High Neutrophil-lymphocyte Ratio Research Articles

Association of low 25-OH-vitamin D levels and peripheral inflammatory markers in patients with autism spectrum disorder: Vitamin D and inflammation in Autism

Inflammatory mechanisms and Vitamin D are reported to play important roles in the pathophysiology of Autism Spectrum Disorders (ASD). There are ample evidences that vitamin D has an anti-inflammatory effect. In this study, we aimed, for the first time, to investigate the 25-OH-vitamin D with inflammation markers in ASD patients. The study included 154 patients with ASD and 98 healthy subjects. 25-OH-Vitamin D levels and simple peripheral inflammatory markers such as Neutrophil-Lymphocyte ratio (NLR), C-reactive protein (CRP) and, sedimentation were measured in all subjects. K-SADS-PL-DSM 5 were administered to all subjects to evaluate the psychiatric diagnosis. Childhood Autism Rating Scale was used to asses severity of autism. In the patient group, high CRP rate, leukocyte, neutrophil and NLR were significantly high compared to the healthy control group. 25-OH-Vitamin D levels were found to be statistically significantly lower in the ASD group. While a significant negative correlation was found between 25-OH-Vitamin D and CRP, NLR, neutrophil counts in ASD patients, a positive correlation was found between lymphocyte counts. Especially in male ASD patients, the relationship between 25-OH-Vitamin D and inflammation markers was more pronounced. Our findings support the association of vitamin D and inflammation in ASD.

The comparison of inflammatory markers in geriatric and nongeriatric endometrial cancers.

The inflammatory markers are associated with adverse clinical outcomes in endometrial cancers (EC), but hematopoietic aging may affect the results. To compare inflammatory markers in geriatric and nongeriatric EC. This study included 342 women with endometrial cancers (n: 171) and age-matched controls (n: 171). Geriatric (⩾ 65 years old) and nongeriatric women in each group was compared for inflammatory markers, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW). Geriatric EC had more common nonendometrioid tumors, myometrial invasion, lymph node metastasis, advanced stage, and low overall survival (OS). Nongeriatric EC had low MPV, high NLR, and PDW compared to nongeriatric control. Geriatric EC had low MPV, lymphocyte, and high NLR, PLR compared to geriatric control (p< 0.05). Geriatric EC had significantly low PDW and high NLR, PLR compared to nongeriatric EC in early stages, not in advanced stages. Lymphocyte count was significantly low in geriatric EC with all stages (p< 0.05). In nongeriatric EC, stage was related to platelet count (r: 0.341, p: 0.0019), and PLR (r: 0.252, p: 0.01). OS was negatively related to PLR (r: -0.267, p: 0.007) and NLR (r: -0.353, p: 0.000). In geriatric EC, myometrium invasion was negatively related to lymphocyte count (r: -0.268, p: 0.035). OS was related to neutrophil count (p: 0.352, p: 0.01). MPV was negatively related to stage (r: -0.335, p: 0.01) and OS (r: -0.337, p: 0.02). The inflammatory responses of geriatric and nongeriatric EC were different in the early and advanced stages. Geriatric EC had low PDW and high NLR, PLR compared to nongeriatric EC in early stages. Decreased lymphocyte count was the most prominent feature of geriatric EC in the early and advanced stages. These results suggested that decreased lymphocyte count may reflect an aggressive course of disease in the elderlies. Future inflammation studies may direct anticancer treatment strategies in geriatric EC. Further research on inflammaging and geriatric EC is needed to increase our understanding of aging and carcinogenesis.

Pandemi servisinde yatan COVID-19 hastalarının yatış kan değerleri ile prognozlarının öngörülebilirliğinin değerlendirilmesi: Retrospektif bir çalışma

