lymphocyte-to-C-reactive Protein Ratio Research Articles

Lymphocyte-to-C-reactive protein ratio and score in patients with heart failure: Nutritional status, physical function, and prognosis.

In heart failure (HF), inflammation is linked to malnutrition and impaired physical function. In this study, we aimed to assess how novel nutritional-inflammatory markers and lymphocyte-to-C-reactive protein ratio (LCR) and score (LCS) are associated with the nutritional status, physical function, and prognosis of patients with HF. This study was a secondary analysis of the FRAGILE-HF study, a prospective observational study conducted across 15 hospitals in Japan. We included 1212 patients (mean age, 80.2±7.8years; 513 women) hospitalized with HF, who were classified into three groups according to their LCS score: 0 (n=498), 1 (n=533), and 2 (n=181). Baseline data on physical examination, echocardiography, blood test results (including lymphocyte counts and CRP levels), and oral medication usage were collected in a clinically compensated state before discharge. Nutritional status and physical function were evaluated using several indices and tests. The primary outcome of this study was all-cause death within 2years. Univariate and multivariate linear regression analyses were performed to evaluate the associations among the nutritional status, physical function, and LCR/LCS. Patients with an LCS score of 2 were older and had a lower body mass index than those in the other two groups. Multivariate linear regression analysis revealed that lower LCR and higher LCS were independently associated with worse nutritional status, lower handgrip strength, shorter physical performance battery score, and shorter 6-min walk distance. At 2years, all-cause death occurred in 254 patients: 86 (17.6%), 113 (21.5%), and 55 (30.9%) with LCS scores of 0, 1, and 2, respectively (P=0.001). Cox proportional hazards analysis revealed that LCR and LCS were significantly associated with 2-year mortality even after adjusting for the conventional risk model (LCS score, 0 vs. 2: hazard ratio, 1.64; 95% confidence interval [CI]; 1.14-2.35; P=0.007; log-transformed LCR: hazard ratio, 0.88; 95% CI, 0.81-0.95; P=0.002). LCR yielded additional prognostic predictability compared with the conventional risk model (continuous net reclassification improvement, 0.153; 95% CI, 0.007-0.299; P=0.041). LCR and LCS emerge as potential predictors of nutritional status, physical function, and prognosis in older patients with HF.

Enteral nutrition in the management of acute pancreatitis: Modulates gut microbiome and alleviates inflammation

BackgroundEnteral nutrition (EN) represents a fundamental and efficacious therapeutic approach in acute pancreatitis (AP). Our objective is to investigate the modulation of gut microbiota through enteral nutrition. MethodsThis prospective observational study enrolled 35 AP patients and implemented timely enteral nutrition intervention. Inflammatory markers, including C-reactive protein (CRP), were assessed before and after EN, while the dynamic alterations in gut microbiota were analyzed using 16S rDNA sequencing technology. ResultsFollowing EN, CRP significantly decreased, effectively mitigating the inflammatory response. Due to inter-individual variations in post-enteral nutrition inflammatory status, patients were further stratified into H group (CRP≥50 mg/L) and L group (CRP<50 mg/L) for subsequent analysis. Comparative evaluation of clinical characteristics between the two groups revealed that the H group exhibited a significantly higher risk of adverse prognosis including respiratory dysfunction and infectious complications. Dynamic monitoring of gut microbiota demonstrated a substantial increase in microbial diversity after EN accompanied by a decrease in opportunistic pathogens such as Enterococcus, Escherella-Shigella, and Klebsiella, along with an augmentation of beneficial bacteria including Bacteroides and Fusobacterium. The composition of gut microbiota varied according to the levels of inflammation among AP patients: Shigella predominated within Group H, while Actinomyces and Enterococcus constituted the dominant bacterial population within Group L. Furthermore, Spearman correlation analysis revealed significant associations between specific microbial communities within the gut and inflammatory markers such as neutrophil to albumin ratio (NAR) and lymphocyte to C-reactive protein ratio (LCR). ConclusionsEN can modify gut microbiota and alleviate inflammation, thereby affecting the severity and prognosis of AP patients.

Complete blood count inflammation derived indexes as predictors of metabolic syndrome in type 2 diabetes mellitus.

