Low Neutrophil-lymphocyte Ratio Research Articles

Analysis of levels and Clinical value of CA19-9, NLR and SIRI in patients with Pancreatic Cancer with different Clinical Features.

This study aimed to investigate the levels of cancer antigen 19-9 (CA19-9), neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammatory index (SIRI) in patients with pancreatic cancer with different clinical features and their clinical value. For this purpose, 78 patients with pancreatic cancer treated in our hospital from January 2018 to January 2021 were divided into two groups according to the NLR and SIRI calculated by blood routine and biochemical examination before operation. To observe and analyze the relationship between serum CA19-19 levels, clinical features and NLR and SIRI values in patients with different clinical stages and tumor diameter, and the diagnostic value of CA19-9, NLR and SIRI in pancreatic cancer. The results showed that the level of serum CA19-9 in patients with stage IV pancreatic cancer was significantly higher than that in patients with stage I, II and III, and the level of CA19-9 in patients with stage III was higher than that in patients with stage I and II, and the level of CA19-9 in patients with stage II was higher than that in patients with stage I. The level of CA19-9 in patients with pancreatic cancer with tumor diameter ≥ 5cm was significantly higher than that in patients with tumor diameter < 5cm. The percentage of patients with age ≤ 60 years old in high NLR group (83.78%) was significantly higher than that in low NLR group (63.41%), and the rate of patients with tumor diameter ≥ 5cm in the high SIRI group (54.05%) was significantly higher than that in low NLR group (26.83%). The rate of patients with tumor diameter ≥ 5cm in the high SIRI group (61.92%) was significantly higher than that in the low SIRI group (31.58%). Among the single indexes, the sensitivity of CA19-9 in the diagnosis of pancreatic cancer was the highest (93.10%). The specificity of Siri in the diagnosis of pancreatic cancer was 89.70%. The sensitivity and specificity of combined detection were 89.7% and 70.00%, respectively. In general, the level of serum CA19-9 in patients with pancreatic cancer increases gradually with the increase of clinical stage and tumor diameter. NLR value is related to patient age and tumor diameter, and SIRI value is related to tumor diameter. Combined detection of CA19-9, NLR and SIRI are of higher value in the early diagnosis of pancreatic cancer.

Predictive Value of Albumin and Neutrophil-to-Lymphocyte Ratio Score for Treatment Completeness and Safety Profiles in Patients With Head and Neck Cancer Receiving Definitive Concurrent Chemoradiotherapy.

Malnutrition and inflammation are common conditions in patients with head and neck cancer (HNC). This study aimed to evaluate the predictive value of albumin combined with neutrophil-lymphocyte ratio (NLR), referring to the albumin-NLR score (ANS), in the prediction of treatment completeness and safety profiles in HNC patients receiving definitive concurrent chemoradiotherapy (CCRT). 461 consecutive HNC patients who received CCRT between 2016 and 2017 at three medical centers in Taiwan were prospectively enrolled and divided into three different groups based on their pretreatment ANS (ANS 0, high albumin and low NLR; ANS 1, low albumin or high NLR; and ANS 2, low albumin and high NLR) for treatment completeness and safety profiles comparison. Overall, 46 patients (10.0%) had incomplete CCRT treatment. Patients in the ANS 2 group experienced a higher rate of incomplete CCRT (20.9%) than those in the ANS 1 (7.4%) and ANS 0 (3.5%) groups. ANS had a better discriminatory ability in predicting CCRT completeness in terms of -2 log-likelihood value, chi-square value, and c-index than the prognostic nutritional index. Patients in the ANS 2 group had significantly higher incidences of grade 3 or higher leukopenia, anemia, neutropenia, thrombocytopenia, non-neutropenic infection, and hypokalemia than those in the other two ANS groups. Our study showed that the ANS can accurately predict the treatment completeness of CCRT in patients with HNC and can be widely used as a simple predictor of treatment tolerance and safety profiles in patients with HNC undergoing CCRT.

