Lymphocyte-to-monocyte Ratio Research Articles

Prognostic value of lymphocyte to monocyte ratio in patients with esophageal cancer: a systematic review and meta-analysis

ObjectivesTo report the largest systematic review and meta-analysis to evaluate prognostic value of lymphocyte to monocyte ratio (LMR) in patients with esophageal cancer.MethodsWe conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until December, 2023 for studies which evaluated the prognostic value of LMR in patients with esophageal cancer. Outcomes measured were overall survival (OS), disease-free survival (DFS), relapse-free survival (RFS), and progression-free survival (PFS).Results11 studies including 3,377 patients with esophageal cancer were included for meta-analysis. Meta-analysis demonstrated that OS (HR: 1.65; 95% CI: 1.19, 2.31; P = 0.003) and DFS (HR: 1.48; 95% CI: 1.09, 2.01; P = 0.01) were significantly shorter in the low LMR group compared with the high LMR group. In addition, meta-analysis revealed a similar PFS (HR: 1.58; 95% CI: 1.00, 2.51; P = 0.05) and RFS (HR: 1.17; 95% CI: 0.93, 1.46; P = 0.18) in the two groups. Subgroup analysis found that the predictive value of LMR for OS remained significant in resectable and unresectable esophageal cancers, and in studies with follow-up ≥24 months and < 24 months. Subgroup analysis based on treatment methods found that the prognostic value of LMR was significant for both patients who received PD-1/PD-L1 inhibitors and those who did not receive PD-1/PD-L1 inhibitors. However, subgroup analysis based on LMR threshold found that the significance remained in studies with LMR threshold<3.5 (HR: 2.09; 95% CI: 1.13, 3.87; P = 0.02) but disappeared in studies with LMR threshold ≥ 3.5 (HR: 1.39; 95% CI: 0.93, 2.07; P = 0.11).ConclusionsLow LMR is associated with poor prognosis in patients with esophageal cancer. Due to the simple availability and low cost of routine blood tests in clinical practice, LMR can be widely used to assess prognosis and construct risk prediction models for patients with esophageal cancer.Systematic review registrationPROSPERO, identifier CRD42024509796.

Association between Monocyte-to-Lymphocyte Ratio and Inflammation in Chronic Kidney Disease : A Cross-Sectional Study.

Inflammation plays a key role in chronic kidney disease (CKD). Monocyte-to-lymphocyte ratio (MLR) is a novel inflammatory marker. The purpose of this study was to evaluate the relationship between MLR and inflammation in CKD patients. In total, 1809 subjects were recruited from Wanzhai Town, Zhuhai City, between December 2017 and March 2018 for a cross-sectional survey. Patients were categorized based on the absence (hypersensitive C-reactive protein (hsCRP) level ≦ 3 mg/L) or presence (hsCRP level > 3 mg/L) of inflammation. Logistic regression models and MLR quartiles were used to explore the relationship between MLR and inflammation in CKD patients. Among 1809 subjects, 403 (22.2%) had CKD. Significant differences in systolic blood pressure, estimated glomerular filtration rate, white blood cell (WBC), neutrophil, monocyte, MLR, and Interleukin-6 (IL-6) levels were observed between noninflammatory group and inflammatory group. The highest MLR quartile had higher Scr, WBC, neutrophil, monocyte, IL-6, and hsCRP values and lower eGFR and lymphocyte values. Comparing the lowest quartile of MLR, the OR (95% CI) of inflammation risk in the highest quartile was 2.30 (1.24-4.27) after adjustment for confounding factors. The area under the curve of MLR for predicting inflammation was 0.631. The cutoff point for the MLR was 0.153. A high MLR was significantly and independently associated with inflammation in patients with CKD, making MLR a potential marker for inflammation in this demographic. MLR may also predict the severity of CKD.

Prognostic value of inflammation-related model in hepatitis B acute-on-chronic liver failure.