Metabolic syndrome (MetS) is a group of comorbidities related to regulating hyperglycemia and acute cardiovascular incidents and complications. With the increasing prevalence in individuals with type 2 diabetes mellitus (T2DM), MetS represents an increasing public health problem and clinical challenge, and early diagnosis is necessary to avoid the accelerated development of diabetic complications. To investigate the role of Complete Blood Count-derived Inflammation Indexes (CBCIIs) in predicting MetS in T2DM individuals. The study was designed as a two-year prospective study and included 80 T2DM individuals divided into MetS and non-MetS groups based on MetS development over two years. The sera samples were analyzed for complete blood count parameters and C-reactive protein (CRP). Based on the laboratory test results, 13 CBCIIs were calculated and analyzed. The receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine prognostic accuracy. There were significant differences between T2DM participants with Mets and those without MetS concerning Neutrophil to Platelet Ratio (NPR) values (p< 0.001), Neutrophil to Lymphocyte and Platelet Ratio (NLPR) (p< 0.001), Platelet to Lymphocyte Ratio (PLR) (p< 0.001), Lymphocyte to C-reactive protein Ratio (LCR) (p< 0.001), C-reactive protein to Lymphocyte Ratio (CRP/Ly) (p< 0.001), Systemic immune inflammation index (SII) (< 0.001), and Aggregate Index of Systemic Inflammation (AISI) (p= 0.005). The results of ROC curve analysis have shown that the LCR (AUC of 0.907), CRP/Ly (AUC of 0.907) can serve as excellent predictors, but NPR (AUC of 0.734), NLRP (AUC of 0.755), PLR (AUC of 0.823), SII (AUC of 0.745), and AISI (AUC of 0.688) as good predictors of MetS in T2 DM individuals. This study confirms the reliability of the CBCIIs as novel, simple, low cost and valuable predictors of MetS developing in T2DM.

Lymphocyte to C-reactive protein ratio is associated with in-hospital cardiac death in elderly patients with non-ST-segment elevation myocardial infarction.

Although percutaneous coronary intervention (PCI) is recommended by guidelines, data from the real world suggest that elderly non-ST-segment elevation myocardial infarction (NSTEMI) patients have a low rate of PCI and a high death rate. Lymphocyte to C-reactive protein ratio (LCR), a novel inflammatory marker, has been shown to be associated with prognosis in a variety of diseases. However, the relationship between LCR and in-hospital cardiac death in elderly NSTEMI patients is unclear. The aim of this study was to investigate the effect of LCR on in-hospital cardiac death in elderly NSTEMI patients without PCI therapy. This was a single-center retrospective observational study, consecutively enrolled elderly (≥75 years) patients diagnosed with NSTEMI and without PCI from February 2019 to February 2024. LCR was defined as lymphocyte count to C-reactive protein ratio. The endpoint of observation was in-hospital cardiac death. The predictive efficacy of the old and new models was evaluated by the net reclassification index (NRI) and the integrated discriminant improvement index (IDI). A total of 506 patients were enrolled in this study, and in-hospital cardiac death occurred in 54 patients (10.7%). Univariate logistic regression analysis showed that left ventricular ejection fraction, LCR, Killip ≥2, and N-terminal B-type natriuretic peptide proteins (NT-proBNP) were associated with the occurrence of in-hospital cardiac death. After adjusting for potential confounders, the results showed that NT-proBNP (OR = 1.695, 95% CI: 1.238-2.322) and LCR (OR = 0.262, 95% CI: 0.072-0.959) were independent risk factors for in-hospital cardiac death. After the addition of LCR to NT-proBNP, the predictive ability of the new model for in-hospital cardiac death was significantly improved (NRI = 0.278, P = 0.030; IDI = 0.017, P < 0.001). Lower LCR is an independent risk factor for in-hospital cardiac death in elderly NSTEMI patients without PCI, and integrating LCR improves the prediction of in-hospital cardiac death occurrence.

The value of lymphocyte-to-C-reactive protein ratio for predicting clinical outcomes in patients with sepsis in intensive care unit: a retrospective single-center study.