Diagnostic and prognostic significance of the lymphocyte/C-reactive protein ratio, neutrophil/lymphocyte ratio, and D-dimer values in patients with COVID-19

In this study, our aim was to examine the diagnostic and prognostic significance of lymphocyte/C-reactive protein ratio (LCR), neutrophil/lymphocyte ratio (NLR) and D-dimer parameters in COVID-19 infection. The LCR, NLR, neutrophil count, mean platelet volume (MPV), C-reactive protein (CRP), and D-dimer parameters were evaluated retrospectively. This was a retrospective cohort study with 1000 COVID-19 positive and 1000 healthy control groups, all over the age of 18 years. Odds ratio (OR) and 95% confidence interval (CI) values were calculated for each parameter found to be statistically significant in the univariate and multivariate logistic regression models. Herein, 127 (12.7%) of the COVID-19+ patients, whose data was included in this study, died. The neutrophil, MPV, CRP, D-dimer, and NLR values were higher in the COVID-19+/deceased group than in the COVID-19+/alive and control groups (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001). The lymphocyte and LCR values were lower in the COVID-19+/deceased group than in the COVID-19+/alive and control groups (p < 0.001, p < 0.001). Variables with statistically significance in predicting COVID-19 infection were lymphocyte, LCR, D-dimer, NLR, CRP, MPV, PLT, and neutrophil values. Statistically significant variables in predicting mortality due to COVID-19 were LCR, CRP, NLR, lymphocyte, D-dimer, neutrophil, and MPV values. A low LCR and high NLR are associated with the presence, prognosis, and mortality due to COVID-19. LCR and NLR parameters can thus be used in clinical monitoring to reduce morbidity and mortality rates.

Factors Associated with the Development of Coagulopathy after Open Traumatic Brain Injury.

Background: The incidence of coagulopathy after open traumatic brain injury (TBI) is high. Coagulopathy can aggravate intracranial hemorrhage and further increase morbidity and mortality. The purpose of this study was to determine the clinical characteristics of coagulopathy after open TBI and its relationship with the prognosis. Methods: This study retrospectively evaluated patients with isolated open TBI from December 2018 to December 2020. Coagulopathy was defined as international normalized ratio (INR) > 1.2, activated thromboplastin time (APTT) > 35 s, or platelet count <100,000/μL. We compared the relationship between the clinical, radiological, and laboratory parameters of patients with and without coagulopathy, and the outcome at discharge. Logistic regression analysis was used to evaluate the risk factors associated with coagulopathy. We then compared the effects of treatment with and without TXA in open TBI patients with coagulopathy. Results: A total of 132 patients were included in the study; 46 patients developed coagulopathy. Patients with coagulopathy had significantly lower platelet levels (170.5 × 109/L vs. 216.5 × 109/L, p < 0.001), and significantly higher INR (1.14 vs. 1.02, p < 0.001) and APTT (30.5 s vs. 24.5 s, p < 0.001) compared to those with no coagulopathy. A Low Glasgow Coma Scale (GCS) score, high neutrophil/lymphocyte ratio (NLR), low platelet/lymphocyte ratio (PLR), and hyperglycemia at admission were significantly associated with the occurrence of coagulopathy. Conclusions: Coagulopathy often occurs after open TBI. Patients with a low GCS score, high NLR, low PLR, and hyperglycemia at admission are at greater risk of coagulopathy, and therefore of poor prognosis. The efficacy of TXA in open TBI patients with coagulopathy is unclear. In addition, these findings demonstrate that PLR may be a novel indicator for predicting coagulopathy.

Correlation of Neutrophil to Lymphocyte Ratio with Expression of Neutrophil Extracellular Traps Within Stroke Emboli.

It has been hypothesized that circulating neutrophils have a direct correlation with the composition of emboli in acute ischemic stroke (AIS). The aim of this study is to evaluate the association between neutrophil-lymphocyte ratio (NLR) in peripheral blood and the expression of neutrophil extracellular traps (NETs) within stroke emboli. Consecutive patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) that underwent mechanical thrombectomy (MT) were included. Patients were divided into two groups based on NLR median value. Retrieved thrombi were histologically analyzed using Martius Scarlett Blue (MSB) for main thrombus components including red blood cells (RBCs), white blood cells (WBCs), fibrin and platelet. Immunohistochemistry staining for von Willebrand Factor (vWF) and anti-citrullinated H3 (H3Cit; NETs marker) was also performed. Samples from a total of 84 patients were included. The average percentage of RBCs, WBCs, fibrin, platelet, H3Cit, and vWF components in thrombi were 45.1%, 3.5%, 21.8%, 29.6%, 19.7% and 14.8% respectively. When stratifying by NLR group [low (≤3.94) versus high (>3.95)], high NLR group had significantly more WBCs (4.5%), fibrin (24.2%), H3Cit (22.7%) and vWF (17.1%) thrombus fractions compared to low NLR group. Additionally, RBC content (38.8%) was lower in the high NLR group. NLR is correlated with the amounts of WBCs, fibrin, NETs and vWF within the thrombi retrieved from AIS patients due to LVO.

