High Level Of Neutrophil/lymphocyte Ratio Research Articles

What can be learned from real-world data about chronic spontaneous urticaria?

Background: Chronic spontaneous urticaria (CSU) is a common disease with complex pathogenesis. Patients' clinical characteristics and responses to treatment vary. Objective: We aimed to investigate the role of data obtained from routinely recommended tests in predicting the response to omalizumab, the only biologic agent approved for treatment, and in defining the clinical characteristics of the patients. Methods: A retrospective study of patients who started omalizumab treatment for CSU between 2015 and 2022 at the Department of Dermatology, Pamukkale University, was conducted. Response criteria were based on the urticaria control test, and patients with a urticaria control test score <12 at 6 months were considered treatment non-responders. Eosinophil and basophil counts, neutrophil-lymphocyte ratio (NLR), systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and total immunoglobulin E (IgE) levels of the patients were evaluated before treatment and at the sixth month of treatment. Results: A total of 23.1% of the patients were unresponsive to omalizumab. The response rate to the omalizumab treatment of the patients with a total IgE level ≤ 30 IU/L (n = 4 [5.7%]) was significantly lower than patients with total IgE level > 30 IU/L (n = 66 [94.3%]) (p = 0.015). The mean ± standard deviation SIRI levels were significantly higher in non-responders versus responders (1.53 ± 1.03 versus 1.15 ± 7.76; p = 0.026). Eosinophil counts positively correlated with basophil counts (r = 587; p < 0.001) and IgE levels (r = 0.290; p = 0.005) but a negative correlation was found with levels of NLR (r = -0.475; p < 0.001), SIRI (r = -0.259; p = 0.013), and SII (r = -0.285; p = 0.006). NLR levels were lower in CSU patients with atopy, than in those without atopy (1.9 ± 0.9 vs 2.9 ± 2.1, p = 0.022). Conclusion: We suggest that eosinopenia and high NLR levels are linked to autoimmune CSU. Predicting a poor response to omalizumab seems possible with total IgE levels < 30 IU/L and high SIRI levels.

Biomarker array for prediction of acute kidney injury after percutaneous coronary intervention for patients who had acute ST segment elevation myocardial infarction

Acute kidney injury (AKI) is a common complication after Percutaneous Coronary Intervention (PCI) for ST segment elevation myocardial infarction (STEMI) and is associated with poor outcomes. AKI is diagnosed by the dynamic change of serum Cr, but it could not predict AKI. This study aimed to evaluate a biomarker array that may fulfill this shortage. Setting: Cardiology Department, Tanta University Hospital. Design: Prospective interventional study included 280 acute STEMI patients who underwent emergency PCI. Serial samples of blood and urine were obtained at the time of admission to the hospital (T0) and PCI unit (T1) and at 12 h and 72 h (T12 and T72) after coronary revascularization to estimate levels of serum Cr, creatine phosphokinase, and heart-type fatty acid-binding protein (H-FABP) and calculation of neutrophil/lymphocyte ratio (NLR) and urinary liver-type FABP (L-FABP). AKI was diagnosed according to the recommendations of the European Renal Best Practice as the times of increased serum Cr concerning baseline level. 85 patients developed AKI. Regression analyses defined a high NLR ratio in the T0 sample as the most significant predictor for early AKI diagnosed at T1 time, while high NLR and serum H-FABP levels in T1 samples as the significant predictors for AKI defined at T12 time. However, high urinary L-FABP levels in T12 samples and high NLR are significant predictors for AKI at T72 time. Combined estimations of serum H-FABP and urinary L-FABP with the calculation of NLR could predict the oncoming AKI and discriminate its pathogenesis. The study protocol was approved by the Local Ethical Committee at Tanta Faculty of Medicine by approval number: 35327/3/22. For blindness purposes, the authors will be blinded about the laboratory results till the end of 72 h after revascularization and the clinical pathologist will be blinded about the indication for the requested investigations.

