Elevated NLR Research Articles

The severity of inflammation in major neuropsychiatric disorders: comparison of neutrophil–lymphocyte and platelet–lymphocyte ratios between schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and obsessive compulsive disorder

Background As non-specific markers of immune dysregulation, neutrophil–lymphocyte and platelet–lymphocyte ratios (NLR and PLR) have been consistently shown to be increased in major neuropsychiatric disorders. Although this increase seems to be trans-diagnostic, the extent to which its magnitude differs between disorders remains largely unclear. Aim The aim of this study was to directly compare the severity of inflammation (as reflected by NLR and PLR) between schizophrenia (Sch), bipolar mania (BD-M), bipolar depression (BD-D), major depressive disorder (MDD) and obsessive compulsive disorder (OCD). Methods NLR and PLR were obtained for a total of 417 subjects (91 Sch, 70 BD-D, 37 BD-M, 93 MDD, 37 OCD, and 95 controls) and analyzed for group differences. Results Sch, BD-M, BD-D and MDD presented with significantly higher NLR compared with both OCD and HC. NLR in BD-M was significantly higher than all the remaining groups, whereas Sch, BD-D and MDD presented with comparably elevated NLR. Moreover, BD-M, Sch and MDD had significantly higher PLR compared with HC. Conclusion These results suggest that the underlying inflammation may be most severe in BD-M, followed by Sch, BD-D and MDD. On the other hand, inflammation may be of negligible intensity in OCD, or at least undetectable by means of NLR or PLR.

Clinical and epidemiological profile of Indian COVID-19 patients from Jaipur: a descriptive study

We analyzed the data of 102 confirmed patients with novel Coronavirus 2 infection (COVID-19) during the early period of nationwide lockdown announced in India after the declaration of pandemic. We analyzed epidemiological, clinical characteristics and outcome of hospitalization in 102 patients with positive results for novel corona virus (SARS-CoV-2) RNA testing which were traced on the basis of history of travel, contact with a confirmed COVID-19 case, resident of hotspot areas or presence of symptoms, thus providing an accurate estimate of the proportion of asymptomatic cases in the initial population. Of 102 patients enrolled in the study, 83.3% (85/102) were asymptomatic and 16.67% (17/102) were symptomatic. Seventy-seven (75.49%) were males and 24.50% (25/102) were females. Eighteen (17.6%) patients had associated comorbidities, the most prevalent of which were diabetes mellitus 10.8% (11/102), hypertension 7.8% (8/102), chronic obstructive pulmonary disease (COPD) in 3.92% (4/102), chronic kidney Disease (CKD) 0.98% (1/102), coronary artery Disease (CAD) 0.98% (1/102) and cerebro-vascular disease (CVD) 0.98% (1/102). The clinical spectrum among symptomatic COVID-19 patients varied from dry cough and fever to respiratory failure and multi-organ failure. Twelve (11.76%) patients were kept in intensive care unit (ICU). Ninety-nine (97.05%) patients recovered while three (2.94%) died during hospital stay. With majority of COVID-19 cases in India being asymptomatic, changes in biochemical and inflammatory profile were small and insignificant in asymptomatic patients when compared to symptomatic patients. Elevated NLR, lymphopenia, age and presence of comorbidities were associated with increased severity and poor outcome.

Hospitalization Outcomes and Mortality Predictors of SARS-Cov-2 Infection in the Elderly: A Single Center Experience from India