Clinical characteristics and surgical outcomes of resectable acinar cell carcinoma of the pancreas-propensity score matching analysis with pancreatic ductal adenocarcinoma

BackgroundSurgical resection is recommended for patients with resectable acinar cell carcinoma (ACC). The aim of this study was to investigate the clinical characteristics and surgical outcomes of resectable ACC in comparison to pancreatic ductal adenocarcinoma (PDAC). MethodA retrospective analysis was performed on all patients who consecutively underwent radical resection with pathologically confirmed ACC and PDAC from December 2011 to December 2018. Clinicopathologic characteristics and follow-up information were analyzed. A 1:3 propensity score matching (PSM) method was used to minimize the bias between ACC and PDAC. ResultsA total of 26 patients with ACC and 1351 with PDAC were included. Compared to PDAC, ACC tended to be larger (4.5 vs. 3.0 cm; p < 0.001) and more frequently located in the pancreatic body/tail (61.5% vs. 36.6%, p = 0.009), with lower total bilirubin levels, lower neutrophil lymphocyte ratio (NLR) levels and lower carbohydrate antigen 19-9 (CA19-9) levels and carcinoembryonic antigen (CEA) levels. There was no difference in postoperative morbidities in patients with ACC and PDAC. The median OS and RFS were longer in ACC when compared to PDAC (OS: 43.5 mo vs. 19.0 mo, p = 0.004; RFS: 24.5 mo vs. 11.6 mo, p = 0.023). After the 1:3 PSM, ACC remained to be a better histological type for OS (p = 0.024), but had comparable RFS with PDAC (p = 0.164). ConclusionPatients with ACC after radical resection had better OS than that with PDAC. However, ACC is also an aggressive tumor with a similar trend of RFS with PDAC after the matching, necessitating the multidisciplinary treatment for resectable ACC disease.

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

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

Safety and efficacy of atezolizumab plus bevacizumab in patients with unresectable hepatocellular carcinoma in early clinical practice: A multicenter analysis.

To assess the impact of clinical factors on the safety and efficacy of atezolizumab plus bevacizumab (ATZ+BV) treatment in patients with unresectable hepatocellular carcinoma (u-HCC). Ninety-four u-HCC patients who were treated with ATZ+BV at multiple centers were enrolled. We defined Child-Pugh (CP)-A patients who received ATZ+BV treatment as a first line therapy as the 'meets the broad sense of the IMbrave150 criteria' group (B-IMbrave150-in, n=46), and patients who received ATZ+BV treatment as a later line therapy or CP-B patients (regardless of whether ATZ+BV was a first line or later line therapy) as the B-IMbrave150-out group (n=48). Patients were retrospectively analyzed for adverse events (AEs) and treatment outcomes according to their clinical characteristics, including neutrophil lymphocyte ratio (NLR) at baseline. The overall incidence of AEs was 87.2% (82/94 patients). The frequency of interruption of ATZ+BV treatment due to fatigue was higher in CP-B than CP-A patients (p=0.030). Objective response (OR) rates of the B-IMbrave150-in group (28.3%, 39.1%) were significantly higher than those of the B-IMbrave150-out group (8.3%, 18.8%; p=0.0157, 0.0401) using Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST, respectively. In multivariate analysis, NLR (hazard ratio (HR), 4.591; p=0.0160) and B-IMbrave150 criteria (HR, 4.108; p=0.0261) were independent factors associated with the OR of ATZ+BV treatment using RECIST. In real-world practice, ATZ+BV treatment might offer significant benefits in patients who meet B-IMbrave150 criteria or have low NLR.