Acute-on-chronic liver failure (ACLF) is characterized by rapid onset, rapid development and a high short-term mortality rate. Systemic inflammation exerts an effect on the disease progression of ACLF. The purposes of this study were to explore the clinical significance that the inflammatory response has on the disease process of hepatitis B virus acute-on-chronic liver failure (HBV-ACLF) patients, to further compare the values of different inflammation-related biomarkers in the prognosis evaluation of HBV-ACLF patients, and to combine inflammatory-related markers to establish a new prediction model. Baseline admission data and 90-day outcomes were collected from 247 patients who met the inclusion criteria. According to the 90-day survival situation, they were divided into a survival group and a death group. The differences in baseline data and inflammation levels between the 2 groups were compared. A regression model was used to analyze the risk factors for 90-day mortality and establish a new model. The study found that the differences between the survival group and the death group were statistically significant in terms of age, total bilirubin (Tbil), prothrombin time (PT), international standardized ratio (INR), inflammation level, and model for end-stage liver disease (MELD) series scores (p < 0.05). The monocyte-to-lymphocyte ratio (MLR)-integrated iMELD model (MLR-iMELD) can effectively predict the 90-day survival rate of HBV-ACLF patients. The area under the receiver operating characteristic (ROC) curve (AUROC) of the new model was 0.792, and the best cutoff for predicting the prognosis of 90 days for patients was -0.33 (sensitivity 0.577 and specificity 0.898). The higher the level of inflammation in patients with HBV-ACLF, the greater the risk of 90-day death. Compared with other inflammation-related markers, the MLR-iMELD model can better predict the 90-day survival rate of HBV-ACLF patients.

Exploring the predictive factors in the gastrointestinal involvement of patients with immunoglobulin A vasculitis.

Immunoglobulin A vasculitis (IgAV), the most common systemic vasculitis in children, typically presents with gastrointestinal (GI) symptoms in about half of cases. This study aimed to analyze the clinical and laboratory findings of patients with IgAV regarding GI involvement. We compared the GI involvement data of the patients diagnosed with IgAV. Of the 210 patients (60.5% female and 39.5% male), 101 had GI involvement, with abdominal pain being the predominant symptom (n=98). White blood cell, neutrophil, monocyte, and platelet counts, C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were significantly elevated in patients with GI involvement (p<0.001, p<0.001, p=0.01, p=0.005, p=0.002, p<0.001, p=0.03, p=0.001, p<0.001, p<0.001, respectively). The cutoff values for SII (>1035.7), SIRI (>1.65), NLR (>2.73), and MLR (>0.28) were determined, yielding respective sensitivities of 46%, 59%, 47%, and 53%, specificities of 83.1%, 69.1%, 81.3%, and 71.9%. Corresponding areas under the curve were 0.658, 0.668, 0.649, and 0.634, respectively (all p<0.001). Although IgAV is a self-limiting disease, GI involvement can lead to serious consequences. Systemic inflammatory indices such as SII and SIRI may be indicative in identifying patients with GI involvement.

The Impact of Systemic Inflammation on Recurrence in Patients with Congenital Nasolacrimal Duct Obstruction.

Background/Objective: Congenital nasolacrimal duct obstruction (CNLDO) is commonly treated by probing, but recurrence remains a clinical issue. This study investigates the potential role of inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), in predicting recurrence after probing in children with CNLDO. Methods: This retrospective cohort study included 172 patients who underwent initial probing for unilateral CNLDO. The patients were then categorized into two groups: those who experienced the complete resolution of symptoms after primary probing, and those who required Ritleng tube intubation due to recurrence following primary probing. Blood samples for calculating inflammatory biomarkers in all subjects were collected during general anesthesia preparation prior to initial probing. NLR, MLR, and PLR values were compared between the groups using the independent samples t-test. The predictive performance of the inflammatory biomarkers for recurrence was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 110 patients were included in the probing group, while 62 patients were in the recurrence group. The mean age at the time of the initial probing procedure was 15 ± 4.06 months in the probing group and 15.83 ± 4.02 months in the recurrence group. There was no difference in the duration of the probing procedure between the groups. The mean age at the time of Ritleng tube intubation in the recurrence group was 37.80 ± 13.34 months. The recurrence group exhibited significantly higher values in all analyzed inflammatory markers compared to the probing group, including the NLR (1.12 ± 0.56 vs. 0.86 ± 0.39, p = 0.002), MLR (0.16 ± 0.06 vs. 0.14 ± 0.06, p = 0.005), and PLR (95.13 ± 24.34 vs. 82.23 ± 22.77, p < 0.001). ROC curve analysis indicated that these inflammatory biomarkers demonstrated moderate performance in predicting recurrence. Conclusions: Recurrence following probing in children with CNLDO was associated with complete blood cell count-derived inflammatory biomarkers. The preoperative assessment of these biomarkers may aid in the individualization of disease management and inform the development of new therapeutic strategies.