Objectives: Prognostic predictors are important for the rapid response and optimal use of the health system during the ongoing COVID-19 pandemic. It has been reported that many hematological parameters may deteriorate starting from the early stages in COVID-19 patients. The aim of the present study was to determine the relationship between hematological and biochemical parameters of patients followed in the service, intensive care hospitalization, and mortality. Methods: The present study is a retrospective study. Participants consist of patients hospitalized in the pandemic service between 1.09.2021 and 15.12.2021. All 366 patients hospitalized in the relevant date range were evaluated, and after exclusion criteria, the study was conducted on 242 patients. Polymerase chain reaction tests of all patients were positive. The hematological and biochemical parameters of the patients on the first day of hospitalization, their age, height, weight, gender, chronic diseases, and steroid treatments were recorded. According to service exits, patients were categorized into three groups: transfer to intensive care (discharged after intensive care treatment), resulting in death (transferred from the ward to intensive care unit and died without discharge), and discharged home (discharged home from the ward without intensive care admission). Results: Of the 242 patients included in the study, 135 (55.8%) were female and 107 (44.2%) were male. Of the patients, 213 (88%) were discharged home from the ward, 8 (3.3%) were transferred to the intensive care unit, and 21 (8.7%) died. The mean age of the patients who died (69.6±13.14 years) was significantly higher than of those transferred to the intensive care unit (61.25±15.75) and discharged home from the service (68.91±12.97). When the patients were divided into two groups as survived and dead; age, lymphocyte, blood urea nitrogen, glomerular filtration rate, aspartate aminotransferase, albumin, C reactive protein, procalcitonin, D-dimer, platelet lymphocyte ratio (TLO) and neutrophil lymphocyte Ratio (NLO) values were significantly different between the two groups. According to the regression model created with significant values, age, high NLO and D-dimer, and low TLO were found to be independent risk factors for mortality. Conclusion: In the present study, age, D-dimer, TLO and NLO measured on the day of hospitalization were found to be independent prognostic markers for mortality in COVID-19 patients.

Combination of Preoperative Circulating Tumor Cell Count and Neutrophil-Lymphocyte Ratio for Prognostic Prediction in Hepatocellular Carcinoma Patients after Curative Hepatectomy.

Background Both the preoperative neutrophil-lymphocyte ratio (NLR) and circulating tumor cell count (CTC) are associated with poor prognosis in hepatocellular carcinoma (HCC). The purpose of this study was to explore the prognostic value of these two indices (CTC-NLR) in HCC. Methods We retrospectively collected demographic and clinical data, including NLR and CTC, from 97 patients with HCC who underwent curative hepatectomy at our institution from March 2014 to May 2017. X-Tile software was used to confirm the optimal cut-off value of NLR and CTC for predicting overall survival (OS) in this study. OS were also analyzed using Kaplan-Meier and Cox regression methods. Based on preoperative CTC and NLR, patients were divided into three groups: CTC-NLR (0), CTC-NLR (1), and CTC-NLR (2). Relationships of CTC-NLR with clinicopathological factors and survival were evaluated. Results Preoperatively, CTC positively correlated with NLR. Patients with NLR and CTC higher than the cut-offs had shorter OS than patients with low NLR and CTC. Kaplan-Meier analysis, and log-rank tests revealed significantly lower OS among patients with CTC-NLR scores of 0, 1, and 2. Uni- and multivariate analyses showed that CTC-NLR (hazard ratio 2.050, P = 0.005), CTC (hazard ratio 2.285, P = 0.032), and NLR (hazard ratio 1.902, P = 0.048) were independent predictor of OS. A time-dependent ROC curve indicated that the prognostic efficacy of the CTC-NLR at 1 year (0.714) was better than that of NLR (0.687) and CTC (0.590); the prognostic efficacy of the CTC-NLR at 2 years (0.746) was better than that of NLR (0.711) and CTC (0.601); the prognostic efficacy of the CTC-NLR at 3 years (0.742) was better than that of NLR (0.694) and CTC (0.629). Conclusions HCC patients with higher NLR and CTC tend to show shorter OS. Preoperative CTC-NLR may be associated with poor survival and might be a reliable prognostic predictor in HCC after curative hepatectomy.

Clinico-epidemiological Characteristics of Acute Covid-19 Patients in a Tertiary Care Hospital of Dhaka, Bangladesh