The Association of Neutrophil Lymphocyte Ratio and Glycemic Markers in Hemodialysis Patients

Background/aims: Neutrophil lymphocyte ratio was found to be as an inflammation marker in the preceding decade and recently related with glycemic indices in patients with diabetes mellitus. The target of this research was to explore the association of neutrophil lymphocyte ratio and glycemic indices in hemodialysis population. Methods: 177 hemodialysis patients (98 diabetic and 79 non-diabetic) aged 56.08±16.06 years were enrolled in this research. Neutrophil lymphocyte ratio was calculated and its association with predialysis glucose and HbA1c was studied. Results: NLR was positively correlated with predialysis glucose (p=0.000, r=0.338), body mass index (p=0.029, r=0.220), white blood cell (p=0.000, r=0.430), platelet (p=0.034, r=0.159), neutrophil (p=0.000, r=0.656) and C-reactive protein (p=0.00, r=0.377) levels. In non-diabetic hemodialysis group, predialysis glucose was still correlated with neutrophil lymphocyte ratio (p=0.047, r=0.224). Diabetics had higher predialysis glucose (185.94±81.11 vs 111.24±25.59, p=0.000) and neutrophil lymphocyte ratio (4.99±4.17 vs 2.82±1.23, p=0.000) compared to non-diabetics. Conclusion: This study revealed that predialysis glucose levels in hemodialysis patients are correlated with neutrophil lymphocyte ratio and hemodialysis patients with diabetes have higher neutrophil lymphocyte ratio levels. Neutrophil lymphocyte ratio should be recognized as a glycemic control marker along with traditional glycemic indices in HD patients.

Prognostic importance of neutrophil-lymphocyte ratio in non-dialysis chronic kidney disease patients—a hospital-based prospective cohort

Aim: In patients with cancer, ischemic heart disease, and peripheral vascular disease, the neutrophil-lymphocyte ratio (NLR), a measure of systemic inflammation, has been demonstrated to predict mortality. This study aimed to evaluate the inflammatory status, and also examine the impact of NLR on renal outcomes (mortality and composite endpoints) in non-dialysis chronic kidney disease (CKD) patients. Methods: This prospective cohort was conducted at a tertiary care public teaching hospital. The NLR greater than 3.53 was taken as an indication of systemic inflammation. The outcome measures include composite endpoints (end-stage renal disease, dialysis commencement, doubling serum creatinine from the baseline), and mortality. Kaplan-Meier plots and a multivariate Cox proportional hazard model were employed to analyze the outcomes. Results: A cohort of 360 patients aged 53.7 years ± 13.9 years had a median follow-up of 14 months ± 4.24 months and was evaluated for inflammatory status and renal outcomes. The proportion of inflammation was found to be 101 (28.7%). Higher NLR levels had shown an increased incidence of mortality (5.3%) and composite endpoints (12.3%). In reference to the NLR quartile (Q1), the highest quartile (Q4) had shown 3 times increased hazards for mortality and 95.0% increased risk of hazards for composite endpoints Q4 hazard ratio (HR) 3.09; 95% confidence interval (CI) 1.38–6.91 (P = 0.006), and Q4 HR 1.93; 95% CI 1.22–3.08 (P = 0.005), respectively. Higher NLR was positively associated with urea, creatinine, alkaline phosphatase, Pt-Global web tool©/Patient-Generated Subjective Global Assessment score and negatively correlated with estimated glomerular filtration rate, albumin, hemoglobin. Conclusions: NLR is a potential predictor of mortality and composite endpoints in CKD patients even before they undergo dialysis. Additionally, inflammation should be regarded as a common comorbid condition in CKD patients due to its high prevalence.

The diagnostic value of the systemic immune-inflammatory index in acute appendicitis cases in the emergency department.