Objectives: This study aimed to assess the outcome and mortality predictors of SARS-CoV-2 infection requiring hospitalization among elderly population. Methods: In this retrospective study, hospitalized elderly people with virologically confirmed SARS-CoV-2 infection were evaluated. Participants were divided into three groups of mild, moderate, and severe based on oxygenation. The primary outcome was death or discharge to home. Results: A total of 169 patients were studied (mean age: 68 years). Apart from respiratory symptoms, other reported symptoms included gastrointestinal complaints in 11% (n = 19), acute stroke in 1.1% (n = 2), delirium in 1.7% (n = 3), and anosmia or ageusia in 8.88% (n = 15). Also, 65 (38.5%) patients required oxygen support, 25 (14.7%) were admitted to the intensive care unit (ICU), 7 (4.1%) required non-invasive ventilation (Fio2 0.6 to 1.0), 14 (8.28%) were mechanically ventilated. 72 (42%) received steroid, and 100 (59%) received prophylactic heparin. Overall mortality was 12.4% (n = 21). Gender had no effect on mortality (P = 0.83). Presence of ≥ 3 risk factors, elevated neutrophil lymphocyte ratio, D-dimer, and lactate dehydrogenase, were associated with mortality (P = 0.001, P = 0.0005, P = 0.05, and P = 0.0005, respectively). Sepsis and cardiovascular events were higher among those who died. Conclusions: We observed a low mortality among the elderly treated with steroids compared to studies done in the pre-steroid period. Elevated NLR, LDH, and D-dimer were associated with mortality.

Neutrophil-to-Lymphocyte Ratio, a Novel Inflammatory Marker, as a Predictor of Bipolar Type in Depressed Patients: A Quest for Biological Markers.

(1) Background: Recent research suggests inflammation as a factor involved in the pathophysiology of mood disorders. Neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte (PLR), and systemic immune-inflammatory (SII) index ratios have been studied as peripheral markers of inflammation in bipolar and major depressive disorders. The purpose of this study is to comparatively analyze these inflammatory ratios among manic episodes of bipolar disorder, bipolar depression and unipolar depression. (2) Methods: 182 patients were retrospectively included in the study and divided into three groups: 65 manic patients, 34 patients with bipolar depression, and 83 unipolar depressive patients. White blood cells, neutrophils, monocytes, lymphocytes, and platelets were retrieved from the patients’ database. NLR, MLR, PLR, and SII index were calculated using these parameters. (3) Results: Patients with manic episodes had elevated NLR (p < 0.001), MLR (p < 0.01), PLR (p < 0.05), and SII index (p < 0.001) compared to unipolar depression and increased NLR (p < 0.05) and SII index (p < 0.05) when compared to bipolar depression. NLR (p < 0.01) and SII index (p < 0.05) were higher in the bipolar depression than unipolar depression. NLR is an independent predictor of the bipolar type of depression in depressive patients. (4) Conclusions: The results confirm the role of inflammation in the pathophysiology of mood disorders and suggest the ability of NLR as a marker for the differentiation of bipolar from unipolar depression.

Study of clinical parameters, diagnostics and outcome in patients with acute respiratory illness in a tertiary care centre during COVID-19 pandemic

Background: We retrospectively analyzed and compared 98 patients admitted in Intensive care unit (ICU) with symptoms of acute respiratory illness (ARI) during the era of COVID-19 pandemic.Methods: We examined patients presenting in emergency department of SMS Medical College, Jaipur between 3rd and 20th May, 2020 with symptoms of ARI who were tested for SARS-CoV-2. Among those hospitalized, we compared symptoms, vital signs, comorbidities, biochemical and hematological parameters including viral diagnostics. We determined differences in outcomes (ICU admission, interventions, acute respiratory distress syndrome and cardiac injury).Results: In a cohort of 98 patients with symptoms of ARI, 9 (9.183%) tested positive for SARS-CoV-2. Patients were divided into group A and B based on SARS CoV2 RNA testing. Among patients with additional viral testing, no co-infections with SARS-CoV-2 were identified by PCR. FDP and d-dimer was positive in 44.44% patients in group A and 68.53% in group B. 11.11% mortality was observed in group A and 14.606% in group B. The most common complication of ARI observed in both groups was coagulopathy 33.33% in group A and 42.696% in group B.Conclusions: Presence of comorbidities, lymphopenia, elderly age and elevated NLR, TLC, PLR and LDH have been associated with increased morbidity and mortality. Tuberculosis was most common coinfection seen in patients presenting with ARI. ARI due to non-COVID-19 illness was more severe than due to COVID-19 and was accompanied by multiple respiratory and systemic symptoms and was associated with hospitalization.

