High Neutrophil-lymphocyte Ratio Research Articles

Efficacy of cabazitaxel in patients with metastatic castration-resistant prostate cancer: A single-center study in Japan.

Cabazitaxel is a next-generation taxane that can prolong overall survival after docetaxel treatment in patients with metastatic castration-resistant prostate cancer. However, the efficacy of cabazitaxel varies among these patients. The clinical indicators of the prognosis after cabazitaxel treatment were analyzed. A retrospective review of patients who received cabazitaxel between February 2015 and June 2021 was performed. All patients had metastatic castration-resistant prostate cancer. Prognostic factors for prostate-specific antigen progression-free and overall survival were analyzed by Cox proportional-hazards analysis and the log-rank test. The study comprised 57 patients who received cabazitaxel (median 4 cycles, range 1-27) at a starting dose of 15-25 mg/m2 . The median age and follow-up duration were 70 years and 9.2 months. The median prostate-specific antigen progression-free survival and overall survival were 2.6 and 10.5 months, respectively. Univariate analysis showed that previous androgen receptor-axis-targeted therapy before cabazitaxel treatment was the only significant risk factor (hazard ratio 2.784, p = 0.022) for prostate-specific antigen progression-free survival. Multivariate analysis for overall survival revealed that poor performance status (≥1) (hazard ratio 2.107, p = 0.039), low hemoglobin (hazard ratio 0.142, p = 0.010), and high neutrophil-lymphocyte ratio (hazard ratio 9.150, p = 0.032) at baseline were significantly associated with a poor prognosis. Previous androgen receptor-axis-targeted therapy was the only risk factor for biochemical progression. Poor performance status, anemia, and high neutrophil-lymphocyte ratio were risk factors for poor prognosis in patients with metastatic castration-resistant prostate cancer treated with cabazitaxel. These risk factors seem useful for identifying patients with survival benefit from cabazitaxel treatment.

High neutrophil-lymphocyte ratio as a predictor of mortality in major burn patients

Major burns are a type of trauma with high mortality risk. Therefore, an accurate predictor of mortality indicators is needed in burn patients. This study used an analytical observational study design with a retrospective case-control approach. One such indicator is the neutrophil-lymphocyte ratio which was studied further in this study. Subjects included 60 burn patients with 30 survivors and 30 mortalities. The sex characteristics of the subjects were predominantly male (70%), with a median age of 38.5 (IQR 30.5 – 52.5) ​​years. Fire (68.3%) was the most common cause of burns. The median neutrophil-lymphocyte ratio decreased from day 1 (median 15.6, IQR 10.1–21.7) to day 3 (median 6.7, IQR 4.4 – 11.8). However, there was a different pattern in which the value of the neutrophil-lymphocyte ratio was found to increase on day 3 in the mortality group. The binomial logistic regression test found that the neutrophil-lymphocyte ratio value greater than or equal to 10 on the 3rd day was significantly associated with mortality risk with an aOR of 13.91 (95% CI 1.77 – 109.47). The conclusion is that A high neutrophil-lymphocyte ratio at day three can be used as a predictor of mortality in major burn patients.

The Association Of Neutrophil Lymphocyte Ratio And In-Hospital Mortality In Acute Coronary Syndrome Patients: Meta Analysis

Coronary artery disease, including acute coronary syndrome (ACS), is a major cause of mortality and morbidity worldwide. The neutrophil lymphocyte ratio (NLR) is a nonspecific marker of inflammation and previous studies have shown that increased NLR is associated with mortality in acute coronary syndrome patients and may act as a prognostic marker. The aim of this study was to assess the association of NLR and in-hospital mortality in ACS patients. The method used in this study was, Literature search was carried out using the Ebsco, Embasse, Nature, Proquest, PubMed, Science Direct and Scopus databases until March 2022 to find an observational cohort study that assessed the association of NLR and in-hospital mortality in ACS patients. A systematic review of published studies following the preferred reporting items for systematic review and guideline meta-analysis (PRISMA) was conducted. Study quality was assessed with the Newcastle Ottawa Scale (NOS) and only high quality studies were included in this meta-analysis. The primary outcome was in-hospital mortality and the effect was measured in Risk Ratio (RR) and 95% CI. Conclusion: A high NLR increases the risk of in-hospital death in acute coronary syndrome patients. Further studies in large settings are needed to assess the NLR threshold values ​​that can predict in-hospital mortality in acute coronary syndrome patients