Inflammatory index is a promising biomarker for maintenance hemodialysis patients with cardiovascular disease

Background and objectivesMaintenance hemodialysis (MHD) patients are at a higher risk of cardiovascular disease (CVD), a common complication and leading cause of death. Persistent micro-inflammation is a unique feature of MHD. Given the established role of inflammation in the pathogenesis of atherosclerosis, this study aims to explore whether novel inflammatory markers (inflammation index) can serve as independent risk factors for CVD in MHD patients.MethodsA cross-sectional survey was conducted on patients from three dialysis centers, categorized into a CVD and non-CVD group based on medical history, laboratory tests, and physical examination. Fasting blood samples were collected from all participants for indicator testing.ResultsThe analysis of 209 patients revealed that 104 had concurrent CVD. Patients in the CVD group were significantly older and exhibited higher anxiety and depression scores. Forward stepwise multivariate logistic regression results identified the inflammation index neutrophil-to-lymphocyte ratio (NLR) (OR = 1.27, 95% CI 1.082–1.491, P < 0.05) and systemic immune-inflammation index (SII) (OR = 1.001, 95% CI 1.0001–1.002, P < 0.05) as independent risk factors for CVD in MHD patients. Receiver operating characteristic (ROC) curve analysis demonstrated that SII, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and NLR all possess predictive diagnostic values for CVD events in this patient population.ConclusionsHemodialysis centers can utilize simple and cost-effective inflammatory markers to proactively identify patients at risk of CVD. Future research into how inflammation contributes to CVD in MHD is required.

Abstract 4136182: Usefulness of Lymphocyte-to-Monocyte Ratio in Predicting Late Recurrence of Atrial Fibrillation after Catheter Ablation and its Association With the Type of Atrial Fibrillation

Introduction: Leukocyte activation is reported to be an important inflammatory pathway underlying atrial fibrillation (AF). The lymphocyte-to-monocyte ratio (LMR) is a novel, cost-effective, and widely available marker of inflammation. Research Questions: The usefulness of LMR in predicting late recurrence of AF (LRAF) after catheter ablation (CA), and the impact of AF type on its usefulness, have not yet been elucidated. Goals: We aimed to elucidate the association between LMR measured just before CA and the risk of LRAF in patients who underwent CA for AF, and to investigate whether the type of AF impacts the predictability of LMR for LRAF. Methods: We enrolled 597 consecutive patients with AF (median age, 65 years; 32% female; 334 patients with paroxysmal AF [PAF] and 263 patients with persistent AF [PeAF]) who underwent initial radiofrequency CA. LMR was measured within 3 days prior to the date of CA, and calculated by dividing the absolute lymphocyte count by the absolute monocyte count using the same blood samples. Any detectable atrial tachyarrhythmia lasting for longer than 30 s beyond a 3-month blanking period after the procedure was considered as LRAF. Patients were followed-up for a maximum of 3 years. Results: During a median follow-up of 24 months, LRAF occurred in 215 patients (96 with PAF and 119 with PeAF). Although there was no significant difference in LMR between patients with and without LRAF in PAF (5.3 [4.1–6.7] vs 5.2 [4.0–6.6], p=0.403), LMR in patients with LRAF was significantly lower than those without LRAF in PeAF (4.7 [3.9–6.4] vs 5.6 [4.5–6.8], p=0.015). Multivariate Cox analysis showed that LMR was an independent predictor of LRAF in PeAF (p=0.008), but not in PAF (p=0.662). Receiver operating characteristic curve analysis revealed that an LMR of 4.8 was a fair discriminator for LRAF in PeAF. Although there was no significant difference in the risk of LRAF between the patients with lower (LMR&lt;4.8) and higher LMR (LMR≥4.8) in PAF, patients with lower LMR had a significantly higher risk of LRAF than those with higher LMR in PeAF (Figure). Conclusions: Pre-ablation LMR was shown to be useful for predicting LRAF in patients with PeAF who underwent CA for AF, while not in patients with PAF.

Abstract 4135746: Assessing Coronary Artery Disease Severity: Leveraging Inflammatory Markers As a Prognostic Indicators

