Mean Neutrophil-lymphocyte Ratio Research Articles

How to predict postoperative delirium in geriatric patients with hip fracture as soon as possible? A retrospective study

PurposeInflammation may play a role in the mechanism of postoperative delirium (POD), a severe complication among older postoperative patients. The purpose of this study was to investigate the risk factors of POD in postoperative patients with hip fracture, especially the inflammation marker– neutrophil–lymphocyte ratio (NLR).MethodsThis retrospective investigation utilized data from the Seventh Medical Center of People’s Liberation Army. 1,242 Eligible patients with hip fracture (829 females), median age 81 years, mean neutrophil-lymphocyte ratio (NLR) 5.28, were enrolled. Receiver operating characteristic (ROC) curve was performed to identify the optimal cut point of NLR for POD. The relationship between NLR and POD occurrence, NLR and POD duration were analyzed by multivariable analysis.ResultsROC curve showed that the optimal cut point of NLR for POD was NLR ≥ 7.6. Multivariate logistic regression analysis showed that NLR ≥ 7.6 (odds ratio [OR] 2.75, [95% confidence interval [CI] 1.51 to 5.02], p = 0.001), stroke (OR 1.05, [95% CI 1.02 to 1.09], p = 0.005), complications, general anesthesia, long length of stay were risk factors of POD, with the largest effect for NLR ≥ 7.6. NLR ≥ 7.6 (β 0.59, [95% CI 0.209 to 0.886], p = 0.038), older age (β 0.054, [95% CI 0.009 to 0.099], p = 0.019), previous stroke (β 0.908, [95% CI 0.085 to 1.731], p = 0.031), and previous heart failure (β 1.679, [95% CI 0.448 to 2.910], p = 0.008) suggested long POD duration.ConclusionsThis study demonstrates an association between NLR and postoperative delirium in geriatric hip fracture patients, and contribute new evidence to support NLR as a potential marker for prediction of POD and POD duration.

Predictive values and relationships of serum PSA levels, delta neutrophil index, neutrophil-lymphocyte ratio and other hematological parameters in patients with acute prostatitis.

This study aimed to evaluate the predictive values and relationships of serum prostate-specific antigen (PSA) levels, delta neutrophil index (DNI), neutrophil-lymphocyte ratio (NLR), and other hematological parameters in patients diagnosed with acute prostatitis. Serum PSA levels and hemogram parameters of patients diagnosed with acute prostatitis were retrospectively analyzed. Healthy patients of the same age group were assigned to the control group. WBC, neutrophil, lymphocyte, thrombocyte (PLT), mean platelet volume (MPV), plateletcrit (PCT), NLR, and DNI were determined. Serum total PSA and C-reactive protein (CRP) levels were also assessed. Total PSA levels (3.48 [1.11-6.66]) in the acute prostatitis (AP) group were significantly higher than those of healthy men (0.82 [0.47-1.39]) (p < 0.001). Total CRP levels (3.88 [1.50-22.03]) in the AP group were significantly higher than those in healthy men (1.15 [0.89-2.00]) (p < 0.001). The sensitivity and specificity of PSA at a cutoff value of 1.52 were 68.4% and 79.7%, respectively. The NLR value in the AP group was 2.62 (1.87-4.42), compared to 1.63 (1.18-2.20) in the healthy group (p < 0.001). Differences in WBC, neutrophil, and lymphocyte counts were also statistically significant (p < 0.001). There were no significant differences in PLT, PCT, or DNI values. Significant positive correlations were observed between PSA, CRP, and DNI values (all p < 0.001). This study demonstrated the usefulness of NLR, PSA, CRP, and WBC as predictors of acute prostatitis. NLR is a simple, inexpensive inflammation parameter that correlates well with CRP levels.

Correlations Between the Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Serum Lipid Fractions With Neovascular Age-Related Macular Degeneration.