Background: The COVID-19 pandemic is a catastrophe enormously affecting the whole world including Bangladesh. This disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began in Wuhan, China, in December 2019, and since then has been spreading globally. Objectives: To find out the sociodemographic, clinical characteristics and in-hospital outcome of patients of acute COVID-19 confirmed cases in a tertiary care hospital. Methodology: It was a hospital based observational study. Consecutive samples were taken from RT-PCR positive cases (ranging from mild to severe form) admitted in COVID-19 unit of Shaheed Suhrawardy Medical College Hospital, Dhaka during the period of July 1st to August 31st 2020. Socio-demographic and clinical data were collected by using a pretested structured questionnaire. The severity of the COVID- cases was assessed based on the WHO interim guideline. Analysis was done with SPSS (Statistical Package for Social Science) version-23. Results: Total 77 cases were found valid for study according to inclusion and exclusion criteria. Male patients were predominant which was 72.7%. Mean age was found 53.32±13.48 years. The mean age was significantly higher (58.82±11.74 years) in severe group. Fever, shortness of breath (SOB), cough and body ache were the most common presenting symptoms. Body ache was significantly higher in mild &amp; moderate group than severe group. SOB and sore throat were significantly higher in severe group (53.5% vs 79.4%) and (9.3% vs 26.5%) respectively. Diabetes 29(37.7%), hypertension 18(23.4%), CKD 16(20.8%) and hypothyroidism 16(20.8%) were most frequent co-morbidities among the patients. Diabetes, CKD, hypothyroidism and COPD were significantly higher in severe group than mild &amp; moderate group. The mean neutrophil lymphocyte ratio (NLR) was found 1.3±0.3 in mild &amp; moderate group and 2.3±1.0 in severe group. Mean C-reactive protein was found 6.2±2.3 mg/L in mild &amp; moderate group and 8.5±3.9 mg/L in severe group. The mean sodium was found 143.6±7.9 mEq/L in mild &amp; moderate group and 136.5±9.8 mEq/L in severe group. The mean potassium was found 4.7±0.7 mEq/ L in mild &amp; moderate group and 3.9±1.2 mEq/L in severe group. Where X-ray chest (CXR) could reveal abnormalities only in 8 cases (10.4%); HRCT-chest was able to find out abnormalities in 56 cases (72.7%). Abnormal HRCT chest was found in 56 patients among them 48(87.3%) showed normal finding on chest x-ray. The difference was statistically significant between two groups. In HRCT chest abnormalities ground glass opacities (GGOs) was the most frequent observation in 33(58.93%) patients. GGOs was found 12(50.0%) in mild &amp; moderate group and 21(65.63%) in severe group. Major complications were pneumonia 39(50.6%) and severe pneumonia 28(36.4%) respectively. Pneumonia was significant higher in mild &amp; moderate group than severe group (76.7% vs 17.6%). Severe pneumonia was observed 27(79.4%) in severe group. The above-mentioned parameters were statistically significant (p&lt;0.05) between two groups. 2 patients (2.6%) died among them both were in severe group and both were male. Conclusion: Male sex and middle-aged population are mostly affected by the SARS-CoV-2. SOB and sore throat were significantly higher in severe group. Where facilities available strongly suspected individuals may go for HRCTchest. High NLR and CRP as well as lower value of sodium and potassium are good predictors for the severe or critical form of disease spectrum. J Bangladesh Coll Phys Surg 2022; 40: 183-190

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.

Altered Hematological Profile

Background: Being a systemic infection, coronavirus disease 2019 (COVID-19) affects hematologic system, along with cardiovascular, pulmonary, gastrointestinal, and neurological systems, resulting in altered hematological parameters. These altered hematological findings are thought to have a role in early risk stratification and prognostication of COVID-19 patients. However, the data on hematological abnormalities associated with the disease among Eastern Indian COVID-19 patients, particularly the Bengalis, are limited. Aim: The aim is to study the association, if any, between various hematological parameters and disease severity of COVID-19. Materials and Methods: The study was a cross-sectional study involving 145 laboratory-confirmed cases of SARS-CoV-2 infection. Based on the disease severity, the patients were divided into three groups: mild, moderate, and severe. Various hematological parameters were analyzed. Results: Of the 145 patients, 82.8%, 9.6%, and 7.5% of the cases were in the mild, moderate, and severe groups, respectively. The mean age was 48 years. The result of our study showed that the age of the patients is directly proportional to the severity of the illness. About 62.1% of the patients were male, whereas the rest (37.9%) were female. Our study showed an independent association of Covid severity with male gender. Although mean total leukocyte count (TLC), absolute count of neutrophil, lymphocyte, eosinophil, neutrophil–lymphocyte ratio (NLR), neutrophil–monocyte ratio (NMR), lymphocyte–monocyte ratio, platelet–lymphocyte ratio, and systemic inflammatory index among mild, moderate, and severe COVID-19 cases were statistically significant (P &lt; 0.05), basophil, monocyte, and platelet count were statistically insignificant among the three groups. Nearly all of the hematological parameters could be used as potential diagnostic biomarkers for subsequent analysis because their area under the curve was higher than 0.50. Conclusion: Severity of COVID-19 is associated with older age, male sex, higher TLC, neutrophilia, lymphopenia, eosinopenia, high NLR, and high NMR. As complete blood count is an inexpensive routine blood investigation, it can be very useful in a resource-poor healthcare facility, which is unable to provide high-end investigations.

Early versus delayed debridement for surgical site infection after oncological neurosurgery.

