High Neutrophil-to-lymphocyte Ratio Research Articles

Elevated hematologic ratios are correlated with acne severity: a national, retrospective cohort study

BackgroundPrior studies demonstrated conflicting results regarding hematologic ratios in acne patients. We sought to further characterize hematologic ratios in acne patients, according to demographics and acne severity.MethodsNational, retrospective cohort study of 122,822 patients using medical records from 2005 to 2024 of patients insured with the largest public healthcare organization in Israel, Clalit Health Maintenance Organization.ResultsModerate–severe acne patients had higher neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) than mild acne patients at diagnosis and 12–18 months before diagnosis. A multivariable regression confirmed the significance of the correlation of increased NLR and PLR with acne severity. Adults and females had higher NLR and PLR than children and males, respectively, at diagnosis, and 12–18 months before diagnosis.ConclusionAcne severity was significantly associated with elevated NLR and PLR. NLR and PLR may also serve as indicators of upcoming acne severity, as they were elevated 12–18 months before diagnosis. These biomarkers may contribute to the diagnosis, management, and follow-up of patients with acne.

The clinical significance of the Neutrophil-to-Lymphocyte Ratio as a novel inflammatory biomarker for assessing the severity of intervertebral disc degeneration

PurposeInflammation is integral to the pathogenesis of intervertebral disc degeneration, yet the role of systemic inflammatory markers in this process remains underexplored. This study aims to explore the association between the Neutrophil-to-Lymphocyte Ratio (NLR) and the severity of disc degeneration.Patients and methodsA retrospective analysis was conducted on 375 patients diagnosed with lumbar disc degeneration between April 2018 and May 2021. All patients underwent a complete blood cell count examination. We applied the Pfirrmann grading system for cumulative disc grading, stratifying patients into two groups: a high-score group (cumulative grade > 17) and a low-score group (cumulative grade ≤ 17), based on the median cumulative grade. The association between the NLR and and the severity of disc degeneration was further analyzed using correlation analysis and logistic regression models. Furthermore, the predictive capacity of the NLR for lumbar disc degeneration was assessed using the Receiver Operating Characteristic (ROC) curve.ResultsWe found a significant positive correlation between high NLR levels and severe disc degeneration. The high-score group exhibited a significantly higher NLR compared to the low-score group [2.63 (1.91–4.18) vs. 2.04 (1.38–2.74), respectively, p < 0.001]. Significant correlations were found between NLR and patient characteristics (including age, BMI, VAS, NSAIDs usage, hemoglobin) and the cumulative grading. Logistic regression analysis identified age and NLR as independent predictors of the severity of disc degeneration. The ROC curve analysis demonstrated a good predictive capability of NLR for lumbar disc degeneration.ConclusionNLR could serve as a promising biomarker for assessing the severity of lumbar disc degeneration and offer potential benefits in both early diagnosis and treatment strategies.

Application of preoperative NLR-based prognostic model in predicting prognosis of intrahepatic cholangiocarcinoma following radical surgery

PurposeTo investigate the application value of the neutrophil to lymphocyte count ratio (NLR) in the prognostic analysis of intrahepatic cholangiocarcinoma (ICC) after radical resection, and to offer guidance for the individualized perioperative diagnosis and treatment of ICC.MethodsThe clinical data of 360 patients diagnosed with ICC following radical surgery were retrospectively analyzed. The cut-off value of NLR was calculated using the minimum p-value method, and then divided into High-NLR (H-NLR) group and Low-NLR (L-NLR) group according to the NLR cut-off value. The prognostic value of NLR in ICC was analyzed. Subsequently, the patients were divided into the hepatolithiasis-related intrahepatic cholangiocarcinoma (HICC) group and the non-hepatolithiasis-related intrahepatic cholangiocarcinoma (NHICC) group based on whether they combined with hepatolithiasis. Multiple regression models were constructed based on NLR and clinicopathological indicators to verify the application value of prognostic models in the survival and recurrence of ICC patients after radical surgery.ResultsThe cut-off value of NLR was 2.36, and the survival analysis disclosed that overall ICC patients with NLR ≥ 2.36 manifested a poor 5-year survival rate and a higher tumor recurrence rate (p < 0.001). In the HICC group, patients with H-NLR presented a poor 5-year survival rate and a higher tumor recurrence rate compared with L-NLR (p < 0.001). The NLR-based survival/recurrence prediction models in the HICC group demonstrated excellent predictive capacity (H-L test: 0.359/0.680, AUC: 0.764/0.791). In the NHICC group, patients with H-NLR exhibited a poor 5-year survival rate compared with L-NLR (p < 0.001), yet there was no significant difference in tumor recurrence between the two groups (p = 0.071). The NLR-based survival prediction model in the NHICC group demonstrated acceptable predictive ability (H-L test: 0.268, AUC: 0.729), while the NLR-based recurrence prediction model did not show an effective predictive ability (H-L test: 0.01, AUC: 0.649).ConclusionNLR is an independent risk factor influencing postoperative survival and recurrence in ICC patients, particularly in HICC patients. Preoperative NLR ≥ 2.36 suggests that patients might have a poor prognosis. The survival and recurrence prediction model constructed based on NLR and other clinical indicators demonstrates good prediction accuracy and can effectively predict the risk of postoperative adverse prognosis in patients with HICC. This study offers a novel idea for the clinical treatment of HICC patients.

