High Neutrophil-to-lymphocyte Ratio Group Research Articles

Prognostic value of pretreatment procalcitonin and neutrophil–lymphocyte ratio in extensive-stage small-cell lung cancer

ABSTRACT Background To investigate the influence of pretreatment neutrophil-to-lymphocyte ratio (NLR) and procalcitonin (PCT) on progression-free survival (PFS) in extensive-stage small-cell lung cancer (SCLC) patients. Method A total of 100 extensive-stage SCLC patients were enrolled in our study. Patients were stratified according to the median values of pretreatment NLR and PCT levels: low NLR group (NLR ≤3.17), high NLR group (NLR＞3.17), low PCT group (PCT ≤0.06; ng/ml), high PCT group (PCT＞0.06; ng/ml). The Kaplan-Meier method and multivariable Cox regression model were used to reveal the prognostic effects of pretreatment NLR and PCT on PFS. Results The median PFS of the total extensive-stage SCLC patients was 6.0 months. The median PFS of low pretreatment NLR group (NLR ≤3.17) was not significantly different from that of high pretreatment NLR group (6.2 months vs 5.8 months; p = .675). Patients with low pretreatment PCT (PCT ≤0.06; ng/ml) had significantly better PFS than patients with high pretreatment PCT (PCT＞0.06; ng/ml) (6.9 months vs 5.7 months; p = .043). With the multivariable Cox regression analysis, the response to first-line chemotherapy (p ≤ .001) and pretreatment PCT (HR = 0.516; 95%CI 0.326–0.817; p = .005) were identified as independent factors associated with PFS. Conclusion Pretreatment PCT is an independent factor associated with PFS in extensive-stage SCLC patients treated with first-line chemotherapy, but pretreatment NLR reflects no significant prognostic value in our study.

Immunotherapy Using Activated Natural Killer Cells Improves Postoperative Neutrophil-to-Lymphocyte Ratio and Long-Term Prognosis of Living Donor Liver Transplant Recipients With Hepatocellular Carcinoma

ObjectivePreoperative neutrophil-to-lymphocyte ratio (NLR) is a well-known prognostic indicator in various malignancies; however, the impact of postoperative NLR on living donor liver transplant (LDLT) recipients is unknown. Immunotherapy with donor liver-derived activated natural killer (NK) cells may improve postoperative NLR by coactivating immune cells or suppressing activated neutrophils. This study aims to clarify the clinical significance of postoperative NLR in recipients after LDLT with HCC and assess whether immunotherapy improves postoperative NLR. MethodsWe conducted a retrospective study of LDLT recipients between 2001 and 2022 to evaluate the clinical significance of postoperative NLR. Furthermore, the correlation between postoperative NLR and the activation marker of infused NK cells was also evaluated. The postoperative NLR was examined 4 weeks after LDLT. ResultsThe postoperative high NLR group (N = 78) had preoperative lower NLR and higher model for end-stage liver disease and a higher rate of postoperative infection within 30 days after LDLT than the postoperative low NLR group (N = 41). Postoperative high NLR (hazard ratio [HR], 2.62; 95% confidence interval [CI], 1.01-6.79; P = .047) and nontreatment of immunotherapy (HR, 3.10; 95% CI, 1.33-7.22; P < .01) were independent risk factors for poor overall survival in multivariate analysis. Furthermore, the activation marker of infused NK cells is inversely correlated with decreased postoperative NLR. ConclusionsThe higher level of postoperative NLR was independently associated with poor prognosis in patients after LDLT with HCC. Immunotherapy using activated NK cells may improve postoperative NLR and long-term prognosis.

Effect of neutrophil to lymphocyte ratio on prognosis of elderly patients with severe sepsis combined with diabetes mellitus

BackgroundTo investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) in the short-term prognosis of elderly patients with severe sepsis combined with diabetes mellitus (DM).MethodsThe clinical data of 162 elderly patients with severe sepsis combined with DM from January 2018 to December 2022 were retrospectively collected. These patients were divided into a survival group (n = 104) and a death group (n = 58) according to 90-day prognosis. The number of neutrophils, lymphocytes, and NLR were compared. The optimal cut-off value for NLR to predict 90-day prognosis in elderly patients with severe sepsis combined with DM was determined using Receiver Operator Characteristic (ROC) curves, and the patients were divided into high and low NLR groups depending on the optimal cut-off value. The Kaplan-Meier method was used to plot the survival curves of the high and low NLR groups. Risk factors for the 90-day death in elderly patients with severe sepsis combined with DM were analyzed by a multivariate cox regression model.ResultsThere were no significant differences in gender, age, history of hypertension and hyperlipidemia, intensive care unit (ICU) stay, duration of mechanical ventilation, and oxygenation index between the survival group and death group (p > 0.05). However, acute physiological and chronic health evaluation II (APACHE II) scores, and sepsis-related organ failure assessment (SOFA) scores were significantly lower in the survival group compared with the death group (p < 0.05). In the survival group, neutrophils counts and NLR were much lower than those in the death group, while lymphocytes counts were much higher (p < 0.05). ROC curves showed that the optimal cut-off value for NLR to predict 90-day mortality in elderly patients with severe sepsis combined with DM was 3.482. Patients were divided into high NLR and low NLR groups based on whether NLR was ≥ 3.482. In terms of the log-rank test results, patients in the low NLR group had a significantly higher 90-day survival rate than those in the high NLR group (Logrank χ2 = 8.635, p = 0.003). The multivariate cox regression model showed that the length of ICU stay longer than 15 days and NLR ≥ 3.482 were independent risk factors for 90-day prognosis in elderly patients with severe sepsis combined with DM.ConclusionNLR ≥ 3.482 can be used to predict whether poor prognosis occurs in the short term after illness in elderly patients with severe sepsis combined with DM, and has good assessment value.