Background: There are no guidelines on the management of surgical site infection (SSI) in neurosurgery. This study sought to analyze whether early debridement improved survival compared to antibiotic therapy alone in patients with postcraniotomy infections after oncological neurosurgeries.Methods: We retrospectively reviewed patient records from 2011 to 2019 to identify patients that had been reoperated for the debridement of SSI after brain tumor resection. If SSI was suspected but not clinically evident, the diagnosis was confirmed by cerebrospinal fluid (CSF) analysis or contrast-based imaging examinations. Immediately after diagnosis, broad-spectrum antibiotics were started for all patients.Results: Out of 81 SSI cases, 57 underwent debridement. Two patients were reoperated 3 times, and three had two surgeries, resulting in a total of 64 procedures. The number of days between SSI diagnosis and surgical intervention did not influence mortality in both univariate and multivariable analyses (Hazard ratio [HR] 1.03, 95% CI 0.93–1.13). Early debridement (<24 h) did not influence rates of antibiotic prescription at discharge (P = 0.53) or hospital length of stay (LOS) (P = 0.16). Higher neutrophil-lymphocyte ratios (NLRs) were associated with the lower survival (HR 1.05, 95% Confidence interval [CI] 1.01–1.08). Multiple cutoffs were tested and values above 3.5 are more significantly associated with worse outcomes (HR 2.2; 95%CI 1.1–4.2).Conclusion: Early debridement does not seem to influence the survival, rates of antibiotic at discharge, or hospital LOS of patients presenting with SSI after neurosurgery for intracranial tumors. High NLRs are strong predictors of worse prognosis in this population.

Neutrophil-to-lymphocyte ratio trend: A novel prognostic predictor in patients with nasopharyngeal carcinoma receiving radiotherapy.

Peripheral neutrophil-lymphocyte ratio (NLR), reflecting immune-inflammation status, shows great potential for tumor progression and outcome. Pre-treatment NLR does not fully reflect the immune-inflammatory response to treatment. This study aimed to introduce the NLR trend as a new indicator and to investigate its prognostic value in patients with nasopharyngeal carcinoma receiving radiotherapy. This retrospective study evaluated patients with nasopharyngeal carcinoma treated with radiotherapy. The NLR trend value was calculated from the fitted line gradient via the NLRs before, during (at least once), and after each patient's first radiotherapy. The Kaplan-Meier curve and log-rank test were used to calculate and compare survival outcomes of different pretreatment NLRs and NLR trends for progression-free survival, locoregional recurrence-free survival (LRFS), and overall survival at 3 and 5 years. Multivariate Cox regression analyses were performed to assess the association between the NLR trend plus 3- and 5-year overall survival. The study included 528 patients. A lower NLR trend predicted worse progression-free survival, LRFS, plus 3- and 5-year overall survival. Multivariate Cox regression analysis showed that the NLR trend independently predicted 3- and 5-year overall survival. Sub-group analysis showed that the prognosis of patients with a low pretreatment NLR and a high NLR trend were superior to those of other groups. The NLR trend independently predicted the prognosis of patients with nasopharyngeal carcinoma receiving radiotherapy. The NLR trend and the pretreatment NLR combination is more precise than pretreatment NLR in predicting prognosis. A high NLR trend may be evidence of a positive immune response to radiotherapy in patients with nasopharyngeal carcinoma.

Preoperative Risk Factors and Prognostic Impact of Postoperative Complications Associated with Total Gastrectomy

Introduction: We evaluated the risk factors for patients with gastric cancer (GC) undergoing total gastrectomy (TG) that predict postoperative complications, including anastomotic leakage, postoperative pneumonia, and heart disease. Methods: We collected 106 patients who received TG for GC between May 2009 and May 2017 at Gunma University Graduate School of Medicine, including clinicopathologic, surgical, postoperative complication, laboratory test, and physiologic test data. Results: Of 106 patients, 92 (86.8%) had no complications, and 14 (13.2%) had complications. Univariate analyses revealed that a high American Society of Anaesthesiologists physical status (ASA-PS) and neutrophil-lymphocyte ratio (NLR) of ≥3.5 significantly correlated with postoperative complications. Multivariate analyses showed that high ASA-PS was an independent prognostic factor of postoperative complications. The cancer recurrence rate was 34.8% in the noncomplication group and 71.4% in the complication group. Conclusion: Patients with postoperative complications are prone to recurrence and poor prognosis. For patients with high-risk GC with poor ASA-PS and high NLR, more thorough perioperative management is essential.