The association of the perioperative neutrophil-to-lymphocyte ratio with wound healing in patients with Wagner grade 3 and 4 diabetic foot ulcers after tibial cortex transverse transport surgery: a prospective observational cohort study

BackgroundDiabetic foot ulcers (DFUs) are severe complications of diabetes, involving multiple etiological factors including neuropathy, vascular insufficiency, and impaired wound healing. The global burden of DFUs is substantial, with significant morbidity and high management costs. Recent advancements have introduced the tibial cortex transverse transport (TTT) technique, which has shown promising results in the management of severe DFUs by promoting angiogenesis and immunomodulation.MethodsThis prospective cohort study enrolled patients with Wagner grade 3 and 4 DFUs, treated using the TTT technique from May 2022 to September 2023 at MianYang Central Hospital. The study assessed the influence of TTT on the perioperative neutrophil-to-lymphocyte ratio (NLR), an established biomarker of systemic inflammation, and its correlation with wound healing outcomes.ResultsA total of 82 patients were enrolled, with 66 completing the study. The survival analysis revealed that patients with a lower preoperative NLR experienced significantly faster wound healing compared with a high NLR (log rank test P< 0.05; hazard ratio (HR) = 0.46; 95% CI: 0.26–0.83). The optimal NLR cutoff values (4.25) were established to predict wound healing times for DFUs. The median NLR was significantly different before TTT surgery, 3 days after TTT surgery, and 1 month after TTT surgery (P<0.05).ConclusionThe TTT technique significantly influences the perioperative NLR and is associated with improved wound healing in DFU patients. The perioperative NLR serves as an effective predictive biomarker for wound healing outcomes, highlighting the significance of interventions targeting NLR values in perioperative management strategies and postoperative monitoring protocols for the treatment of diabetic foot ulcers (DFUs) in clinical practice.

A multidimensional analysis of the impact of obesity on immune checkpoint inhibitor therapy efficacy

BackgroundObesity is a well-known risk factor for developing malignant tumors and promoting tumor cell growth and spread. However, recent studies have shown that obese cancer patients, who typically have a worse prognosis than nonobese cancer patients, show a significant improvement in survival after receiving immune checkpoint inhibitor (ICI) therapy. This phenomenon is known as the “obesity paradox”. However, this phenomenon is influenced by tumor type and sex. Therefore, this study aimed to explore the impact of obesity on immunotherapy efficacy from multiple perspectives, aiming to verify this paradox and provide new scientific evidence on the effect of obesity on ICI efficacy.MethodsThis retrospective study evaluated the data of patients who received ICI therapy between June 2019 and August 2023. Automatic segmentation of skeletal muscle, subcutaneous fat, and visceral fat was performed using Slice-O-Matic software, and the corresponding skeletal muscle index (SMI), subcutaneous fat index (SFI) and visceral fat index (VFI) were calculated. The neutrophil-to-lymphocyte ratio (NLR) was determined by dividing the neutrophil count by the lymphocyte count. Univariate and multivariate Cox regression analyses were used to evaluate the correlation between body mass index (BMI), body composition parameters, and the NLR with overall survival (OS) and progression-free survival (PFS) in obese patients receiving ICI therapy.ResultsWe analyzed 219 patients with a median age of 60 years (IQR 53–69 years; 155 men and 64 women). Obese patients, particularly those with visceral fat accumulation, exhibited extended OS after ICI therapy (log­rank P = 0.027). Cox multivariate analysis revealed that the NLR (HR = 1.036; 95% CI: 0.996 to 1.078; P = 0.002) was independently associated with OS. Patients with a high NLR had worse OS than those with a low NLR.ConclusionsThis study corroborates the veracity of the "obesity paradox" under specific conditions and identifies NLR as an independent prognostic factor, with elevated NLR indicative of a poor prognosis.