Comparison of Clinical Characteristics and Outcomes of Younger and Elderly Patients with Severe COVID-19 in Korea: A Retrospective Multicenter Study.

Old age is associated with disease severity and poor prognosis among coronavirus disease 2019 (COVID-19) cases; however, characteristics of elderly patients with severe COVID-19 are limited. We aimed to assess the clinical characteristics and outcomes of patients hospitalized with severe COVID-19 at tertiary care centers in South Korea. This retrospective multicenter study included patients with severe COVID-19 who were admitted at seven hospitals in South Korea from 2 February 2020 to 28 February 2021. The Cox regression analyses were performed to assess factors associated with the in-hospital mortality. Of 488 patients with severe COVID-19, 318 (65.2%) were elderly (≥65 years). The older patient group had more underlying diseases and a higher severity score than the younger patient group. The older patient group had a higher in-hospital mortality rate than the younger patient group (25.5% versus 4.7%, p-value < 0.001). The in-hospital mortality risk factors among patients with severe COVID-19 included age, acute physiology and chronic health evaluation II score, presence of diabetes and chronic obstructive lung disease, high white blood cell count, low neutrophil-lymphocyte ratio and platelet count, do-not-resuscitate order, and treatment with invasive mechanical ventilation. In addition to old age, disease severity and examination results must be considered in treatment decision-making.

Combination of psoas muscle mass index and neutrophil/lymphocyte ratio as a prognostic predictor for patients undergoing nonsurgical hepatocellular carcinoma therapy.

Background and AimReliable predictors for hepatocellular carcinoma (HCC) are urgently needed. The psoas muscle index (PMI) is a simple and rapid method for evaluating muscle atrophy. Furthermore, the neutrophil/lymphocyte ratio (NLR) is a prognostic factor that is easy to calculate in everyday clinical practice. We aimed to investigate the value of the PMI and NLR as prognostic factors for patients receiving nonsurgical HCC therapy, hepatic arterial infusion chemotherapy (HAIC), transcatheter arterial chemoembolization (TACE), or molecular targeted drugs such as sorafenib (SOR) and lenvatinib (LEN).MethodsWe enrolled 87 patients with HCC who were treated with HAIC, TACE, SOR, or LEN. The primary endpoint was overall survival (OS) with variable PMI or NLR status. For Barcelona Clinic Liver Cancer (BCLC)‐B patients, useful prognostic factors were examined by comparing the OS between stratified groups. Prognostic factors including PMI and NLR were evaluated by univariate and multivariate analysis.ResultsAnalysis of HAIC or TACE (HAIC/TACE) and SOR or LEN (SOR/LEN) patients showed significant differences in OS between low and high PMI. In patients treated with TACE, there was a significant difference in OS between low and high NLR. For BCLC‐B and low PMI, the prognosis was significantly worse for SOR/LEN than for TACE, although there was no difference for high PMI, suggesting that PMI may be useful for treatment selection. In addition, the prognostic formula composed of PMI, NLR, and up‐to‐seven criteria developed in the present study may be useful.ConclusionPMI and NLR are considered to be independent prognostic factors for HCC.

Prognostic role of neutrophil lymphocyte ratio and mean platelet volume in Bell’s palsy: Comparison of diabetic and non-diabetic patients