Introduction: Cardiovascular disease continues to be the leading cause of death and a significant cause of morbidity in the United States. In recent years, there has been increased interest in the role of inflammation in predicting and modifying the risk of coronary artery disease. Of the multitude of inflammatory markers studied subsequently, two of the most easily and widely obtained is the neutrophil to lymphocyte ratio (NLR) and the monocyte to lymphocyte ratio (MLR), which can be calculated from a complete blood count with differential. Multiple retrospective studies have demonstrated that the NLR and MLR have been used to diagnose ACS, predict mortality at a year after ACS, and risk stratify patients prior to percutaneous coronary intervention. Research Question: Are the NLR/MLR useful tools in predicting the severity of coronary artery disease (CAD) in patients admitted to a tertiary medical center in Southern Nevada for ACS between 2021 and 2023? Methods: A sample of n=344 patients was used to examine the potential significance of NLR/MLR to diagnose ACS and for predicting CAD severity. Traditional diagnostic test evaluation was used for determining CAD with a ratio of NLR=3.5 + MLR=0.35 (data medians) as the cut-off value. Patient risk group status (1:low risk to 4:high risk) was used as a binary outcome to test NLR/MLR between low and high risk groups using a nonparametric MWW test of medians. Additionally, ROC analysis was used to estimate an optimized cut-off for NLR/MLR as determined by AUC. Results: Results demonstrate for predicting ACS using the median NLR, sensitivity=88.07; specificity=14.88; PPV=52.01; NPV=54.35), LR(+)=1.03 and LR(-)= 0.80, using the median MLR results showed sensitivity=87.28; specificity=14.11; PPV=50.84; NPV=52.17, LR(+)=1.01 and LR(-)= 0.90. Subpopulation analysis demonstrated a statistically significant difference in NLR between “high risk ACS” vs “Low Risk ACS” (p&lt;0.001). Examination of the ROC curve for predicting the high-risk group suggested an optimized cutoff of NLR=3.7; however, AUC was only 0.617, and sensitivity and specificity were not improved compared to using the median NLR. Conclusion: Our findings suggest that an NLR greater than 3.7 may indicate multivessel involvement or proximal/left main disease in CAD patients. However, due to its low specificity and AUC, NLR alone cannot reliably distinguish between single-vessel and multivessel CAD.

Evaluation of pseudoexfoliation syndrome patients with systemic immune indexes

PurposeThe aim of this study was to investigate the level of peripheral blood systemic immune indexes in pseudoexfoliation syndrome (PXS) patients and to compare the results with healthy controls.MethodsThis study included 143 healthy controls (group 1) and 100 patients (group 2). Peripheral blood samples were collected from all participants. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), systemic immune inflammation index (SIII), systemic inflammation response index (SIRI), systemic inflammation modulation index (SIMI) and aggregate systemic inflammation index (AISI) were calculated.ResultsAccording to complete blood count, leukocyte, monocyte and platelet counts showed a statistically significant difference between the two groups (p < 0.001 for all). Systemic immune indexes (NLR, PLR, SIII, SIRI, SIMI and AISI) in group 2 were statistically significantly higher compared to group 1 (PLR for p = 0.011, others p < 0.001).ConclusionIn conclusion, systemic immune indexes (NLR, MLR, PLR, SIII, SIRI, AISI and SIMI) were elevated in PXS patients compared to healthy controls. These indexes may serve as an easy, simple and cost-effective tool to assess the degree of systemic inflammation in patients, playing an important role in recognizing the underlying mechanisms of diseases and thus potentially guiding treatment.

Predictive value of systemic immune-inflammatory biomarkers for drug-induced liver injury in hepatitis B virus surface antigen positive tuberculosis patients: A retrospective observational study.

Drug-induced liver injury (DILI) is a major concern in tuberculosis (TB) treatment. For early detection of DILI, immune-inflammatory biomarkers are needed for better management. To explore the predictive effect of systemic immune-inflammation index (SII) combined with neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), eosinophil (EOS%), and CD4/CD8 on DILI occurrence in TB patients with HBsAg positive. This is a retrospective study enrolling patients who were treated with anti-tuberculosis drugs and infected with hepatitis B virus (HBV) in the Guangzhou Chest Hospital from 2018 to 2023. Population demographics and clinical data of 2643 patients were collected by reviewing electronic medical records. Using a propensity score matching model, the study ultimately included 516 patients (258 patients with DILI and 258 patients without DILI). Logistic regression analysis was conducted to investigate the predictive role of systemic immune-inflammatory biomarkers (SII, NLR, MLR, EOS%, and CD4/CD8) in DILI in hepatitis B virus surface antigen-positive TB patients (HBV-TB-DILI). As compared to patients without DILI, patients with DILI have elevated levels of systemic immune-inflammatory biomarkers (SII, NLR, MLR, EOS%, and CD4/CD8), (all P < .05). The SII, NLR, MLR, PLR, EOS%, and CD4/CD8 are risk factors of HBV-TB-DILI. The NLR, MLR, SII, and EOS% were positively correlated with liver function (P < .001). The combination of SII, NLR, MLR, EOS%, and CD4/CD8 demonstrated good predictive performance for DILI occurrence in HBV-TB patients. The combination of SII, NLR, MLR, EOS%, and CD4/CD8 demonstrated good predictive performance for DILI occurrence in HBV-TB patients.

The Prevalence of Malnutrition and Sarcopenia and the Relationship with Inflammation and Anemia Among Community-Dwelling Older Adults: A Preliminary Cross-Sectional Study.