The lymphocyte-to-C-reactive protein ratio (LCR) was a novel biomarker of inflammation that had been implicated in various diseases. Nevertheless, the role of LCR in the context of sepsis patients admitted to the Intensive Care Unit (ICU) had not been thoroughly elucidated. This study aimed to determine the significance of the LCR in predicting the prognosis of sepsis patients within ICU. A sample of sepsis patients requiring ICU care was selected from the Affiliated Hospital of Jiangsu University. These patients were then segmented into four quartiles based on their LCR levels. The primary endpoint of the study was 30-day mortality and the secondary endpoint was the occurrence of Acute Kidney Injury (AKI). Survival analysis, via the Kaplan-Meier method and log-rank test, was conducted to assess survival rates. Cox proportional hazards regression and logistic regression models were employed to investigate the association between LCR and clinical outcomes. Additional subgroup analyses were conducted to evaluate the influence of other confounding factors on the relationship between LCR and patient outcomes. A total of 1,123 patients were enrolled in this study, with a median age of 75 (65-84) years, and 707 (63.0%) of them were male. The 30-day mortality rate was 28.1%, while the incidence of AKI was 45.6%. A progressive decrease in LCR levels was found to be associated with an increased cumulative incidence of 30-day mortality (log-rank P < 0.001). Multivariable Cox proportional hazards analyses demonstrated that LCR was an independent predictor of 30-day mortality [per 1-unit increase in LCR: HR (95%CI): 0.370 (0.142-0.963); P = 0.042]. Additionally, multivariable logistic regression analysis revealed a significant association between LCR and AKI occurrence [per 1-unit increase in LCR: OR (95%CI): 0.541 (0.307-0.953); P = 0.034]. Furthermore, subgroup analysis indicated a stronger correlation for patients aged over 65 years compared to those aged 65 or younger (p for interaction <0.05) in predicting 30-day mortality or AKI occurrence based on LCR. A reduction in LCR was notably linked to 30-day mortality and the occurrence of AKI in sepsis patients. These findings suggested that LCR could potentially serve as a valuable tool in identifying sepsis patients at a heightened risk of adverse outcomes.

Predictive Value of Inflammatory Indicators on the Efficacy of Preoperative Neoadjuvant Chemotherapy in Patients With Locally Advanced Rectal Cancer

Objective: To investigate the relationship between peripheral blood neutrophil‐to‐lymphocyte ratio (NLR), lymphocyte‐to‐monocyte ratio (LMR), platelet‐to‐lymphocyte ratio (PLR), lymphocyte‐to‐C‐reactive‐protein ratio (LCR), and monocyte‐to‐leukocyte ratio (MWR) and the efficacy of neoadjuvant chemotherapy (NAC) for patients with locally advanced rectal cancer before and after chemotherapy.Methods: Seventeen rectal cancer patients who underwent NAC at West China Hospital of Sichuan University from March 31, 2022, to April 30, 2024, were selected as the study subjects, and the predictive value of peripheral blood NLR, LMR, PLR, LCR, and MWR were included in the least absolute shrinkage and selection operator (LASSO) regression analysis for the pathological efficacy, and the significant variables were screened out and the nomogram was constructed from them. Decision curve analysis (DCA) was applied to evaluate the predictive performance of the model.Results: LASSO regression screened three predictive variables of NLR, LMR and LCR before neoadjuvant therapy that could predict pathological complete remission (pCR), as well as changes in PLR, LCR, and MWR after neoadjuvant therapy that could predict chemotherapy inefficacy. Nomograms and DCA curves were drawn based on the variables, and internal validation showed that the model had good predictive ability.Conclusion: The comprehensive hematological prediction model for effective NAC in rectal cancer has a good predictive ability for NAC efficacy, which can provide guidance for individualized patient treatment.

Relationship between the lymphocyte to C‑reactive protein ratio and coronary artery disease severity.

Coronary atherosclerosis is a chronic systemic inflammatory disease. Laboratory parameters such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune inflammation index (SII) have been used to assess inflammation degree and coronary artery disease (CAD) severity. The lymphocyte-to-C-reactive protein ratio (LCR) is a new SII. However, its relationship with CAD development and severity is unclear. A total of 1,107 patients (479 in control group, 628 in CAD group) underwent coronary angiography. The routine and biochemical indices of the venous blood of patients were assessed before coronary angiography. LCR, SII, NLR and PLR were calculated and statistical analyses were performed. Propensity score matching (PSM) and a logistic regression model were used to analyze the relationship between LCR and CAD. After the PSM, 384 pairs of patients with or without CAD were successfully matched. After the median binary classification of all indicators, uni- and multivariate logistic regression analyses showed that platelet count was an independent risk factor and LCR was an independent protective factor. Using the same method, in the coronary heart disease severity group, 212 pairs were successfully matched and NLR and PLR were independent risk factors, while LCR was an independent protective factor. In conclusion, LCR is an independent protective factor against CAD development and severity.