Acute appendicitis (AA) is one of the most common causes of acute abdomen conditions and continues to cause mortality and morbidity despite all the improvements. There is still a necessity for inexpensive and easily calculable index and scoring systems with fewer side effects for the diagnosis of AA and the detection of complications. Since the systemic immune-inflammation index (SIII) is an index that could be used in this context, we aimed to measure the success and reliability of SIII for the diagnosis of AA and related complications and to contribute to the literature. Our study was carried out retrospectively in a tertiary care hospital and conducted with 180 AA patients (study group-SG) and 180 control group (CG) patients. Demographic data, laboratory data, and clinical data of the cases, as well as the Alvarado score (AS), adult appendicitis score (AAS), and SIII and neutrophil/lymphocyte ratio (NLR) values calculated from laboratory data, were recorded in the previously created study form. p<0.05 was accepted as the significance level for the study. In this study, age and gender were similar in the SG and CG groups. SIII and NLR levels calculated in SG cases were found to be significantly higher than CG. In addition, SIII and NLR levels were found to be significantly higher in complicated AA cases than in complicated cases. Although SIII was more significant in the diagnosis of AA, NLR was more successful than SIII in detecting the presence of complications. SIII, NLR, AAS, and AS were significantly positively correlated in the diagnosis of AA. In the presence of peritonitis, SIII and NLR were also found to be significantly higher when compared to cases without peritonitis. We found that SIII is a usable index in the diagnosis of AA and the prediction of complicated AA. However, NLR was found to be more significant than SIII in estimating complicated AA. In addition, it is recommended to be careful in terms of peritonitis in cases with high SIII and NLR levels.

Kovid-19 Hastalarında NLR, D-Dimer ve MPV Değerleri Mortaliteyi ve Klinik Ciddiyeti Öngörebilir Mi?

Objective: In this study, we aim to determine the relationship between neutrophil/lymphocyte ratio (NLR), D-dimer, and mean platelet volume (MPV) parameters with mortality and clinical severity in Covid-19 patients. Materials and Methods: This retrospectively planned study included Covid-19 patients admitted to the emergency department between March 2020 and September 2020. Sociodemographic characteristics, laboratory parameters, and imaging results of the patients were obtained. The patients were grouped according to the development of mortality and clinical follow-up. Results: Seven hundred patients were included in the study and the mean age of the patients was 49.1±18.2 years. Mortality developed in 5.4% (n=38) of the patients. NLR, D-dimer, and MPV levels of patients who developed mortality were higher than those who survived (p&amp;lt;0.001; p &amp;lt;0.001 and p=0.035, respectively). In ROC analysis, &amp;gt;6 NLR levels, &amp;gt;8.45 MPV levels, and &amp;gt;0.57 D-dimer levels were found to be predictive for mortality (p&amp;lt;0.001; p=0.019; p &amp;lt;0.001, respectively). Conclusions: The high NLR, D-dimer, and MPV levels obtained at the time of admission in Covid-19 patients can be used as an indicator of mortality. Elevated NLR and D-dimer levels are useful in determining the severity of the disease and clinical follow-up.

Predictive value of neutrophil-to-lymphocyte ratio and neutrophil-to-monocyte ratio in severe traumatic brain injury: a retrospective cohort.

The neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), the lymphocyte-monocyte ratio (LMR), the neutrophil-monocyte ratio (NMR) and the systemic immune inflammation index (SII) are associated with clinical outcomes in oncological diseases, cardiovascular diseases, infectious / inflammatory diseases, endocrinological, pulmonary and brain injuries. Here, we investigate its association with hospital mortality in patients with severe traumatic brain injury. We retrospectively reviewed clinical data from patients with severe traumatic brain injury (sTBI) who were treated in our department between January 2015 and December 2020. NLR, PLR, NMR, LMR and SII data were collected between admission and day 3, as well as other indicators related. The relationship between hematological ratios and in-hospital mortality were analyzed. A total of 96 patients were included in study, hospital mortality was 40.6% (N.=39). The levels of NLR on admission (D0), NLR day 1 (D1), NLR day 2 (D2), NLR day 3 (D3), NMR day 1 (D1) and NMR day (2) remained significantly higher in patients with death intra-hospital (P=0.030; P=0.038; P=0.016; P=0.048; P=0.046 and P=0.001, respectively). Multivariate logistic analysis showed that higher NLR values at admission and day 2 NMR were associated with in-hospital mortality (OR=1.120, P=0.037; and OR=1.307, P=0.004, respectively). Analysis of the recipient operating characteristic (ROC) curve showed that the NLR on admission had a sensitivity of 59.0% and a specificity of 66.7% (area under the curve 0.630, P=0.031, Youden's Index 0.26) and the NMR of day 2 had a sensitivity of 67.7% and a specificity of 70.4% (area under the curve 0.719, P=0.001, Youden's index 0.38) to predict mortality intra-hospital based on the best threshold. Our analysis indicates that higher NLR levels on admission and day 2 NMR are independent predictors of in-hospital mortality in patients with sTBI.