ObjectivesA low Neutrophil Lymphocyte Ratio (NLR) has been shown to be associated with good prognosis in Bell’s Palsy (BP). However, the effect of chronic diseases that may affect the NLR, including Diabetes Mellitus (DM), has not been clarified in this context. This study aimed to evaluate the relationship between NLR and Mean Platelet Volume (MPV) in BP according to whether it is accompanied by DM, and their relationship with prognosis. MethodsA prospective observational study was conducted from May 2014 to May 2020 in a tertiary referral center, of all 79 consecutive participants diagnosed with BP in department of otolaryngology and 110 consecutive healthy participants admitted to the check-up unit. Patients diagnosed with BP were divided into two groups according to whether they were diagnosed with DM: diabetic BP patients (DM-BP, n = 33) and non-diabetic BP patients without any chronic disease (nonDM-BP, n = 46). Neutrophil (NEUT) and Lymphocyte (LYM) counts, and Mean Platelet Volume (MPV) were assessed from peripheral blood samples, and the NLR was calculated. Prognosis was evaluated using the House–Brackmann Score (HBS) six months after diagnosis. ResultsThe mean NLR was 2.85 ± 1.85 in BP patients and 1.69 ± 0.65 in the control group. The mean NLR was significantly higher in BP patients than healthy controls (p < 0.001). The mean NLR was 2.58 ± 1.83 in the nonDM-BP group, 3.23 ± 1.83 in the DM-BP group, and 1.69 ± 0.65 in the control group. The NLR was significantly higher in the nonDM-BP and DM-BP groups than in the control group (p < 0.05). The recovery was 90% according to the HBS. The optimal cut-off value was 2.41 (p = 0.5). ConclusionThe NLR was increased in both diabetic and non-diabetic BP and had similar prognostic value in predicting the HBS before treatment in diabetic and non-diabetic patients with BP. MPV wasn’t significantly different in diabetic and non-diabetic BP patients compared with the normal population.

EARLY IDENTIFICATION OF HIGH RISK COVID-19 PATIENTS USING HEMATOLOGICAL INDICES

Coronavirus disease 2019 (COVID-19) is a recent respiratory infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with serious complications, severe acute respiratory syndrome (ARDS), cytokine storm, and coagulopathies. Complete blood count (CBC) is a routine inexpensive and easy test that provides information regarding formed blood content such as white blood cells (WBC), platelet, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) to detect degree of inflammation. This study attempts to assess, at an early phase of the disease, the prognosis of COVID-19 patients and predict high risk patients who will most probably develop ARDS and cytokine storm by analyzing blood cells count. This study is a single-center case series on COVID‐19 patients who were prospectively analyzed at Al-Furat General Hospital in Baghdad from March to August 2020. Up to 123 Covid-19 patients in two groups, 100 who survived versus 23 who did not survive were included. Patients with abnormal renal and hepatic tests were excluded. Results revealed that the median age of patients was 40 years, ranging from 2-84 years of age. Males (61.8%) were more affected by COVID-19 than females (38.2%). Survived patients exhibited far lowered WBC count (6.06±3.17) than non-survived patients (11.4±6.08; p&lt;0.0001). Lymphocyte count in survived patients (1.6±1.1) were higher than non-survived patients (1.1±0.4; p&lt;0.004). Neutrophils showed lower count (3.7±2.7) in survived patients than non-survived patients (8.9±4.5). Also, receiver operator characteristic (ROC) analysis for NLR, LMR and PLR revealed a cut off value for abnormally high or low NLR &gt;5, LMR ≤1.8, and PLR &gt;176 with area under curve (AUC) 0.9, 0.8, and 0.6, respectively. These cut off values represent landmarks above or below which poor prognosis and non-survival is highly predicted. NLR was found to be the most prognostic index to detect bad prognosis and non-survival of the disease at 90% sensitivity, followed by LMR and then PLR. The percentage of non-survived patients who had abnormally high NLR (82.6%), LMR (65.2%) and PLR (56.5%) were far higher than survived patients (NLR: 9%; LMR: 8%; PLR: 22%).

The Applicability of Neutrophil-Lymphocyte Ratio in Predicting The Survival of Nasopharyngeal Cancer: An Evidence Based Case Report

Background: Having high prevalence and mortality with a distinctive geographical distribution, nasopharyngeal cancer (NPC) has caused a huge burden in the world. There are several prognostic factors in NPC, however additional marker is needed to give a better picture on disease outcome. Innate and adaptive immunity play a great role in disease progression, however, the role of neutrophil-lymphocyte ratio (NLR) is still controversial. This study aims to investigate the role of NLR status as a prognostic factor in NPC. Methods: Literature searching was conducted through Pubmed, Cochrane, Proquest, EBSCO and Science Direct under specific keywords. Further filtering double and screening for eligibility criteria were performed before critical appraisal and measurement of level of evidence by The Centre for Evidence-Based Medicine (CEBM) University of Oxford. Review for the best available evidence was done by two-independent reviewer. Results: 130 records were retrieved and 6 final articles were finally appraised. All studies were published after 2017 with sample sizes of 140-5973 subjects. NLR cut-off were varied across studies (2.21-3.6) and the overall survival (OS) ranging from 51-82.5%. Moreover, 5-year disease specific survival (DSS) and progression free survival (PFS) for low and high NLR were 76-90.5% vs 53-82.1% and 68-86.2% vs 52-76.5%, respectively. Conclusion: NLR status can be used to predict OS in NPC patients. A careful approach should be taken in determining treatment options. Further research is needed to know the role of NLR in combination with other biomarker in predicting the survival of patients.