Eosinopenia and neutrophil-to-lymphocyte count ratio as prognostic factors in exacerbation of COPD

Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPDs) are one of the most important clinical aspects of the disease, and when requiring hospital admission, they significantly contribute to mortality among COPD patients. Our aim was to assess the role of eosinopenia and neutrophil-to-lymphocyte count (NLR) as markers of in-hospital mortality and length of hospitalization (LoH) among patients with ECOPD requiring hospitalization. We included 275 patients. Eosinopenia was associated with in-hospital deaths only when coexisted with lymphocytopenia, with the specificity of 84.4% (95% CI 79.6–88.6%) and the sensitivity of 100% (95% CI 35.9–100%). Also, survivors presented longer LoH (P < 0.0001). NLR ≥ 13.2 predicted in-hospital death with the sensitivity of 100% (95% CI 35.9–100%) and specificity of 92.6% (95% CI 88.8–95.4%), however, comparison of LoH among survivors did not reach statistical significance (P = 0.05). Additionally, when we assessed the presence of coexistence of eosinopenia and lymphocytopenia first, and then apply NLR, sensitivity and specificity in prediction of in-hospital death was 100% (95% CI 35.9–100) and 93.7% (95% CI 90.1–96.3), respectively. Moreover, among survivors, the occurrence of such pattern was associated with significantly longer LoH: 11 (7–14) vs 7 (5–10) days (P = 0.01). The best profile of sensitivity and specificity in the prediction of in-hospital mortality in ECOPD can be obtained by combined analysis of coexistence of eosinopenia and lymphocytopenia with elevated NLR. The occurrence of a such pattern is also associated with significantly longer LoH among survivors.

Significance of preoperative hematologic scoring in predicting death among patients with non-metastatic renal cell carcinoma undergoing nephrectomy

PurposeNeutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are hematologic scoring and indicators of the systemic inflammatory response. The increasing use of NLR and PLR have been associated with poor outcome in various types of malignancy. We evaluated the effect of NLR and PLR on survival outcomes of nonmetastatic renal cell carcinoma (RCC). Materials and methodsWe retrospectively review 150 patients who had undergone nephrectomy for nonmetastatic RCC between 2006 and 2016. Cancer specific survival (CSS) was assessed using Kaplan–Meier method and compared using log-rank test. We applied univariate and multivariate Cox regression model to analyze the association of NLP and PLR with clinical outcome. ResultsAt median follow up of 33 months, 45 patients had died. High PLR (>100) was an independent prognostic hematologic marker for CSS (hazard ratio [HR] 2.61, 95% confidence interval [CI],1.08–6.31; P = 0.034). Univariate analysis identified elevated NLR (p = 0.005), and anemia (p = 0.023) were significantly associated with CSS. ConclusionElevated PLR is a strong hematologic prognosis factor in term of survival for patients with nonmetastatic RCC undergoing nephrectomy with curative intent. The PLR is an easily obtained biomarker which is useful for preoperative risk stratification.

Prognostic value of systemic immune-inflammation index in patients with urinary system cancers: a meta-analysis.

The systemic immune-inflammation index (SII), an inexpensive and widely available hematologic marker of inflammation, has been linked to tumor progression, metastatic spread, and poor patient prognosis. The objective of this study is to explore the prognostic value of SII in patients with urinary system cancers (USCs). A comprehensive literature search was conducted by searching the PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang databases from inception to May 10, 2020, to identify potential studies that assessed the prognostic role of the SII in USCs. The hazard ratio (HR) with a 95% confidence interval (CI) were used to evaluate the correlation between SII and overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS) in USCs patients. A total of 12 studies, including 2,693 USCs patients, were eventually included in the meta-analysis. Elevated SII index was significantly associated with poor OS (HR=1.28, 95% CI: 1.17-1.39, p<0.001), PFS (HR=1.51, 95% CI: 1.25-1.82, p<0.001) and CSS (HR=3.42, 95% CI: 1.49-7.91, p<0.001). Furthermore, subgroup analysis indicated that higher SII than a cutoff value could predict poor OS in renal cell carcinoma (HR=1.23, p<0.001), prostate carcinoma (HR=1.95, p<0.001), bladder carcinoma (HR=5.40, p<0.001), testicular cancer (HR=6.09, p<0.001) and upper tract urothelial carcinoma (HR=2.19, p<0.001). Besides, these associations did not vary significantly by tumor subtypes and stages of USCs, sample sizes, study types, cutoff value defining elevated NLR, treatment methods, and NOS scores. SII may serve as a useful prognostic indicator in USCs and contribute to prognosis evaluation and treatment strategy formulation. However, more well-designed studies are warranted to verify our findings.