Introduction Age-related macular degeneration, a chronic and progressive disease, is one of the leading causes of vision loss globally among the elderly population. Multiple hypotheses have been proposed regarding its pathogenesis, including the presence of lipid metabolism alteration. Dysfunctional lipid handling within retinal pigment epithelial cells has been implicated in the accumulation of lipofuscin and subsequent induction of oxidative stress and inflammation, all contributing to retinal degeneration. The present study aims to comparatively analyze the serum lipid fractiondistributions in patients with neovascular age-related macular degeneration (AMD) and controls. Materials and methods A retrospective study was carried out between January 2021 and December 2023 on 91 naïve patients with neovascular AMD and 90 controlsadmitted for routine cataract surgery. All subjects underwent a comprehensive ophthalmological exam, including ophthalmoscopy and optical coherence tomography (OCT) with central macular thickness (CMT) measurement. A complete blood count with differential and lipid fractions values was analyzed. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were comparatively analyzed between the control group and the test group. Results The groups were comparable in terms of age (73.84 ±7.52 years for the neovascular AMD group vs 72.1±10.92 years in controls; p=0.8) and gender distribution (p=0.243). The mean NLR and PLR values were slightly higher in the AMD groupbut not statistically significant (p=0.51, p>0.99, respectively). Comparative analysis of lipid profile fractions showed significantly higher HDL-C values in the exudative AMD group compared to normal subjects (61.27±19.4 mg/dL vs 50.99±7.86 mg/dL, p=0.006). Also, the proportion of subjects with HDL-C>60 mg/dL was higher in the exudative AMD group (p=0.014). There were no significant differences in total cholesterol (189.77±53.39 mg/dL vs 190.43±37.84 mg/dL, p=0.681), LDL-C, and TG. Logistic regression analysis showed that serum HDL-C and HDL-C values >60 mg/dL are significantly associated factors with neovascular AMD. However, there is no statistical correlation between the values of these biochemical parameters and visual acuity or CMT in the neovascular AMD patient group. Conclusions There were no correlations between NLR and PLR with neovascular AMD in the study group. Higher HDL-C valuesexceeding 60 mg/dL were associated with neovascular age-related macular degeneration and could represent a possible therapeutic target in neovascular AMD.

Systemic Inflammatory Markers and Clinical Outcomes of Open versus Biportal Endoscopic Transforaminal Lumbar Interbody Fusion.

The purpose of this study is to preliminarily assess the change in perioperative systemic inflammatory markers and clinical outcomes between open TLIF and BE-TLIF procedures. In total, 38 patients who underwent single-level lumbar fusion surgery (L4-5 or L5-S1) were retrospectively reviewed. 19 patients were treated by the BE-TLIF technique, while the other patients were managed using open TLIF. The perioperative serum C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), and platelet/lymphocyte ratio (PLR) of the two groups were compared to determine if there was a statistical difference. Meanwhile, clinical evaluations were conducted to assess various factors including operative duration, estimated blood loss (EBL), drainage catheter stay, length of hospitalization, visual analogue scale (VAS), and Oswestry disability index (ODI) scores. The perioperative analysis revealed that BE-TLIF cases experienced a longer operative duration than open TLIF cases (open TLIF: 138.63 ± 31.59 min, BE-TLIF: 204.58 ± 49.37 min, p < 0.001). Meanwhile, the EBL showed an increased trend in the BE-TLIF group (260.7 ± 211.9 mL) in comparison with the open TLIF group (200.9 ± 211.9 mL) (p =0.485). In terms of systemic inflammatory markers, the mean postoperative CRP, NLR, LMR, and PLR were lower in the BE-TLIF group than in the open TLIF group, although these differences were not statistically significant (p > 0.05). The VAS and ODI scores in both groups were significantly improved after surgery (p < 0.05). There was no significant difference found between BE-TLIF and open TLIF in terms of systemic inflammatory markers, and clinical outcomes. Overall, BE-TLIF can be considered a viable choice for lumbar canal decompression and interbody fusion for less invasion. It is worth noting that BE-TLIF does have a longer operation time, indicating that there is still potential for further improvement in this technique.

