns. Patients with extensive burns with early myocardial injury have a higher fatality rate, and early myocardial injury is an independent risk factor for the patients' death.

High Neutrophil-to-Lymphocyte Ratio Predicts One-Year Risk of Pneumonia Post-Stroke Discharge

Introduction: The neutrophil-to-lymphocyte ratio (NLR) may predict stroke-associated pneumonia, which is generally defined as pneumonia occurring in the first week after stroke. However, little is known whether the initial NLR is associated with pneumonia risk during the long-term follow-up in stroke survivors. We aimed to determine the relationship between admission NLR and the risk of post-stroke pneumonia within 1 year after discharge from acute stroke care. Methods: Hospital databases were searched to identify adult patients hospitalized for acute stroke. Admission NLR was extracted using differential leukocyte counts. The outcome of interest was hospitalized pneumonia occurring within 1 year after discharge from hospitalization for stroke. Multivariable Cox proportional-hazards models were used to determine the independent effects of the NLR on the risk of pneumonia. Results: In this study, 5,741 patients with acute stroke (mean age, 68 years; men, 62.1%) were analyzed. The median NLR was 2.72 (interquartile range, 1.78–4.49). Of the patients, 342 (6.0%) developed pneumonia within 1 year after discharge. In the multivariable models, the NLR was a significant predictor of pneumonia after discharge whether it was analyzed as a continuous or dichotomized variable. The corresponding adjusted hazard ratios were 1.037 (95% confidence interval [CI], 1.013–1.061) and 1.361 (95% CI, 1.087–1.704), respectively. Conclusion: The NLR could predict the risk of post-stroke pneumonia up to 1 year after discharge from acute stroke care. It may help identify high-risk stroke survivors, for whom appropriate interventions can be targeted.

STUDY OF NEUTROPHIL TO LYMPHOCYTE RATIO AS A PROGNOSTIC MARKER IN ACUTE ST ELEVATED MYOCARDIAL INFARCTION

Objectives: Previous studies have demonstrated the role of inflammation in acute STEMI. We examined cellular inflammatory response to STEMI in the blood and its association with in-hospital mortality and/or adverse clinical events. The neutrophil-to-lymphocyte ratio (NLR) was found to be a useful inflammatory marker for predicting adverse outcomes. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would be associated with increased adverse outcomes in patients with acute STEMI. Material and Methods: The study consisted of 100 patients with acute STEMI who were admitted in various wards of M.B.S. Hospital, Kota in year 2018-20, after obtaining informed consent. The complete blood cell count (CBC) was obtained from all patients within 12-24 hours of the onset of symptoms. Total leukocytes were counted and differential count was obtained for neutrophils, lymphocytes and neutrophil/lymphocyte ratio (NLR) were evaluated. The patients were divided into two groups [High NLR and Low NLR] according to their admission NLR results. Association of cellular response (NLR) with the incidence of post-MI mortality/complications was assessed by using chi-square test with yates correction. Results showed that patients with increase Results: d NLR at admission were having increased in hospital complication and mortality at 5 days. In-hospital mortality and post-STEMI complication rate were 9% and 42%, respectively. Patients in high NLR group had higher rate of complications (69.4% vs. 26.5%, p &lt;0.001) and death (19.4% vs. 3.12%, p=0.018) in hospital than those in low NLR group. Cardiogenic shock (36.11% vs.3.12%, p &lt;0.001), pulmonary edema (44.44% vs. 9.37%, p&lt;0.001), heart failure (55.55% vs. 23.43%, p=0.003), arrhythmias (33.33% vs. 9.37%, p =0.006) occurred more in high NLR group. Risk factors were not found to have a major impact on NLR. Differences of the risk factor data in the both groups were not statistically significant (P &gt; 0.05) in our study. It can be concluded that in patients with acute STEMI, NLR can be tak Conclusion: en as simple, inexpensive, reproducible and universally available inflammatory biomarkers for determining in-hospital mortality and complications.

Admission neutrophil-to-lymphocyte ratio predicts length of hospitalization and need for ICU admission in adults with Status Epilepticus

Background and objectivesStatus epilepticus (SE) is a time-dependent neurological emergency. The current study evaluated the prognostic value of admission neutrophil-to-lymphocyte ratio (NLR) in patients with status epilepticus. MethodsIn this retrospective observational cohort study we included all consecutive patients discharged from our neurology unit with the clinical or EEG diagnosis of SE from 2012 to 2022. Stepwise multivariate analysis was conducted to test the association of NLR with length of hospitalization, need for Intensive Care Unit (ICU) admission and 30 days mortality. Receiver operating characteristic (ROC) analysis was performed to identify the best cutoff for NLR to identify patients who will need ICU admission. ResultsA total of 116 patients were enrolled in our study. NLR was correlated with length of hospitalization (p = 0.020) and need for ICU admission ( p = 0.046). In addition, the risk of ICU admission increased in patients with intracranial hemorrhage and length of hospitalization was correlated with C-reactive protein-to-albumin ratio (CRP/ALB). ROC analysis identified a NLR of 3.6 as best cutoff value to discriminate need of ICU admission (area under the curve [AUC]=0.678; p = 0.011; Youden's index=0.358; sensitivity, 90.5%, specificity, 45.3%). DiscussionIn patients with SE admission NLR could be a predictor of length of hospitalization and need for ICU admission.

Admission Neutrophil-to-Lymphocyte Ratio as a Predictive Factor in the Outcome of Acute Spontaneous Intracerebral Hemorrhage.