Chronic stress promotes acute myeloid leukemia progression through HMGB1/NLRP3/IL-1β signaling pathway.

Acute myeloid leukemia (AML) is an aggressive hematologic malignancy with poor prognosis and overall survival. Clinical investigations show that chronic stress is commonly present in the course of AML and associated with adverse outcome. However, the underlying molecular mechanisms are elusive. In the present study, a chronic restraint stress mouse model was established to evaluate the effect of stress on AML. We found that mice under chronic stress exhibited significantly increased liver and spleen infiltration of leukemic cells and poorer overall survival. This was accompanied by elevated cellular NLR family pyrin domain containing 3 (NLRP3) and interleukin-1β (IL-1β) in the liver or bone marrow, and secreted IL-1β in the plasma, indicating the activation of inflammasomes under chronic restraint stress. High mobility group box 1 (HMGB1) expression was markedly increased in newly diagnosed AML patients, but reduced in complete remission AML patients. The expression level of HMGB1 was positively correlated with NLRP3 mRNA in AML patients. Knockdown of HMGB1 significantly decreased NLRP3 and IL-1β expression in AML cell lines, and secreted IL-1β in supernatant of AML cell culture, while HMGB1 stimulation caused contrary effects. These results implied that HMGB1 could be involved in the regulation of inflammasome activation in AML development. Mice model showed that chronic restraint stress-facilitated proliferation and infiltration of AML cells were largely abrogated by knocking down HMGB1. Knockdown of HMGB1 also ameliorated overall survival and remarkably neutralized NLRP3 and IL-1β expression under chronic restraint stress. These findings provide evidences that chronic stress promotes AML progression via HMGB1/NLRP3/IL-1β dependent mechanism, suggesting that HMGB1 is a potential therapeutic target for AML. KEY MESSAGES: • Chronic restraint stress promoted acute myeloid leukemia (AML) progression and mediated NLRP3 inflammasome activation in xenograft mice. • HMGB1 mediated NLRP3 inflammasome activation in AML cells. • Knockdown of HMGB1 inhibited AML progression under chronic stress in vivo.

Prognostic Utility of Pretreatment Neutrophil-Lymphocyte Ratio in Advanced Larynx Cancer.

Purpose:Neutrophil-lymphocyte ratio has been explored as a prognosticator in several cancer types, but its association with larynx cancer outcomes is not well known. We aimed to identify an optimal NLR cutoff point and examine the prognostic utility of this biomarker in patients with locoregionally advanced larynx cancer treated with curative intent.Methods:In the Veterans Affairs’ (VA) national database, we identified patients with locoregionally advanced (T3-4N0-3M0) laryngeal squamous cell carcinoma diagnosed between 2000 and 2017 and treated with curative intent. NLR cutoff points were calculated using Contal/O’Quigley’s method. Outcomes of larynx cancer-specific survival (CSS), overall survival (OS), and non-larynx cancer survival (NCS) were evaluated in multivariable Cox and Fine-Gray models.Results:In 1047 patients, the optimal pretreatment NLR cutoff was identified as 4.17 - 722 patients with NLR ⩽ 4.17, 325 patients with NLR > 4.17. The elevated NLR cohort had a higher proportion of T4 disease (39.4% vs 28.4%), node positive disease (52.3% vs 43.1%), and surgical treatment (43.7% vs 35.2%). In multivariable analysis, NLR > 4.17 was independently associated with worse OS (HR 1.31, 95% CI 1.12-1.54, P = .001) and worse CSS (HR 1.46, 95% CI 1.17-1.83, P < .001), but not with NCS (HR 0.94, 95% CI 0.75-1.18, P = .58).Conclusion:In locoregionally advanced larynx cancer treated with curative intent, we identified elevated NLR to be associated with inferior OS and CSS. Further prospective studies are needed to investigate pretreatment NLR and our identified 4.17 cutoff as a potential larynx cancer-specific marker for this high risk population.

