Neutrophil-lymphocyte Ratio In Patients Research Articles

Prognostic Significance of the Combined Score of Plasma Fibrinogen and Neutrophil-Lymphocyte Ratio in Patients with Spontaneous Intracerebral Hemorrhage

Background The combination of plasma fibrinogen and neutrophil to lymphocyte ratio (F-NLR) score is a novel inflammatory marker constituted by peripheral blood fibrinogen concentration and neutrophil to lymphocyte ratio. In the current study, we aim to explore the relationship between admission F-NLR score and intracerebral hemorrhage (ICH) and assess its prognostic predictive ability in ICH patients. Methods The original cohort was consecutively recruited from August 2014 to September 2017, and the validation cohort was consecutively recruited between October 2018 and March 2020. The primary outcomes were 3-month functional outcome and 1-month mortality. All statistical analyses were performed using SPSS and R software. Results A total of 431 and 251 ICH patients were included in original cohort and validation cohort, respectively. In the original cohort, F-NLR score could independently predict the 3-month functional outcome (adjusted OR 2.013, 95% CI 1.316-3.078, p = 0.001) and 1-month mortality (adjusted OR 3.036, 95% CI 1.965-4.693, p < 0.001). Receiver operation characteristic (ROC) analyses and predictive model comparison indicated that F-NLR score had a stronger predictive ability in the 3-month outcome and 1-month mortality. Validation cohort verified the results. Conclusion F-NLR score was an independent indicator for both the 3-month functional outcome and 1-month mortality, and its prognostic predictive ability was superior to fibrinogen and NLR in both the original and the validation cohort.

The role of neutrophil-lymphocyte ratio in patients with chronic obstructive pulmonary disease in Babylon province

The role of neutrophil-lymphocyte ratio in patients with chronic obstructive pulmonary disease in Babylon province

Clinical picture and laboratory disorders in adult patients with pre-existing cardiomyopathy and COVID infection

Abstract COVID infection is presented with different clinical manifestations in different population groups. A number of studies have shown increased mortality in patients with pre-existing cardiomyopathy, which is common in the elderly population. Patients with COVID infection have an increased incidence of cardiac disease, most commonly myocarditis, acute heart failure and coagulation dysfunction seen after an increase in the value of D-dimer. Methods We analyzed the data of patients hospitalized in our institution for a period of one month (December 2020), positive for COVID 19 virus, with the presence of cardiomyopathy and associated comorbidity, their clinical picture, as well as laboratory tests - with reference to inflammatory markers and D-dimer. Results During the study period, 53 patients were positive for COVID infection. The average age of the patients was 76.01 years. Total mortality was 17.78% (45 patients recovered, while 8 died). We divided the patients into 2 groups - patients with cardiomyopathy before COVID infection and those who did not have it. In the first group 30 patients were included with compensated cardiomyopathy with drugs before COVID infection, and in the second group 23 patients were included without cardiomyopathy. The clinical picture in 75.5% of patients was moderate, in 11.3% it was severe with reduced saturation &amp;lt;92%, while in 13.2% it was asymptomatic. During the infection in some of the above patients there was a deterioration of the clinical picture presented with fever, dyspnoea, cardiac decompensation, pulmonary finding, and increase in inflammatory markers and D-dimer. Mortality in the first group was 20% while in the second 15%. The mean value of D-dimer was 1785.37 ng/ml. The mean value of D-dimer in patients with cardiomyopathy was 2153.21 ng/ml (from 329.28 ng/ml to 5680 ng/ml), while in patients without cardiomyopathy it was 1305.58 ng/ml (from 513.57 ng/ml to 5286.69 ng/ml). The mean value of D-dimer in patients who survived the infection was 1490.84 ng/ml, while the value of D-dimer in deceased patients was 3442.09 ng/ml. CRP was elevated in 88.68% of patients, and 9.43% of patients had values above 100 mg/L indicating severe secondary bacterial infection. In 20% of these patients there was a lethal outcome. The median neutrophil lymphocyte ratio in patients was 5,873. The normal value of this ratio (under 3) had 17 patients (32.07%) in the rest was increased, and over 15 (indicating severe infection) had 7.55% of patients of whom 50% of the infection had a lethal outcome. Conclusion Patients with cardiomyopathy before COVID infection had a more severe clinical picture; they also had heart failure, which increased the risk of lethal outcome. There was also an increasing trend of inflammatory markers and D-dimer. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): PHI Specialized hospital for geriatric and palliative medicine 13 November Skopje