The Association Of Neutrophil Lymphocyte Ratio And In-Hospital Mortality In Acute Coronary Syndrome Patients: Meta Analysis

Coronary artery disease, including acute coronary syndrome (ACS), is a major cause of mortality and morbidity worldwide. The neutrophil lymphocyte ratio (NLR) is a nonspecific marker of inflammation and previous studies have shown that increased NLR is associated with mortality in acute coronary syndrome patients and may act as a prognostic marker. The aim of this study was to assess the association of NLR and in-hospital mortality in ACS patients. The method used in this study was, Literature search was carried out using the Ebsco, Embasse, Nature, Proquest, PubMed, Science Direct and Scopus databases until March 2022 to find an observational cohort study that assessed the association of NLR and in-hospital mortality in ACS patients. A systematic review of published studies following the preferred reporting items for systematic review and guideline meta-analysis (PRISMA) was conducted. Study quality was assessed with the Newcastle Ottawa Scale (NOS) and only high quality studies were included in this meta-analysis. The primary outcome was in-hospital mortality and the effect was measured in Risk Ratio (RR) and 95% CI. Conclusion: A high NLR increases the risk of in-hospital death in acute coronary syndrome patients. Further studies in large settings are needed to assess the NLR threshold values ​​that can predict in-hospital mortality in acute coronary syndrome patients

Elevated IL-18 predicts poor prognosis in critically ill COVID-19 patients at a Brazilian hospital in 2020-21.

Background: A dysregulated inflammatory response contributes to decline in patients with COVID-19. This cross-sectional study evaluated biomarkers of unvaccinated patients admitted to the intensive care unit of a hospital in Fortaleza, Brazil. Methods: Twenty cytokines were quantified upon hospital admission; clinical and laboratory data were analyzed, as well as sociodemographic data, to search for an association with clinical outcomes, including fatal (n = 40) or recovered cases (n = 38). Results: Fatal cases exhibited significantly higher levels of IL-18 (p = 0.009); deceased patients were older (p = 0.0001), had a lower number of platelets (p = 0.0063) and higher neutrophil–lymphocyte ratio (p = 0.0230) than those who recovered. Conclusion: These findings indicate that IL-18 is a possible marker to predict poor prognosis in critically ill patients with COVID-19.

The values of systemic immune-inflammation index and neutrophil-lymphocyte ratio in predicting testicular germ cell tumors: A retrospective clinical study.

PurposeTo determine whether complete blood count (CBC) based inflammatory parameters can be used as markers predicting testicular germ cell tumors (TGCT).Material and methodsBetween 2013 to 2018 the data of 58 patients with testicular TGCT undergoing radical orchiectomy and 54 malignancy-free healthy men were retrospectively analyzed as tumor group and control group. Patient baseline characteristics including age, pathological stage and pre-surgery CBC based inflammatory parameters including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), systemic immune-inflammation index (SII), lymphocyte ratio (LR), neutrophil ratio (NR), mean platelet volume (MPV) and red cell distribution width (RDW) were analyzed and compared between tumor group and control group. Receiver operating characteristic (ROC) curve were used analyzing data with significantly difference to assess the discriminative ability of the markers for TGCT, area under the curve (AUC), cut-off value, sensitivity and specificity were calculated. The binary logistic regression model was used to evaluate the association between significant inflammatory markers and risk of TGCT.ResultsMean age of the tumor and control group was 41.1 ± 15.36 and 44.89 ± 9.2 years, respectively. Mean NLR, SII and RDW were significantly higher in tumor group compared with control group with P=0.005, P=0.001 and P=0.016, respectively; there were no significantly differences of age, PLR, LMR, LR, NR, MPV and RDW between groups. The ROC curve for NLR, SII and RDW was plotted in the diagnosis of TGCT and tumor progression, the cut-off value for NLR, SII and RDW were found as 3.38 (AUC: 0.704, sensitivity=51.4%, specificity=88.6%, P=0.003), 881.24 (AUC: 0.725, sensitivity=45.7%, specificity=91.4%, P=0.001) and 0.14 (AUC: 0.63, sensitivity=28.6%, specificity=97%, P=0.063), respectively. Patients were divided into two groups according to the threshold values, respectively. By using the multivariable logistic regression models, NLR ≥ 3.38 (OR, 5.86; 95% CI, 1.67-20.65, P=0.006) and SII ≥ 881.24 (OR, 4.89; 95% CI, 1.48-15.32, P=0.009) were independent risk factors predicting TGCT. Significantly statistical difference of pathological stage was also found between groups with respect to NLR cut-off values (P=0.034) and SII cut-off values (P=0.049). Combined the data together, NLR and SII both exhibited good differential diagnosis potential which could be used as markers predicting the TGCT.ConclusionAs the CBC based inflammation parameters, both NLR and SII could be used as effective tumor markers predicting the TGCT, and higher NLR and SII are associated with higher pathological stage. In addition, SII is a more powerful tool among these two inflammatory markers.