The relationship between neutrophil-to-lymphocyte ratio and cerebral collateral circulation in patients with symptomatic severe intracranial artery stenosis or occlusion

BackgroundThe neutrophil/lymphocyte ratio (NLR) has been considered a prognostic indicator for determining the systemic inflammatory response and atherosclerosis. We aimed to determine the relationship between NLR and the development of cerebral collateral circulation in patients with symptomatic severe stenosis or occlusion of intracranial arteries. MethodsAll patients underwent digital subtraction angiography (DSA) within 14 days of admission and were divided into a group with good collateral circulation (77 patients) and a group with poor collateral circulation (86 patients) according to the DSA collateral compensation grading method. Apo B, total cholesterol, LDL, and Neutrophil count in the poor side branch group were significantly higher than in the good side branch group. Multifactorial analysis showed that high NLR levels were a valid predictor of poor collateral circulation in patients with symptomatic severe intracranial artery stenosis or occlusion. Spearman correlation analysis showed that the size of the collateral branch score was negatively correlated with NLR (r = −0.509, P < 0.001) and cholesterol content (r = −0.249, P = 0.002). NLR predicted poor collateral circulation with an AUC of 0.620 (sensitivity 66.7 %, specificity 61.3 %, 95 % CI = 0.517–0.723,P < 0.05). ConclusionWe demonstrate a correlation between NLR levels and the development of collateral circulation in the brain in patients with symptomatic severe stenosis or occlusion of the intracranial arteries.

Nomograms Based on Fibrinogen, Albumin, Neutrophil-Lymphocyte Ratio, and Carbohydrate Antigen 125 for Predicting Endometrial Cancer Prognosis.

Background: This study aimed to determine the prognostic value of the preoperative levels of fibrinogen, albumin (ALB), neutrophil-lymphocyte ratio (NLR), and carbohydrate antigen 125 (CA125) in endometrial cancer and to establish nomograms for predicting patient survival. Methods: Patients with endometrial cancer (n = 1483) who underwent surgery were included in this study, and their preoperative fibrinogen, ALB, NLR, and CA125 levels and clinicopathological characteristics were collected. Patients were randomized into a training cohort (70%, n = 1038) and an external validation cohort (30%, n = 445). The Cox regression analysis was performed using the data for the patients in the training cohort to identify independent prognostic factors; nomograms for predicting prognosis were established and validated. Results: High fibrinogen (≥3.185 g/L), NLR (≥2.521 g/L), and CA125 (≥35 U/mL) levels and low ALB (&lt;4.185 g/L) levels were independently associated with poor progression-free survival (PFS) and poor overall survival (OS) in patients with endometrial cancer. Prognostic prediction model nomograms were developed and validated based on these results. Calibration curves and C-indexes underscored the good predictive power of the nomograms, and both the net reclassification index (NRI) and integrated discrimination improvement (IDI) values of the prognostic prediction model nomograms were improved. Conclusions: Nomograms that are developed based on preoperative fibrinogen, ALB, NLR, and CA125 levels accurately predict PFS and OS in patients with endometrial cancer.