The Impact of the Neutrophil-to-Lymphocyte Ratio on In-Hospital Outcomes in Patients With Acute ST-Segment Elevation Myocardial Infarction.

Introduction The neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of cardiovascular diseases, influencing their progression and prognosis. The exact role of the NLR in acute ST-segment elevation myocardial infarction (STEMI) is unclear. We investigated the possible association between peak NLR values within the first three days after STEMI onset and in-hospital outcomes in patients undergoing primary percutaneous coronary intervention (PCI). Methods This retrospective study included 641 patients who were diagnosed with acute STEMI and treated with primary PCI for 18 months at Dr. Siyami Ersek Hospital. The NLR was calculated using the maximum values obtained during the first three days after admission. The patients were divided into quartiles according to their NLR values for further analysis of potential complications during and after hospitalization, up to a follow-up period of three months. Results Significant differences were found in factors such as age, body mass index (BMI), and length of hospital stay among these groups. Specifically, we found that in-hospital mortality rates were significantly higher in the Q4 group, and there were variations in target vessel revascularization (TVR) rates, major adverse cardiac events (MACE) rates, and other clinical outcomes. Some parameters, such as reinfarction rates and certain procedural outcomes, did not show significant differences among the groups. However, despite the differences, most of the patients achieved successful outcomes after PCI, with the best results in the low NLR group and the worst results in the high NLR group. Conclusion Higher NLR values were associated with a higher risk of unfavorable outcomes during hospitalization.

Value of markers of systemic inflammation for the prediction of postoperative progression in patients with pancreatic neuroendocrine tumors.

Non-invasive prognostic predictors for rare pancreatic neuroendocrine tumors (PNETs) are lacking. We aimed to approach the prognostic value of preoperative systemic inflammatory markers in patients with PNETs. The clinical data of 174 patients with PNETs undergoing surgical treatment were retrospectively analyzed to explore the correlation of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and platelet to white blood cell ratio (PWR) with clinicopathological parameters and the progression of tumor after the operation. The optimal cutoff values for predictors and the area under the curve (AUC) of the receiver operating characteristic (ROC) were estimated. Univariate and multivariate Cox proportional hazards models were used to assess the relation between NLR, LMR, PLR, and progression-free survival (PFS), examined by the Kaplan-Meier and log-rank tests. The scores of the NLR (P = 0.039) and PLR (P = 0.011) in the progression group were significantly higher than those in the progression-free group, and the LMR was significantly lower than those in the progression-free group (P = 0.001). The best cutoff values of NLR, LMR, and PLR before operation were 2.28, 4.36, and 120.91. The proportions of tumor progression in the high NLR group (P = 0.007) and high PLR group (P = 0.013) obviously increased, and the proportion of tumor development in the low LMR group was higher than that in the high LMR group (P < 0.001). The K-M survival curve showed that the progression-free survival rate was lower in the high NLR group (P = 0.004), the low LMR group (P < 0.001), and the high PLR group (P = 0.018). The results of the multivariate Cox proportional hazards model suggested that preoperative LMR (HR = 3.128, 95% CI: 1.107~8.836, P = 0.031) was an independent predictor of PFS. The markers of systemic inflammation, especially LMR, can predict the postoperative progression of PNETs.

The correlation between preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and postoperative recurrence of chronic rhinosinusitis

Objective:Neutrophil-to-lymphocyte ratio （NLR） and platelet-to-lymphocyte ratio （PLR） play important roles in the poor prognosis of different inflammatory and neoplastic diseases, but their effects on postoperative recurrence of chronic rhinosinusitis（CRS） are unknown. The aim of this study was to investigate the correlation between preoperative NLR and PLR and the risk of postoperative recurrence in CRS. Methods:Clinical data were collected from patients with CRS who underwent initial functional endoscopic sinus surgery from October 2018 to February 2022 at our institution. Follow-up was until February 2023, and the study endpoint was defined as patient postoperative recurrence or follow-up time up to date. The optimal preoperative NLR and PLR threshold values were obtained based on subject work curve analysis, and they were divided into high and low level subgroups, respectively, and the clinical characteristics and postoperative recurrence rates of patients were compared between groups; patients were divided into non-recurrent CRS and recurrent CRS according to their postoperative recurrence, and Kaplan-Meier survival curves and logistic regression analysis were performed to explore the correlation between NLR and PLR and CRS The correlation between NLR and PLR and postoperative recurrence was investigated by Kaplan-Meier survival curve and logistic regression analysis. Results:A total of 630 patients with CRS were included, including 382 and 140 patients with high NLR and high PLR, respectively. The postoperative recurrence rates of CRS patients in the high NLR and high PLR groups were significantly higher than those in the low NLR and low PLR groups（P<0.05）. The recurrent CRS had higher NLR and PLR levels and higher proportion of high NLR and high PLR than the non-recurrent CRS（P<0.05）, and similarly the duration of recurrent CRS and the rate of allergic rhinitis with recurrence were significantly higher than the non-recurrent CRS（P<0.05）. Kaplan-Meier survival curves showed that postoperative CRS was significantly higher in the high NLR and high PLR groups compared with the low NLR and low PLR groups. recurrence was significantly higher（P<0.05）. In addition, logistic regression analysis showed that high NLR, high PLR, disease duration, and combined allergic rhinitis were significantly associated with an increased risk of postoperative recurrence of CRS（P<0.05）. Conclusion:Both high preoperative NLR and high PLR are independent risk factors for postoperative recurrence of CRS, and they are expected to be new indicators for postoperative prognostic assessment and risk stratification of CRS patients. In addition, disease duration and comorbid allergic rhinitis were significantly associated with the risk of postoperative recurrence of CRS.