C-Reactive protein and Neutrophil lymphocyte ratio in Depressive disorder: a hospital based cross sectional study

Aim of the studyTo evaluate High sensitive C-reactive Protein (Hs CRP) and neutrophil lymphocyte ratio (NLR) in patients with Depression and to compare HsCRP and NLR in Major Depressive disorder (MDD) and Recurrent depressive disorder (RDD)Subject or material and methodsThis was a hospital-based case control study conducted in year 2019 for 3 months duration. Ninety eight patients with Depressive disorder and 50 healthy controls were included. HAM-D, HsCRP and NLR was assessed for all subjects.ResultsHsCRP and NLR was more in patients with Depression than in controls and this was statistically significant. HsCRP and NLR was more in RDD compared to MDD. Both HsCRP, NLR were positively correlated with age, duration of illness, number of depressive episodes and HAMD scores. The odds of suicidal ideas in depressive patients was more with increase in HsCRP and NLR.DiscussionTo the best of our knowledge, this is the first study to compare inflammatory parameters in MDD and RDD. In our study, CRP and NLR were more in RDD compared to MDD. This could be explained by immune dysregulation and chronic inflammation in RDD. Resistance to antidepressant therapy, and relapse of depression causes an activation of inflammatory response. In the present study, we observed an association between suicidal ideas and CRP, NLR.ConclusionsInflammation plays a significant role in depression as indicated by elevated HsCRP and NLR. These parameters help to assess suicidal risk. A futuristic study can be taken up to assess the effect of antidepressants on their levels.

Abstract 2455: Development of a bioluminescence reporter mouse model for tracking and quantifying Ly6G+ neutrophils in vivo

Abstract Immunotherapy has revolutionized the way cancer is treated; however, despite tremendous success, not all patients benefit from immunotherapy. Identifying biomarkers predictive of effective treatment response to current and novel immunotherapies is of utmost importance. Multiple studies have indicated neutrophil-lymphocyte ratio (NLR) may be a predictive biomarker of immunotherapy response. We analyzed hematological parameters across multiple preclinical murine tumors to determine if NLR predicts tumor growth and response to treatment. The hematological survey identified NLR to be strongly correlated to tumor weights, with larger tumors exhibiting higher NLRs. In addition, mouse tumors that have been characterized as resistant or partially responsive to immunotherapy had a higher NLR than tumors responsive to immunotherapy. To track neutrophils in vivo, we generated a BAC transgenic mouse wherein firefly luciferase (Luc2), diphtheria toxin receptor (DTR), and enhanced green fluorescence protein (eGFP) genes were expressed under the endogenous Ly6G promoter. The Ly6G promoter enables tracking of Ly6G+ neutrophils using luciferase-based bioluminescence imaging (BLI), depletion of Ly6G+ neutrophils by diphtheria toxin treatment, and the ability to perform flow analyses using the eGFP marker. In vivo and ex vivo BLI demonstrated that the Ly6G+ cells were primarily expressed in bone marrow, blood, spleen, and the digestive tract. To ensure the specificity of the bioluminescence signal, we isolated Ly6G+ and Ly6G- immune cells and performed in vitro BLI. In vitro BLI confirmed that bioluminescence was exclusive to Ly6G+ cells. To confirm that the Luc2-DTR-eGFP (LDG) reporter cassette expression did not affect neutrophil activity and function, we quantified the level of myeloperoxidase (MPO), a marker of neutrophil activation, in the phorbol myristate acetate (PMA)-induced ear edema mouse model. Neutrophil activity was measured using luminol enabled BLI of MPO. Luminol-BLI following PMA-induced ear edema demonstrated similar MPO activity between wildtype and transgenic mice. Finally, we investigated if the LDG reporter cassette impacted tumor growth. Measures of tumor burden in this transgenic line recapitulated our hematological findings. Tumors with higher NLR showed higher tumor BLI signal when compared to tumors with lower NLR ratio, demonstrating that the LDG reporter cassette did not impact tumor growth in the transgenic mice and importantly, providing a tool to track Ly6G+ cells in tumors. Our results demonstrate that NLR in tumor correlates with response to immunotherapy across multiple tumor types. Here we describe the development of a transgenic mouse to track intratumoral Ly6G+ cells. These transgenic mice provide a valuable tool for profiling oncology compounds, including those targeting immune cells, and for understanding the mechanism of action of such agents. Citation Format: Milind D. Chalishazar, Nicolas Solban, Johnny Kopinja, Doug Linn, Razvan Cristescu, Heather Zhou, Thomas Rosahl, Brian Long, Weisheng Zhang, Eric Hostetler. Development of a bioluminescence reporter mouse model for tracking and quantifying Ly6G+ neutrophils in vivo [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2455.

Absolute lymphocyte count and C-reactive protein-albumin ratio can predict prognosis and adverse events in patients with recurrent esophageal cancer treated with nivolumab therapy.