39P Prognostic value of neutrophil-lymphocyte ratio in patients with advanced pancreatic cancer

Pancreatic cancer is an aggressive tumor with a poor prognosis and high rate of mortality. Recently, systemic inflammation-based prognostic markers have been established to predict the prognosis in patients with pancreatic cancer. Among those indicators, we aimed to investigate the utility of neutrophil-to-lymphocyte ratio (NLR) as prognostic factors in Tunisian advanced pancreatic cancer. A retrospective study was conducted at the department of Medical Oncology in Sfax, including 31 patients treated for a locally advanced or metastatic pancreatic cancer, from 2011 to 2017. NLR was evaluated and correlated with survival. Value cutoffs were adopted to discriminate patients as follows: low NLR < 3 and high NLR≥6. A total of 31 patients were included. The median age was 60 years (range 36-77). Sixty-one per cent were male and 29% had a performance status (PS) ≥2. The median duration to consultation was 2,7 months and the main symptom for consultation was abdominal pain (87%) followed by jaundice (29%) and weight loss (26%). The median size was 45 mm. Metastases were found in 16 patients (51,6%). Chemotherapy was indicated in 19 patients, in 38% in case of neoadjuvant situation and 51% for metastatic cases. NLR was <6 in 24 cases and ≥6 in 7 cases. The median overall survival (OS) was 7 months. The 1-year and 2-year OS were, respectively, 12.9% and 3.2%. NLR ≥6 was associated with lower OS (1-year OS 0% vs 16.7%, p=0.0001). Other prognosis factors were PS ≥2, high rate of CA19-9 and stage IV (p= 0.001, p=0.021, p=0.027). Our study concluded that in addition to the other prognosis factors, inflammation-based markers such as NLR ≥6 may be useful as prognostic factors for advanced pancreatic cancer.

Relationship Between Lymph Node Metastasis and Lymph Node Density and Preoperative Neutrophil-Lymphocyte Ratio in Patients Undergoing Radical Cystectomy

Relationship Between Lymph Node Metastasis and Lymph Node Density and Preoperative Neutrophil-Lymphocyte Ratio in Patients Undergoing Radical Cystectomy

The clinical significance of neutrophil-lymphocyte ratio in patients treated with hemodialysis complicated with lung infection.

The goal of this work was to investigate the potential significance of neutrophil-lymphocyte ratio (NLR) in patients treated with maintenance hemodialysis (MHD).Herein, we retrospectively reviewed the electronic medical records of 100 patients with end-stage renal failure who were treated with MHD. All patients enrolled in this study met the inclusion criteria and were followed. The differences in each indicator between the two groups were compared using the Wilcoxon rank-sum test. On the other hand, Spearman correlation and logistic regression analysis were used to explore the correlation and risk factors for pulmonary infection between NLR and other indicators. Finally, we determined the optimal cut-off values for NLR, hypersensitive c-reactive protein (hs-CRP), and procalcitonin (PCT) diagnosis of pulmonary infection using the receiver operating characteristic curve.We found that NLR was positively correlated with age, PCT, hs-CRP, and hospital stay, but negatively correlated with hemoglobin, red blood cell, and Albumin. The expression levels of PCT, hs-CRP, and NLR in the infected group decreased significantly than those before treatment. Multiple regression analysis revealed that NLR is an important independent risk factor for MHD patients with pulmonary infection. Additionally, receiver operating characteristic curve analysis showed that the sensitivity, specificity, and area under the curve were 87.76%, 100%, and 0.920 when using NLR combined with hs-CRP to predict pulmonary infection in MHD patients, whereas that of NLR combined with PCT were 87.76%, 96.08%, and 0.944, respectively.Findings from this study suggested that NLR is an independent risk factor for MHD patients with pulmonary infection, which can effectively predict pulmonary infection. Moreover, sensitivity and specificity were greatly enhanced when using NLR combined with PCT/hs-CRP to predict pulmonary infection in MHD patients.