Neutrophils-to-Lymphocytes Ratio in Children with Acute Heart Failure

Background: Heart failure is a common cause of morbidity and mortality in pediatric patients in the third world. Heart failure in children occurs due to heart lesions that cause volume overload as in large ventricular septal defect or due to lesions that causes obstruction to flow as in aortic stenosis. Objective: This study aimed to evaluate the neutrophils to lymphocytes ratio in children with heart failure & to investigate if this ratio is helpful in predicting mortality and adverse outcome in those patients. Patients and methods: Our study was performed over a number of 80 children 40 of them were having CHD with acute heart failure, 20 of them were congenital heart disease (CHD) without failure and 20 of them were normal. The was conducted in Pediatric Cardiology Unit and Pediatric ICU, Zagazig University Children Hospitals during the period from February 2017 till May 2018. Results: Our present work showed that neutrophils, CRP and NLR were statistically higher in the Heart failure group compared to cardiac group and control group. While lymphocytes and oxygen saturation (SO2) were statistically lower in the heart failure group. The echocardiographic findings showed that compared to cardiac group, the heart failure group was significantly higher regarding PAP and LVEDD but significantly lower regarding EF and FS. Conclusion: Elevated NLR seems to be a predictor of short-term mortality in patients with acute heart failure.

Preoperative Risk Classification Using Neutrophil-to-Lymphocyte Ratio and Albumin for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy.

PurposeTo improve the preoperative prediction of the outcomes of patients diagnosed with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), we explored various preoperative laboratory factors and established a prognostic risk stratification method.Patients and MethodsWe retrospectively reviewed 232 UTUC patients who underwent RNU from September 2010 to October 2019 and analyzed their comprehensive clinicopathologic data and preoperative blood-based biomarkers. Kaplan–Meier analysis, receiver-operating characteristic (ROC) curves analysis and Cox regression analysis were performed to assess the relationship between these factors and the prognosis.ResultsThe median follow-up and age were 24 months and 68.5 years, respectively. Preoperative elevated neutrophil-to-lymphocyte ratio (NLR > 3.44) and decreased albumin (ALB < 39.8 g/L) were negatively correlated with progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) in both univariate and multivariate analyses. Patients were sorted into three groups based on their NLR and ALB: the low-risk group (neither elevated NLR nor decreased ALB), intermediate-risk group (either elevated NLR or decreased ALB) and high-risk group (elevated NLR and decreased ALB). Their 5-year PFS rates were 77.8%, 52.6% and 32.3%; their 5-year CSS rates were 97.7%, 71.4% and 32.9%; and their 5-year OS rates were 92.7%, 70.4% and 29.2%, respectively (all P < 0.0001). ROC curves analysis showed that NLR plus ALB had a more accurate prognostic value (P < 0.05).ConclusionPreoperative risk classification using NLR and ALB was identified as an independent prognostic factor for patients with UTUC. The combination of NLR and ALB may help to determine the most appropriate treatment options before RNU.

Association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume with the risk of gestational diabetes mellitus

Objective In the present study, we aimed to investigate the correlation of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume with the risk of gestational diabetes mellitus. Methods The study enrolled 120 pregnant women who were the 24th and 28th weeks of gestation, including GDM group (n = 58), the control group (n = 62). The NLR, PLR and MPV levels were measured. Results NLR, PLR and MPV were significantly higher in GDM compared with control group. Logistic regression analysis showed that elevated WBC, NLR, PLR and MPV was an independent variable for predicting GDM in pregnancy. The OR and 95% CI was (OR: 1.6, 95% CI: 1.2–2.5), (OR: 4.1, 95% CI: 1.3–13.1), (OR: 5.5, 95% CI: 1.5–20.0), (OR: 4.0, 95% CI: 1.2–12.0), respectively. Conclusion Increased WBC, PLR, NLR, MPV were independent predictors of GDM.