Prognostic value of preoperative P-CRP in patients with osteosarcoma: A retrospective study of 101 cases.

This study aimed to investigate the value of the product of peripheral blood platelet and serum C-reactive protein (P-CRP), an inflammatory indicator, for the prognosis of patients with osteosarcoma. Patients with osteosarcoma who were diagnosed and treated at the First Affiliated Hospital of Guangxi Medical University, China, between January 2012 and December 2019 were included in this retrospective study. Receiver operating characteristic curves were used to calculate the optimal cut-off values for inflammatory indicators such as P-CRP, the C-reactive protein/albumin ratio (CRP/Alb), the neutrophil–lymphocyte ratio (NLR), and the platelet–lymphocyte ratio (PLR) in the peripheral blood of patients before treatment. Based on the cut-off values, the patients were divided into high P-CRP and low P-CRP groups, high CRP/Alb and low CRP/Alb groups, high NLR and low NLR groups, and high NLR and low NLR groups; the Kaplan–Meier method was used to compare the overall survival (OS) rates and OS times of the above groups. Univariate and multivariate Cox regression models were used to analyze the effects of various factors on the prognosis of osteosarcoma and to determine the independent influencing factors. The Kaplan–Meier survival analysis results suggested that the OS rate of the high P-CRP group was significantly lower than that of the low P-CRP group (14.0% vs 67.2%, P < .001). The univariate analysis results suggested that tumor volume, tumor stage, NLR, PLR, P-CRP and CRP/Alb were factors that affected the prognosis of patients with osteosarcoma, and the differences were statistically significant (P < .05). The multivariate analysis results showed that tumor volume (hazard ratio [HR] = 1.061; 95% CI, 1.001–1.125; P = .046) and preoperative P-CRP (HR, 1.037; 95% CI, 1.024–1.050; P < .01) were independent prognostic factors affecting the OS rate after osteosarcoma surgery. The results of our study showed that P-CRP is a novel and promising prognostic indicator for patients with osteosarcoma. The higher the P-CRP level in the peripheral blood of patients is before treatment, the worse the prognosis might be.

506P The prognostic utility of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in carcinoma of unknown primary (CUP): An experience from a tertiary UK cancer centre

CUP is a heterogeneous disease entity, as a result prognostication in this cohort of patients (pts) can be difficult. High NLR (hNLR) and PLR (hPLR) have been shown to be associated with poorer prognosis in solid tumours, however, their utility in CUP is poorly described. We aimed to examine the role of NLR/PLR as prognostic markers in pts with CUP at our centre.

Peripheral Inflammatory Indexes Neutrophil/Lymphocyte Ratio (NLR) and Red Cell Distribution Width (RDW) as Prognostic Biomarkers in Advanced Solitary Fibrous Tumour (SFT) Treated with Pazopanib.