Role of Neutrophil-Lymphocyte Ratio in Predicting Severity of COVID-19

Background: Higher neutrophil-lymphocyte ratio (NLR) is considered as cardinal findings with prognostic potentials in identification of severe COVID-19 cases. However, whether baseline NLR could be a predictor of disease severity and outcome remained to be investigated. Hence, this study was conducted with an aim to evaluate the relation of NLR (on admission) with disease severity. Objective: The objective of the study was to estimate the neutrophil-lymphocyte ratio among COVID-19 patients and its role in predicting disease severity. Method: This cross-sectional study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2020 to June 2021. Ninety-four COVID-19 admitted patients were enrolled following inclusion &amp; exclusion criteria. Informed consent was taken from the subjects. Ethical clearance was obtained from institutional review board (IRB) of BSMMU. Complete blood count for N-L ratio was done by standard procedure on admission by SYSMEX XN-2000 haematology analyser. Clinical and laboratory information were recorded with a semi-structured questionnaire. After collection of all the required data, analysis was done by SPSS 24.0. Results: Mean age of the patients was 56.59±12.25 years, wherein maximum patients were male (67%), non-smoker (80.9%), and retired/current service holder (51.1%). Maximum patients were hypertensive (61.7%) and diabetic (56.4%). Besides, maximum study patients (64.9%) were in severe category of COVID-19, followed by moderate (20.2%) and mild (14.9%) category according to National Guidelines on Clinical Management of COVID-19 criteria. Mean NLR was 5.40±4.35 (SD), wherein on admission NLR was significantly higher among severe COVID-19 patients compared to mild/moderate category (6.90±4.64 vs 2.61±1.53, p &lt;0.05). 28-days hospital mortality was found to be significantly associated with NLR (p&lt;0.05). Receiver operator curve analysis found highly significant cut-off value for NLR (3.42) with 75.4% sensitivity and 75.8% specificity in predicting severe COVID-19 patients (AUC= 0.841, p value &lt;0.001). Multivariate logistic regression analysis found NLR as an independent predictor for severe COVID-19 (OR=4.68, 95% CI: 1.29-16.81, P=0.019). Pearson correlation analysis showed that NLR had significant positive correlation with CRP and D-dimer as p value &lt;0.05. Conclusion: NLR can predict the disease severity and outcome of hospitalized COVID-19 patients. However, further larger study is recommended.

The role of neutrophil to lymphocyte ratio with wound healing in open tibial fracture grade IIIA

Introduction: Open fractures of the tibia are challenging injuries to treat. The neutrophil-lymphocyte ratio (NLR) has been used to predict poor prognosis in various orthopedic conditions. This study aims to analyze the role of NLR in the wound healing of patients with open fractures. Methods: This is a retrospective study with data taken from all patients with grade IIIA open tibial fractures admitted to the hospital for treatment between January 2018 and June 2023. The initial NLR value and wound healing state were recapped after 6 weeks of follow-up. A statistical analysis between NLR values and wound healing state was done to measure the significance between variables. Results: There were 49 participants included in this study. Our current study found a significant difference between the mean NLR value of the healed and nonhealed wound (12.59±11.2 vs 10.46±7.9, P =0.015). The mean NLR in the healed group was significantly higher than in the nonhealed group. Calculating NLR involves dividing the absolute count of neutrophils by the total count of lymphocytes, which can be obtained through a complete blood count test. This ratio offers valuable insights into the balance between inflammatory and anti-inflammatory responses in the body. Conclusion: The NLR was significantly higher in the healed group than in the nonhealed group. Further research with higher-quality studies might be needed to prove its prognostic factor.

Esophageal cancer: a twenty-four-year experience at a tertiary care center with an evaluation of the prognostic significance of the neutrophil-lymphocyte ratio

BackgroundA high neutrophil-lymphocyte ratio (NLR) may be associated with worse survival in esophageal cancer (EC). Our aims were to describe the demographic and clinical data of EC in a tertiary referral center in Lebanon and to determine the prognostic value of NLR.MethodsA retrospective cohort study based on chart review of patients diagnosed with EC was conducted at the American University of Beirut Medical Center (AUBMC). The demographic characteristics, clinical presentation and outcomes were described and compared between squamous cell carcinomas (ESCC) and adenocarcinomas (EAC). Data about esophageal cancer incidence were obtained from the National Cancer Registry, the Ministry of Public Health and GLOBOCAN 2020. Cox regression analysis was performed to determine whether the NLR is an independent predictor of survival, using variables based on clinical knowledge and previously established data.Results110 patients were diagnosed with EC, which was the least common among other gastrointestinal malignancies. Our follow up rates reached 86.4%. The median survival was 9 months (IQR 3–25.5.) and was comparable between ESCC (median of 7 months, IQR 2–25) and EAC (median of 9 months, IQR 3–26.3), p = 0.803. Advanced stage was associated with a worse prognosis (p = 0.037). The mean NLR(±SD) was 5.20 ± 6.8, with no significant difference between EAC and ESCC (4.5 ± 3.4 vs. 5.9 ± 9.2, p = 0.420) or between early or advanced stages (5.4 ± 8.1 vs. 4.7 ± 6.8, p = 0.732). The area under the curve for the NLR was 0.560 (95% CI: 0.374–0.746, p = 0.488). After adjusting for age, gender, TNM staging and grading, cox regression analysis showed that an increased NLR was a significant predictor of mortality, with an adjusted hazard ratio of 1.095 (p = 0.011).ConclusionEC is quite uncommon in Lebanon despite a high prevalence of smoking and obesity. Advanced stage and high NLR were associated with a negative prognostic value.