Predictive value of immunotherapy-induced inflammation indexes: dynamic changes in patients with nasopharyngeal carcinoma receiving immune checkpoint inhibitors

BackgroundImmune checkpoint inhibitors (ICIs) have achieved substantial advancements in clinical care. However, there is no strong evidence for identified biomarkers of ICIs in NPC.MethodsIn this retrospective study, 284 patients were enrolled into a training or validation cohort. Inflammatory indexes based on peripheral blood parameters were evaluated, including the systemic immune-inflammation index (SII), the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), the lymphocyte-to-C-reactive protein ratio (LCR), and the lymphocyte-monocyte ratio (LMR). The optimum cut-off value for patient stratification was identified using X-tile. The Kaplan-Meier method and Cox’s proportional regression analyses were used to identify prognostic factors.ResultsImmunotherapy significantly changed the levels of SII, NLR, PLR, LCR and LMR in NPC patients. Patients with lower SII, NLR, and PLR, as well as those with higher LCR and LMR, before immunotherapy had superior PFS (all p < 0.05). Moreover, PFS in the decreased SII, reduced NLR and increased LMR group was significantly longer than in the opposite group (all p < 0.05). Both univariate and multivariate analyses validated that baseline SII and LMR, and the immunotherapy-related SII reduction and LMR elevation were independent prognostic factors for PFS in advanced NPC patients receiving ICIs.ConclusionsImmune checkpoint inhibitor treatments significantly changed the levels of SII, NLR, PLR, LCR and LMR in NPC patients treated with immunotherapy. A lower baseline SII and a higher baseline LMR, and a reduction in SII and an elevation in LMR after immunotherapy are favorable factors for predicting survival among advanced NPC patients.

A Predictive Model of New-Onset Atrial Fibrillation After Percutaneous Coronary Intervention in Acute Myocardial Infarction Based on the Lymphocyte to C-Reactive Protein Ratio.

Lymphocyte to C-reactive protein ratio (LCR) is a recognized systemic inflammatory marker and novel prognostic indicator for several cancers. This study investigated the relationship between preoperative LCR and new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Patients with AMI (n=662) with no history of atrial fibrillation (AF) were enrolled and classified into NOAF and non-NOAF groups based on the occurrence of postoperative NOAF during hospitalization. Logistic regression models were used to analyze NOAF risk factors and to assess the association between preoperative LCR and NOAF incidence. We constructed a new nomogram from the selected NOAF risk factors, and tested its predictive performance, degree of calibration, and clinical utility using receiver operating characteristic and calibration curves, decision curve analysis, and clinical impact curves. Overall, 84 (12.7%) patients developed NOAF during hospitalization. The LCR was significantly lower in the NOAF group. Preoperative LCR accurately predicted NOAF after AMI and was correlated with increased NOAF risk. Age, body mass index, diabetes, serum albumin levels, uric acid levels, left atrium (LA) diameter, left ventricular ejection fraction, left circumflex artery stenosis > 50%, and Killip class II status were independent predictors of NOAF after AMI. In addition, a new nomogram combined with LCR was constructed to stratify the risk of NOAF in patients with AMI. The performance of the new nomogram was satisfactory, as shown by the receiver operating characteristic curve, calibration curve, decision curve analysis and clinical impact curve. Preoperative LCR was an independent predictor of NOAF in patients with AMI after PCI. The novel nomogram combined with LCR could rapidly and individually identify and treat patients at a high risk of NOAF.

COVID-19 Seyrinde NLR, LMR, PLR, d-NLR, LeCR, LCR, NMR Biyoparametrelerinin Etkinliğinin Değerlendirilmesi

Background/Objective: Severe inflammatory response of the immune system has a serious role in the progression of Coronavirus disease 2019 (COVID-19). The clinical benefits of early diagnosis of immune activation of COVID-19 have been emphasized repeatedly in the trials to this date. In this study, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), derived neutrophil-to-lymphocyte ratio (d-NLR), lymphocyte-to-C reactive protein ratio (LCR), leukocyte-to-C reactive protein ratio (LeCR), neutrophil-to-monocyte ratio (NMR) biomarkers were evaluated for predicting clinical course of COVID-19. &#x0D; Methods: In this retrospective cohort study, 383 laboratory-confirmed COVID-19 cases, who had been hospitalized in a tertiary care hospital between April and November 2020, were included. Patients, including 279 mild and 104 severe cases, were sequentially selected. Blood tests, conducted at the time of admission, were examined. Data was analyzed and ROC analysis was performed by using SPSS 22.0 program. &#x0D; Results: 44.3% of the patients included in the study were female, 99.2% of the patients had viral pneumonia, 27.2% met clinical criteria for severe disease and median age was 58 years. Age, duration of hospitalization, white blood cell count, neutrophil count, ferritin, CRP, procalcitonin, D-dimer, troponin levels were higher and lymphocyte, monocyte counts were lower in the group with clinically severe disease. The diagnostic sensitivities of LCR, CRP, d-NLR, NLR, LeCR were found to be high (AUC&gt; 0.8) for the prediction of clinical severity with cut-off values of 15, 74.65, 2.55, 4, 133 respectively. &#x0D; Conclusion: High CRP, d-NLR, NLR and low LCR, LeCR are early predictors of the clinical severity, these patients should be under hospital follow-up for close monitoring and early intervention.