Simple SummaryPazopanib treatment in advanced solitary fibrous tumour patients, assessed in the prospective GEIS-32 phase II clinical trial, has shown longer progression-free survival and overall survival versus chemotherapy treatment in control patients. In recent years, the interest in the prognostic and predictive value of different peripheral inflammatory indexes, such as neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and red cell distribution width, has been increased in sarcomas, showing significant results in different soft tissue sarcomas. However, they have not been previously analysed in solitary fibrous tumour (SFT) patients. These indexes were retrospectively analysed in the typical- and malignant-SFT cohorts treated with pazopanib of the GEIS-32 trial to evaluate their predictive or prognostic value.Pazopanib was assessed prospectively in the GEIS-32 phase II study (NCT02066285) on advanced solitary fibrous tumour (SFT), resulting in a longer progression-free survival (PFS) and overall survival (OS) compared with historical controls treated with chemotherapy. A retrospective analysis of peripheral inflammatory indexes in patients enrolled into GEIS-32 was performed to evaluate their prognostic and predictive value. Patients received pazopanib 800 mg/day as the first antiangiogenic line. The impacts of baseline neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and red cell distribution width (RDW) on PFS, OS, and Choi response were evaluated by univariate and multivariate analysis. Metastasis-free interval (MFI), mitotic count, and ECOG were also included as potential prognostic factors. Sixty-seven SFT patients, enrolled in this study, showed a median age of 63 years and a female/male distribution of 57/43. The median follow-up from treatment initiation was 16.8 months. High baseline NLR, PLR, and standardised RDW were significantly associated with worse PFS and OS. NLR, RDW, MFI, and mitotic count were independent variables for PFS, while RDW and ECOG were independent for OS. Further, NLR and mitotic count were independent factors for Choi response. High baseline NLR and RDW values were independent prognostic biomarkers for worse outcome in advanced SFT patients treated with pazopanib.

High neutrophil percentage and neutrophil-lymphocyte ratio in acute phase of ischemic stroke predict cognitive impairment: A single-center retrospective study in China.

Background and aimsRecently, various hemocyte and blood cell ratios have garnered researchers' attention, as a low-cost, widely prevalent, and easy-to-measure index for diagnosing and predicting disease. Therefore, we sought to investigate the effect and predictive value of the peripheral blood neutrophil percentage and neutrophil-lymphocyte ratio (NLR) in the acute phase of ischemic stroke (AIS) in post-stroke cognitive impairment (PSCI).MethodsWe selected 454 patients with mild AIS and acquired general clinical data. The patients were divided into PSCI and post-stroke no cognitive impairment (PSNCI) groups according to their Montreal Cognitive Assessment (MOCA) scores. We assessed whether there were differences in clinical data, peripheral blood neutrophil percentage, and NLR values between the different groups. We also analyzed the independent influences on the occurrence of PSCI using a binary logistic regression. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the above inflammatory indicators and models containing different inflammatory indicators for PSCI.ResultsIn total, 454 patients were included, of whom 253 (55.7%) patients were in the PSCI group, with a mean age of 62.15 ± 7.34 years and median neutrophil percentage and NLR of 0.64 (0.32–0.95) and 2.39 (0.71–54.46), respectively. Both neutrophil percentage (adjusted OR = 1.025; 95% confidence interval: 1.005–1.406) and NLR as a categorical variable (Q5, adjusted OR = 2.167; 95% CI: 1.127–4.166) were independent risk factors for PSCI, and the Q5 group (NLR ≥ 4.05) had significantly worse overall cognition and executive function.ConclusionsNeutrophil percentage and NLR in the acute phase of AIS were independently associated with PSCI, and a high NLR was strongly associated with executive function. In addition, neutrophil percentage and NLR have diagnostic values for PSCI.

Comparison of Immune Response and Immunobiology in COVID-19 (Coronavirus Disease 2019) Mild-Moderate Degree and Severe Degree

The difference in immunological profiles between mild-moderate and severe cases of COVID-19 can be seen in lower lymphocyte counts, leukocytes, and higher neutrophil-lymphocyte ratios. And lower percentages of monocytes, eosinophils, and basophils in severe COVID-19 cases. Proinflammatory cytokines such as TNF-α, IL-1, and IL-6, as well as IL-8 and infection markers such as procalcitonin, ferritin, and C-reactive protein, were also found to be higher in severe clinical cases. T Helper, T suppressor, and T regulatory were found to be decreased in COVID-19 patients with lower numbers of T helper and T regulatory in severe cases.

P-060: A HIGHER GRANULOCYTE-LYMPHOCYTE RATIO IS ASSOCIATED WITH IMPROVED RED BLOOD CELL INDICES AND AGE IN DUFFY ANTIGEN-NEGATIVE SICKLE CELL DISEASE PATIENTS.