Testis torsiyonu ve epididimo-orşit ayırıcı tanısında hematolojik parametrelerin öngörü değeri

OBJECTIVE: Testicular torsion (TT) is a urologic emergency that may result in organ loss. The most common differential diagnosis is epididymo-orchitis (EO). The aim of this study was to evaluate the usefulness of hematologic parameters and inflammatory markers in the differential diagnosis of TT and EO. MATERIAL and METHODS: Data obtained from complete blood counts of patients admitted to the emergency department with acute scrotum and diagnosed with TT and EO between January 2015–2024 were retrospectively evaluated. Demographic characteristics of the patients and the parameters in the complete blood counts at the time of presentation were recorded. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and monocyte/eosinophil ratio (MER) were calculated. The groups were compared in terms of age, hematologic parameters, NLR, PLR and MER. Receiver operating characteristic and areas under the curve of the parameters found significant were determined. Univariate and multiple logistic regression analysis were used to determine the risk factors for differential diagnosis. RESULTS: A total of 149 patients were included in the study. The TT group consisted of 79 patients and the EO group consisted of 70 patients. The median age of all patients was 23 years, the median age in the TT group was 20 years, and the median age in the EO group was 23 years. There was a statistically significant difference between the two groups in terms of age, lymphocyte count, monocyte count, eosinophil count, mean platelet volume (MPV), NLR and PLR (p&lt;0.05). In multiple logistic regression analysis, only MPV value ≤9.35 was found to be an important predictive factor for the differential diagnosis of TT and EO. CONCLUSION: MPV seems to be a useful parameter in the differential diagnosis of TT and EO. In this regard, prospective, multicenter studies as well as meta-analyses with larger sample sizes should be included in guideline recommendations with their contribution to the literature. Keywords: testicular torsion, epididymo-orchitis, acute scrotum, mean platelet volume, hematological inflammatory markers

Understanding the Etiopathogenesis of Non-Arteritic Anterior Ischemic Optic Neuropathy with Laboratory Findings.

The role of inflammation and hemostasis in non-arteritic anterior ischemic optic neuropathy (NAION) was investigated by examining related blood tests. The predictive values of these laboratory indicators and their effects on prognosis were reviewed. In this study, 48 patients diagnosed with NAION and 50 healthy volunteers were included. All subjects underwent full ophthalmological examination. All patients were treated with oral corticosteroids (methylprednisolone 1 mg/kg/day) for 15 days after that corticosteroid medication was reduced and stopped. Each patient was monitored at least for 12 months. The mean platelet volume (MPV), platelet distribution width (PDW), neutrophil/lymphocyte ratio (NLR), and red cell distribution width (RDW) values were recorded. These findings were compared with control group. The mean MPV, RDW, and NLR values were significantly higher in NAION group (respectively, p<0.001, p=0.006, and p<0.001). There was no statistically significant difference between group 1 and group 2 in PDW values, but the mean PDW value was higher in the patient group compared to the control group (p=0.435). Based on the receiver operating characteristic (ROC) curve, the NLR had the strongest predictive value. This was followed by MPV, RDW, and PDW with lower diagnostic predictive values. MPV, NLR, and RDW were found to be elevated and have diagnostic predictive values in NAION patients. Easily accessible and simple laboratory methods could help us show systemic inflammation and ischemic events in NAION patients. As a result, inflammatory reactions besides ischemic changes may play a role in the etiopathogenesis of NAION. These biomarkers can be evaluated to ensure that patients with risk factors for the development of NAION.

Effect of inflammatory response before mechanical thrombectomy on prognosis in stroke patients.

<p>Mechanical thrombectomy is the most important treatment modality in acute stroke; despite successful thrombectomy, good functional outcome is not achieved in a significant proportion of patients. This study examined the effect of neutrophil lymphocyte ratio (NLR) values at admission on functional outcomes in successfully recanalized patients.</p>. <p>Patients who underwent mechanical thrombectomy due to anterior system major vessel occlusion were retrospectively analyzed and compared with the admission NLR values and 3-month clinical modified Rankin Scale (mRS) scores of successfully recanalized patients.</p>. <p>Of a total of 126 patients who underwent thrombectomy within the specified period, 97 patients with successful recanalization were included in the study. The overall successful recanalization rate was calculated as 77%. The mean NLR of patients with mRS &le;2 (n=65) was found to be significantly lower than patients with mRS&ge;3 (n=32) (p&lt;0.001). A weak and significant correlation was found between National Institutes of Health Stroke Scale (NIHSS) value and NLR (r= 0.315, p=.002).</p>. <p>NLR value has been found to be associated with futile recanalization in me&shy;chanical thrombectomy patients. There&shy;fore, we think that suppression of inflammation before thrombectomy will increase the chan&shy;ce of successful thrombectomy.</p>.