Hematological Parameters in Patients with Covid-19: Age and Gender Aspects

During the pandemic of COVID-19, the availability of robust laboratory data for patient triage is of paramount importance. This study aimed to investigate the hematological profile of patients with COVID-19 at an early stage of the disease who were admitted to the hospital. We used the retrospective analysis of hemograms of 332 patients with COVID-19 to calculate the average values of white blood cell variables, the neutrophil-lymphocyte ratio (NLR)1, and the systemic immune-inflammation index (SII). At the stage of hospital admission, the most typical change in the blood picture of patients with COVID-19 was a decrease in the absolute count of lymphocytes and eosinophils, especially in patients with severe and extremely severe disease. High absolute neutrophil counts frequently occurred in severe and critically ill patients, too. The majority of patients had a high level of NLR and SII. As a whole, high neutrophil count and lymphocytopenia were common among males, and a pronounced age-dependent increase in cases of neutrophilia and eosinopenia was observed for females. The clinical value of individual hematological parameters and/or their combination varies significantly depending on the gender and age of patients, which predetermines a differentiated approach to build a robust scale for diagnosis and disease progression assessment.

Do neutrophil-lymphocyte ratio and platelet-lymphocyte ratio have a role in determining mortality in intensive care patients undergoing plasmapheresis? Single-center experience.

Plasmapheresis is a frequently used procedure that removes the pathogenic components from circulation. We aimed to evaluate the relationship between plasmapheresis, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and mortality in the intensive care unit (ICU) between 2014 and 2021. Forty-nine patients (27 females and 22 males) were included. Demographic characteristics, laboratory values of the day of admittance to the ICU, APACHE II scores, and length of stay were recorded. The mean age was 52.73 ± 16.93. APACHE II value (p=0.003; p < 0.01), NLR ratio (p=0.001; p < 0.01) and PLR ratio (p=0.001; p < 0.01) of the surviving group were lower than those of the deceased group, which was statistically significant. As high PLR and NLR levels suggest increased mortality in the ICU population, attention should be paid for increased NLR and PLR when plasmapheresis is decided on in the ICU.

Prognostic Values of Inflammation-Based Scores and Fibrosis Markers in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization.

Background: Inflammation is a key feature shaping the microenvironment of hepatocellular carcinoma (HCC), and liver fibrosis is associated with the prognosis of patients with HCC. In this study, we investigated whether baseline inflammation-based scores and serum fibrosis markers can help in predicting the prognosis of HCC patients treated with transarterial chemoembolization (TACE). Methods: A total of 605 consecutive patients with HCC treated by TACE were included. The systemic immune-inflammation index (SII), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), FIB-4 index, and aspartate aminotransferase-to-platelet ratio index (APRI) were analyzed regarding their associations with disease progression and survival. Results: All tested inflammation-based scores and fibrosis markers were significantly associated with tumor progression and overall survival in the univariate analyses. In the multivariate analysis, NLR (hazard ratio [HR], 1.06; p = 0.007) and FIB-4 (HR = 1.02, p = 0.008) were independent risk factors for disease progression, along with α-fetoprotein (AFP) levels, maximum tumor size and number, and presence of vascular invasion. Furthermore, NLR (HR, 1.09; p < 0.001) and FIB-4 (HR, 1.02; p = 0.02) were independent prognostic factors for survival. Conclusions: High baseline NLR and FIB-4 levels might help the prediction of disease progression and death in patients with HCC after TACE.

High Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Low Lymphocyte Levels Are Correlated With Worse Pathological Complete Response Rates.