Association Between Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease in Acute Myocardial Infarction Patients

Background: Acute myocardial infarction is one of the leading causes of death across the world. Determination of severity is important in patients with acute myocardial infraction for the therapeutic decision making. Neutrophil to Lymphocyte Ratio (NLR) has been proposed as a new prognostic marker in patients with acute MI. Several international studies have found to compare the relation between NLR and severity of coronary artery disease. In these studies, they demonstrated that the NLR is higher in severe CAD. In our country no such study has been done yet to predict the severity of coronary artery disease by estimating NLR in acute MI patients. Moreover, NLR is cheap, easily available, non-invasive and routinely done procedure. Objectives: This study was conducted to find out the association of NLR to severity of CAD in acute MI patients. Methods: This observational cross sectional analytical study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, SSMC and Mitford Hospital and NICVD, Dhaka from March 2021 to February, 2022. Patients with acute MI (STEMI and NSTEMI) were approached for this study according to inclusion and exclusion criteria. They were divided into two groups according to NLR: Group A NLR &gt;2.5 and Group B NLR ≤2.5. Coronary angiogram was done during index hospitalization. The severity of coronary artery disease was assessed by Vessel score and Gensini score. According to Gensini score was non severe (≤50) severe (&gt;50). Results: Among 70 patients in our study 30 (42.8%) were in the high NLR group (Group A) and 40 (57.14%) were in low NLR group (Group B). In group A mean NLR was 5.15 ± 2.21 and in group B mean NLR was 1.65 ± 0.35, this difference was statistically significant. Severe coronary artery disease in terms of vessel score and Gensini score was significantly higher in group A than group B (p value 0.001). We found strong positive correlation between NLR and Gensini score (r= 0.7, p= 0.001), and moderate positive correlation between NLR nad vessel score (r= 0.5, p= 0.001). With the increase of NLR, vessel score and Gensini score increases demonstrating more severe CAD. Simple logistic regression analysis of variables of interest revealed that hypertension (p=0.003), diabetes mellitus (p=0.008), dyslipidaemia (p=0.007), WBC count(p=0.034), Neutrophil count (p=0.000), Lymphocyte count (p=0.000), NLR (p=0.000), LVEF (p=0.001) were independent predictor of severe coronary artery disease with odds ratio (OR) being 5.32, 3.88, 4.42, 1.00, 1.20, 0.834, 2.28, 0.805 respectively. In multivariate logistic regression analysis, after adjustment of confounding, hypertension (p=0.028, OR=5.87) and NLR (P=0.004, OR=1.81) remain independent predictor of severe CAD. In ROC curve analysis, the AUC of NLR for predicting severity of CAD is 0.8 with p value &lt; 0.001, 95% CI (0.78-0.96) and with 75% sensitivity and 86.5% specificity. So, from this study, it is evident that NLR is directly associated with coronary artery disease severity. Conclusion: Increased NLR was associated with angiographically severe coronary artery disease in acute Myocardial Infarction patients, and this association is independent of conventional cardiovascular risk factors. Bangladesh Heart Journal 2024; 39(1): 1-9

Prognostic Value of Neutrophil-to-lymphocyte Ratio for Patients with Acute Coronary Syndrome and Obstructive Sleep Apnea

Objective: This study was aimed at investigating the effects of the neutrophil-to-lymphocyte ratio (NLR) on the long-term prognosis of patients with acute coronary syndrome (ACS) and obstructive sleep apnea (OSA). Methods: This prospective study enrolled patients with ACS and OSA at Anzhen Hospital between June 2015 and January 2020. OSA was defined by an apnea-hypopnea index ≥15 events·h−1. Baseline NLR was classified as high or low, according to the median. The primary endpoint was major adverse cardiovascular events (MACE), comprising cardiovascular death, recurrent myocardial infarction, stroke, and ischemia-driven revascularization. Results: A total of 1011 patients with ACS and OSA were enrolled, 506 of whom were in the high NLR (≥2.54) group. No significant differences in sleep monitoring indicators were observed. During a median follow-up of 2.8 (1.4, 3.6) years, a non-linear correlation between NLR and the incident risk of MACE was observed. After adjustment for clinically relevant confounders, a high NLR was independently associated with elevated MACE risk (adjusted HR = 1.45, 95% CI: 1.02–2.06, P = 0.040). Conclusions: In patients with ACS and OSA, a high NLR was associated with poorer clinical outcomes during long-term follow-up. Trial registration: ClinicalTrials.gov; Number: NCT03362385; URL: www.clinicaltrials.gov.