A growing body of evidence supports that inflammatory mechanisms are involved in secondary brain injury after intracerebral hemorrhage (ICH) which has implications on the morbidity and mortality of stroke patients. Neutrophil-to-lymphocyte ratio (NLR) is a comprehensive index marker of inflammation and immune status of a patient. The prognostic value of NLR in predicting in-hospital mortality and functional outcome of patients with spontaneous intracerebral hemorrhage will be assessed in this study. We retrospectively selected 151 hemorrhagic stroke patients, and demographic and clinical characteristics were collected and computed for NLR. Receiver operating characteristic analysis using Youden's index was utilized to determine the NLR cut-off value with the best sensitivity and specificity. The association of NLR with the in-hospital mortality and functional outcome was assessed using Logistic regression analysis. Pearson Product Model Correlation was employed to evaluate the correlation of NLR with ICH volume. Admission NLR >7 showed a significant association (p=<0.001 OR 7.99) with in-hospital mortality with a sensitivity of 70.83% and specificity of 72.82%. Furthermore, computed NLR of more than 6.4 showed significant association (p=0.040 OR 2.92) with poor functional outcome. However, our study revealed that admission NLR showed a low level of correlation (r=0.2968, p=0.002) with the volume of ICH. This study demonstrated that ICH patients with an elevated NLR is associated with increased in-hospital mortality and poor functional outcome and that NLR can be used to predict clinical outcome among patients with spontaneous ICH.

Neutrophil-lymphocyte ratio as a predictor of outcome following traumatic brain injury: Systematic review and meta-analysis.

The neutrophil-to-lymphocyte ratio (NLR) is a simple and routinely performed hematological parameter; however, studies on NLR as a prognostic tool in traumatic brain injury (TBI) have yielded contradictory results. This systematic review and meta-analysis was conducted according to the Preferred Reporting Items in the Systematic Review and Meta-Analysis guidelines 2020. Electronic databases of PubMed, Cochrane Library, Web of Science, and Scopus were searched. The population consisted of TBI patients in the absence of moderate and severe extracranial injury. Day 1 NLR was taken for the analysis. The outcomes evaluated were mortality and the Glasgow Outcome Scale (GOS). No restrictions were placed on the language, year and country of publication, and duration of follow-up. Animal studies were excluded from the study. Studies, where inadequate data were reported for the outcomes, were included in the qualitative synthesis but excluded from the quantitative synthesis. Study quality was evaluated using the Newcastle-Ottawa scale (NOS). The risk of bias was estimated using the Cochrane RoBANS risk of bias tool. We retrieved 7213 citations using the search strategy and 2097 citations were excluded based on the screening of the title and abstract. Full text was retrieved for 40 articles and subjected to the eligibility criteria, of which 28 were excluded from the study. Twelve studies were eligible for the synthesis of the systematic review while seven studies qualified for the meta-analysis. The median score of the articles was 8/9 as per NOS. The risk of selection bias was low in all the studies while the risk of detection bias was high in all except one study. Ten studies were conducted on adult patients, while two studies reported pediatric TBI. A meta-analysis for GOS showed that high NLR predicted unfavorable outcomes at ≥6 months with a mean difference of -5.18 (95% confidence interval: -10.04, -0.32); P = 0.04; heterogeneity (I2), being 98%. The effect estimates for NLR and mortality were a mean difference of -3.22 (95% confidence interval: -7.12, 0.68), P = 0.11, and an I2 of 85%. Meta-analysis for Area under the curve (AUC) receiver operating characteristic of the included studies showed good predictive power of NLR in predicting outcomes following TBI with AUC 0.706 (95% CI: 0.582-0.829). A higher admission NLR predicts an increased mortality risk and unfavorable outcomes following TBI. However, future research will likely address the existing gaps.

Altered neutrophil-to-lymphocyte ratio in sepsis secondary to canine parvoviral enteritis treated with and without an immunomodulator in puppies.

Neutrophil-to-lymphocyte ratio (NLR) is a cheap and easy-to-obtain biomarker that mirrors the balance between innate and adaptive immunity. Cortisol and catecholamines have been identified as major drivers of NLR. High cortisol levels increase neutrophils while simultaneously decreasing lymphocyte counts. Likewise, endogenous catecholamines may cause leukocytosis and lymphopenia. Thus, NLR allows us to monitor patient severity in conditions such as sepsis. Twenty-six puppies with sepsis secondary to canine parvoviral enteritis were treated with and without an immunomodulator. Our group determined the NLR and the plasmatic cortisol levels by chemiluminescence, and norepinephrine (NE) and epinephrine (E) by HPLC during the first 72 h of clinical follow-up. Our results showed that at admission puppies presented an NLR value of 1.8, cortisol of 314.9 nmol/L, NE 3.7, and E 3.3 pmol/mL. Both treatments decreased admission NLR values after 24 h of treatment. However, only the puppies treated with the immunomodulator (I) remained without significant changes in NLR (0.7-1.4) compared to the CT group, and that showed a significant difference (P < 0.01) in their NLR value (0.4-4.6). In addition, we found significant differences in the slope values between the admission and final values of NLR (P < 0.005), cortisol (P < 0.02), and E (P < 0.05) between treatments. Then, our data suggest that the immunomodulator positively affects the number of lymphocytes and neutrophils involved in NLR as well as major drivers like cortisol and epinephrine, which is reflected in clinical parameters and survival.