Association Between Nutritional Status and Neutrophil Lymphocyte Ratio in Patients with Lung Cancer at Persahabatan Hospital, Indonesia

Context: Systemic inflammation in patients with lung cancer can be seen by the increase of neutrophil lymphocyte ratio (NLR) where these examinations are common in hospitals. Systemic inflammation can cause anorexia resulting in decreased nutrition intake of patients with lung cancer and affecting their nutritional status. One of the diagnostics of nutritional status for patients with lung cancer is using the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria that consist of decreased nutritional intake, weight loss, decreased muscle mass and subcutaneous fat mass, general or local fluid accumulation, and functional capacity. Malnutrition can be diagnosed if there are two of the six criteria. Aims: The study aims to determine the relationship between nutritional status and NLR in patients with lung cancer at Persahabatan Hospital in East Jakarta, Indonesia. Settings and Design: This cross-sectional study included 52 patients with lung cancer in oncology outpatient clinic of Persahabatan Hospital. Methods and Material: Data of characteristics subject were taken from interviews, physical examinations, laboratory analysis, and patients medical records in the oncology outpatient clinic of Persahabatan Hospital. Statistical analysis used chi-square or Fisher exact test to assess relationship between nutritional status and NLR (P

The effect of neutrophil-lymphocyte ratio in patients with COPD in Sohag University Hospital

NLR has also been evaluated as diagnostic and prognostic marker in COPD. Chronic inflammation in COPD resulting in the recruitment of the lymphocytes and neutrophils. Which, once activated, release neutrophil elastase, cathepsin G, proteinase-3, matrix metalloproteinase (MMP)-8 and MMP-9, and myeloperoxidase (MPO), which contribute in the pathophysiological mechanisms of emphysema and COPD. Aim of study Evaluate the NLR as a biomarker that can detect the severity and duration of COPD in patients with acute exacerbation and frequency of future exacerbation; we thus monitored NLR in COPD to evaluate it as a biomarker in patients and investigated its association with a variety of clinical aspects of COPD. Methodology It was a prospective observational study that was carried out among COPD patients with acute exacerbation and asymptomatic persons (controls). The study included 67 participants, 38 cases were COPD patients while 39 cases were healthy controls who were older than 40 years. The study was conducted among patients who admitted to chest department of Sohag University Hospital during period between February 2019 to January 2020, after the approval of the ethical committee and written consents where taken from the participants. Patients were diagnosed to have COPD according to the GOLD. The following laboratory investigations were done: complete blood count (CBC) inflammatory markers as neutrophil-lymphocyte ratio (NLR), were evaluated. Results The mean age of the studied COPD cases was 63.5(7.8) years and the mean age of the controls was 60(6.5) years. All the studied COPD cases and the matched controls were males. Compared to controls the levels of neutrophil, lymphocyte, basophil, eosinophil, NRL and platelet were significantly higher among the studied COPD cases. There was significant positive correlation between levels of leucocytes, neutrophils and NLR and duration of exacerbation. While, lymphocytes level was inversely associated with duration of exacerbation. Conclusions The present study demonstrates that NLR is associated with mortality and duration exacerbations, in COPD patients. For predicting exacerbations, we estimated the threshold of NLR to be 1.3 at baseline.

A High Neutrophil-Lymphocyte Ratio Is Associated With Increased Morbidity and Mortality in Patients With Coronavirus Disease 2019.