Correlations of baseline neutrophil-lymphocyte ratio with prognosis of patients with lupus nephritis: A single-center experience.

We aimed to evaluate the correlations among the neutrophil-to-lymphocyte ratio (NLR), lupus nephritis (LN) clinical characteristics, and renal prognosis of patients with LN. We enrolled 122 patients who were diagnosed with LN at the Rheumatology Department of the People's Hospital, Xinjiang Uygur Autonomous Region from January 2013 to April 2022. We determined the occurrence of renal adverse events in patients with LN by reviewing medical records and follow-up data. Correlations were analyzed using the Spearman test, and the quartile method was applied to classify all of the 122 patients who had completed follow-up into low, medium, and high NLR groups. The Kaplan-Meier survival curve was used to conduct survival analysis, and Cox regression analyses were used to explore possible potential risk factors. The baseline NLR of patients with LN was positively correlated with C-reactive protein (CRP), serum creatinine, blood urea nitrogen, and systemic lupus erythematosus disease activity index scores (P < 0.05) and negatively correlated with estimated glomerular filtration rate (eGFR) and serum albumin (P < 0.05). Patients who completed follow-up were divided into three NLR groups based on their NLR values: 30 in the low (NLR ≤ 2.21), 62 in the medium (NLR > 2.21 and NLR ≤ 6.17), and 30 in the high NLR group (NLR > 6.17). The patient survival time before developing poor renal prognosis was significantly different among the three groups (P < 0.05). High NLR (hazard ratio [HR] = 3.453, 95% confidence interval [CI]: 1.260-9.464), CRP (HR = 1.009, 95% CI: 1.002-1.017), eGFR (HR = 0.979, 95% CI: 0.963-0.995), and 24-h proteinuria values (HR = 1.237, 95% CI: 1.025-1.491) as well as anti-double stranded DNA antibody positivity (HR = 3.056, 95% CI:1.069-8.736) were independent risk factors associated with a poor renal prognosis for patients with LN. The baseline NLR in peripheral blood can be used as a reference index for evaluating renal function and disease activity in patients with LN, and a high NLR has predictive value for the prognosis of patients with LN.

Correlation between preoperative peripheral blood NLR, PLR, LMR and prognosis of patients with head and neck squamous cell carcinoma

BackgroundMarkers that can be used to evaluate the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) remain undefined.ObjectiveThis study aimed to investigate the prognostic impact of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in patients with HNSCC who underwent surgery-based treatment for the first time.MethodsThis retrospective study included patients HNSCC who underwent surgery-based treatment at our institution between January 2018 and December 2020. Specificity and sensitivity were analyzed using receiver operating characteristic (ROC) curves and the critical value was determined. Patients were divided into low and high groups according to NLR, PLR, and LMR the critical value. Log-rank and Cox proportional hazards models were used to evaluate the associations between preoperative NLR, PLR, LMR, and overall survival (OS).ResultsA total of 304 patients with HNSCC were included, of whom 190 (62.5%) and 114 (37.5%), 203 (66.8%) and 101 (33.2%), 98 (32.2%), and 206 (67.8%) cases were classified as low NLR and high NLR groups, low PLR and high PLR groups, and low LMR and high LMR groups, respectively. Univariate analysis showed that white blood cell count (WBC), neutrophil count (NEU), platelet count (PLT), NLR, pathologic N stage (pN stage), TNM stage and postoperative complications were significantly associated with OS (p < 0.05). Multivariate analysis showed that NEU, NLR, TNM stage and postoperative complications were independent negative prognostic factors for HNSCC (p < 0.05).ConclusionPreoperative NLR is an independent negative prognostic factor for HNSCC. Patients with an increased NLR may have a poor OS.

Significance of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Monocyte-to-Lymphocyte Ratio in the Prognosis of Newly Diagnosed Multiple Myeloma Patients