Correlation of Neutrophil Lymphocyte ratio with HbA1c in patients of type 2 Diabetes Mellitus attending Medical Department of a Tertiary Care Centre

Background: Type 2 diabetes mellitus is associated with chronic low-grade inflammation. Neutrophil lymphocyte is an indicator of subclinical inflammation. One of the novel inflammatory markers is neutrophil to lymphocyte ratio. We find only less studies that are directly accessing the relation between NLR and HbA1c, in the present study we aim to correlate neutrophil lymphocyte ratio with glycemic control in patients having type 2 diabetes.&#x0D; Methods: Hospital based observational cross section study was carried out at department of medicine at Bharatpur Period August 2023 to December 2023. 176 patients with type 2 diabetes mellitus as per ADA criteria aged more than 18 years were included in the study. Microsoft excel and SPSS version 20.0 were used for collection and analysis of the data, p&lt;0.05 was considered as significant.&#x0D; Results: Out of 176 cases having mean age 55.78±9.111, Mean BMI of all participant was 28.37±4.061, mean absolute Neutrophil count was 7.36±7.123 10³/μl and Mean neutrophil lymphocyte ratio count was 4.03±1.545, in which 147 patients (83.5%) had NLR within normal limit, and remaining 29 patients (16.5%) had NLR within more than 3.53. In our study 123 patients (69.9%) had HbA1C more than 9.0. The association of NLR with HbA1c which was significant association (p=0.047) noted between two parameters indicating higher frequency of NLR had a positive correlation with HbA1c and was found to be an independent predictor of poor glycemic control in patients with type 2 diabetes mellitus.&#x0D; Conclusions: Our study concluded that the association of NLR with HbA1c which was significant association. The Association of HbA1c with absolute neutrophil count was which significant and association of HbA1c with absolute lymphocyte count was which significant. Type 2 DM patients with raised NLR should be evaluated for cardiovascular, renal and ocular complications of diabetes. NLR may be useful as an easily measurable, noninvasive, widely available and cost-effective parameter for the disease monitoring tool during follow up of diabetic patients.

Neutrophil lymphocyte ratio and platelet lymphocyte ratio as a marker for disease severity in children with COVID-19

Background: It had been observed that there is relationship of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) with disease severity in children with COVID-19 and post-COVID, multisystem inflammatory disease in children (MIS-C). Study conducted to determine NLR and PLR correlation with this disease severity. Methods: Prospective descriptive analytical study conducted at the children’s hospital and university of child health sciences, Lahore. Consecutive confirmed cases of COVID-19 infection and post-COVID, MIS-C diagnosed on the basis of RT-PCR from nasopharyngeal swab and antibody test admitted from March 2020 to October 2021 were included through consecutive sampling. Complete blood (CBC) was done and NLR and PLR was determined Results: Majority 198 (74.2%) of the 267 patients had a diagnosis of COVID-19 and 69 (25.8%) were post-COVID MIS-C. There was a male preponderance 177 (66.3%) and the mean age was 6.1±4.7 years (95% CI: 5.62-6.74). Majority children had mild disease 80 (30%), 34 (12.7%) were critical and there were 37 (13.8%) deaths. Underlying comorbidity was present in 55 (20.6%). As the severity of symptoms changed from asymptomatic to severe disease, there was a significant rise of mean NLR from 1.88±1.40 to 5.47±4.77 respectively (p&lt;0.001). PLR however, failed to show any kind of association with severity of the symptoms (p=0.922). Conclusions: NLR served as a marker of disease severity among pediatric patients suffering from COVID-19 and MIS-C. However, PLR failed to show any relation with disease severity.

Can the Inflammatory Cell Ratio NLR and PLR be Used as a Reliable Marker in Colon Cancer? A Prospective Study.