The neutrophil-lymphocyte ratio is an inexpensive and simple inflammatory marker. A higher ratio, indicative of an acute hyperinflammatory response or diminished overall physiologic health status, has been associated with poor prognoses. This study aimed to evaluate the prognostic potential of admission neutrophil-lymphocyte ratio in patients admitted to the medical ICU with coronavirus disease 2019. Retrospective review of prospectively collected data. Medical ICU from a large medical center. 2,071 consecutive patients admitted to the medical ICU with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 between March 15, 2020, and December 30, 2020, were grouped by neutrophil-lymphocyte ratio above or below the median (7.45) at the time of hospital admission. Complete blood count with differential at the time of hospital admission. A neutrophil-lymphocyte ratio above 7.45 at the time of hospital admission was associated with increased need for mechanical ventilation (45.8% vs 38.0%, p < 0.0001), vasopressor therapy (55.6% vs 48.2%, p = 0.001), and decreased survival through 180 days (54.8% vs 67.0%, p < 0.0001). Patients with a high neutrophil-lymphocyte ratio exhibited a 1.32 (95% CI, 1.14-1.54) times greater risk of mortality than those with a low neutrophil-lymphocyte ratio. The neutrophil-lymphocyte ratio at the time of hospital admission is an independent risk factor for morbidity and mortality. This prognostic indicator may assist clinicians appropriately identify patients at heightened risk for a severe disease course and tailor treatment accordingly.

Neutrophil-Lymphocyte Ratio in Patients with COVID-19 as a Simple Tool to Predict Requirement of Admission to a Critical Care Unit.

IntroductionCoronavirus disease-2019 (COVID-19) pandemic has overloaded the healthcare system beyond its functional capacity. Late referral to higher levels of care may be one of the factors associated with higher mortality. Therefore, we aimed to find simple demographic and laboratory parameters which predict the requirement of admission to a critical care unit.Materials and methodsA case–control study was undertaken in adult age population >18 years, admitted in a dedicated COVID hospital in South India. A total of 50 patients with severe disease (cases) were compared with 143 mild or asymptomatic cases (controls). Those demographic and laboratory parameters that were found to be significant on univariate analysis were used for multiple logistic regression analysis.ResultsUnivariate analysis of demographic and laboratory data showed higher age, male sex, presence of diabetes mellitus, higher values of C-reactive protein, ferritin, D-dimer, neutrophil–lymphocyte ratio (NLR), and lactate dehydrogenase to be significantly associated with cases. Multivariate logistic regression analysis of these significant variables showed NLR and ferritin to be the independent predictors of the requirement of admission to a critical care unit. The receiver-operating characteristic curve showed an NLR value of 5.2 and a ferritin value of 462 μg/L that were able to predict the requirement of admission in critical care units.ConclusionHigh ferritin and NLR were independent predictors of the requirement of admission in critical care units. NLR is a simple tool that can be used in resource-limited settings for triage and early referral to higher levels of care.How to cite this articleMaddani SS, Gupta N, Umakanth S, Joylin S, Saravu K. Neutrophil-Lymphocyte Ratio in Patients with COVID-19 as a Simple Tool to Predict Requirement of Admission to a Critical Care Unit. Indian J Crit Care Med 2021;25(5):535–539.

The Predictive Value of Interleukin-6 and Neutrophil-Lymphocyte Ratio in Patients with Severe and Extremely Severe Oral and Maxillofacial Space Infections.