Background Multiple myeloma is a cancer of the plasma cells, characterized by abnormal proliferation in the bone marrow. In 2023 about 12,590 deaths are expected to occur secondary to the disease. It is important to identify the predictors of disease progression for prognostication.Tumor microenvironment influences the growth of malignant plasma cells. Neutrophilia can enhance tumor growth, angiogenesis and provide a favorable matrix for metastasis. Lymphopenia is also suggestive of disease progression. Hence, an increased neutrophil-to-lymphocyte ratio (NLR) has been linked with a poor prognosis in many cancers. Monocytes are thought to be recruited by tumor cells for suppressing the immune cells and aiding in prolonged survival. In patients with multiple myeloma, a low platelet count is linked to a worse prognosis since a greater marrow myeloma burden leads to inhibition of thrombopoiesis.Hence, a low platelet-to-lymphocyte ratio (PLR) and high monocyte-to-lymphocyte ratio (MLR) are linked with worse prognosis.The aim of our study was to investigate the role of NLR, PLR and MLR in the prognosis of our patients. Methods This is a retrospective study that analyzed patients diagnosed with Multiple Myeloma from 2012 to 2022 at Saint Vincent Cancer Center, Worcester, Massachusetts. We performed a chart review and collected demographics including age at the time of diagnosis, gender, BMI, race. Additionally, we also collected data such as multiple myeloma type, R-ISS staging, complete blood count (cbc), chemotherapy used, auto stem cell transplant, 5-year survival. NLR, PLR and MLR were calculated based on pre-treatment cbc. Based on literature review, cutoffs for High NLR (≥2), Low NLR (&amp;lt;2), High PLR (≥120.00), low PLR (&amp;lt;120.00) and high MLR (≥0.27), and low MLR (&amp;lt;0.27) were made. SPSS was used for analysis of the data. A logistic regression was used to calculate the Odd's ratio (OR). A p value less than equal to 0.05 was considered significant. Results The total number of patients analyzed were 97. 47.4% (n=46) were females and 52.6% (n=51) were males. Mean age at diagnosis was 69.3 years. Mean BMI was 30.16 kg/m 2. 35.1% (n=34) of the patients had IgG subtype. 36.1% (n=35) of our study population belonged to R-ISS stage 2. 38.1% (n=37) of the patients were treated with lenalidomide, bortezomib, dexamethasone combination. Mean NLR was 3.4, mean PLR was 166.949 and mean MLR was 0.46. 66% (n=64) of the patients belonged to the high NLR group, 61.9% (n=60) to the high PLR group and 64.9% (n=63) to the high MLR group. Out of 97 patients, 56.7% (n=55) were alive at 5 years. High NLR (≥2) was associated with lower odds of 5-year survival with a p value of 0.037 and a 95% confidence interval (0.095-0.931). High MLR (≥0.27) was associated with lower odds of 5-year survival with a p value of 0.042 and a 95% confidence interval (0.124-0.962). PLR did not correlate with 5-year survival and was not statistically significant (p value of 0.157). Conclusions Based on our study, a high NLR (≥2) and high MLR (≥0.27) were associated with lower odds of 5-year survival. Hence NLR and MLR are independent prognostic factors in newly diagnosed multiple myeloma patients which can be economical and effective methods for early evaluation of patient prognosis.

The predictive role of hematologic markers in resectable NSCLC patients treated with neoadjuvant chemoimmunotherapy: a retrospective cohort study.

Neoadjuvant chemoimmunotherapy is an important therapeutic modality for resectable nonsmall cell lung cancer (NSCLC). The roles of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio in predicting the efficacy and prognosis of patients with resectable NSCLC receiving neoadjuvant chemoimmunotherapy remain uncertain. This study aimed to explore the association of baseline and preoperative NLR, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio with the treatment response and survival of patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy. Data of patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy between May 2019 and July 2022 at our institute, were retrospectively analyzed. Peripheral blood cell counts were obtained at baseline and before surgery. Data that may affect treatment efficacy were also collected and analyzed, including age, sex, BMI, cumulative smoking exposure, pathological type, clinical stage, PD-L1 tumor proportion score, immune checkpoint inhibitors, dosage of neoadjuvant therapy, duration from final therapy to surgery, and baseline and preoperative oncological markers. The present work has been reported in compliance with REporting recommendations for tumor MARKer prognostic studies (REMARK) criteria and guidelines (Supplemental Digital Content 1, http://links.lww.com/JS9/A860 ). A total of 116 patients were included in the study. Univariate logistic regression analysis showed that a higher baseline NLR ( P =0.001) and preoperative NLR ( P =0.001) were associated with a lower incidence of pathological complete response (pCR) following neoadjuvant therapy. Multivariate analysis indicated that a lower incidence of pCR was achieved in the high baseline NLR group ( P =0.014). Higher baseline NLR ( P =0.021), preoperative NLR ( P =0.004) and higher preoperative CEA levels ( P =0.059) were associated with shorter disease-free survival (DFS). Multivariate Cox proportional hazard regression analyses showed that shorter DFS was achieved in the high preoperative NLR group ( P =0.033). In patients with resectable NSCLC treated with neoadjuvant chemoimmunotherapy, a higher baseline NLR was associated with a lower incidence of pCR, and a higher preoperative NLR was associated with a shorter DFS. However, a future prospective study with a large sample size and long-term follow-up is needed to verify the predictive value of NLR in these patients.

Association between the neutrophil-to-lymphocyte ratio and risk of in-hospital heart failure and arrhythmia in patients with acute myocardial infarction.