Impact of neutrophil-to-lymphocyte ratio on clinical outcomes in patients with acute or chronic coronary syndrome undergoing percutaneous coronary intervention

Abstract Background Neutrophil-to-lymphocyte ratio (NLR) has recently emerged as an inflammatory biomarker associated with atherosclerosis and cardiovascular events. However, its role in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. Purpose We aimed to evaluate the clinical impact of baseline NLR in patients undergoing PCI for acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). Methods We retrospectively evaluated all consecutive patients undergoing PCI between 2012-2022 in a large tertiary US hospital. We excluded patients for whom NLR was not available and those who were deemed to have active hematological or infective diseases, including patients presenting with extremely low or high lymphocyte and neutrophil counts or with hs-CRP above 10 mg/L. Quartiles of NLR were derived in the overall population and patients were stratified according to clinical presentation. Within each group, we estimated the risk of 12-month adverse events using the lowest NLR quartile as reference. The primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause death, myocardial infarction (MI), or stroke. Secondary endpoints were MACE individual components and any periprocedural or post-discharge clinically relevant bleeding. Results A total of 7,201 patients were included in the analysis; of these 3,975 (55.2%) had ACS and 3,226 (44.8%) CCS. Patients in the 4th quartile (NLR > 5.0) were more frequently male, older, and presented more often with chronic kidney disease and complex coronary artery disease. Smoking, diabetes and history of CAD, as well as triglycerides, LDL, non-HDL and total cholesterol levels were lower in the 4th NLR quartile. In patients presenting with CCS, the risk of MACE, all-cause death, MI was similar across NLR quartiles, while the risk of bleeding increased stepwise (Figure 1). In patients presenting with ACS, the 4th NLR quartile had the highest adjusted risk of MACE (HRadj 1.82, 95% CI 1.25-2.67; P=0.002), all cause death (HRadj 2.56, 95% CI 1.41-4.66; P<0.001), and bleeding (HRadj 1.82 95% CI 1.25-2.63, P<0.001) at 1 year, as compared to the lowest quartile (Table 1). Conclusions Among patients undergoing PCI, elevated NLR is strongly associated with risk of MACE and all-cause mortality in patients presenting with ACS but not in those with CCS. Conversely, the risk of bleeding was augmented with higher NLR in both ACS and CCS patients undergoing PCI. In this setting, NLR may inform risk stratification at the time of PCI.

Neutrophil-to-lymphocyte ratio can predict the clinical prognosis of patients with primary adosteronism

Abstract Background Excess aldosterone-mediated inflammatory response is thought to be a factor in the high risk of cardiovascular events in patients with primary aldosteronism (PA). Leucocyte related inflammatory parameters, especially NLR, were significantly independent of aldosterone (PAC) in PA patients. However, the impact of NLR on the long-term prognosis of PA patients is unclear. Objective To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) on the long-term prognosis of patients with primary aldosteronism (PA). Methods The data for this study were derived from the Tianjin Health and Medical Big Data Super platform, comprising a retrospective cohort of patients discharged from 72 hospitals in our city from 2010 to 2023. According to the inclusion and exclusion criteria, 570 patients were ultimately included in the statistical analysis. Each patient had laboratory measurements, including blood cell counts, taken after admission and before interventional treatment. The primary endpoint was major cardiovascular events (MACEs), defined as cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke. Results During a mean follow-up period of 5 years, 125（21.9%）MACEs were recorded. ROC curve analysis displayed that the best cut-off value of NLR for predicting MACEs was 4.87. The MACEs of the high NLR group at 1 year, 3 years, and 5 years were higher than those of the low NLR group（25.0% vs 9.4%，40.3% vs17.1% 和 40.3% vs 19.3%；P＜0.05).Kaplan-Meier survival curve analysis showed that the survival rate of the low NLR group was higher than that of the high NLR group (P<0.001). The results of multivariate Cox proportional hazards regression analysis showed that NLR was an independent risk factor affecting the prognosis of PA patients, and the difference was statistically significant (P<0.05). Conclusions Elevated NLR is associated with adverse prognosis in patients with PA. NLR can serve as a simple and practical indicator to evaluate the long-term prognosis of PA patients. These findings warrant external validation, preferably in a prospective design.