The Combination of Preoperative Nutritional Risk Screening-2002 and Neutrophil-to-Lymphocyte Ratio is a Useful Prognostic Marker in Patients with Esophageal Squamous Cell Carcinoma

The aim of this study was to investigate the prognostic values of a novel evaluated system, named the CONN (combination of Nutritional Risk Screening 2002 [NRS-2002] and neutrophil-to-lymphocyte ratio [NLR]), in patients with esophageal squamous cell carcinoma (ESCC) by curative esophagectomy. A total of 278 patients with ESCC receiving standard curative esophagectomy were retrospectively analyzed. The CONN was calculated by combined NRS-2002 and NLR according to the corresponding cutoff values: patients with both elevated NRS-2002 (≥3.0) and NLR (≥3.0) were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively. In our univariate analysis, the following factors were significantly associated with poor PFS and OS: T stage, N stage, TNM stage, NLR, NRS-2002 and CONN (all P < 0.05). Furthermore, multivariate Cox regression analysis showed that N stage (P = 0.039), NRS-2002 (P = 0.041) and CONN (P = 0.001) were independent prognostic factors for PFS. While T stage (P = 0.017), N stage (P = 0.048), NLR (P = 0.021), NRS-2002 (P = 0.001) and CONN (P = 0.001) were independent prognostic factors for OS. In conclusion, CONN was an independent prognostic marker for survival prediction in patients with ESCC receiving surgery.

M62. PERIPHERAL INFLAMMATION MARKERS IDENTIFY SUBSET OF PATIENTS WITH SCHIZOPHRENIA AND RELATED PSYCHOSES WHO HAVE INTELLECTUAL DECLINE FROM PREMORBID LEVELS

BackgroundHigher inflammation has been identified in a substantial subset of both high-risk and chronically ill patients with schizophrenia and related psychoses and this may account for some of the heterogeneity of the schizophrenia. There is also much heterogeneity in cognitive deficits related to schizophrenia with some patients showing a marked decline from premorbid intellectual levels while others show little change from either normal or low intellect. However, the relationship between intellectual change with the illness onset and inflammation in schizophrenia has not been established.MethodsHere, we report the assessment of two common markers of inflammation from two independent samples of generally chronically ill patients with schizophrenia and related psychoses (one sample of 73 patients versus 70 healthy controls from Sydney, NSW, Australia and one sample of 297 patients from Syracuse, NY, USA). Peripheral venous blood samples were collected from all patients and blood markers of inflammation (C-Reactive Protein, CRP, and Neutrophil to Lymphocyte Ratio, NLR) were assayed using standard procedures. Assessment of premorbid and current intellectual abilities were obtained from the Sydney cohort of patients.ResultsGrouping the patients and controls from the Sydney sample into those with elevated (> 3 mg/L) versus normal (< 3 mg/L) CRP levels revealed 42% of the patients versus 20% of the healthy controls had elevated CRP (Chi Square = 9.16, p = .002) and further evidence of inflammation with an elevated mean NLR of 2.5. The frequency of peripheral inflammation was confirmed by the independent sample from Syracuse in which 39% of the patients (n= 115) had an elevated NLR above a cutoff score for normal of 2.2 which was consistent with the Sydney sample. Patients from the Sydney sample who had an elevated CRP also had a significant mean 15-point IQ decline from premorbid IQ levels, whereas the patients with CRP levels within normal limits did not show a statistically significant drop in IQ from premorbid levels (mean IQ decline 7.6 points). Healthy controls with normal CRP had no IQ change (0.0 points) and healthy controls with elevated CRP has a slight, non-significant IQ decline (mean 2.3 points).DiscussionThus, our study showed supportive evidence of elevated peripheral inflammation markers in subgroups of chronically ill patients with schizophrenia from two independent samples and a link between marked intellectual decline from premorbid levels and current peripheral inflammation in one chronically ill subgroup of patients with schizophrenia suggesting a role for inflammation in the cognitive impairment of a substantial proportion (40%) of patients with schizophrenia.