Background: Older people are more likely to have poor nutrition and low muscle mass, which leads to poor physical performance and anemia, resulting in a poor quality of life and risks to mobility and mortality. Furthermore, malnutrition may, in part, raise the level of inflammatory biomarkers as well as muscle catabolism. Moreover, a range of indices related to systemic inflammation, obtained from routine complete blood count (CBC) tests, have been applied to inflammation markers. However, these biomarkers remain insufficiently addressed in the evidence supporting the presence of sarcopenia and malnutrition. This study aimed to explore sarcopenia in terms of malnutrition, anemia, and inflammation among Thai community-dwelling older people. Methods: This study enrolled community-dwelling older people aged 60 years and above. All participants were requested to complete a questionnaire assessing for sarcopenia (SARC-F) and nutritional status using the mini nutritional assessment (MNA). In addition, blood samples were obtained for the CBC test. Logistic regression analysis explored the risk of sarcopenia, CBC, and malnutrition status. Results: Of 126 older people (aged 62-88 years) enrolled, 12 individuals (9.52%) had sarcopenia. Furthermore, 34.9% and 5.56% of the participants were demonstrated to have anemia and malnutrition, respectively. Nutrition status was positively associated with hemoglobin levels (r = 0.241, p = 0.007) and negatively related to SARC-F scores (r = -0.190, p = 0.034). Older people with anemia show an increased risk of malnutrition at an odds ratio (OR) of 3.375. Moreover, individuals with anemia were at a higher risk of developing sarcopenia (OR 4.982) than those with no anemia. However, individuals with a high level of inflammatory markers, e.g., a high systemic inflammatory response index (SIRI) and monocyte-to-lymphocyte ratio (MLR), had a higher risk of sarcopenia than those with low SIRI and MLR values. The systemic immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) were also positively associated with SARC-F scores. Conclusions: The association between sarcopenia, malnutrition status, and anemia might overlap in clinical manifestation. In addition, future research directions regarding the utility of routine CBC testing should focus on sarcopenia and malnutrition status.

Effectiveness of long-term bimekizumab treatment and predictive factors for responders in moderate-to-severe psoriasis: A 52-week real-world study.

Psoriasis is a chronic, inflammatory skin disease in which the interleukin (IL)-23/IL-17 axis plays a central role. Bimekizumab is a novel antibody that targets both IL-17A and IL-17F. This retrospective study aimed to assess the long-term effectiveness and safety of 52-week treatment with bimekizumab, and to identify predictive factors for short- (16 weeks) and long-term (52 weeks) responders (i.e., achievers of a Psoriasis Area and Severity Index (PASI) score of 100) to bimekizumab in Japanese patients with psoriasis. The study was conducted on 56 Japanese patients (aged ≥ 15 years) with moderate-to-severe psoriasis treated with bimekizumab from May 2022 to March 2024. The therapeutic effectiveness was evaluated by the transition of PASI scores during treatment. Baseline characteristics and clinical and laboratory indexes were compared between responders and poor responders. Treatment-emergent adverse events (TEAEs) were recorded to assess the safety of the treatment. At week 52, the achievement of PASI 100, static Physician's Global Assessment 0/1, and the Dermatology Life Quality Index 0/1 were 72.4%, 94.7%, and 93.3%, respectively. Short-term responders showed lower baseline values of neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio (MLR), and systemic inflammatory response index compared to poor responders. Long-term responders showed younger age and lower MLR compared to poor responders. TEAEs were mild or moderate, without serious adverse events. Long-term treatment with bimekizumab is effective and safe for psoriasis patients. Lower MLR and younger age might predict long-term response to treatment with bimekizumab, aiding in personalized treatment strategies.

Diagnostic role of the neutrophil‑to‑lymphocyte ratio and the platelet‑to‑lymphocyte ratio in breast cancer: A systematic review and meta‑analysis.

Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) may be indicative of breast cancer (BC); however, this remains inconclusive. With the aim to assess the current literature to evaluate the diagnostic roles of NLR PLR and LMR in BC, a systematic literature search was performed using the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, VIP database and China Biology Medicine disc databases up to August 29, 2023. The standardized mean deviation and 95% confidence intervals (CI) for each outcome was reported, and heterogeneity and publication bias were assessed. Overall, 39 studies were included in the present study. Pooled analysis with the random-effects model demonstrated that patients with BC had significantly higher NLR and PLR, and a lower LMR, compared with non-BC subjects. The pooled sensitivities of the NLR and PLR were 0.68 (95% CI, 0.59-0.75) and 0.55 (95% CI, 0.36-0.72), respectively, and the pooled specificities of the NLR and PLR were 0.75 (95% CI, 0.68-0.81) and 0.80 (95% CI, 0.51-0.94), respectively. However, the limited number of studies included hindered the evaluation of the diagnostic role of LMR. In summary, a higher NLR and PLR and lower LMR were associated with the presence of BC. NLR and PLR may be potential blood-based biomarkers for the differentiation of BC. Despite these findings, further studies are needed to validate their clinical applicability and practicality. International Prospective Register of Systematic Reviews registration no. CRD42024522226.