Clinical significance of blood cell ratios in healthy and sick Leishmania infantum-seropositive dogs

BackgroundThe accuracy of blood cell ratios (BCRs) as cost-effective and easily accessible diagnostic and prognostic markers of inflammatory conditions has been investigated in veterinary medicine in recent years.MethodsNeutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR) ratios were studied in 195 dogs clinically evaluated and tested for anti-Leishmania infantum (Li) antibodies (Li-seronegative (Li−), n = 10; Li-seropositive clinically healthy (Li+healthy), n = 100; Li-seropositive with clinical and/or clinicopathological abnormalities (Li+sick), n = 85). The Li+sick dogs were classified in LeishVet stages IIa/IIb (Li+IIa/IIb) (n = 66) and III/IV (Li+III/IV) (n = 19). BCR relationships with LeishVet clinical stage, antibody levels, and serum protein electrophoretic fraction concentrations were investigated.ResultsHigher NLR values were found in Li+, Li+healthy, and Li+IIa/IIb sick dogs compared to Li− dogs (P < 0.001). Higher NLR and MLR were found in Li+sick (NLR, P < 0.001; MLR, P = 0.034) and Li+III/IV dogs (NLR, P < 0.001; MLR, P = 0.005) compared to Li− dogs, and in Li+III/IV dogs (NLR, P = 0.002; MLR, P < 0.001) compared to Li+healthy. All three BCRs were higher in Li+sick (NLR, MLR, P < 0.001; PLR, P = 0.023) and Li+IIa/IIb dogs (NLR P < 0.001; MLR P = 0.001; PLR, P = 0.012) compared to Li+healthy dogs. The BCRs failed to distinguish dogs with moderate (Li+IIa/IIb) and severe or very severe disease (Li+III/IV). BCRs demonstrated weak positive correlations with serum globulin fractions and antibody levels, and weak negative correlations with serum albumin level were found. Li+sick dogs presenting hypoalbuminemia showed higher MLR ratios (P = 0.001) than those with normal albumin values.ConclusionsThis study shows that BCR measures provide useful information for differentiating antibody-positive healthy and sick dogs at diagnosis. Dogs with hypoalbuminemia showed higher MLR values despite monocytosis being very rare.Graphical

Neutrophil‑to‑lymphocyte ratio and risk of disease progression in patients with nivolumab‑treated unresectable or recurrent gastric cancer.

Studies have associated neutrophil-to-lymphocyte ratio (NLR) with overall survival (OS) and progression-free survival (PFS) in patients with gastric cancer (GC). The present study aimed to examine the relationship between dynamic changes in NLR during treatment and disease progression in patients with unresectable or recurrent GC treated with nivolumab monotherapy as a third-line or later regimen. Patients treated with nivolumab as a third-line or later therapy for unresectable or recurrent GC at Gifu University Hospital (Gifu, Japan) from April 2017 to December 2021 were included. Pretreatment data and those obtained every 2 weeks after the treatment commenced were evaluated. The association between all NLR values and disease progression for each patient was evaluated using a time-dependent Cox proportional hazards model and restricted cubic spline (RCS) curves. The study included 44 patients (23 men and 21 women). The response and disease control rates were 6.8 and 27.3%, respectively. The median PFS and OS of all patients were 1.84 months [95% confidence interval (CI), 1.32-2.14] and 5.93 months (95% CI, 3.75-10.75), respectively. The risk for progressive disease (PD) increased with higher NLR (hazard ratio, 2.25; 95% CI, 1.3-3.87). The RCS curves also indicated that the higher the NLR, the higher the risk for PD, especially if the NLR value was <3.0. NLR during treatment could predict the risk of PD, suggesting that NLR could be integrated with tumor markers, computed tomographic images and other modalities to enable treatment selection without delay.

Prognostic value of pre-treatment neutrophil-to-lymphocyte ratio in patients with brain metastasis from cancer: a meta-analysis.

Evidence shows that inflammatory responses play an essential role in the development of brain metastases (BM). The goal of this meta-analysis was to critically evaluate the literature regarding the use of the neutrophil to lymphocyte ratio (NLR) to predict the prognosis of patients with BM to help clinicians institute early interventions and improve outcomes. We conducted systematic review and meta-analysis, utilizing data from prominent databases, including PubMed, Cochrane Library and China National Knowledge Infrastructure databases. Our inclusion criteria encompassed studies investigating the studies that assessed the association between NLR and overall survival (OS). We included 11 articles, with 2629 eligible patients, to evaluate the association between NLR and OS. High NLR was significantly associated with shorter OS, with a pooled hazard ratio (HR) of 1.82 (95% CI 1.57-2.11). Subgroup analysis revealed that this association was consistent across different regions, with HRs of 2.03 (95% CI 1.67-2.46) in Asian populations and 1.58 (95% CI 1.35-1.84) in non-Asian populations. Additionally, in a subgroup analysis based on NLR cut-off values, patients with NLR ≥ 3 had an HR of 1.69 (95% CI 1.46-1.96), while those with NLR < 3 had an HR of 2.26 (95% CI 1.64-3.11). Sensitivity analysis confirmed that no single study significantly influenced the pooled effect size. Our meta-analysis confirmed the prognostic value of NLR in patients with brain metastasis.