The Relation Between Serum-based Systemic Inflammatory Biomarkers and Locoregional Lymph Node Metastasis in Clinical Stages I to II Right-sided Colon Cancers: The Role of Platelet-to-Lymphocyte Ratio.

It aimed to evaluate the relationship between the systemic inflammatory markers and the lymph node metastasis in clinical stages I to II right-sided colon cancers. A total of 51 eligible clinical stages I to II right-side located colon cancer patients were included in the study. Complete mesocolic excision and central vascular ligation procedures were performed in all cases. All the patients were divided into 2 main groups, pN - (n = 22) and pN + (n = 29). Demographic parameters, preoperative serum-based inflammatory biomarkers, and histopathological findings were compared between the groups. The mean age was 61.0 (54 to 71) years. Of the patients, 51.0% (26/51) were females. The open surgical approach was performed on 54.9% (28/51) of the patients and 45.1% (23/51) was performed laparoscopy. The mean total number of retrieved lymph nodes was 29.1. The lympho-vascular invasion was significantly higher in the pN + group (89.7% vs 50.0%). There were no significant differences in neutrophil-to-lymphocyte ratio, C-reactive protein-to-albumin ratio, mean platelet volume-to-platelet ratio, hemoglobine-albuminelymphocyte-platelet score, systemic inflammation index, lymphocyte-to-monocyte ratio, neutrophil-to-monocyte ratio, lymphocyte-to-C-reactive protein ratio (LCR), neutrophil-to-albumin ratio, and prognostic nutritional index. However, the mean platelet-to-lymphocyte ratio (PLR) was significantly lower in the pN + group (pN - : 282.1 vs pN + : 218.7, P = 0.048). The cutoff value for PLR was determined as 220 according to receiver operating characteristic analysis, with a 63.6% sensitivity and 65.6% specificity. Although it has limited sensitivity and specificity, decreased preoperative PLR was significantly associated with lymph node metastasis in patients with clinical stages I to II right-sided colon cancer. It should be considered as a biomarker for nodal involvement when planning treatment strategies.

The Role Played by Novel Inflammatory Markers in Assessment of Peripheral Artery Disease.

Background and Objectives: Atherosclerosis is a multifactorial process in which inflammatory markers have both therapeutic and prognostic roles. Recent studies bring into question the importance of assessing new inflammatory markers in relation to the severity of peripheral artery disease (PAD), such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-C-reactive protein ratio (LCR). Materials and Methods: We conducted a retrospective and descriptive study including 652 patients with PAD, who were divided into two groups according to the severity of the ankle-brachial index value: mild and moderate obstruction (257 patients) and severe obstruction (395 patients). We evaluated demographics, anthropometric data and clinical and paraclinical parameters in relation to the novel inflammatory biomarkers mentioned above. Results: Weight (p = 0.048), smoking (p = 0.033), the number of cardiovascular risk factors (p = 0.041), NLR (p = 0.037), LCR (p = 0.041) and PLR (p = 0.019), the presence of gangrene (p = 0.001) and the number of lesions detected via peripheral angiography (p < 0.001) were statistically significant parameters in our study. For the group of patients with severe obstruction, all three inflammatory biomarkers were statistically significantly correlated with a serum low-density lipoprotein-cholesterol level, the number of cardiovascular risk factors, rest pain, gangrene and a risk of amputation. In addition, directly proportional relationships were found between NLR, PLR and the number of stenotic lesions (p = 0.018, p = 0.016). Also, NLR (area under the curve <AUC> = 0.682, p = 0.010) and PLR (AUC = 0.692, p = 0.006) were predictors associated with a high risk of amputation in patients with an ABI < 0.5. Conclusions: in our study, we demonstrated the importance of assessing inflammatory markers in relation to the presence of cardiovascular risk factors through the therapeutic and prognostic value demonstrated in PAD.

An Investigation of the Relationship Between the Severity Scoring Index and Laboratory Parameters in Pediatric Patients with Crimean-Congo Hemorrhagic Fever: A 12-Year Retrospective Evaluation.