Predicting the prognosis and adverse events (AEs) of nivolumab therapy for recurrent esophageal cancer is very important. The present study investigated whether a simple blood biochemical examination could be used to predict prognosis and AEs following nivolumab treatment for relapse of esophageal cancer. A total of 41 patients who received nivolumab treatment for recurrent esophageal cancer after esophagectomy were analyzed. The absolute lymphocyte count (ALC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) and C-reactive protein-albumin ratio (CAR) were assessed at the time of nivolumab induction as indices that can be calculated by blood biochemical examinations alone. Median values were 1,015 for ALC, 3.401 for NLR, 242.6 for PLR, 0.458 for MLR and 0.119 for CAR, and patients were divided into two groups according to values. A high ALC, low NLR, low PLR, low MLR and low CAR were associated with a better response to nivolumab. In addition, patients with the aforementioned indices, with the exception of low PLR, or better response were more likely to develop AEs in univariate analysis. In multivariate analysis, a high ALC [odds ratio (OR): 4.857, P=0.043] and low CAR (OR: 9.099, P=0.004) were identified as independent risk factors for AEs. Survival analysis revealed that overall survival and progression-free survival (PFS) rates after nivolumab treatment differed significantly between the high and low groups of ALC, NLR, PLR, MLR and CAR. The multivariate analysis identified a low ALC [hazard ratio (HR): 3.710, P=0.003] and high CAR (HR: 2.953, P=0.007) as independent poor prognostic factors of PFS. In conclusion, ALC and CAR have potential as biomarkers for outcomes of recurrent esophageal cancer following nivolumab treatment.

Evaluation of Rapid SARS-CoV-2 Antigen Detection as a Single Diagnostic Test and When Combined with C-Reactive Protein Level or Neutrophil to Lymphocyte Ratio in Suspected COVID-19 Subjects.

Background Rapid antigen detection tests of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) play a crucial role in the control of the current coronavirus disease 2019 (COVID-19) pandemic. Data about the real diagnostic performance of such tests is still insufficient and hence their evaluation is of high priority. Objectives The aim of this study was to evaluate the diagnostic performance of BIOCREDIT COVID-19 antigen test alone and in combination with either C-reactive protein (CRP) or neutrophil/lymphocyte ratio (NLR) in comparison to real-time quantitative polymerase chain reaction (RT-qPCR). Additionally, we investigated the selection criteria of the suspect for best performance of the antigen test. Materials and Methods Paired nasopharyngeal (NP) swabs were collected from 200 suspected COVID-19 subjects for SARS-CoV-2 RNA by RT-qPCR and for antigen detection by BIOCREDIT test. Simultaneously, for all suspect, clinical presentations were recorded as well as CRP level and NLR were determined. Results Among 200 tested NP swabs, 125 (62.5%) were RT-PCR positive. Overall sensitivity, specificity and accuracy of BIOCREDIT test were 34.4, 98.7, and 58.5%, respectively. Sensitivity of the BIOCREDIT test was higher in COVID-19 suspect, with high viral load (100%), severely ill (56.2%), with fever alone (40%), elevated CRP (41.1%), and high NLR (36.2%). In combination with NLR or CRP, sensitivity of BIOCREDIT test increased to 89.4 and 81.6%, respectively, while its specificity decreased to 67 and 59%, respectively. Conclusion The overall low sensitivity of BIOCREDIT/COVID-19 antigen test does not permit its use as a single diagnostic test for COVID-19. However, its use should be restricted only if it is combined with either CRP or NLR in suspect with certain criteria.

Comparison of the prognostic effect of sarcopenia on atezolizumab plus bevacizumab and lenvatinib therapy in hepatocellular carcinoma patients.

Background and AimSarcopenia has received much attention as a poor prognostic factor in various fields, and has also been reported to worsen prognosis in patients with hepatocellular carcinoma (HCC) treated with sorafenib or lenvatinib (LEN). Atezolizumab/bevacizumab (ATZ/BEV) is recommended as first‐line drug therapy for unresectable‐HCC, but the effect of sarcopenia on patients treated with ATZ/BEV is unknown.MethodsWe enrolled 98 patients treated with ATZ/BEV or LEN. Computed tomography performed before the initiation of drug therapy was used to diagnose sarcopenia in accordance with the criteria proposed by the Japanese Society of Hepatology. Patients were divided into two groups based on the presence or absence of sarcopenia in each regimen, and patient characteristics, adverse events, and prognosis were compared.ResultsIn ATZ/BEV therapy, 57.1% of patients had sarcopenia. The sarcopenia group had significantly more women (P = 0.0125) and more macroscopic vascular invasion (P = 0.0270). Sarcopenia had no significant effect on progression‐free survival (PFS) and overall survival (OS). In LEN therapy, 63.4% of patients had sarcopenia. The sarcopenia group was significantly older (P = 0.0064) and had a higher number of women (P = 0.0003), a higher neutrophil–lymphocyte ratio (P = 0.0222), worse albumin–bilirubin grade (P = 0.0087), and worse best response (P = 0.0255). PFS (P = 0.0091) and OS (P = 0.0006) were worse in the sarcopenia group. In multivariate analysis, age (P = 0.0362), lymphocyte–monocyte ratio (P = 0.0365), and sarcopenia (P = 0.0268) were independent prognostic factors for OS.ConclusionIn ATZ/BEV therapy, sarcopenia does not determine prognosis, and therapeutic efficacy can be expected even in cases of sarcopenia.