Neutrophil-to-lymphocyte ratio as a prognostic biomarker in patients with peripheral artery disease: A systematic review and meta-analysis.

The neutrophil-to-lymphocyte ratio (NLR) is a simple and routinely obtained parameter reflecting systemic inflammation, including in peripheral artery disease (PAD). This systematic review aimed to assess the role of NLR as a prognostic biomarker in patients with PAD. A systematic search was conducted across PubMed, ScienceDirect, Web of Science, Scopus, ProQuest, EBSCO, and Cochrane. Random-effects meta-analysis was used to pool risk ratios, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A bivariate model was used to generate summary receiver operating characteristics with the corresponding area under the curve (AUC). This review included 5243 patients with PAD from nine eligible studies. High NLR corresponded to at least a twofold increased risk of all-cause mortality (ACM), major adverse limb events (MALE), and major adverse cardiovascular events (MACE). NLR's performance was good for predicting 1-year ACM (AUC 0.71 [95% CI: 0.59-0.79], sensitivity 58.2% [95% CI: 45.3-71.0], specificity 72.6% [95% CI: 65.6-79.62], PPV 41.0% [95% CI: 31.2-50.7], NPV 82.7% [95% CI: 74.1-91.3]) and 1-year MALE (AUC 0.78 [95% CI: 0.75-0.80], sensitivity 65.4% [95% CI: 41.6-89.2], specificity 77.7% [95% CI: 71.0-84.3], PPV 53.7% [95% CI: 47.3-60.1], NPV 83.91% [95% CI: 73.2-94.6]). However, these values tended to decrease as the follow-up duration extended, except for the pooled specificities, which exhibited the opposite pattern. NLR emerges as a simple and cost-effective prognostic biomarker with decent performance for poor outcomes in patients with PAD (PROSPERO Registration No.: CRD42023486607).

Association between the neutrophil-to-lymphocyte ratio and cancer in adults from NHANES 2005–2018: a cross-sectional study

Inflammation plays a crucial role in cancer development. The neutrophil-to-lymphocyte ratio (NLR), a measure of inflammation, is obtained from a complete blood count. However, little is known about the association between NLR and cancer in the general adult population in the United States. This study aimed to evaluate whether NLR is associated with cancer in American adults. This retrospective cross-sectional study included 28,016 adult participants from the National Health and Nutrition Examination Survey (NHANES) dataset spanning 2005 to 2018. Data on demographics (age, sex, race, marital status, Poverty-Income Ratio, education level), lifestyle factors (smoking, alcohol consumption, body mass index), medical conditions (hypertension, diabetes, cardiovascular disease), and laboratory parameters (hemoglobin, platelet count, alanine aminotransferase, creatinine, albumin, and lactate dehydrogenase), were collected. Logistic regression analysis was used to investigate the research objectives. Of the total 28,016 participants, 2639 had cancer. The mean age was 49.6 ± 17.6 years, and 50% were male. A positive association between NLR and cancer risk was observed after multivariate adjustment (OR = 1.20, 95% confidence interval (CI) = 1.05–1.36, p = 0.006). Similar patterns were observed in subgroup analyses (all p-values for interaction > 0.05). A higher NLR was directly correlated with an increased risk of developing cancer in adults.

Neutrophil/lymphocyte ratio identifies low-risk polycythaemia vera patients for early Ropeginterferon alfa-2b therapy.

We investigated the effect of Ropeginterferon alfa-2b (Ropeg) versus phlebotomy-only (Phl-O) on the neutrophil-to-lymphocyte ratio (NLR) in 126 patients randomized in the low-polycythaemia vera (PV) phase II trial. Patients with a baseline NLR ≥3.5 vs. <3.5 had a longer history of PV, were more likely to have splenomegaly, higher JAK2V617F variant allele frequency (VAF) (56% vs. 20% p = 0.001) and more proliferative disease. Ropeg was superior to Phl-O in reducing NLR (p = 0.008), and the reduction was strongly influenced by the reduction in neutrophils and less by a change in lymphocytes (-59% and -14% respectively). This effect was associated with the achievement of the low-PV primary end-point (p = 0.021), symptom reduction and reduction in JAK2 VAF. Interestingly, the reduction in JAK2 VAF from baseline was linearly associated with the reduction in NLR. Patients who failed Phl-O at 12 months had characteristics that distinguished them from responders, including very high NLR and resistance to cross-over to 100 μg Ropeg every 2 weeks suggesting higher escalated doses of Ropeg. In conclusion, the study provides evidence that NLR can serve as a valuable biomarker to assess and guide treatment with Ropeg in the early stage of low-risk PV patients.