Purpose: A higher Neutrophil-Lymphocyte ratio (NLR) has been associated with poor prognosis in many diseases. Most Africans are neutropenic due to the duffy antigen null status. The duffy antigen null status however, has been associated with a higher risk of organ damage in people living with sickle cell disease (SCD). We therefore sought to determine the effect of the proportion of these blood cells to one another on SCD prognosis in Nigeria. Materials and methods: One hundred and thirty (130) sickle cell disease patients in steady state and 117 healthy age- and sex-matched controls were recruited from a tertiary institution in Nigeria. All the participants gave informed consents and blood samples were taken for Full Blood Count and phenotyping by High Performance Liquid Chromatography. Demographic and clinical details were obtained by questionnaire administration. Neutrophils make up over 90% of granulocytes, hence the granulocyte-lymphocyte ratio was determined from the available absolute counts of granulocytes and lymphocytes. A subset of 110 patients who were not on hydroxyurea was used for the analysis. The patients were divided into 3 age groups (< 7years, 8 – 17years and >17years). Data analysis was done using IBM SPSS version 23. Results: The mean absolute lymphocyte counts (ALC) and absolute granulocyte counts (AGC) in SCD patients (5.142 and 5.295 x103/µL respectively) were higher than in controls (2.952 and 2.171 x 103/µL respectively) (p<0.001). ALC and AGC decreased with age (p<0.001, p=0.02 respectively) in the SCD patients. A similar trend in ALC was observed in the control group while there was no significant difference in the AGC of children <7years and adults (>17years) (Fig 1). The mean granulocyte-lymphocyte ratio (GLR) in SCD patients increased from 1.01 in children <8years to 1.40 in adults. For the control group, the GLR decreased from 0.75 in children <8years to 0.66 in children 8–17years old and an increase to 0.95 in adults (Fig 2). In the SCD patients, GLR was positively correlated with RBC (rs=0.351, p<0.001), HGB (rs=0.256, p=0.004), HCT (rs=0.295, p<0.001) and HbA2 (rs=0.293, p<0.001). HbA2 was positively correlated with RBC (rs=0.201, p=0.028) while HbF was negatively correlated with RBC (rs=-0.257, p=0.006) and showed no correlation with the GLR (rs=-0.008, p=0.930). ALC however had a negative correlation with RBC (rs=-0.395, p<0.001), HGB (rs=-0.452, p<0.001) and HCT (rs=-0.395, p<0.001). AGC also had a negative correlation with HGB (rs=-0.245, p=0.006) and HCT (rs=-0.179, p=0.047). These relationships were not observed in the control group except for a positive correlation between HGB and GLR (rs=0.273, p=0.003) and a negative correlation between HGB and ALC (rs=-0.295, p=0.001). GLR was negatively associated with the frequency of painful crisis in the last one year (p<0.001). Conclusion: AGC and ALC decreased with age in our patients with an increase in the GLR. A positive correlation of GLR with RBC, HGB, HCT and HbA2 infers a protective role of a higher GLR/NLR to RBC survival in our patients. A higher GLR may be associated with better clinical outcomes, and neutropenia due to the duffy antigen null status may exacerbate the course of SCD in blacks.Fig 1. The mean absolute counts of granulocyte and lymphocytes in both cases and controls.Figure 1. The percentage of granulocytes and lymphocytes in both cases and controls The authors do not declare any conflict of interest

Correlation between neutrophil/lymphocyte ratio and cognitive impairment in cerebral small vessel disease patients: A retrospective study.

Background and objectiveThe blood neutrophil/lymphocyte ratio (NLR) is an objective and convenient parameter of systemic inflammation. Elevated NLR is associated with an increased risk of mild cognitive impairment (CI) in the elderly. However, few data are available on the impact of the NLR on CI in patients with cerebral small vessel disease (CSVD).MethodsA total of 66 CSVD subjects with CI and 81 CSVD subjects without CI were evaluated in this study. Clinical, laboratory, radiological, and cognitive parameters were collected. The NLR was obtained with the absolute neutrophil count being divided by the absolute lymphocyte count in fasting blood samples. Logistic regression analysis was performed to evaluate the factors associated with CI. Receiver operating characteristic curves were illustrated to predict factors associated with CI in patients with CSVD.ResultsThe NLR of the CI group was significantly higher than that of subjects without CI (2.59 vs. 2.21, P = 0.003). In multivariate analysis, NLR was positively correlated to the CI (OR: 1.43, 95% CI: 1.05–1.96, P = 0.024). It was suggested that the optimum NLR cutoff point for CI was 1.89 with 69.7% sensitivity and 59.3% specificity. Subjects with NLR ≥ 1.89 showed higher possibilities of CI compared to those with NLR < 1.89 (OR: 3.38, 95% CI: 1.62–7.07).ConclusionsCorrelations were found between NLR and CI. Patients with CSVD who have higher NLR might have an increased risk of CI.