Objective: To investigate the effect of hemogram parameters on predicting pathological complete response (pCR) in locally advanced rectal cancer.Methodology: A total of 227 patients with rectal cancer treated with neoadjuvant concurrent chemoradiotherapy (CRT) were retrospectively analyzed. All patients were divided into two subgroups as high or low hemogram parameters according to the cut-off value obtained using the receiver operating characteristic (ROC) curve.Results: In patients with low neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) levels, pCR rate was statistically significantly higher than the group with high NLR and PLR levels (for NLR: 39.77% vs. 5.34%; p<0.001, for PLR: 32.38% vs 7.01%; p<0.001 respectively). In addition, the pCR rate was significantly better in patients with high lymphocyte levels compared to the group with low lymphocyte levels (33.33% vs. 7.5%; p<0.001, respectively). According to the multivariate logistic regression analysis result, NLR and PLR levels were considered as independent predictors to predict pathological complete response [p<0.001, HR: 0.128 (95% CI=0.051 - 0.322) for NLR; p=0.017, HR: 0.332 (95% CI=0.134 - 0.821) for PLR, respectively].Conclusion: Our study showed that high NLR, PLR, and low lymphocyte levels were correlated with worse pCR rates. In addition to that, NLR and PLR emerged as independent predictive markers.

Association between neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and C-reactive protein levels and metabolic status in patients with a bipolar disorder

Objectives Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-Reactive Protein (CRP) are markers of inflammation that are elevated in bipolar disorder (BD) and are also related to a higher risk of metabolic syndrome (MetS). This study aimed at investigating for the first time the association between NLR, PLR, and CRP and the metabolic status in BD. Methods We assessed the association between biomarkers and the metabolic status: number of metabolic risk factors, presence of MetS, insulin sensitivity (Quantitative Insulin Sensitivity Check Index, QUICKI) and insulin resistance (Homeostatic Model Assessment for Insulin Resistance, HOMA-IR index), in a sample of 219 outpatients with BD. Results 25.9% of the sample met the criteria for MetS. High levels of CRP were found in 12% of the sample. Older age, low PLR, high NLR, and high CRP levels significantly predicted a higher number of MetS risk factors (p < 0.001). Older age and low PLR were associated with a greater likelihood of developing MetS (p = 0.007). Conclusions Although further studies are needed to replicate and validate these findings, inflammatory biomarkers as CRP, PLR and NLR could be useful tools to identify patients with a BD at risk for a metabolic adverse outcome.

Association Between Neutrophil-Lymphocyte Ratio and Frailty: The Chinese Longitudinal Healthy Longevity Survey.

Background: Inflammation has been reported to play an important role in frailty syndrome. The neutrophil–lymphocyte ratio (NLR) has recently emerged as an informative marker for systematic inflammation. However, few studies have examined the association between NLR and frailty. This study aims to examine the association between NLR and frailty in community-dwelling older adults.Methods: Community-dwelling older adults aged ≥ 65 years in the 2011 (n = 2,354) and 2014 (n = 2,458) waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Frailty status was determined using the 38-item frailty index (FI) and categorized into “robust” (FI ≤ 0.1), “pre-frail” (0.1 < FI ≤ 0.21), or “frail” (FI > 0.21). NLR was calculated using a derived formula: NLR = (white blood cell–lymphocyte)/lymphocyte.Results: A total of 3,267 participants were finally included. In cross-sectional analyses, participants with higher NLR levels had increased likelihood of frailty [the 3rd quartile: adjusted odds ratio (OR) = 1.29; 95% confidence interval (CI): 1.02–1.63; the 4th quartile: OR = 1.59; 95% CI: 1.23–2.02) compared with those in the 1st quartile group. During the 3-year follow-up, 164 of the 1,206 participants, robust or pre-frail at baseline, developed frailty, and 197 of the 562 participants, robust at baseline, developed pre-frailty or frailty. Among the robust and pre-frail participants in 2011, after multivariate adjustment, those in the 4th quartile group had a higher frailty incidence than those in the 1st quartile group (OR = 2.06; 95% CI: 1.18–3.59). Among the robust participants in 2011, those in the 4th quartile group also had a higher pre-frailty or frailty incidence than those in the 1st quartile group (OR = 1.95; 95% CI: 1.07–3.55).Conclusion: Among community-dwelling older adults, higher NLR levels were found to be associated with increased odds of prevalent and incident frailty.