Neutrophil-to-lymphocyte ratio and its association with latent tuberculosis infection and all-cause mortality in the US adult population: a cohort study from NHANES 2011-2012.

There has been little study done on the possible connection between all-cause mortality and the neutrophil-to-lymphocyte ratio (NLR), particularly in individuals with latent tuberculosis infection (LTBI). The objective of this research was to examine the correlation between the NLR and LTBI, along with their effects on all-cause mortality in a cohort of individuals who had either LTBI or not. This research incorporated data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, with a total of 4938 subjects involved. To investigate the connection between LTBI and variables, multivariable logistic regression models were used. Multivariable Cox proportional hazards models and Kaplan-Meier (KM) survival curves were employed to examine the association between NLR and all-cause death in individuals with and without LTBI. When analyzed as a continuous variable, The calculated odds ratios (ORs) for the different models-Model 1, Model 2, and Model 3 were 0.86, 0.83, and 0.84 (P < 0.005). NLR was evaluated as a categorical parameter, revealing that individuals in the tertile T3 had a notably lower rate of LTBI in comparison to those in the T1 group. After adjusting for different confounders, the odds ratio for T3 varied in the various models, being 0.75 (0.60∼0.95), 0.69 (0.54∼0.89), and 0.71 (0.56∼0.92), respectively. Additionally, higher NLR was significantly link to a greater risk of all-cause mortality in individuals with or without LTBI. Following multivariate adjustment, an 8% (Model 3, HR 1.08, 95% CI 1.05-1.12, P < 0.001) greater risk of mortality from all-cause was linked to every unit rise in NLR. Results from the study revealed a negative correlation between NLR and the likelihood of LTBI as well as a higher risk of death from all causes. Therefore, NLR may be a helpful technique for risk categorization in the adult LTBI in the United States. To clarify the underlying mechanisms and any therapeutic implications of these findings, more investigation is necessary.

Admission neutrophil-to-lymphocyte ratio to predict mortality in burn patients: a meta-analysis.

The neutrophil-to-lymphocyte ratio (NLR) proves to be a convenient and cost-effective marker with studies showing that a high NLR can serve as a mortality indicator in burn cases. We conducted a meta-analysis aiming to explore whether on-admission NLR values could serve as predictors of mortality in burn patients. PubMed, Web of Science, Scopus and Embase were searched from inception until January 2024. We included all studies investigating burn patients that contain information on the NLR value at the time of hospital admission and mortality outcomes. The studies were critically appraised using the NIH Quality Assessment Tool. Nine studies fulfilled our criteria with a total population of 1837 participants, including 1526 survivor Burn patients and 311 non-survivor Burn patients. The overall mean difference measured by random model showed a significant increase in NLR by 5.06 (95% CI 3.42, 6.68) p ≤ 0.001 for the non-survivor group over the survivors group with heterogeneity I2 = 67.33%, p ≤ 0.001. A meta-regression was done to investigate the potential source of heterogeneity among studies. The results showed that age (p = 0.394), gender (p = 0.164), and sample size (p = 0.099) did not contribute to the source of heterogeneity, however, the burn surface area contributed significantly (p = 0.002). A leave-one-out meta-analysis was done, showing that omitting Le Qui et al., leads to significantly decrease the heterogeneity to be I2 = 2.73%. Meta-regression repeated to assess the burn surface area again to be found noncontributing (p = 0.404). Our findings support that elevated NLR values can serve as a mortality indicator in burn cases. This will have a great clinical impact by aiding in stratifying the burn patients on admission.

Neutrophil-to-HDL-C Ratio as an inflammatory biomarker in patients with anxiety and obstructive coronary artery disease: A retrospective study