Absolute lymphocyte count is an independent predictor of survival in patients with metastatic renal cell carcinoma treated with nivolumab.

Programmed cell death-1 antibody therapy has demonstrated improved progression-free survival and overall survival in patients with metastatic renal cell carcinoma. However, there are limited studies on biomarkers that can predict the efficacy of immune checkpoint inhibitors. We examined the influence of peripheral inflammatory biomarkers on the clinical outcomes of patients with metastatic renal cell carcinoma treated with nivolumab. Data of 38 patients with metastatic renal cell carcinoma, who were treated with nivolumab monotherapy after receiving at least one molecular targeted therapy from November 2016 to February 2021, were retrospectively reviewed and analyzed. Median progression-free survival and overall survival were significantly shorter in patients with low absolute lymphocyte count (<1300/μl) versus those with high absolute lymphocyte count (progression-free survival: P=0.0102; overall survival: P=0.0026). Median overall survival was shorter in patients with high neutrophil-lymphocyte ratio (≥3.0) versus those with low neutrophil-lymphocyte ratio (P=0.0344). Multivariate analysis showed that absolute lymphocyte count was an independent factor for progression-free survival (hazard ratio=2.332, 95% confidence interval=1.012-5.375, P=0.0468) and overall survival (hazard ratio=4.153, 95% confidence interval=1.108-15.570, P=0.0347). Increased absolute lymphocyte count, 1 month after nivolumab initiation, was a positive predictive factor for progression-free survival (hazard ratio=0.419, 95% confidence interval=0.189-0.926, P=0.0317) and overall survival (hazard ratio=0.285, 95% confidence interval=0.091-0.890, P=0.0308). Our study indicates that peripheral absolute lymphocyte count, before nivolumab initiation, is a predictor of poor response in metastatic renal cell carcinoma. Additionally, increased absolute lymphocyte count, 1 month post-nivolumab initiation, can be a predictor of the effects of nivolumab.

Elevated neutrophil to lymphocyte ratio is associated with decreased amputation-free survival after femoropopliteal percutaneous revascularization.

An elevated neutrophil-lymphocyte ratio (NLR) is a biomarker associated with adverse outcomes after cardiovascular surgery. This study evaluates the association of preoperative NLR with clinical outcomes after peripheral vascular intervention (PVI) of the femoropopliteal segments. A retrospective review identified 488 patients who underwent percutaneous interventions of femoropopliteal arteries between 2011 and 2018 and had a pre-procedural complete blood count with differential with normal white blood cell count within 30 days prior to intervention. Amputation-free survival (AFS), survival, and freedom from major amputation were assessed using Kaplan-Meier methods. Cohorts of patients with NLR <3 (Low), 3-4 (Mid), and >4 (High) were compared using univariate and multivariable statistical models. In these analyses NLR was analyzed as a continuous variable to correlate with clinical outcomes. Mean age was 71.7±12.8 years and males constituted 55.5%. The majority of patients presented with chronic limb threatening ischemia (CLTI, 78.5%). Increasing NLR was correlated with increasing rates of comorbidities, except for smoking history. The 30-day mortality rates increased with increasing NLR: 1.4%, 4.3%, and 7.0% for low (<3), mid (3-4) and high (>4) NLR groups, respectively (P=0.005). Patients with a lower pre-operative NLR achieved significantly greater amputation-free survival at 4-year follow-up: low NLR, 65.5%; mid NLR, 37.5%; and high NLR, 17.6% (P<0.0001). By multivariable analysis, increasing NLR, advanced age, CLTI, and dialysis-dependent renal failure reduced AFS. Elevated NLR is an independent predictor of decreased AFS following percutaneous interventions of femoropopliteal segments. Further research on identification and modulation of risk factors for high NLR are warranted.

The Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio Predicts Disease-Free Survival in Resectable Esophageal Squamous Cell Carcinoma.

BackgroundRecent studies have revealed that the presence of systemic inflammation is associated with poor survival for esophageal squamous cell carcinoma. We aimed to investigate prognostic values of preoperative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in resectable esophageal squamous cell carcinoma.MethodsA cohort of 167 resectable ESCC patients was retrospectively reviewed between January 2017 and September 2020. The best cut-off value of NLR and PLR was selected by plotting the receiver operating characteristic curve. All reviewed patients were divided into high NLR/PLR or low NLR/PLR group to evaluate prognostic factors.ResultsAmong the 167 patients, 34 (20.36%) were women and 133 (79.64%) were men. The mean age was 62.64 ±7.91 years, with an age range from 44 to 85 years. All patients were divided into low NLR (<2.20) or high NLR (≥2.20) group (AUC=62.5% with the sensitivity of 61.8% and specificity 60.9%, P=0.025), low PLR (<110) or high PLR (≥110) group (AUC=59.6% with the sensitivity of 82.4% and specificity 35.3%, P=0.083). High NLR and PLR were associated with a larger tumor diameter (P<0.05), while high NLR was also associated with poor tumor classification (P=0.022). There was a positive correlation between NLR and PLR (r = 0.614, P < 0.001). High NLR and PLR were significantly associated with poor disease-free survival. Multivariate analyses identified NLR as a prognostic factor in resectable ESCC.ConclusionThe NLR and PLR predict disease-free survival in resectable esophageal squamous cell carcinoma.

Hypertension Severity and Inflammatory Burden as Evaluated by Neutrophil–Lymphocyte Ratio

Background: Different studies implicated inflammation as associative or causative factor in the development of hypertension (HT). It has been reported that low-grade inflammation enhances development of HT, as high blood pressure is linked with high neutrophils, lymphocytes, C-reactive protein, and interleukin 6. Neutrophil–lymphocyte ratio (NLR) may reflect underlying chronic low-grade inflammation in different inflammatory disorders and cardiovascular diseases including HT. Telmisartan (TLS), which is an angiotensin II receptor type 1 blocker that used in the management of HT, may reduce the associated inflammatory disorders. Thus, the aim of the present study was to assess the level of NLR in relation to the HT severity in patients treated with TLS. Methods: Forty-four patients with severe HT compared with matched 20 patients with mild HT as controls were recruited. Anthropometric and biochemical variables as well as NLR were measured. Results: Blood pressure and lipid profile were higher in patients with severe HT on antihypertensive therapy other than TLS. TLS treatments had improved blood pressure; lipid profile and low NLR compared to patients with severe HT not were on TLS treatment. Conclusion: TLS reduces HT severity through reduction of NLR; therefore, it regarded the optimum angiotensin receptor blocker (ARB) drug in the management of HT. Thus, preclinical and prospective studies are warranted in this regards.

Association of Postoperative Neutrophil Lymphocyte Ratio (NLR) and Monocyte Lymphocyte Ratio (MLR) with the Presence of Osteoporosis in Japanese Patients after Hip Fracture Surgery: A Retrospective Cohort Study.

Background The diagnosis of osteoporosis is based on bone mineral density measurements expressed as a percentage of the young adult mean (YAM) in Japan. Osteoporosis is defined as YAM <70%, and intervention is recommended at this cutoff. Because osteoporosis has a strong association with systemic metabolic disorders, we postulated that patients with YAM <70% had higher inflammatory biomarker concentrations owing to the higher systemic stress compared with YAM >70%. Method We retrospectively reviewed 94 patients with low-trauma hip fractures. Blood examinations were performed on postoperative day (POD) 1 and POD 7. We used neutrophil lymphocyte ratio (NLR) and monocyte lymphocyte ratio (MLR) to evaluate postoperative recovery. After dividing the 94 patients into two groups according to a YAM cutoff of 70%, we compared the differences in NLR and MLR. Results On POD 1, patients with YAM >70% had a median NLR of 5.7 and a median MLR of 0.66, which were significantly lower than for patients with YAM <70% (8.8 and 0.9, respectively). Similarly, on POD 7, patients with YAM >70% had a median NLR of 2.0 and a median MLR of 0.31, which were significantly lower than for patients with YAM <70% (3.5 and 0.43, respectively). Conclusion A YAM cutoff of 70% is an appropriate intervention threshold regarding postoperative recovery after hip fracture surgery. Mini-. Patients with YAM >70% showed lower NLR and MLR on POD 1 and POD 7. A YAM cuffoff of 70% is an appropriate intervention threshold regarding postoperative recovery after hip fracture surgery.