Inflammatory markers of hemogram parameters as predictive factors for disease severity in anti-N-methyl-D-aspartate receptor encephalitis

ObjectiveThis study aimed to investigate the utility of inflammatory markers of hemogram parameters as objective indicators of disease severity in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. MethodsA total of 98 patients were retrospectively reviewed. Inflammatory markers of hemogram parameters, including neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio, were acquired within 24 h of admission. We then analyzed their utility as predictive factors for disease severity at different time points assessing with the modified Rankin Scale (mRS). ResultsThere were 49 patients in the mild group (mRS ≤ 2) and 49 patients in the moderate-to-severe (mRS > 2) group at admission. The moderate-to-severe group presented more frequently with psychiatric symptoms and central hypoventilation, as well as a lower lymphocyte count, a higher neutrophil count, a higher NLR and a higher MLR (all p < 0.05) when compared with the mild group. NLR and MLR showed similar positive correlations with mRS scores (r = 0.40, r = 0.40, both p < 0.001). Further multivariate logistic regression analyses indicated that NLR > 4.232 was an independent risk factor for moderate-to-severe status at admission. Meanwhile, NLR and MLR were associated with disease severity at different stages of follow-up but showed no independent predictive value. ConclusionOur findings suggested that NLR was an independent risk factor for moderate-to-severe status in the initial stage of anti-NMDAR encephalitis with a cut-off value of > 4.232.

The Association between Early Changes in Neutrophil-Lymphocyte Ratio and Survival in Patients Treated with Immunotherapy.

Dynamic changes in the blood-based biomarkers could be used as a prognostic biomarker in patients treated with immune checkpoint inhibitors (ICIs), although the data are limited. We evaluated the association between the neutrophil–lymphocyte ratio (NLR) and early NLR changes with survival in ICI-treated patients. We retrospectively evaluated the data of 231 patients with advanced-stage cancer. We recorded baseline clinical characteristics, baseline NLR and fourth-week NLR changes, and survival data. A compound prognostic score, the NLR2-CEL score, was developed with the following parameters: baseline NLR (<5 vs. ≥5), ECOG status (0 vs. ≥1), Charlson Comorbidity Index (CCI, <9 vs. ≥9), LDH (N vs. ≥ULN), and fourth-week NLR change (10% or over NLR increase). In the multivariable analyses, higher NLR (HR: 1.743, p = 0.002), 10% or over NLR increase in the fourth week of treatment (HR: 1.807, p = 0.001), higher ECOG performance score (HR: 1.552, p = 0.006), higher LDH levels (HR: 1.454, p = 0.017), and higher CCI (HR: 1.400, p = 0.041) were associated with decreased OS. Compared to patients with the lowest scores, patients in the highest score group had significantly lower OS (HR: 7.967, 95% CI: 3.531–17.979, p < 0.001) and PFS. The composite score had moderate success for survival prediction, with an AUC of 0.702 (95% CI: 0.626–0.779, p < 0.001). We observed significantly lower survival in patients with higher baseline NLR values and increased NLR values under treatment.

The Neutrophil-to-Lymphocyte Ratio and the Platelet-to-Lymphocyte Ratio as Predictors of Mortality in Older Adults Hospitalized with COVID-19 in Peru.