Simple approaches for detecting the tumor stage of colon cancer patients are required during the preoperative period. In recent years, the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been employed as predictive parameters for systemic inflammatory response and long-term prognosis in a variety of malignancies. The purpose of this study was to determine whether the NLR and PLR correspond with tumor characteristics in colon cancer patients. About 90 patients with colon cancer who reported to our institute during the time interval July 2021 to December 2022 were included in the study. The NLR and PLR were calculated using data obtained from a complete blood count evaluation. The relationship between inflammatory cell ratio and tumor-specific characteristics were analyzed. Neutrophil-lymphocyte ratio and PLR correlated with pTNM staging in 88 patients. Two patients exhibited diffuse peritoneal metastasis. A significant association was found between PLR and early (Tis + T1 + T2) and advanced (T3 + T4) groups. Although the difference was not statistically significant, patients with lymphovascular invasion (LVI) and perineural invasion (PNI) had greater mean NLR and PLR. Platelet-lymphocyte ratio was found to be more accurate than NLR in predicting colon cancer tumor depth/invasion. A high PLR value aids in prognosticating advanced T-stage colon cancer patients and can be used as a valuable tool for preoperative counseling, but it must be validated with a survival analysis. The tumor microenvironment contains a variety of inflammatory cells that contribute to the growth and spread of the neoplasm. The NLR and PLR have been shown to be clinically and prognostically important in a variety of gastrointestinal cancers. The results of this study demonstrate that PLR was more accurate than NLR in predicting colon cancer tumor depth/invasion. Also, a high PLR value aids in prognosticating advanced T-stage colon cancer patients and may be used as a valuable tool for preoperative counseling. Ramesh SK, Swain SK, Munikrishnan V, et al. Can the Inflammatory Cell Ratio NLR and PLR be Used as a Reliable Marker in Colon Cancer? A Prospective Study. Euroasian J Hepato-Gastroenterol 2023;13(2):61-65.

Interleukin-33, endothelin-1, and inflammatory parameters in chronic spontaneous urticaria

Background: Endothelin-1 (ET-1) and interleukin-33 (IL-33) can modulate the activation of mast cells and basophils in the pathophysiology of allergic diseases, interplaying with other mediators of “low-grade inflammation.” Objective: To compare ET-1, IL-33, the neutrophil-lymphocyte ratio (NLR), eosinophil-lymphocyte ratio (ELR), platelet-lymphocyte ratio (PLR), eosinophil-basophil ratio (EBR), systemic immune inflammation index (SII), and system inflammation response index (SIRI) in patients with chronic spontaneous urticaria (CSU) and are antihistamine sensitive (AHS), antihistamine resistant (AHR), omalizumab sensitive (OmS), and omalizumab resistant (OmR). Methods: A prospective observational study enrolled 68 consecutive patients with CSU diagnosed and managed according to the dermatology section of the European Academy of Allergology and Clinical Immunology (EAACI), the European Union funded network of excellence, the Global Allergy and Asthma European Network (GA2LEN), the European Dermatology Forum (EDF), and the World Allergy Organization guidelines. Patients with a urticaria control test score of &gt;12 are considered treatment sensitive, and ≤ 12 are considered resistant. The control group consisted of 20 sex-matched subjects without urticarial diseases. Total immunoglobulin E (IgE), antinuclear antibodies (ANA), thyroid stimulating hormone, antithyroid peroxidase, mean platelet volume (MPV), NLR, ELR, PLR, EBR, SII, SIRI, ET-1, and IL-33 were measured at the study entry and compared between the study groups. Results: Thirty AHS group, 38 AHR group, and 20 control group patients were included. The AHS, AHR, and control groups did not differ in demographic parameters, but the CSU groups were characterized by higher indicators of inflammation. In comparison with the AHS group, the AHR group was characterized by higher levels of IL-33 (p = 0.007), ET-1 (p = 0.032), C-reactive protein (p = 0.016), MPV (p = 0.002), and higher rates of positive ANA (p = 0.019). Of the 38 patients from the AHR group, 30 (79%) were included in the OmS group and 8 (21%) were included in the OmR group. The OmR group was characterized by higher levels of C-reactive protein (p = 0.022), EBR (p &lt; 0.001), higher rates of ANA (p = 0.004), and lower levels of ET-1 (p = 0.025) than the OmS group. Conclusion: Our study did not confirm NRL, PRL, SII, and SIRI, PLR as the biomarkers of treatment response to antihistamines and/or omalizumab in CSU. Higher blood levels of IL-33 and ET-1 characterize AHR CSU.

Red Cell Distribution Width and Neutrophil Lymphocyte Ratio as A New Biomarker for Severity in Rheumatoid Arthritis and its Comparison with DAS 28 ESR Score