Pretreatment systemic immune-inflammation index and lymphocyte-to-monocyte ratio as prognostic factors in oral cavity cancer: A meta-analysis.

The predictive implications of the pretreatment systemic immune-inflammation index (SII) and lymphocyte-to-monocyte ratio (LMR) in oral cavity cancer have been investigated extensively, however, the findings are conflicting. To assess the predictive importance of SII and LMR in patients with oral cavity cancer, a comprehensive Meta-analysis of the literature was conducted using the databases from PubMed, Embase, and the Cochrane Library. To determine the link between SII and LMR and overall survival (OS) and disease-free survival (DFS), hazard ratio (HR) and 95% confidence interval (CI) were retrieved. The analysis comprised a total of 18 papers, covering 19 trials (SII = 5, LMR = 12, SII + prognostic nutritional index (PNI) = 2). According to pooled data, increased SII predicted poor OS (HR: 1.61, 95% CI: 1.38-1.87, P < .001) and DFS (HR: 1.90, 95% CI: 1.11-3.27, P = .02) while high LMR was linked with improved OS (HR: 0.64, 95% CI: 0.54-0.77, P < .001) and DFS (HR: 0.69, 95% CI: 0.61-0.79, P < .001). In addition, subgroup analysis indicated that high SII and low LMR negatively correlated with OS regardless of country, cutoff value, sample size, or types of Cox regression analysis. High SII and low LMR may predict worse survival in patients with oral cavity cancer. SII and LMR may therefore represent effective indicators of prognosis in oral cavity cancer.

Relation Between Monocyte-to-lymphocyte Ratio and Depressive Symptoms in Patients with Non-severe COVID-19 Infection

Background and Aim: Mental health of non-hospitalized patients and those with non-severe infections has attracted lower attention in comparison to other patients. Circulating monocytes are deeply involved in all stages of COVID-19 infection. The present study aimed to investigate the relationship between monocyte-to-lymphocyte ratio (MLR) and depressive symptoms in patients with non-severe COVID-19 infection. Methods: The study included 312 patients with non-severe COVID-19 infection diagnosed on the basis of a positive reverse-transcriptase polymerase chain reaction (RT-PCR) test of nasopharyngeal swabs. Depressive symptoms were assessed using the validated Arabic version of the 7-item Hamilton Depression Rating Scale (HAMD). According to the obtained scores, patients were classified to have mild (10-13), moderate (14-17), or severe depression (&gt;17). Results: The present study included 312 patients with non-severe COVID-19. According to HAMDS, clinically significant depression was diagnosed in 144 patients (46.2 %). They comprised 38 patients (12.2 %) with mild depression, 30 patients (9.6 %) with mild-tomoderate depression and 76 patients (24.4 %) with moderate-to-severe depression. Multivariate logistic regression analysis identified male sex [OR (95% CI): 2.07 (1.27-3.36), p = 0.003], presence of dyspnea [(OR (95 % CI): 1.99 (1.21-3.27), p = 0.007], D dimer levels [OR (95% CI): 2.32 (1.19-4.52), p = 0.013], MLR [OR (95% CI): 0.52 (0.28-0.99), p = 0.046] and abnormal CT findings [OR (95% CI): 1.79 (1.08-2.95), p = 0.023] as significant predictors of depression in the studied patients. Conclusion: Low MLR is related to depressive symptoms in patients with non-severe covid-19 infection. Other predictors include male sex, dyspnea, abnormal CT findings and elevated D-dimer levels.

Systemic Immune-Inflammation-Based Biomarker and Fragility Fractures in People Living With HIV: A 10-Year Follow-Up Cohort Study in China.