Neutrophil Lymphocyte Ratio and Serum Ferritin Levels in COVID-19: A Cross-sectional Study

Introduction: Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) causing Coronavirus Disease (COVID-19) has challenged the world. A complete blood workup as well as continuous tracking of haematological parameters play a vital role in revealing the risks of disease progression and eventually help in better treatment and outcome. Aim: To access the haematological parameters {Complete Blood Count (CBC), Neutrophil Lymphocyte Ratio (NLR) and Serum Ferritin (S. ferritin) levels} in COVID-19 patients to correlate its association with the severity of the disease. Materials and Methods: The present study was a cross-sectional study in which 200 patients who were confirmed as COVID-19 positive by real time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) in the month of July-August 2020 were included. Blood was collected from patients of COVID-19 using the routine methods and was evaluated for CBC and S. ferritin levels. Neutrophil Lymphocyte Ratio (NLR) was also calculated. Results: The NLR was positively correlated with severity of COVID-19. Patients with higher NLR levels were admitted to Intensive Care Unit (ICU) because of severity in their condition. In the present study, 42 of 47 (89.4%) ICU patients had S. ferritin levels &gt;1000 ng/mL whereas only 8 (5.2%) of non ICU patients had S. ferritin levels &gt;1000 ng/mL. Conclusion: The NLR and S. ferritin positively correlated with the severity of COVID-19 disease.

ARE SOME INFLAMMATORY MARKERS BETTER THAN OTHERS AT DETERMÄ°NING GASTRÄ°C CANCER PROGNOSIS?

Purpose: In patients with stomach cancer, the inflammatory response of the host, and tumor markers, play essential roles in determining the prognosis. This study aimed to predict prognosis in previously untreated gastric cancer patients using inflammatory markers. Materials and Methods: This retrospective study evaluated 100 patients with stomach cancer, treated between 2015 and 2018. Pre-and postoperative blood samples were analyzed for the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), the systemic inflammatory index (SII), and other immune markers. Results: The survival rate was significantly higher in patients with an SII level &amp;amp;lt; 1190.4 compared to patients with an SII level &amp;amp;gt; 1190.4 (p &amp;amp;lt; 0.05). The disease-free survival was 47.7 months in the group with a low SII (84.4%) and 37 months in the group with a high SII (80%). In the ROC analysis, the AUC for NLR, PLR, and SII was 0.611, 0.65, and 0.64, respectively (p-values: 0.058, 0.010, and 0.011). The preoperative values were not significant; however, the postoperative values were significant for prognosis. Conclusion: During the pre-and postoperative periods, analysis of the inflammatory markers (NLR, PLR, and SII) guides the treatment and follow-up as much as the histopathological features of the tumor. High NLR and SII levels shortened overall survival during the 4-year follow-up.

Association Between Neutrophil-Lymphocyte Ratio and All-Cause Mortality and Cause-Specific Mortality in US Adults, 1999-2014.

BackgroundNeutrophil-lymphocyte ratio (NLR) is a novel marker of inflammation. Emerging studies have evaluated the relationship of NLR with cardiovascular diseases and malignant conditions. However, rare studies regarded the association between NLR and long-term health status. This study aimed to evaluate the association of NLR with all-cause mortality and cause-specific mortality among adults in the United States.MethodsWe obtained eight cycles data of National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2014, and enrolled 32328 participants after certain screening. By weighted chi-square test and linear regression analysis, we analyzed the correlation between NLR and baseline characteristics of the participants. Kaplan–Meier curves and Cox regression models were used to assess the survival relevance of NLR. We conducted stratified analysis, interaction analysis, and sensitivity analysis to robustness of our results.ResultsParticipants with high NLR levels had a higher risk of death. After adjustment for baseline characteristics, the hazard ratio comparing the higher vs lower NLR levels was 1.43 (95% CI, 1.18–1.73) for all-cause mortality, 1.27 (95% CI, 0.84–1.92) for cancer mortality, and 1.44 (95% CI, 0.96–2.16) for cardiovascular disease mortality. Stratified analysis found that the observed associations between NLR levels and mortality did not differ significantly.ConclusionIn this nationally representative cohort of US adults, higher NLR was significantly associated with an increased risk of all-cause mortality.