Background The prognostic value of the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with COVID-19 is rarely described in older adults. We aimed to estimate the prognostic value of NLR and PLR, determining the mortality of adults over 60 years of age hospitalized for COVID-19 in three hospitals in Peru from March to May 2020. Methods We performed a secondary analysis of data from a retrospective cohort carried out in Lambayeque, Peru, from March 18 to May 13, 2020. Older adults hospitalized for COVID-19 were included. The outcome variable was in-hospital mortality by all causes, while the exposure variable was the NLR and PLR (categorized in tertiles and numerically, performing a logarithmic transformation). We included sociodemographic variables, comorbidities, vital functions, laboratory markers, and treatment received during hospital stay. We evaluated the association between NLR and PLR using the hazard ratio (HR) in a Cox regression model. We estimated HR with their respective 95% confidence intervals (95% CI). We estimated cumulative/dynamic time-dependent ROC curves and reported area under the curve ROC (AUC-ROC) for 15-, 30-, and 60-day mortality with their respective simultaneous confidence intervals (confidence bands (CB)). Also, we estimated an optimal cut-off point based on the maximally selected rank statistics. Results A total of 262 hospitalized older adults were analyzed, 71.8% (n = 188) of whom were male with a median age of 70 years (interquartile range: 65-78). The mean NLR and PLR were 16.8 (95% CI: 14.9-18.7; SD: 15.5) and 50.3 (95% CI: 44.6-55.9; SD: 46.3), respectively. The mortality rate was 68.7% (95% CI: 62.7-74.3). The adjusted Cox regression analysis showed that the high NLR (adjusted HR (aHR) = 2.12; 95% CI: 1.43-3.14) and PLR (aHR = 1.90; 95% CI: 1.30-2.79) tertiles were associated with a higher risk of mortality. The maximum AUC-ROC values at 60 days of follow-up for NLR and PLR were 0.713 (95%CB: 0.627-0.800) and 0.697 (95%CB: 0.583-0.754), respectively. Conclusions The NLR and PLR are predictors of higher risk of mortality, and these results suggest that both could be reliable and practical markers for the identification of older adults at high risk of mortality by COVID-19. NLR and PLR have prognostic value, with an AUC greater than 0.5; however, by themselves, they are weak prognostic markers. It is important to carry out future studies incorporating these two markers into preexisting models or designing new ones considering them.

Preoperative Neutrophil-Lymphocyte Ratio for predicting surgery-related acute kidney injury in non-cardiac surgery patients under general anaesthesia: A retrospective cohort study.

This study was conducted to investigate the relationship between the Neutrophil-Lymphocyte Ratio (NLR) and the incidence of surgery-related acute kidney injury (AKI) in non-cardiac surgery patients under general anaesthesia. In this retrospective study, 5057 patients from Third Xiangya hospital from January 2012 to December 2016 and 1686 patients from Second Xiangya hospital from January 2016 to December 2016 for non-cardiac surgery under general anesthesia were included. According to receiver operating characteristic (ROC) curve constructed by NLR for postoperative AKI, the cut-off point was obtained as the basis for grouping low or high NLR. The baseline characteristics of two sets were compared with each other. A multi-factor model was constructed by Least absolute shrinkage and selection operator (LASSO) method with the training set, and verified by outside validation set. 243 patients (3.604%) developed postoperative AKI. The ROC curve showed that the AUC of the NLR for predicting postoperative AKI in non-cardiac surgery was 0.743 (95% CI, 0.717-0.769), and the cut-off value was 3.555 (sensitivity, 86.4%; specificity 51.9%). There was no significant difference in the baseline characteristics of training set and validation set. The AUC in the training set was 0.817 (95% CI, 0.784-0.850), and the AUC in the validation set was 0.804 (95% CI, 0.749-0.858), the AUC deviation was 0.012 (P > 0.05) from validation set, and the likelihood ratio test showed P < 0.05. This study showed that preoperative high NLR (NLR≥3.555) was an independent risk factor associated with postoperative AKI (OR, 2.410; 95% CI, 1.371-4.335) in patients for non-cardiac surgery under general anesthesia.

Predictive Value of Neutrophil-Lymphocyte Ratio as a Marker in Antiresorptive Agent-Related Osteonecrosis of the Jaw: A Retrospective Analysis.

Antiresorptive agent-related osteonecrosis of the jaw (ARONJ), a multifactorial disease, can drastically affect a patient’s quality of life. Moreover, disease progression to severe acute inflammation can hinder treatment. Therefore, we aimed to investigate the diagnostic value of the neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) in predicting the risk of acute inflammation in patients with ARONJ. In total, 147 patients with ARONJ were enrolled between 1 January 2011 and 31 December 2019. They were divided into two groups according to their baseline NLR (high NLR vs. low NLR) or PLR (high PLR vs. low PLR) to analyze the relationship between NLR and PLR and the outcomes of acute inflammatory events. An optimal NLR cut-off value of 2.83 was identified for hospitalization for an inflammatory event. Logistic regression analysis showed that NLR > 2.83 was associated with an increased risk of hospitalization for an inflammatory event. A PLR cut-off value of 165.2 was identified for hospitalization for an inflammatory event. However, logistic regression analysis showed that PLR > 165.2 was not significantly associated with hospitalization for an inflammatory event. Our study findings suggest that the NLR has diagnostic value in predicting the risk of hospitalization for inflammatory events among patients with ARONJ.