This study was to probe into the relationship between the neutrophil-to-lymphocyte ratio (NLR) and both in-hospital and long-term heart failure risk in patients with acute myocardial infarction (AMI). 990 patients with AMI, including 386 with non-ST-segment elevation myocardial infarction (NSTEMI) and 604 with segment elevation myocardial infarction (STEMI) were recruited between January 2019 and March 2022. The in-hospital acute heart failure (AHF) and arrhythmia events were recorded. The NLR was significantly greater in the AHF group in STEMI and NSTEMI patients, with a higher frequency of arrhythmia in comparison to the non-AHF group. A high NLR was related to a high level of myocardial injury markers, accompanied with more AHF and arrhythmia events. Multivariate logistic regression analyses revealed that high NLR is independently linked with increased in-hospital AHF and arrhythmia risk. Receiver operating characteristic curve analyses revealed that the prognostic value of NLR for in-hospital AHF was 0.704 in STEMI patients and 0.766 in NSTEMI patients. However, during a median follow-up of 28 months with 32 heart failure patients, there was no significant difference between the low NLR group (n = 18) and the high NLR group (n = 14). Further analysis showed that the two groups did not significantly differ in the occurrence of heart failure within 12 months of discharge. Our results indicate that NLR is an independent risk factor of in-hospital AHF in AMI patients. However, NLR has no value in predicting long-term heart failure.

Prognostic value of systemic inflammation response index in hepatoblastoma patients receiving preoperative neoadjuvant chemotherapy.

Inflammation is closely associated with tumor development and patient prognosis. The objective of this study is to assess the prognostic value of the preoperative inflammatory indexes in pediatric hepatoblastoma patients who receive neoadjuvant chemotherapy. A retrospective analysis was performed on clinical and pathological data of 199 hepatoblastoma patients who underwent hepatectomy with preoperative neoadjuvant chemotherapy from January 2015 to June 2020. The receiver operating characteristic curve was used to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) in predicting OS and EFS. Patients were grouped based on optimal cutoff values of preoperative inflammatory indexes. Survival rates were calculated using the Kaplan-Meier method, and survival outcomes were compared between groups using the log-rank test. Univariate and multivariate Cox proportional hazards regression models were used to identify independent prognostic factors, and a nomogram was constructed using R software to predict the probability of OS. The receiver operating characteristic curve showed prognostic value for OS, not EFS, in preoperative inflammatory indexes. Patients were categorized into low/high groups: SII ≤ 266.70/higher, NLR ≤ 1.24/higher, PLR ≤ 85.25/higher, and SIRI ≤ 0.72/higher. High NLR, PLR, SII, and SIRI groups had significantly lower 5-year OS than their low counterparts (all p-value < 0.05). The Cox analysis identified four independent prognostic factors: SIRI (HR=2.997, 95% CI: 1.119-8.031), microvascular invasion (HR=2.556, 95% CI: 1.14-5.73), the post-treatment extent of disease (POSTTEXT) staging (IV vs. I: HR=244.204, 95% CI:11.306-5274.556), and alpha-fetoprotein (>100 ng/ml: HR=0.11, 95% CI: 0.032-0.381) for hepatoblastoma patients with neoadjuvant chemotherapy. High SIRI group had more patients with adverse NLR, SII, and POSTTEXT III (all p-value < 0.05). Independent prognostic factors led to an OS nomogram with a concordance index of 0.85 (95% CI: 0.78-0.91, p-value = 1.43e-27) and the calibration curve showed a good fit between the prediction curve and the true curve. SIRI is an independent prognostic factor of hepatoblastoma patients receiving neoadjuvant chemotherapy. The OS nomogram based on SIRI, POSTTEXT staging, MiVI, and AFP can be used to assess the prognosis of those patients.

A high platelet-to-lymphocyte ratio predicts all-cause mortality and cardiovascular mortality in maintenance hemodialysis patients

Purpose The aim of this study was to further assess whether the platelet-to-lymphocyte ratio (PLR) is independently associated with all-cause mortality and cardiovascular mortality in maintenance hemodialysis (MHD) patients. Methods From January 1, 2014, to December 31, 2014, patients undergoing regular hemodialysis in the Blood Purification Center of the General Hospital of Northern Theatre Command were retrospectively selected. A total of 303 MHD patients were enrolled in accordance with the inclusion and exclusion criteria. For each patient, the endpoint of follow-up was either death or December 31, 2021. The primary endpoints were all-cause and cardiovascular death. A receiver operating characteristic (ROC) curve was drawn to detect the predictive ability of PLR, and the optimal critical value of PLR was determined to be 107.57. Kaplan–Meier curves and Cox proportional analysis were used to assess the prognostic value of PLR. We used the same method to evaluate the correlation between the neutrophil-to-lymphocyte ratio (NLR) and the prognosis of MHD patients. Results At the end of follow-up, 128 MHD patients had progressed to all-cause death, and 73 MHD patients had progressed to cardiovascular death. In multivariate Cox regression, both the high PLR group and the high NLR group were independently associated with all-cause mortality (HR 2.608, 95% CI 1.579–4.306, p < .001 vs. HR 1.634, 95% CI 1.023–2.610, p = .04). Only high PLR expression was associated with cardiovascular mortality (HR 3.379, 95% CI 1.646–6.936, p = .001). Conclusions High PLR levels can independently predict all-cause and cardiovascular mortality in MHD patients.