Objective: To determine the association of red cell distribution width (RDW)and neutrophil-lymphocyte ratio (NLR)with the severity of rheumatoid arthritis by using DAS28 ESR. Additionally, toxic granulations were assessed as an indicator of disease severity. Study Design: Cross-sectional study. Place and Duration of Study: Rheumatology Outpatient Department, Federal Government Polyclinic Hospital, IslamabadPakistan, from Dec 2020 to Jun 2021. Methodology: Two hundred ninety rheumatoid arthritis patients were included. DAS 28 ESR was calculated using the DAS 28 ESR calculator, and RDW and NLR were extracted from the complete blood picture and peripheral smears. Results: There were 238(82.1%) female and 52 17.9%) male study participants. The mean age of patients was 45.2±12.8. The mean RDW, NLR and DAS 28 ESR in the study were 45.67±4.25, 2.93±1.35 and 4.29±1.25, respectively. Toxic granulations on peripheral smears were also found in 188(64.8%) patients. A significant positive association was found using the Spearman rho correlation between the DAS28 ESR score, RDW and NLR (p-value 0.024 and &lt;0.001, respectively). Conclusion: Red cell distribution width and neutrophil-lymphocyte ratio, along with toxic granulations, can be used as reliable biomarkers of inflammation in rheumatoid arthritis patients. Values higher than the reference range indicate higher disease severity.

Differences in Neutrophil Lymphocyte Ratio (NLR) between Sepsis and Septic Shock Patients in a Tertiary Hospital in Indonesia

Sepsis is a severe medical condition characterized by organ dysfunctions resulting from the body's response to an infection. Septic shock is a complication of sepsis that involves circulatory, cellular, and metabolic disturbances. The body's response to infection is typically marked by an increase in neutrophils and a decrease in lymphocytes, leading to increased Neutrophil Lymphocyte Ratio (NLR). This study aimed to investigate the differences in NLR between sepsis and septic shock patients treated at Dr. H. Abdul Moeloek Provincial Hospital, Lampung, Indonesia. This study utilized a comparative analytic study approach with a cross sectional design. A total of 96 sepsis patients who met the inclusion and exclusion criteria treated during the period January 2018 - December 2020 at Dr. H. Abdul Moeloek Provincial Hospital, Lampung, Indonesia, were included in this study. The study found that most of sepsis patients showed an increase in neutrophils (89.58%), a decrease in lymphocytes (94.79%), and elevated NLR values (87.5%). The mean NLR value of septic shock patients (20.10±5.89) was significantly higher than that of sepsis patients (18.01±1.35) (p=0.025). It indicates that the NLR value increases significantly in patients who develop septic shock compared to those with sepsis alone. The findings suggest that NLR could be a potential biomarker for septic shock diagnosis. However, the effectiveness of NLR in predicting the severity of sepsis and determining the risk of mortality in these patients still needs to be examined by conducting studies that involve a larger sample size.

The role of N-acetylcysteine in decreasing neutrophil-lymphocyte ratio in COVID-19 patients: A double-blind, randomized controlled trial

N-acetylcysteine has antioxidant and anti-inflammatory activities that could potentially improve the clinical outcomes of coronavirus disease 2019 (COVID-19) patients. N-acetylcysteine potentially inhibits NLRP3 (NOD-, LRR- and pyrin domain-containing protein 3) inflammasome and results in control oxidative stress and cytokine release in COVID-19 patients. The aim of this study was to assess the effect of N-acetylcysteine in reducing the neutrophil-lymphocyte ratio (NLR) in COVID-19 patients. A randomized controlled clinical trial was conducted among severe and moderate COVID-19 patients. The treatment group received oral 1200 mg daily of N-acetylcysteine (three times a day) and the standard care for COVID-19, while the control group received standard care for COVID-19 and a placebo. The NLR was determined on the first day of admission and after the seventh day of treatment. A paired Student t-test was used to compare the NLR before and after treatment while independent Student t-test was used to compare the NLR between treatment and control groups. A total of 40 severe and moderate COVID-19 were enrolled, 20 people in each group, with a mean age was 44.68±13.24 years old. The mean NLR on the first day was 9.44 in the treatment group and 8.84 in the control group. After the seventh day, the mean NLR was 4.27 and 11.54 in the treatment group and control group, respectively. The mean changes of NLR (the pre-treatment compared to post-treatment) in the treatment and control group were reduced 4.05 and increased 3.34, respectively. The NLR in treatment group significantly decreased compared to the control group (p&lt;0.001). In conclusion, N-acetylcysteine 1200 mg daily could reduce the NLR in severe and moderate COVID-19 patients.