Background: There are limited studies on the severity of Crimean-Congo hemorrhagic fever (CCHF) in children. The study aimed to investigate the correlation between the severity scoring index (SSI) score and other laboratory parameters in children. Materials and Methods: Patients younger than 18 years of age who were diagnosed with CCHF in 2011-2022 were included in the study. The SSI score and laboratory parameters at the time of admission were taken into consideration. Results: At 12-year follow-up, 81 pediatric patients were diagnosed with CCHF. According to the SSI calculated at the time of admission, 59 (72.8%) patients were in the mild group and 22 (27.2%) patients were in the moderate group. According to Spearman's correlation analysis results, a positive correlation was found between the SSI score and c-reactive protein (CRP) (r = 0.737, p < 0.001), lactate dehydrogenase (r = 0.312, p = 0.010), alanine transaminase to lymphocyte ratio (r = 0.428, p < 0.001), neutrophil to lymphocyte ratio (r = 0.406, p < 0.001), and derived-neutrophil lymphocyte ratio (r = 0.389, p < 0.001). In addition, lymphocyte to c-reactive protein ratio (LCR) (r = -0.782, p < 0.001), lymphocyte count (r = -0.422, p < 0.001), and white blood cell (r = -0.250, p = 0.026) values were negatively correlated with the SSI. Conclusions: A strong correlation (r > 0.7) was found between LCR (r = -0.782) and CRP (r = 0.737) and the SSI.

Machine-Learning Algorithms Using Systemic Inflammatory Markers to Predict the Oncologic Outcomes of Colorectal Cancer After Surgery.

This study aimed to investigate the clinical significance of machine-learning (ML) algorithms based on serum inflammatory markers to predict survival outcomes for patients with colorectal cancer (CRC). The study included 941 patients with stages I to III CRC. Based on random forest algorithms using 15 compositions of inflammatory markers, four different prediction scores (DFS score-1, DFS score-2, DFS score-3, and DFS score-4) were developed for the Yonsei cohort (training set, n = 803) and tested in the Ulsan cohort (test set, n = 138). The Cox proportional hazards model was used to determine correlation between prediction scores and disease-free survival (DFS). Harrell's concordance index (C-index) was used to compare the predictive ability of prediction scores for each composition. The multivariable analysis showed the DFS score-4 to be an independent prognostic factor after adjustment for clinicopathologic factors in both the training and test sets (hazard ratio [HR], 8.98; 95% confidence interval [CI] 6.7-12.04; P < 0.001 for the training set and HR, 2.55; 95% CI 1.1-5.89; P = 0.028 for the test set]. With regard to DFS, the highest C-index among single compositions was observed in the lymphocyte-to-C-reactive protein ratio (LCR) (0.659; 95% CI 0.656-0.662), and the C-index of DFS score-4 (0.727; 95% CI 0.724-0.729) was significantly higher than that of LCR in the test set. The C-index of DFS score-3 (0.725; 95% CI 0.723-0.728) was similar to that of DFS score-4, but higher than that of DFS score-2 (0.680; 95% CI 0.676-0.683). The ML-based approaches showed prognostic utility in predicting DFS. They could enhance clinical use of inflammatory markers in patients with CRC.

Comprehensive comparative analysis of the prognostic impact of systemic inflammation biomarkers for patients underwent cardiac surgery.

Inflammation plays an integral role in the development of cardiovascular disease, and few studies have identified different biomarkers to predict the prognosis of cardiac surgery. But there is a lack of reliable and valid evidence to determine the optimal systemic inflammatory biomarkers to predict prognosis. From December 2015 and March 2021, we collected 10 systemic inflammation biomarkers among 820 patients who underwent cardiac surgery. Time-dependent receiver operating characteristic curves (ROC) curve at different time points and C-index was compared at different time points. Kaplan-Meier method was performed to analyze overall survival (OS). Cox proportional hazard regression analyses were used to assess independent risk factors for OS. A random internal validation was conducted to confirm the effectiveness of the biomarkers. The area under the ROC of lymphocyte-to-C-reactive protein ratio (LCR) was 0.655, 0.620 and 0.613 at 1-, 2- and 3-year respectively, and C-index of LCR for OS after cardiac surgery was 0.611, suggesting that LCR may serve as a favorable indicator for predicting the prognosis of cardiac surgery. Patients with low LCR had a higher risk of postoperative complications. Besides, Cox proportional hazard regression analyses indicated that LCR was considered as an independent risk factor of OS after cardiac surgery. LCR shows promise as a noteworthy representative among the systemic inflammation biomarkers in predicting the prognosis of cardiac surgery. Screening for low LCR levels may help surgeons identify high-risk patients and guide perioperative management strategies.