BackgroundAnxiety is a common comorbidity with coronary artery disease (CAD). The neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-high-density lipoprotein cholesterol (HDL-C) ratio (NHR), lymphocyte-to-HDL-C ratio (LHR), and monocytes-to-lymphocyte ratio (MLR) can predict the severity of CAD. This retrospective study aimed to explore the relationship between NLR, NHR, LHR, and MLR and the presence of obstructive or severe CAD (OCAD, SCAD) in patients with comorbid anxiety and chest pain. MethodsA total of 1063 patients with anxiety and chest pain were divided into an NOCAD group and OCAD group according to computed topography angiography (CCTA). The 455 patients in the OCAD group were further divided into the NSCAD group (n = 216) and SCAD group (n = 239) according to coronary angiography (CAG) results, and the Gensini score (GS) was calculated. Demographic and laboratory data were collected. ResultsMultiple regression analysis showed that higher NLR, NHR, and LHR served as independent risk factors for OCAD in patients with anxiety and chest pain (OR 1.37, 95%CI: 1.13–1.65, p = 0.001; OR 2.24, 95%CI: 1.89–2.65, p < 0.001; OR 2.47, 95%CI: 1.87–3.62, p < 0.001), and both were significantly associated with SCAD (OR 1.93, 95%CI: 1.44–2.59, p < 0.001; OR 4.45, 95%CI: 3.28–6.31, p < 0.001; OR 2.86, 95%CI: 1.93–4.25, p < 0.001). Area under the receiver operating characteristic curve analysis showed that NHR had the highest predictive value for OCAD and SCAD compared with NLR and LHR (AUC 0.71, sensitivity 57.14 %, specificity 68.20 %; AUC 0.86, sensitivity 83.68 %, specificity 74.54 %, respectively). When NHR and GS were combined, the predictive value for SCAD further increased compared to other parameters (AUC 0.94, sensitivity 92.05 %, specificity 87.05 %). ConclusionNLR, NHR, and LHR were associated with severity of coronary stenosis in patients with comorbid anxiety and chest pain. Among these systemic inflammatory markers, NHR served as a more effective independent predictor of OCAD and SCAD in these patients.

Alterations in intratumoral and peripheral immune status in recurrent gliomas and their prognostic implications for patients underwent reoperation

BackgroundReoperation is a treatment option for recurrent gliomas, yet factors impacting survival following reoperation remain poorly defined. Tumor immunity is profoundly associated with disease progression. Here, we analyze the immune status characteristics and their prognostic implications in recurrent gliomas. MethodsIntratumoral and peripheral immune characteristics between primary and recurrent gliomas were compared by conducting immunohistological staining and hematological examination with our in-house samples, and analyzing bulk and single-cell sequencing data from publicly available sources. Survival analysis was conducted to identify immunological markers with prognostic significance. ResultsWe observed a significant reduction in peripheral lymphocyte count, while an elevation in neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width-to-platelet ratio (RPR) in patients with recurrent gliomas than in newly-diagnosed patients. Higher NLR and RPR indicated worse survival following reoperation in recurrent patients. Transcriptomic and immunohistological analysis showed an increased infiltration of tumor-associated macrophages (TAMs) and CD8+ T cell in recurrent gliomas compared to primary gliomas in both IDH-wildtype and mutant subtypes. Moreover, the abundance of TAMs emerged as an independent indicator for an inferior prognosis in recurrent gliomas. Single-cell profiling revealed a significant heterogeneity in the phenotypes of TAMs between primary and recurrent gliomas. Notably, TAMs enriched in recurrent gliomas exhibited elevated expression of interferon-γ-induced genes, multiple immunosuppressive molecules (TGFB1, CD276), and increased activity in glycose and lipid metabolism, indicating metabolic reprogramming. ConclusionRecurrent gliomas demonstrate augmented immune cell infiltration, but they fail to overcome TAMs-induced immunosuppression. Immunosuppressive indices, including TAM abundance, peripheral NLR and RPR, have prognostic implications for recurrent gliomas.

Predictive value of neutrophil to lymphocyte ratio for clinical outcome in patients with atrial fibrillation: a systematic review and meta-analysis.

The association between the Neutrophil-to-Lymphocyte Ratio (NLR) and the prognosis of Atrial Fibrillation (AF) has been extensively studied, yet clinical outcomes have varied. Consequently, this analysis was undertaken to explore the link between NLR and the prognostic markers of AF. We conducted an exhaustive search across electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, to investigate the correlation between the NLR and indicators of adverse clinical outcomes associated with AF from the database establishment date through March 31, 2024. In this study, the recurrence rate of AF was the primary outcome measure, while the secondary outcome measures were mortality, stroke, and left atrial thrombus. Odds ratio (OR), relative risk (RR), hazard ratio (HR) and standard mean difference (SMD) with a 95% confidence interval (CI) were integrated for assessment, and the stability of prognostic outcomes and publication bias were verified by sensitivity analysis and Egger's test, respectively. Subgroup analyses were performed to pinpoint the sources of heterogeneity. This analysis included 20 studies, encompassing a total of 59,256 patients. Our statistical analysis of both categorical and continuous variables revealed that an elevated NLR was significantly associated with increased risks in AF patients for recurrence (categorical variable: OR = 1.39, 95% CI = 1.21-1.60; continuous variable: SMD = 0.49, 95% CI = 0.24-0.74), mortality (categorical variable: OR = 1.87, 95% CI = 1.59-2.20), stroke (categorical variable: OR = 1.56, 95% CI = 1.13-2.17; continuous variable: SMD = 0.77, 95% CI = 0.63-0.91), and left atrial thrombus (categorical variable: OR = 1.87, 95% CI = 1.27-2.75; continuous variable: SMD = 0.59, 95% CI = 0.30-0.89). Subgroup analyses found that high NLR was significantly linked to AF recurrence when the NLR was >3. High NLR was significantly linked to the risk of stroke in AF when the NLR was ≤3. This study suggested that a high NLR is significantly linked to prognostic risk markers of AF, and NLR may be an effective biomarker for the prognosis of AF in clinical practice. PROSPERO (CRD42024530970).