High Neutrophil-Lymphocyte Ratio and Low Lymphocyte-Monocyte Ratio Combination after Thrombolysis Is a Potential Predictor of Poor Functional Outcome of Acute Ischemic Stroke.

(1) Background: Ischemic stroke is one of the leading causes of death and disability. An inflammatory response is observed in multiple stages of cerebral ischemia, particularly in the acute phase. Recent publications revealed that the neutrophil–lymphocyte ratio (NLR) and lymphocyte–monocyte ratio (LMR) may be used to predict long-term prognosis in acute ischemic stroke (AIS) after thrombolysis. To test whether there is a relationship between the combination of these parameters and long-term prognosis, we analyzed the NLR–LMR combination in AIS patients treated with intravenous recombinant tissue plasminogen activator (rtPA); (2) Methods: The study included 285 adults with a diagnosis of AIS and rtPA treatment within a 4.5 h time window. Blood samples were obtained at admission and 24 h after thrombolysis to calculate pre- and post-thrombolysis NLR and LMR. Clinical data, including NIHSS was registered on admission and day 1. The long-term outcome was defined 90 days post-event by the modified Rankin Scale (mRS). Therapy-associated intracranial hemorrhage (ICH) was classified according to ECASS II. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs of NLR and LMR as predictors of therapy outcomes; (3) Results: Patients were stratified by cutoffs of 5.73 for NLR and 2.08 for LMR. The multivariate logistic regression model, including all possible confounders, displayed no significant association between NLR or LMR with 3-months functional prognosis. The combination of high NLR–low LMR vs. low NRL–high LMR as obtained 24 h after thrombolysis was found to be an independent predictor of poor 3-months functional outcome (mRS ≥ 2; OR 3.407, 95% CI 1.449 to 8.011, p = 0.005). The proportion of patients between low NLR–high LMR and high NLR–low LMR groups from admission to day 1 showed no significant change in the good outcome group. On the other hand, in the poor outcome group (mRS ≥ 2), low NLR–high LMR and high NLR–low LMR groups displayed a significant shift in patient proportions from 67% and 21% at admission (p = 0.001) to 36% and 49% at 24 h after thrombolysis (p < 0.001), respectively; (4) Conclusions: Our study demonstrated for the first time that a high NLR–low LMR combination as observed at 24 h after thrombolysis can serve as an independent predictor of 3-months poor outcome in AIS patients. This simple and readily available data may help clinicians to improve the prognostic estimation of patients and may provide guidance in selecting patients for personalized and intensified care post-thrombolysis.

Relationship Between Systemic Inflammation Index and No-Reflow Phenomenon in Patients With ST-Segment Elevation Myocardial Infarction.

This study aimed to evaluate the relationship between no-reflow phenomenon and systemic inflammation index (SII) and to compare the predictive capacity of SII together with the neutrophil-lymphocyte ratio (NLR), and the platelet-lymphocyte ratio (PLR) in patients with ST-elevation myocardial infarction (STEMI). A total of 785 patients were included. The thrombolysis in myocardial infarction (TIMI) flow degree has been used to describe the no-reflow phenomenon. The study population was divided into two groups regarding the presence of no-reflow phenomenon including 110 patients with no-reflow (TIMI frame count 0-2) and 675 patients without no-reflow (TIMI frame count 3). The NLR [6.6 (4.6-11.6) vs 3.2 (2.0-5.3); P < .001], PLR [175 (121.3-220) vs 102.6 (76.1-150.1); P < .001] and SII [1921(1225-2906) vs 738.5 (450.5-1293); P < .001] were significantly higher in the no-reflow group. High NLR (OR: 1.078, 95%CI: 1.027-1.397; P = .021), PLR (OR: 1.009, 95%CI: 1.003-1.021; P = .041) and SII (OR: 1.216, 95%CI: 1.106-1.942; P = .004) were found to be independently associated with no-reflow phenomenon. The comparison of the receiver-operating characteristic curves showed that area under the curve of SII was greater than that of NLR (.789 vs .766, P = .007) and PLR (.789 vs .759, P = .048). SII levels may predict no-reflow phenomenon better than NLR and PLR.