Neutrophil–Lymphocyte Ratio as a Prognostic Marker in Adrenocortical Carcinoma

ABSTRACT Purpose The purpose of the present study was to analyze the impact of the neutrophil–lymphocyte ratio (NLR) on the long-term outcomes of patients with adrenocortical carcinoma (ACC). Methods This retrospective, single-institution study included 48 patients with the diagnosis of ACC. The primary outcomes of the study were differences in overall survival (OS) and disease-specific survival (DSS) with respect to the NLR level. Results Patients with ENSAT stage IV had higher levels of NLR compared to those with ENSAT stage I–III (5.7 (1.6–12.5) vs 3.3 (1.3–11); p = .01). A higher NLR was also observed among patients with cortisol-secreting tumors (4.6 (1.7–12.5) vs 2.8 (1.3–10.3); p = .003) and those with Ki-67 index >10% (4.3 (1.3–12.5) vs 2.6 (1.6–11.0); p = .005). With respect to survival, the univariate analysis revealed worse ACC-related survival (p = .02) and OS (p = .004) in patients with NLR >3.9 than in those with NLR ≤3.9. In addition, patients with NLR >3.9 had a higher Weiss score (p = .046), a higher Ki-67 index (p = .006) and a higher disease stage (p = .01) compared to patients with NLR ≤3.9. No differences between the groups were observed regarding excess glucocorticoid secretion. Conclusion The study demonstrated that a higher NLR level in ACC patients was associated with unfavorable outcomes in terms of DSS and OS. These results indicate that NLR might be used as an additional marker in ACC risk stratification and identification of patients with the most adverse prognosis.

The Effect of High Dose Intravenous Vitamin C During Radiotherapy on Breast Cancer Patients' Neutrophil-Lymphocyte Ratio.

Background: Breast cancer is very common, and the incidence is growing every year. Most breast cancers are treated with radiation after surgery. As a side effect of radiation therapy, inflammation, as well as the neutrophil-lymphocyte ratio (NLR), level increases. However, high NLR levels act as independent prognostic factors for increased mortality in all cancers. In this study, the authors investigated whether administration of vitamin C, which is effective in suppressing inflammation, may help to reduce high levels of NLR produced by radiation therapy. Methods: This study was performed retrospectively among 424 patients who were diagnosed with breast cancer and were treated with postoperative radiotherapy at Kosin University Gospel Hospital from January 2011 to December 2017. Among them, 354 patients received radiation therapy without vitamin C (the control group), and 70 experimental patients received vitamin C intravenously twice a week for at least 4 weeks during radiation therapy. The experimental group was divided into two groups according to the dose administrated: a low-dose vitamin C group (less than 1 g/kg, 52 patients) and a high-dose vitamin C group (more than 1 g/kg, 18 patients). The authors conducted three NLR measurements: before and after radiation therapy and at 3 months after radiation therapy; the authors then compared the change in NLR over time between the groups using repeated measures analysis of variance. Results: In the control group and the low-dose vitamin C-administered group, NLR was increased at the endpoint compared to before the radiotherapy, whereas NLR values in the high-dose vitamin C group were 8.4 ± 1.7, 5.9 ± 1.3, and 4.3 ± 1.5, showing a continuous decrease and a statistically significant difference (pinteraction = 0.033). These results were similarly observed in models adjusted by the patient's age and American Joint Committee on Cancer stage, with borderline significance (pinteraction = 0.065). Conclusions: Elevated NLR, a measure of systemic inflammation, has been associated with higher mortality cancer patients, including breast cancer patients. In this observational study, NLR was significantly decreased during radiation therapy in patients administered high-dose vitamin C.