The neutrophil-lymphocyte ratio predicts all-cause and cardiovascular mortality among United States adults with COPD: results from NHANES 1999-2018.

Neutrophil-to-lymphocyte ratio (NLR) is considered a biomarker of systemic inflammation and immune activation. However, its relationship with the risk of mortality in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to investigate the association between NLR and the risk of all-cause and cardiovascular mortality in patients with COPD. Data were collected from the National Health and Nutrition Examination Survey (NHANES) from January 1999 to December 2018. The calculation method of NLR involves dividing the neutrophil count by the lymphocyte count in the total blood cell count. The optimal NLR threshold associated with survival outcomes was determined using the maximally selected rank statistics method (MSRSM). The relationship between NLR and the risk of all-cause mortality and cardiovascular mortality in COPD was investigated using a weighted multivariable Cox regression model. Additionally, restricted cubic spline (RCS) was employed to discuss the potential relationship between NLR patients in different groups and the risk of mortality. In this study, 716 adults with COPD were included using the maximally selected rank statistics method, among whom 208 had higher NLR (≥2.56) and 508 had lower NLR (<2.56). During a median follow-up of 111.5 months, 162 COPD patients died from all causes, and 49 patients died from cardiovascular diseases. After adjusting for demographic, socioeconomic status, and lifestyle factors, the risk of all-cause mortality (HR = 2.07, 95%CI: 1.46-2.94) and cardiovascular mortality (HR = 3.03, 95%CI: 1.63-5.65) in patients with higher NLR was increased by 2-3 times compared to those with lower NLR. Kaplan-Meier analysis revealed significantly lower survival rates in patients with higher NLR for all-cause mortality and cardiovascular mortality (p < 0.05). Restricted cubic spline analysis showed a linear correlation between NLR and the risk of all-cause mortality and cardiovascular mortality. NLR has a high value in independently predicting long-term all-cause and cardiovascular mortality risks in community-dwelling COPD patients. Therefore, NLR can serve as a cost-effective and widely available indicator for assessing the prognosis of COPD patients.

The prognostic utility of the neutrophil to lymphocyte ratio in paediatric brain tumours: a retrospective case control study

Introduction Paediatric brain tumours (PBT) are the most common cause of death among all childhood cancers. The neutrophil to lymphocyte ratio (NLR) has been shown to prognosticate many adult cancers. There is a paucity of literature on the NLR in PBTs. This study aims to study the link between PBTs and the NLR by comparing the preoperative serum NLR in children under 16 with brain tumours with their outcome in terms of grade of brain tumour and overall survival. Methods This is a retrospective case control study. The NLRs were compared between patients with benign or malignant PBTs and patients who were alive or dead. Receiver-operating characteristic (ROC) curve analyses were performed and Youden indexes were calculated to evaluate the predictive potential of the NLR. A cut-off point of NLR > 4 was selected for the calculation of odds ratios. Results A total of 515 patients were included in this study. 53.8% were male. 66.2% had benign PBTs. 81.0% were alive at the time of the study. Patients with malignant PBTs had a higher NLR compared to patients with benign PBTs (p = 0.0066**). There was no difference in the NLR between patients who were dead compared to those who were alive (p = 0.1682 ns). The NLR had a Youden’s index of 0.1567 to predict malignant PBTs and 0.1285 to predict survival. Conclusion A high NLR was associated with an increased odds of having a malignant PBT but a reliable cut-off point was not identified and the underlying mechanisms for this remain unknown. The NLR is a poor diagnostic biomarker due to its poor overall sensitivity and specificity. More research is required to further study the role of immunity in PBTs.