Prognostic role of an inflammation scoring system in radical resection of oral squamous cell carcinoma.

BackgroundInflammatory markers can influence the postoperative prognosis and outcome of malignant tumors. However, the role of inflammatory factors in oral squamous cell carcinoma (OSCC) are still debatable. The primary objective of this investigation was to detect the preoperative blood fibrinogen and neutrophil–lymphocyte ratio (NLR) in OSCC patients and to determine the predictive validity of F-NLR (combined fibrinogen and NLR score).MethodsA total of 365 patients with oral cancer after surgery were separated into three classes: F-NLR of 2, with hyperfibrinogenemia (> 250 mg/dL) and high NLR (> 3.2); F-NLR of 1, with only one higher index; and F-NLR of 0, with no higher indices. Univariate and multivariate analyses were used to identify risk factors for the demographic and clinical characteristics of patients in the three F-NLR groups. Kaplan–Meier survival analysis was used to assess the prognosis.ResultsPreoperative F-NLR showed a relatively better predictive role in oral cancer prognosis than fibrinogen and NLR alone. Multivariate analysis revealed that F-NLR has the potential to be an independent predictor for OSCC cancer-specific survival (P < 0.001). Patients with high scores had a relatively poorer prognosis than those with low scores (P < 0.001).ConclusionsOur findings indicate that blood F-NLR may serve as an independent prognostic factor in OSCC patients.

Higher neutrophil–lymphocyte ratio is associated with depressive symptoms in Japanese general male population

Relationships between the neutrophil–lymphocyte ratio (NLR) and/or the platelet-lymphocyte ratio (PLR) and neuroinflammatory diseases have been reported. Depression is also associated with neuroinflammation. Here, we determined the association between the NLR, PLR, and depressive symptoms. This cross-sectional study is a secondary analysis of the data of the Iwaki Health Promotion Project 2017. We analyzed the characteristics and laboratory data of 1,015 Japanese subjects (597 females, 408 males) including their NLR and PLR values. We assigned the subjects with a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16 to the depressive symptoms group. We performed a multivariate logistic regression analysis to determine whether the NLR and/or PLR were associated with depressive symptoms (CES-D ≥ 16). Two hundred subjects (19.7%; 122 [20.4%] females, 78 [19.1%] males) were assigned to the depressive symptoms group. There were significant differences between the non-depressive symptoms and depressive symptoms groups in the NLR [median (25th to 75th percentile): 1.54 (1.24, 1.97) vs. 1.76 (1.32, 2.37), P = 0.005] and the PLR [median (25th to 75th percentile): 123.7 (102.0, 153.9) vs. 136.8 (107.0, 166.5), P = 0.047] in males, but not in females. The multivariate logistic regression analysis demonstrated that the NLR was significantly associated with depressive symptoms in males (adjusted odds ratio: per 1 increase, 1.570; 95% confidence interval: 1.120–2.220; P = 0.009). In conclusion, our findings indicate that higher NLR may be associated with depressive symptoms in males.

The Values of Systemic Immune-Inflammation Index and Neutrophil-Lymphocyte Ratio in Predicting Biochemical Recurrence in Patients With Localized Prostate Cancer After Radical Prostatectomy.