Fragility fractures are a significant concern among people living with HIV(PLWH) due to the combined effects of chronic inflammation, immune dysregulation, and antiretroviral therapy. Traditional biomarkers have limited predictive value for fragility fractures in this population. This study aims to evaluate the systemic immune inflammation-based scores as novel biomarkers for predicting fragility fractures in PLWH in China. We conducted a cohort study of PLWH in the orthopedic department of Beijing Ditan Hospital from January 2011 to September 2023. We monitored fragility fractures and collected data on demographics, clinical characteristics, and laboratory parameters. Multivariate Cox and logistic regression models were used to assess the predictive value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) for fragility fractures. Restricted cubic splines (RCS) were employed to explore potential nonlinear relationships, and subgroup analyses were conducted to examine the stability of these associations. During a median follow-up of 5.5 years, our study included 1148 PLWH patients, and 204 patients (17.8%) experienced fragility fractures. After adjusting for all covariates, SII and SIRI were identified as independent risk factors for fragility fractures in PLWH, whereas NLR, PLR, and MLR were not. Patients with higher levels of SII and SIRI had a significantly increased risk of fragility fractures compared to those with lower levels (HR: 1.96, 95% CI: 1.24-3.10, p = 0.004; HR: 1.83, 95% CI: 1.16-2.88, p = 0.009). RCS analysis indicated a stable linear relationship between SIRI and fragility fractures. Furthermore, KM curves demonstrated that patients with higher SII and SIRI scores had a higher likelihood of experiencing fragility fractures. Our research shows that SII and SIRI are promising biomarkers for predicting fragility fractures in PLWH. Clinicians should consider incorporating SIRI into clinical practice to improve fracture risk stratification and guide preventive strategies for this vulnerable population.

Combined Bone Mineral Density (BMD) and Monocyte-to-Lymphocyte Ratio (MLR) Predicts Recurrence and Prognosis in Hepatocellular Carcinoma Patients Following Liver Resection.

Bone mineral density (BMD) and monocyte-to-lymphocyte ratio (MLR) were recently identified as novel risk factors for patients with several malignancies. The objective of this study was to validate the role of preoperative BMD/MLR as a potential prognostic biomarker in patients with hepatocellular carcinoma (HCC) undergoing liver resection. This investigation enrolled 442 adult patients diagnosed with HCC who underwent liver resection. The patients were classified into high- and low-BMD/MLR groups based on the median, and forward stepwise logistic regression was employed to identify independent predictors for early HCC recurrence. To mitigate the impact of confounding factors, a propensity score matching (PSM) analysis was conducted between patients in the high- and low-BMD/MLR groups. The Kaplan-Meier method was employed to assess and compare the disease-free survival (DFS) and overall survival (OS) between the two cohorts. The study categorized patients into high-BMD/MLR and low-BMD/MLR groups. Forward stepwise logistic regression analysis revealed that low BMD/MLR (P < 0.001), tumor size > 50 mm (P < 0.001), and AFP > 200 ug/L (P = 0.001) were significantly associated with the early recurrence of HCC. Moreover, the results suggested that DFS and OS were significantly shorter in the low-BMD/MLR group compared to the high-BMD/MLR group, both before and after PSM (P < 0.05). Preoperative BMD/MLR held promise as a prognostic biomarker for early recurrence and prognosis in patients with HCC who underwent liver resection. Furthermore, the integration of tumor size, AFP level, and BMD/MLR demonstrated a robust predictive capacity for early recurrence within this patient population.

Association of innate versus specific immunity with heart failure incidence: a prospective study.

Immune disorders are key heart failure (HF) triggers, but little is known about whether the status of immunity affects the incidence of HF. To explore this, we used blood cell counts and derived ratios to investigate the association between immunity status markers and HF incidence. The number and proportion of peripheral blood leucocytes in a physiological state are related to the body's immune status. Neutrophils, monocytes, SII (systemic immune-inflammatory index), NLR (neutrophil-to-lymphocyte ratio), and PLR (platelet-to-lymphocyte ratio) serve as innate immunity status markers, while lymphocytes and LMR (lymphocyte-to-monocyte ratio) serve as specific immunity status markers. 330 362 UK Biobank (UKB) participants were finally examined. Cox proportional hazard models were used to explore the relationship between immunity status markers and HF incidence. Flexible parametric survival models were used to capture time-varying relationships between blood cell ratios and HRs for HF. Subgroup analyses were conducted by age, sex, and body mass index. Finally, sensitivity analyses were performed to validate the results. During a median follow-up of 14.1 years, 9611 (2.9%) participants developed HF. Neutrophils, monocytes, SII, and NLR were positively associated with HF incidence, with fully adjusted per SD increment HR (95% CI) of 1.20 (1.17 to 1.22), 1.09 (1.07 to 1.12), 1.12 (1.10 to 1.14), and 1.16 (1.14 to 1.18), respectively. Platelets, lymphocytes, and LMR were inversely correlated with HF incidence, with fully adjusted per SD increment HR (95% CI) of 0.97 (0.95 to 1.00), 0.97 (0.95 to 0.99), and 0.90 (0.88 to 0.92), respectively. The innate immunity status markers were positively associated with HF incidence, while specific immunity status markers exhibited an inverse association, offering novel insights for HF prediction and intervention.