Comparison of Clinical and Diagnostic Features of Pediatric Oncology Patients With or Without COVID-19 Infection: A Retrospective Chart Review.

There is a scarcity of data summarizing the clinical picture, laboratory, and imaging findings and outcome in children with malignancy and coronavirus disease 2019 (COVID-19) infection. This study characterizes a detailed comparison of pediatric oncology patients with and without COVID infection. A retrospective study was conducted at The Indus Hospital, Karachi, from March 2020 to June 2020. Clinical presentation, laboratory and imaging findings, disease severity, and outcome were compared between cohorts. The mean age of children with and without COVID was 8.0±4.9 and 7.4±4.1 years, respectively. Hematologic malignancy comprised the largest number of patients, followed by solid tumors. Lymphocytosis and low neutrophil-lymphocyte ratio was observed in the COVID positive group. Cardiac dysfunction (1.4% vs. 0%), acute respiratory distress syndrome (8% vs. 0%) and lower peripheral capillary oxygen saturation/fraction of inspired oxygen ratio (473 vs. 486) found to be associated with severe disease in COVID positive group (P<0.05). Overall mortality in children with COVID was 6.8% versus 2.7% in children without COVID. Pediatric patients with malignancy have different clinical features and laboratory parameters as compared with children without malignancy. Acute respiratory distress syndrome, absolute lymphocytosis and low neutrophil-lymphocyte ratio is associated with severe disease in children with malignancy and COVID infection. In contrast to adults, biochemical markers and complete blood count parameters do not help recognize COVID infection in pediatric patients with malignancy.

Neutrophil Lymphocyte Ratio (NLR) as a predictive factor radiological response of Neoadjuvant Chemotherapy (NAC) in Locally Advanced Rectal Cancer (LARC)

Background: Resistance of Neoadjuvant Chemotherapy (NAC) in Locally Advanced Rectal Cancer (LARC) makes patients lose their therapeutic window for tumor resection oncologically. As one of the inflammatory biomarkers, Neutrophil Lymphocyte Ratio (NLR) has a significant role in tumor progression. This study aims to evaluate the NLR values as a predictive factor radiological response of NAC in LARC.Methods: This study used a cross-sectional study to assess the relationship of pre-chemotherapy NLR with NAC response. All subjects were LARC patients who underwent the NAC FOLFOX regiment at the Dr. Soetomo General Hospital from January 2016 to December 2020. Variables assessed in this study included tumor size (T), staging, pathology, metastasis status, Complete Blood Count (CBC) and abdominopelvic CT-scan examination before and after (3rd cycle) NAC FOLFOX regiment, after 3rd cycle NAC FOLFOX regiment, gender, and albumin level. Data were analyzed using SPSS version 23 for Windows.Result: A total of 102 LARC patients underwent NAC. There were 62 patients (60.8%) with low pre-chemotherapy NLR (&lt;2.15) and 40 patients (39.2%) with high pre-chemotherapy NLR (&gt; 2.15). There were 57 patients with a positive response to NAC (Complete Response (CR)/Partial Response (PR)), with 48 patients have low NLR (84.2%) and 9 patients (15.8%) with high NLR. There was a significant relationship between pre-chemotherapy NLR and type of histopathology (OR 11.810; 95% CI: 4.561-30.579; p&lt;0.001) to the radiological response of NAC in the Chi-Square test. However, a logistic regression test found that the OR value of pre-chemotherapy NLR increased to 13.649 (95% CI: 4.266-43.671; p&lt;0.001) to the radiological response of NAC.Conclusion: Pre-chemotherapy NLR can be used as one of the predictive factors of radiological response after the NAC FOLFOX regiment in LARC patients.