PurposeTo investigate the association between preoperative systemic immune-inflammation index (SII) and neutrophil–lymphocyte ratio (NLR) and oncological outcomes in localized prostate cancer (PCa) patients after radical prostatectomy (RP).MethodsBetween January 2014 and December 2019, 291 patients with pathologically confirmed localized PCa who underwent RP were included in this study. The threshold values of SII and NLR for biochemical recurrence (BCR) were calculated according to Youden’s index based on the receiver operating characteristic (ROC) curve, then the patients were divided into two groups by the threshold values of SII and NLR, and the clinicopathological outcomes were analyzed and compared between groups, respectively. The binary logistic regression model was used to evaluate the association between SII, NLR, and pathological outcomes including Gleason score (GS) and pathological T (pT) stage. Kaplan–Meier curves and univariable and multivariable Cox regression models were used to determine the association between high SII, high NLR, and BCR-free survival, respectively.ResultsThe median follow-up time was 48 months (IQR 36–62), and 114 (39.18%) patients developed BCR. The AUC of SII for BCR was 0.813 (P < 0.001), with a threshold value of 528.54, a sensitivity of 72.9%, and a specificity of 76.3%; the AUC of NLR for BCR was 0.824 (P < 0.001), with a threshold value of 2.62, a sensitivity of 71.2%, and a specificity of 81.6%. Patients were divided into two groups according to the threshold values of SII and NLR, respectively. Patients in the high SII group had higher tPSA, GS, pT stage, and BCR rate than patients in the low SII group (P = 0.004, 0.04, 0.007, and <0.001, respectively), and patients in the high NLR group had higher tPSA, GS, pT stage, and BCR rate than patients in the low NLR group (P = 0.04, 0.02, 0.006, and <0.001, respectively). Multivariable logistic regression analysis revealed that high SII was significantly correlated with adverse pathological outcomes of GS (HR, 1.656; 95% CI, 1.00–2.742, P = 0.042) and pT stage (HR, 1.478; 95% CI, 0.972–3.64, P = 0.028); there was no association between high NLR and pathological events. Kaplan–Meier analysis showed significantly poorer BCR-free survival in patients with high SII or high NLR (P < 0.001 and <0.001, respectively). By using the multivariable Cox regression model, high SII (HR, 4.521; 95% CI, 2.262–9.037, P < 0.001) and high NLR (HR, 4.787; 95% CI, 2.339–9.798, P < 0.001) were both significant predictors of BCR after RP.ConclusionHigh SII was significantly related to unfavorable clinicopathological outcomes. High preoperative SII and NLR were related to higher BCR rate in localized PCa after RP, and they were all independent risk factors associated with shorter BCR-free survival. These two factors might provide promising and inexpensive methods for predicting clinical outcomes in patients with RP.

Association of obstructive sleep apnea syndrome with hematological parameters and comorbid diseases

Background &amp; Objective: Obstructive sleep apnea syndrome (OSAS) has a close relationship with many diseases. Hematological parameters are simple diagnostic methods and can give an idea about severity of some diseases. The aim of this study was to examine the relationship of OSAS with comorbid diseases and relationship between OSAS severity, oxygen desaturation index (ODI) and hematological parameters. Methods: This retrospective and cross-sectional study was conducted by evaluating the medical files of patients who underwent polysomnography between 2012 and 2018. 1,119 patients (198 controls; 921 OSA) were participated to the research. Results: Congestive heart failure, hypertension (HT), asthma and chronic obstructive pulmonary diseases (COPD) were seen in 143, 424, 254 and 177 patients respectively. Severe OSAS was found more common in male. Except the patients with HT; neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) levels were higher and lymphocyte levels were lower in patients with comorbid diseases. WBC and erythrocyte distribution width (RDW) levels were higher in patients with COPD than without COPD; PLT levels were higher in patients with asthma than without asthma. WBC level of the moderate-severe OSAS was significantly higher than the control and mild OSAS (p=0.001). Platelet distribution width (PDW) value of the OSAS was higher than the control group (p=0.005). The apnea-hypopnea index and ODI levels were higher in patients with comorbidity than without comorbidity (p=0.001). Conclusions: It can be said that lymphopenia, high NLR, PLR, WBC, RDW and PDW may be useful markers for predicting severity of OSAS in comorbid diseases. The presence of OSAS should be detected in order to treat comorbidity appropriately.

J-shaped associations and joint effects of fasting glucose with inflammation and cytokines on COVID-19 mortality

ObjectivesThe aim of this study was to investigate the dose-response relationship of admission fasting glucose (FBG) with corona virus disease 2019 (COVID-19) mortality and to further evaluate potential interactions of hyperglycemia with inflammation and hypercoagulation on COVID-19 outcomes. MethodsThis retrospective study included 2555 consecutively hospitalized patients with COVID-19, until death or discharge, in Wuhan Union hospital between January 1 and April 9, 2020. The poor early outcomes included admission to intensive care unit, intubation, and deaths occurring within 28 days. We used splines nested in Cox regression to visualize dose-response associations and generalized additive models to fit three-dimensional (3D) trend plots for joint effects of FBG with markers of inflammation and coagulation. ResultsJ-shaped associations existed between hospitalized mortality or poor early outcomes and FBG with a nadir at 5 mmol/L, which were more evident in women. 3D plots demonstrated significant joint effect trends, and patients with hyperglycemia and high neutrophil-lymphocyte ratio, C-reactive protein, lactate dehydrogenase, procalcitonin, d-dimer, and interleukin-6 had 7.4-25.3-fold risks; the proportions of joint associations attributed to additive interactions reached 30% to 54%. ConclusionsFBG was associated with hospitalized mortality and poor early outcomes in a J-shaped manner, and a combination of hyperglycemia, inflammation, hypercoagulation, and cytokines conferred a dramatically higher risk.