227. RELATIONSHIP BETWEEN 90-DAY PROGNOSIS NUTRITIONAL INDEX AND INFLAMMATORY RESPONSE MARKERS AND LONG-TERM SURVIVAL IN ESOPHAGEAL CANCER

Abstract Background The incidence rate of esophageal cancer in Asia is mainly squamous cell carcinoma, which is characterized by high mortality and poor prognosis. The prognosis of tumors is not only related to the biological characteristics of tumor cells, but also closely related to the nutritional status and inflammatory response of patients. The aim of this study is to investigate the relationship between nutritional index (PNI) and inflammatory response markers (NLR, LMR) at 90 days after surgery and long-term survival in patients with esophageal squamous cell carcinoma. To provide reference for accurately assessing the condition, identifying survival risks, and improving long-term prognosis. Methods The data of ESCC patients who underwent radical resection for esophageal cancer from April 2018 to November 2018 were extracted (n = 66). Calculate the prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and other indicators of patients at 90 days after operation. ROC was used to calculate the cut-off values of PNI, NLR, and LMR. KaplanMeier survival curve was used to analyze the relationship between different PNI, NLR, LMR levels and long-term survival of patients. All patients were followed up regularly after surgery, and the last follow-up time was April 2023. Results The best cut-off values of PNI, NLR, and LMR were 42.8, 3.27, and 4.76, respectively. Kaplan Meier survival analysis showed a correlation between postoperative PNI, NLR, LMR at 90 days and overall survival and disease-free survival. At 90 days after surgery, the OS (P = 0.007) and DFS (P = 0.038) of patients in the high PNI group (PNI ≥ 42.8) were better than those in the low PNI group; The OS (P = 0.002) and DFS (P = 0.048) of patients in the low NLR group (NLR &amp;lt; 3.27) were better than those in the high NLR group; The OS (P = 0.001) and DFS (P = 0.039) of patients in the high LMR group (LMR ≥ 4.76) were better than those in the low LMR group. Conclusions PNI, NLR, and LMR are important predictors of OS and DFS in patients with esophageal squamous cell carcinoma after radical resection of esophagus. Patients with PNI ≥ 42.8, NLR&amp;lt;3.27, and LMR ≥ 4.76 at 90 days after surgery have better OS and DFS.

Influence of Pre-treatment Lymphocyte/Monocyte Ratio and Neutrophil/Lymphocyte Ratio on the Prognosis of Patients with Extranodal NK/T-Cell Lymphoma

To explore the influence of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) on the prognosis of patients with extranodal NK/T cell lymphoma (ENKTL). The clinical data of 203 patients with ENKTL admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2020 were retrospectively analyzed. The ROC curve determined the limit values of LMR and NLR; Categorical variables were compared using a chi-square test, expressed as frequency and percentage (n,%). Continuous variables were expressed as medians and extremes and compared with the Mann-Whitney U test; Progression-free survival (PFS) and overall survival (OS) of different grouped LMR and NLR patients were analyzed using Kaplan-Meier curves and compared with log-rank tests. The COX proportional risk regression model was used to perform one-factor and multi-factor analysis of PFS and OS. The optimal critical values of LMR and NLR were determined by the ROC curve, which were 2.60 and 3.40, respectively. LMR≤2.60 was more likely to occur in patients with bone marrow invasion (P=0.029) and higher LDH (P=0.036), while NLR≥3.40 was more likely to occur in patients with higher ECOG scores (P=0.002), higher LDH (P=0.008), higher blood glucose (P=0.024), and lower PLT (P=0.010). Kaplan-Meier survival analysis showed that PFS and OS of patients in the high LMR group were significantly better than the low LMR group, while PFS and OS in the low NLR group were significantly better than the high NLR group. The results of multivariate COX analysis showed that EBV-DNA positive (P=0.047), LMR≤2.60 (P=0.014), NLR≥3.40 (P=0.023) were independent risk factors affecting PFS in patients with ENKTL. LMR≤2.60 (P<0.001), NLR≥3.40 (P=0.048), and high β2-MG (P=0.013) were independent risk factors affecting OS in patients with ENKTL. Low LMR and high NLR before treatment are associated with poor prognosis in patients with ENKTL, which also can be used as an easily testable, inexpensive, and practical prognostic indicator in the clinic.

Neutrophil-to-lymphocyte ratio as a predictor of immune checkpoint inhibitor therapy response in advanced bladder cancer.