The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients

AimTo accumulate evidence that indicated the key role played by virus-triggered inflammation in the 2019-novel coronavirus disease (COVID-19) which emerged in Wuhan City and rapidly spread throughout China. MethodsAge, neutrophil(NEU)-to-lymphocyte (LYM) ratio (NLR), lymphocyte-to-monocyte (MON) ratio, platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) of 93 patients with laboratory confirmed COVID-19 were investigated and compared. The receiver operating characteristic curve was applied to determine the thresholds for five bio-markers, and their prognostic values were assessed via the Kaplan–Meier curve and multivariate COX regression models. ResultsThe median age was 46.4 years old, and 37cases were females. A total of 27.8% of patients had been to Wuhan, and 73.1% had contacted with people from Wuhan. Fever (83.8%) and cough (70.9%) were the two most common symptoms. Elevated NLR and age were significantly associated with illness severity. The binary logistic analysis identified elevated NLR (hazard risk [HR] 2.46, 95% confidence interval [CI] 1.98–4.57) and age (HR 2.52, 95% CI 1.65–4.83) as independent factors for poor clinical outcome of COVID-19. NLR exhibited the largest area under the curve at 0.841, with the highest specificity (63.6%) and sensitivity (88%). ConclusionsElevated age and NLR can be considered independent biomarkers for indicating poor clinical outcomes.

The systemic immune-inflammation index predicts prognosis in intrahepatic cholangiocarcinoma: an international multi-institutional analysis

BackgroundThe objective of this study was to examine whether the systemic immune inflammation index (SII) was associated with prognosis among patients following resection of intrahepatic cholangiocarcinoma (ICC). MethodsThe impact of SII on overall (OS) and cancer-specific survival (CSS) following resection of ICC was assessed. The performance of the final multivariable models that incorporated inflammatory markers (i.e. neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR] and SII [platelets∗NLR]) was assessed using the Harrell's concordance index. ResultsPatients with high SII had worse 5-year OS (37.7% vs 46.6%, p < 0.001) and CSS (46.1% vs 50.1%, p < 0.001) compared with patients with low SII. An elevated SII (HR = 1.70, 95% CI 1.23–2.34) and NLR (HR = 1.58, 95% CI 1.10–2.27) independently predicted worse OS, whereas high PLR (HR = 1.17, 95% CI 0.85–1.60) was no longer associated with prognosis. Only SII remained an independent predictor of CSS (HR = 1.55, 95% CI 1.09–2.21). The SII multivariable model outperformed models that incorporated PLR and NLR relative to OS (c-index; 0.696 vs 0.689 vs 0.692) and CSS (c-index; 0.697 vs 0.689 vs 0.690). ConclusionSII independently predicted OS and CSS among patients with resectable ICC. SII may be a better predictor of outcomes compared with other markers of inflammatory response among patients with resectable ICC.

Prognostic significance of inflammatory indices in hepatocellular carcinoma treated with transarterial chemoembolization: A systematic review and meta-analysis.

ObjectivesTo investigate the association between inflammatory indices and clinical outcomes of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) by performing meta-analysis.MethodsA systematic literature search for relevant studies published up to August 2019 was performed by using PubMed, Web of Science, EMBASE, China National Knowledge Internet (CNKI) and Wanfang databases. Pooled hazard ratios (HR) or odds ratio (OR) and 95% confidence intervals (95% CI) were calculated.ResultsA total of 5280 patients from 22 studies were finally enrolled in the meta-analysis. The results demonstrated that elevated preoperative NLR, PLR, and CRP was associated with poor OS in HCC patients treated by TACE (HR = 1.81, P<0.00001; HR = 1.56, P = 0.007; HR = 1.45, P<0.00001, respectively). In addition, high NLR was significantly correlated with the presence of tumor vascular invasion (OR = 1.49, P = 0.002). Elevated PLR tended to be correlated with higher incidence of tumor size>3 cm (OR = 2.42, P = 0.005).ConclusionsElevated preoperative NLR, PLR, and CRP are associated with poor prognosis in HCC patients treated with TACE. These inflammatory indices may be convenient, accessible, affordable and dependable biomarkers with prognostic potential for HCC patients treated by TACE.