Neutrophil to Lymphocyte Ratio As A Predictor of Endoscopic Damage in Caustic Injuries

Objective: To assess the ingestion of caustic substances is a medical emergency and esophagogastroduodenoscopy (EGD) is helpful in diagnosis, prognostication and management. Here, we investigated the NLR of patients, to assess the correlation of neutrophil lymphocyte ratio (NLR) with degree of caustic injury and to evaluate whether NLR can predict the degree of caustic endoscopic injury. Method: This cross sectional study was carried out on 180 patients in gastroenterology department of DHQ teaching hospital, Gujranwala from 1st Jan 2021 to 31 Dec 2021. The endoscopy was performed and CBC was sent for analysis of NLR. The esophageal and stomach mucosal injury was graded by Zargar's classification and divided into low grade and high grade. Independent sample t test was used for comparison between mean NLR versus low and high grade injury. Results: Patients with high grade damage has remarkably higher values of NLR as compared to low grade. For prediction of grade of damage, ROC analysis was used and AUC (area under curve) value was 0.838 (95% CI (0.783-0.894, p&lt;0.001) and if we take NLR cut-off value as 3.5, the sensitivity will be 96.0% and specificity 63.3%, if we take cut-off value as 4.5, the sensitivity will be 93.1% and specificity 48.1% and if we take cut-off value as 5.5, the sensitivity will be 75.2% and specificity 35.4%. Conclusion: Neutrophil to lymphocyte ratio can predict degree of gastroesophageal injury in patients with caustic ingestion.

Correlation of Severity of Depression with a Novel Inflammatory Marker: Neutrophil to Lymphocyte Ratio

Introduction: Many new inflammatory markers are being extensively used recently for assessing the severity and prognosis of chronic conditions. Neutrophil-Lymphocyte ratio (NLR) because of its simplicity and affordability stands out. Its applicability to psychiatric disorders specifically Depression is an eye-opener. Hamilton Rating Scale for Depression (HAM-D), a clinician-based scoring system is better among other self-scoring systems where the study population is semi-illiterate. Materials and Method: Total of 80 patients over a period of 1 year presenting to psychiatric OPD with depressive symptoms were evaluated for the severity of Major Depressive Disorder (MDD) using HAM-D scale. A score of 7-17, 18-24 and &gt;25 was categorised under mild, moderate, and severe degrees respectively. NLR was calculated and was correlated with their severity. Statistical analysis was done using PSPP software and p value of &lt;0.05 was considered significant. Results: Out of the 80 patients 45 were females and 35 were males. The average age was 35.41 years ± 10.13 SD. 23 patients categorised under mild depression had mean NLR of 1.56 ± 0.46 SD, 40 patients with moderate depression and 17 patients with severe depression had mean NLR of 2.70 ± 1.08 SD and 4.62 ± 1.31 SD respectively. The mean value of NLR for patients of severe depression lied in the Mild-Moderate Inflammation zone (3-7). P-value was &lt;0.05 and was considered significant. Discussion: A novel and easy biomarker like NLR can be as useful as assessing Inflammatory Cytokines like IL-6, IL-1 and TNF-α for assessing the severity of MDD. Rise of cortisol in persistent stress favours an increase in neutrophils and a reduction in lymphocytes, and thus, increased NLR. Thus, a rise of NLR with increasing severity of Depression could become a robust tool in future for predicting mortality and severity in patients suffering from MDD.

Hemodialysis: The Life Boat for AKI Patients in the COVID Cytokine Storm.

Interleukin-6 (IL-6), a biomarker of hyperinflammatory immune response, can be used to determine the severity of coronavirus disease 2019 (COVID-19) in patients with multi-organ involvement requiring critical care. The aim of our study is to understand the utility of hemodialysis, not only in terms of reducing renal burden, but also improving the outcome by tackling the COVID cytokine storm syndrome. In this prospective, observational study, 126 patients admitted to the COVID intensive care unit (ICU) wards were treated with hemodialysis for acute kidney injury (AKI). Patients' routine baseline blood parameters were evaluated. IL-6 was measured predialysis in all patients and on the day of discharge in the patients who survived. Out of total 126 patients, 79 were survivors and 47 were nonsurvivors. Among nonsurvivors, majority were older (P = 0.009). Both the groups had a higher percentage of males (78.72% and 55.69% in survivors and nonsurvivors, respectively). Mean neutrophil lymphocyte ratio (NLR) and D-dimer level were significantly higher in nonsurvivors compared to survivors (P < 0.001). Mean serum urea, creatinine, and IL-6 levels were significantly greater in nonsurvivors (P < 0.001). Mean number of hemodialysis sessions received by survivors was higher. The curve between delta IL-6 and delta serum creatinine for survivors showed a significant positive association (r = 0.819, P < 0.001). Our study establishes IL-6 as a poor outcome predictor in COVID ICU patients with AKI. It also emphasizes the use of hemodialysis as a cost-effective lifesaving therapeutic interventional modality to not only improve the renal outcome, but also curb the cytokine storm by reducing IL-6 levels.