e16586 Background: Immune checkpoint inhibitor (ICI) therapy is a novel and promising agent for treating muscle invasive bladder cancer (MIBC). However, there is a need for further understanding of which patient factors or biological markers can be used to help identify patients who will have a successful response to ICI therapy. We hypothesized that Neutrophil-to-Lymphocyte Ratio (NLR) could be predictive of response to ICI therapy as this ratio has previously been reported to correlate with a higher number of myeloid derived suppressor cells. Methods: A retrospective cohort analysis was performed on patients with advanced or metastatic bladder cancer who were treated with ICI therapy at a single institution between 2015-2020. Information on survival, disease recurrence, and patient characteristics was gathered. Neutrophil and lymphocyte numbers were recorded at time of ICI administration and a ratio of neutrophils to lymphocytes was calculated. The median of these values was calculated and used to divide the cohort into low NLR and high NLR. Tissue samples from a subset of these patients were collected and sent for multiplex immunohistochemistry with a myeloid and T cell staining panel. Results: In a cohort of 115 patients with advanced bladder cancer treated with ICI, the mean time to last follow up or event (death or disease progression) was 375.78 days (SD 41). 35 patients (30%) had either a complete or partial response to ICI therapy. A Kaplan Meier survival analysis shows a significant difference in survival between the low and high NLR group, with lower NLR having a longer event free survival (Wilcoxon rank p = 0.0156). Multiplex IHC showed variable tumor and adjacent microenvironmental distributions of myeloid and lymphoid marker positive populations in ICI responders and non-responders. Conclusions: In an effort to better predict which patients may benefit from ICI therapy, we have studied NLR at the time of ICI administration and its association with event free survival. Our results suggest that a lower NLR could be associated with a longer event free survival. Further research is being conducted to study the immune microenvironment as it relates to bladder cancer response to ICI therapy.

THE ROLE OF NEUTROPHIL TO LYMPHOCYTE RATIO IN TOXICITY AND RESPONSE OF HEAD AND NECK CANCER PATIENTS TREATED WITH CONCURRENT CHEMORADIATION

Background- Neutrophil to Lymphocyte Ratio (NLR) is a haematogical marker which signies inammatory burden and treatment outcome of a malignancy. We investigated prognostic value of NLR in Head and Neck Squamous Cell Carcinoma (HNSCC) patients treated with concurrent chemoradiotherapy. To compare acute toxicity, locoregional control, disease burden w Aims &amp; Objective- ith patients with high (&gt;4) and low (≤4) NLR groups. Head and neck squamous cell carcinoma patients treated with concurre Materials And Methods- nt chemoradiotherapy were retrospectively selected from the records of Department of Radiation Oncology, Medical College Kolkata between 2018-2021. Baseline Neutrophil to Lymphocyte Ratio (NLR) was calculated using Differential Leucocyte Count (DLC) of Complete Blood Count (CBC) measured 10 days before the treatment initiation. An NLR value of greater than 4 has been considered as high. Data regarding stage at presentation, acute oral mucositis, acute dysphagia, anaemia, clinicoradiological response to treatment at 6 weeks after completion of chemoradiation were taken. ResultsWe analysed 150 patients between 2018-2021. Primary sites were oral cavity (37.3%), oropharynx (24%), hypopharynx (10.7%), larynx (28%). Our data suggests high baseline NLR correlates with poor prognosis because of more disease burden and poor treatment response. More numbers of locally advanced disease (T3 &amp; T4) belong to high NLR group (P value= &lt;0.0001). Grade II or more acute toxicities i.e oral mucositis, dysphagia was observed in high NLR group (P value &lt;0.0001), which were statistically signicant. Complete radiological response is lower in high NLR group, which was statistically signicant (P Value = &lt;0.0001). Mean Local Recurrence Free Survival (In Months) was less in high NLR group, this was also statistically signicant. This study suggests that in head and neck squamous c Conclusion- ell carcinoma, high NLR is correlated with higher stage of presentation, more acute locoregional toxicity during chemoradiotherapy, poor response to therapy and low local recurrence free survival (In Months)

Relationship between Neutrophil to Lymphocyte Ratio (NLR) and Gensini Score in Patients with Coronary Artery Disease (CAD) at Mataram City General Hospital: A Cross Sectional Study

Highlights: It discusses the relationship between NLR and the severity of coronary atherosclerosis. There is significant difference from the previous NLR research Abstract: Background. Neutrophil to Lymphocyte Ratio (NLR) is a marker of systemic inflammation correlated with the incidence of Coronary Artery Disease (CAD). Neutrophils infiltrate the coronary artery plaque causing acceleration of atherosclerosis. T lymphocyte recruitment is required at the early stages of plaque formation. Previous studies have shown that heightened NLR was correlated with the percentage of stenosis at the site of the multivessel lesion. Aims. This study aimed to determine the relationship between NLR with Gensini score of coronary arteries in CAD patients at Mataram City General Hospital. Material and method. This was a cross sectional study conducted in Mataram City General Hospital. Fifty-nine patients diagnosed with CAD participated in the study. Blood collection and coronary angiography were performed to assess NLR and Gensini Score. The main variables were NLR and Gensini Score. Gensini score of 1-29 was considered as mild atherosclerosis and Gensini score of 30 or more was considered as severe atherosclerosis. NLR was considered high if the value of NLR were &gt; 2.385 based on previous studies. Spearman test was performed to assess correlation between variables. Results. Approximately 53% subjects were categorized as severe atherosclerosis and 48% as mild atherosclerosis. The median values of Gensini score in the low NLR group were 25.0 and in the high NLR group were 40.0 (p=0,19). The median values of NLR in the mild group of atherosclerosis were 1.78 and in the severe atherosclerotic group were 2.15 (p=0,59). There was no significant difference in NLR between severe atherosclerosis and mild atherosclerosis groups. NLR was not associated with Gensini score (p=0,32). Conclusions. There was no significant relationship between Neutrophil to Lymphocyte Ratio with Gensini score of coronary arteries in CAD patients at Mataram City General Hospital.