Prevalence and Risk Factors of Pulmonary Embolism in COPD Patients Complicated with Secondary Polycythemia.

This study aimed to establish the prevalence of pulmonary embolism (PE) in chronic obstructive pulmonary disease (COPD) patients with secondary polycythemia (SP) and explore the risk factors for PE in COPD patients with SP. We analyzed the prevalence of PE among COPD patients with SP who were hospitalized at Qinghai Provincial People's Hospital between January 2015 and December 2020. From January 2021 to January 2024, we enrolled patients into three groups (COPD+SP+PE, COPD+SP, and control) and performed laboratory measurements, biomarkers, echocardiography, and pulmonary function tests. Patients in the COPD+SP group received clinical treatment, and biomarkers were measured again seven days after treatment. The prevalence of PE in patients with COPD SP was 5.21%. We found that COPD+SP+PE group had significantly higher levels of erythrocyte distribution width (RDW), platelet volume distribution width (PDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte to large platelet ratio (MLPR), 5-hydroxytryptamine (5-HT), activated protein C (APC), urokinase-type plasminogen activator (u-PA), thrombomodulin (TM), interleukin-38 (IL-38), tissue factor (TF), and fractalkine (FKN) in contrast to COPD+SP group. Biomarkers, such as FKN, β-thromboglobulin (β-TG), APC, u-PA, TM, TF, and IL-38, were risk factors for COPD patients with SP who are complicated by PE. Clinical treatment significantly reduced the levels of β-TG, IL-38, APC, endothelin-1 (ET-1), u-PA, FKN, TM, 5-HT, and neutrophil extracellular traps (NETs) in patients with COPD+SP. PE incidence was significantly higher in patients with COPD and SP. In COPD patients with SP, routine joint detection of blood and cardiac markers, blood gas analysis, and pulmonary function tests can help to identify patients with PE. APC, u-PA, TF, FKN, TM, and IL-38 are risk factors for PE in patients with COPD and SP, and clinical treatment can effectively reduce this risk.

Novel predictor of thrombosis after left atrial appendage closure -Neutrophil to Lymphocyte Ratio (NLR), platelet to LymPhocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR)-

Abstract Background Cardiogenic embolism by left atrial thrombi is one of the most important atrial fibrillation (AF)-related clinical problems. In a previous survey, 91% of nonrheumatic AF-related left atrial thrombi was originated in the left atrial appendage (LAA). The WATCHMAN device was developed as a permanent implantable device to seal off the LAA to prevent cardiogenic embolism. It has been used in Japan since September 2019. The WATCHMAN family is the only left atrial appendage closure (LAAC) device in Japan. After percutaneous left atrial appendage closure (LAAC), DRT is an important issue in some cases. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) are known as cancer prognostic factors and indicators of immune status. There are few reports on the predictor for device related thrombosis (DRT), transient ischemic attack (TIA), and ischemic stroke. Finding novel biomarkers could help clinical decision in antithrombotic therapy post LAAC and follow-up intervals. Purpose To investigate the association of NLR, PLR, and LMR with device related thrombosis, transient ischemic attack, and ischemic stroke in patients with LAAC. Methods Our database of LAAC was respectively analyzed. All LAAC cases were performed between January 2020 and September 2023. Blood cell counts were sampled in three days before LAAC. Postoperative antithrombotic therapy was individualized based on the patient’s background. We examined their background and clinical events. Results A total of 116 consecutive patients underwent LAAC in our institution excepting for one case that could not be performed due to a huge LAA (follow-up period, 610±37 days; age, 75±1 years; male sex, 73%; left ventricular ejection fraction, 58±1%; CHAD2S2-VASc, 4.6±0.1; HAS-BLED, 3.4±0.1). The results are shown in the Figure. Receiver-operating characteristic curve analysis confirmed the best cut-off value of NLR, PLR, and LMR for composite of DRT, TIA, and ischemic stroke (AUC = 0.69; 0.70; 0.67). In the univariate analysis, NLR&amp;lt;1.88, PLR&amp;lt;144, and LMR&amp;gt;3.40 are the independent predictor for the combination of DRT, TIA, and ischemic stroke (p-value = 0.02; 0.04; 0.05, respectively). Conclusion Low NLR, low PLR, and high LMR are the independent predictor for the combination of DRT, TIA, and ischemic stroke. These parameters can be useful in routine use because they can be easily calculated without additional costs.