3:45 PM Abstract No. 27 Neutrophil-lymphocyte ratio correlates with survival in MUlticenter Study of RAS Mutations (MURAS) in patients with colorectal liver metastases receiving Y90 radioembolization treatment

To assess the clinical outcome and prognostic factors of patients receiving Y90 radioembolization to treat colorectal liver metastases. Multi-institution retrospective study of patients with CRLM who received Y-90 radioembolization after undergoing molecular testing was performed. Patients treated between 2008 and 2019 were included from 7 institutions within the United States and Europe. Patient demographics, systemic therapy regimens, tumor characteristics, laboratory values and overall survival were analyzed between patients with differing histopathologic and genomic status. Neutrophil-Lymphocyte Ratio was calculated using pretreatment lab values. Kaplan-Meier survival estimation and multivariate Cox regression were analyzed. 445 patients treated with Y90 radioembolization fulfilled the inclusion criteria. Of the total cohort, those available patients who had documented pre-Y90 lab values available within 30 days prior to treatment were evaluated. Average age at diagnosis was found to be 59.9 years for all patients (59.4% female, 40.6% male). Decreased survival post Y90 treatment was shown in those patients with elevated Neutrophil-to-lymphocyte ratio (> 2.0). The median survival in patients with elevated NLR was 7.5 months, as compared to 11.5 months in those patients with normal NLR pretreatment (P = 0.02). Patient demographics including age, gender and race were not shown to be significant in overall survival post-Y90 treatment (P values >0.05). The average number of systemic chemotherapy treatments prior to Y90 was 2.15 and was similar between NLR subgroups (elevated vs. normal). NLR persisted as a significant predictor of survival on multivariate analysis (p = 0.038; HR 1.68 CI: 1.03-2.86.) Pretreatment neutrophil-to-lymphocyte ratio is a significant prognostic factor in patients with colorectal liver metastases receiving Y90 radioembolization.

Retrospective analysis of prognostic value of neutrophils to lymphocyte ratio and platelet count in patients with colorectal carcinoma

Background: Colorectal cancer (CRC) is the third most common cancer in men and second in women with 1.8 million new cases (1,026,000 men and 823, 3 women) and almost 881.000 deaths. Rates are substantially higher in males than in females Worldwide in 2018.Aim of the work: In this retrospective study we aimed to evaluate the prognostic impact of baseline NLR and platelet count on the clinicopathological factors and outcome in patients of all stages Colorectal cancer treated from 1st of January 2014 to the end of December 2016 in Department of Clinical Oncology and Nuclear Medicine, Ain Shams University hospitals, Cairo, Egypt.Patients and methods: Out of 409 patient’s medical records in the GI oncology unit, Ain Shams Clinical Oncology Department were reviewed from the period between 1st of January 2014 to 30 December 2016. Total neutrophils, lymphocytic, and platelets’ counts were available for only 169 patients. Study ended in 1st of August 2018 with median period of follow up of 27.5 month, ranging between 1/1/2014 to 1/8/2018. All patients (169) were pathologically proven colorectal adenocarcinoma, with age ranging from 18-75 years old (median age: 55.5 yrs.)Results: Out of 169 patients enrolled in this study, 124 patients were resectable and underwent curative surgeries, 44 patients tumour was right located and 80 patient’s tumour located in the left sided colon. 45 patients were metastatic from the start. Postoperative Platelets ≥ 310 in our study was statistically significant regarding OS, PFS and DFS (P values &lt;.001, &lt;.001 and 0.007) respectively. Pre-treatment platelet revealed more frequent thrombocytosis in metastatic group than locally advanced group, yet statistically was not significant (P Value = .066). Postoperative NLR ≥ 2 was significant regarding OS, PFS and DFS among 169 enrolled patients (P values &lt;.001, .002 and &lt;.001) respectively. In the multivariate analysis, elevated postoperative NLR was proven as both independent prognostic and predictor factor for DFS, PFS and OAS. (sig. =.03, .03, ≤ 0.001 respectively). And platelet count is both independent prognostic factor and predictor for both PFS, OS with significance =.04, =.03 respectively).Conclusion: Abnormal NLR ratio (≥ 2) acting as a prognostic and predictor of decrease in DFS, PFS and OS in all patients groups. It also showed that abnormal platelet count (≥ 310) is prognostic and predictor of significant decrease in PFS and OS. Multidisciplinary management is needed to aware surgeons about importance of adequate lymph node dissection, our study showed a statistically significant decrease in OAS in patients underwent inadequate LNs dissection.