Sex-specific differences in the effect of lymphocyte-to-C-reactive protein ratio on subclinical myocardial injury in the general population free from cardiovascular disease

Background and aimThe Lymphocyte-to-C-reactive protein ratio (LCR) combines information on immune and inflammatory status. Lymphocytes reflect immune health, while C-reactive protein (CRP) signals systemic inflammation. Some studies have linked LCR with cardiovascular outcomes, suggesting it could help identify at-risk individuals. However, its clinical utility needs further research validation. To investigate the association between lymphocyte-to-C-reactive protein ratio (LCR) and subclinical myocardial injury (SC-MI) in individuals who are free from cardiovascular disease (CVD) within the general population. Methods and resultsThe study included individuals in the National Health and Nutrition Examination Survey (NHANES) III. SC-MI was defined as having a Cardiac Infarction Injury Score (CIIS) greater than 10 units on a 12-lead electrocardiogram. Logistic regression models were employed to investigate the association between LCR and SC-MI. In total, 5870 individuals were included in the study, among whom 3266 had a history of SC-MI. Compared with the lowest quartile (Q1) in male, the odds ratios (OR) of SC-MI in Q2, Q3, and Q4 were 0.67 (95%CI: 0.53–0.86), 0.66 (95%CI: 0.51–0.84), and 0.70 (95%CI: 0.55–0.89), respectively. The data shows a trend where the OR of SC-MI are lower in higher quartiles of LCR, compared to the lowest quartile, in the male population (P for trend = 0.006). In other words, the likelihood of SC-MI tends to be lower among males with higher LCR values. However, after adjusting for potential confounding variables, the relationship between LCR and SC-MI displays a pattern of an initial decline, followed by a minor upward shift. ConclusionLCR is independently and inversely associated with SC-MI risk in the general population free from CVD. Furthermore, the observed association is exclusive to males, indicating a need for further randomized controlled trials to substantiate the efficacy of implementing LCR reduction as a means of CVD prevention in the male population.

Lymphocyte to C-Reactive Protein Ratio as an Early Biomarker to Distinguish Sepsis from Pneumonia in Neonates.

Neonatal sepsis is an acute and severe disease that seriously threatens the life and health of newborns. Neonates with pneumonia may also have unrecognized neonatal sepsis. Early diagnosis of neonatal sepsis is beneficial for early treatment. This study aimed to evaluate the clinical significance of the lymphocyte-to-C-reactive protein ratio (LCR) as an early biomarker to distinguish sepsis from pneumonia. This retrospective study enrolled 1635 neonates with pneumonia from February 2016 to March 2022. Among them, 182 cases were diagnosed with sepsis based on the positive blood culture results. Clinical and laboratory data were extracted from the electronic medical records. LCR was calculated as the ratio of the total lymphocyte count (×109 cells/L) to the C-reactive protein level (mg/L). Binary logistic regression analysis was conducted to evaluate the clinical significance of LCR as an early biomarker in distinguishing sepsis from pneumonia. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic value of LPCR in sepsis cases. All statistical analyses were conducted using Statistical Product and Service Solutions, version 24.0. The neonates with pneumonia combined with sepsis had a lower LCR than that of the neonates with pneumonia. Further analysis showed that the prevalence of neonatal pneumonia combined with sepsis was significantly higher in the low-LCR group than in the high-LCR group (20.7% vs 5.5%, P < 001). Binary logistic regression revealed that LCR was an independent risk factor for identifying pneumonia combined with sepsis. The ROC curve analysis revealed that LCR had better power than the lymphocyte count and CRP level individually in diagnosing neonatal pneumonia combined with sepsis (0.72 vs 0.65 vs 0.66, P < 0.001), with 62% sensitivity and 72% specificity. LCR can be a potential early biomarker in distinguishing neonates with sepsis from those with pneumonia.

Pretreatment Lymphocyte to C-Reactive Protein Ratio: An Independent Predictor of Overall Survival in Metastatic Hormone-Naïve Prostate Cancer Patients

IntroductionThe purpose of this study was to investigate the clinical value of combination of systematic inflammatory factors in predicting the outcomes of primary androgen deprivation therapy (ADT) plus first-generation antiandrogen treatment in metastatic hormone-naïve prostate cancer (mHNPC) patients. Materials and MethodsA total of 361 consecutive mHNPC patients from the discovery (n = 165) and validation (n = 196) cohorts were analyzed. All patients received primary ADT with surgical castration or pharmacologic castration accompanied by first-generation antiandrogens. We evaluated the prognostic impact of pretreatment lymphocyte to C-reactive protein ratio (LCR) on overall survival (OS) in both cohorts. ResultsThe median follow-up in the discovery and validation cohorts was 43.4 and 50.9 months, respectively. In the discovery cohort, low LCR (using an optimal cutoff threshold of 14,025) was significantly correlated with poor OS compared with high LCR (P < .001). Multivariate analysis revealed that the biopsy Gleason score and LCR were independent prognostic factors for OS. In the validation cohort, low LCR was also significantly correlated with poor OS compared with high LCR (P = .001). A multivariate analysis revealed that the extent of disease on bone scan grade, lactate dehydrogenase, and LCR were all independent predictors of OS. ConclusionsPretreatment low LCR is an independent predictor of poor OS in mHNPC patients. This may be informative in predicting the susceptible patients’ developing worse outcomes after being treated with primary ADT plus first-generation antiandrogen.

New biomarkers in peripheral artery disease cardiovascular rehabilitation - keep it simple

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) plays an essential role in the management of patients with peripheral artery disease (PAD) [1]. Patients enrolment in an integrative and multidisciplinary program, can improve the functional status, quality of life, and long-term morbidity and mortality [2]. We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. Based on a long-term mortality prognostic index in PAD [3], we enrolled two groups of patients: low and low-intermediate risk (group 1, n=45) versus high-intermediate and high risk (group 2, n=52). We analyzed demographics, clinical, and paraclinical parameters, focusing on novel inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), white blood cells-to-MPV ratio (WMR) and lymphocyte-to-C-reactive protein ratio (LCR). The 6 months follow-up showed that a minimum 50% decrease compared to initial levels was associated with both short and long-term clinical and functional improvement. A decrease in NLR (p &amp;lt; 0.001), PLR (p = 0.028), WMR (p = 0.009) and LCR (p = 0.036) levels correlated positively with improved metabolic profile - low-density lipoprotein cholesterol (p= 0.015), triglycerides (p= 0.041) , fasting glucose (p=0.011) -, as well as improved exercise capacity - assessed through peak oxygen uptake (p = 0.008), pain-free walking distance (p = 0.024) and maximum walking distance (p = 0.032) at 6 months follow-up for group 1. Assessment of these inflammatory biomarkers had a statistically significant prognostic role in our study, being an accessible tool for clinical cardiologists in evaluating CR programs effectiveness in patients with PAD.

Lymphocyte-to-C-Reactive Protein Ratio as an Early Sepsis Biomarker for Neonates with Suspected Sepsis.

Neonatal sepsis is an extremely dangerous and fatal disease among neonates, and its timely diagnosis is critical to treatment. This research is aimed at evaluating the clinical significance of the lymphocyte-to-C-reactive protein ratio (LCR) as an early sepsis indicator in neonates with suspected sepsis. Between January 2016 and December 2021, 1269 neonates suspected of developing sepsis were included in this research. Among them, sepsis was diagnosed in 819 neonates, with 448 severe cases, as per the International Pediatric Sepsis Consensus. Data related to clinical and laboratory tests were obtained via electronic medical records. LCR was calculated as total lymphocyte (109 cells/L)/C-reactive protein (mg/L). Multivariate logistic regression analysis was employed to evaluate the effectiveness of LCR as an independent indicator for determining sepsis in susceptible sepsis neonates. Receiver operating characteristic (ROC) curve analysis was conducted for investigating the diagnostic significance of LCR in sepsis. When suitable, the statistical tool SPSS 24.0 was used for statistical analyses. LCR decreased significantly in the control, mild, and severe sepsis groups. Further analyses exhibited that there was a substantially greater incidence of sepsis in neonates in the low-LCR group (LCR ≤ 3.94) as opposed to the higher LCR group (LCR > 3.94) (77.6% vs. 51.4%, p < 0.001). Correlation analysis indicated a substantial negative association of LCR with procalcitonin (r = -0.519, p < 0.001) and hospital stay duration (r = -0.258, p < 0.001). Multiple logistic regression analysis depicted LCR as an independent indicator for identifying sepsis and severe cases of this disease. ROC curve analysis indicated the optimal cutoff value of LCR in identifying sepsis to be 2.10, with 88% sensitivity and 55% specificity. LCR has proven to be a potentially strong biomarker capable of identifying sepsis in a timely manner in neonates suspected to have the disease.