Objective To investigate the correlation between clinical manifestation and neutrophil-lymphocyte ratio, C-reactive protein (CRP), and interleukin-6 (IL-6) in the patients with severe and extremely severe oral and maxillofacial space infection (OMSI). Methods In this retrospective study, we included 18 patients with severe and extremely severe OMSI from November 2012 to October 2018. Pearson or Spearman correlation coefficients were calculated to measure the association between the number of complications and locations and the number and percentage of lymphocyte, leukocyte, neutrophil, eosinophil, basophil, monocyte, CRP, and IL-6. A multivariable regression model was used to predict the number of complications and locations from these measures. Results IL-6 was positively correlated with neutrophil-lymphocyte ratio (rs = 0.773, P = 0.005), percentage of neutrophil (rs = 0.927, P = 0.001), and the number of neutrophil (rs = 0.627, P = 0.039). It was negatively correlated with percentage of monocyte (rs = −0.773, P = 0.005). CRP was positively correlated with neutrophil-lymphocyte ratio (rs = 0.556, P = 0.020) and percentage of neutrophil (rs = 0.515, P = 0.035). It was negatively correlated with the number of lymphocyte (rs = −0.517, P = 0.017), percentage of lymphocyte (rs = −0.578, P = 0.015), number of eosinophil (rs = −0.560, P = 0.020), percentage of eosinophil (rs = −0.504, P = 0.039), number of basophil (rs = −0.504, P = 0.039), and percentage of basophil (rs = −0.548, P = 0.023). The number of the involved organs was positively correlated with neutrophil-lymphocyte ratio (rs = 0.511, P = 0.030). The number of complications was positively correlated with the percentage of neutrophils (r = 0.738, P = 0.001), the neutrophil-lymphocyte ratio (r = 0.576, P = 0.012), IL-6 (rs = 0.907, P = 0.001), and CRP (rs = 0.599, P = 0.011). Multivariable regression analysis showed that the neutrophil-lymphocyte ratio (β = 0.080) was a significant predictor of the number of the involved organs and the neutrophil-lymphocyte ratio (β = 0.099). In addition, IL-6 (β = 0.002) was a significant predictor of the number of complications. Conclusions The neutrophil-lymphocyte ratio and IL-6 contributed to the assessment of general condition in severe and profound OMSI patients. These parameters can be used as predictors to evaluate the severity of OMSI.

The Prognostic Value of a Derived Neutrophil-Lymphocyte Ratio in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

The systemic immune-inflammatory index (SII) and derived neutrophil-lymphocyte ratio (dNLR) are novel indexes that simultaneously reflect the host inflammatory and immune status and have prognostic value in some cancers. SII was associated with major cardiovascular events in coronary artery disease patients who received percutaneous coronary intervention (PCI). However, dNLR correlations with clinical outcomes in acute coronary syndrome (ACS) patients undergoing PCI remain unclear. This study aimed to elucidate the predictive values of SII and dNLR on the long-term prognosis of patients with ACS undergoing PCI. In total, 1,553 ACS patients undergoing PCI were consecutively enrolled from January 2016 to December 2018. The subjects were divided into high and low SII and dNLR groups for comparison (high vs. low). The SII and dNLR cutoff values for predicting major adverse cardiovascular events (MACE) were calculated using receiver operating characteristic curves, and Kaplan-Meier curves and Cox regression models were used for survival analyses. The endpoint was a MACE, which included all-cause mortality and rehospitalization for severe heart failure during follow-up. The Kaplan-Meier curves showed that a higher SII or dNLR value was associated with a higher risk of MACE (all P < 0.001). Multivariate Cox regression models showed that SII (hazard ratio [HR]: 2.545; 95% confidence interval [CI]: 1.416-4.574; P = 0.002) and dNLR (HR: 2.610, 95% CI: 1.454-4.685, P = 0.001) were independent predictors for MACE. dNLR may be a suitable laboratory marker to identify high-risk ACS patients after PCI.

Neutrophil-lymphocyte ratio in patients with retinitis pigmentosa patients

Neutrophil-lymphocyte ratio in patients with retinitis pigmentosa patients

Clinical significance of neutrophil-lymphocyte ratio in patients with low-risk prostate cancer

Aim: Active surveillance is a highly emphasized approach to low-risk prostate cancer. Upgrading and upstaging should be evaluated carefully in this strategic management. This study aimed to analyze the relationship of neutrophil-lymphocyte ratio (NLR) with these two clinical conditions.Materials and Methods: Demographic data, prostate-specific antigen (PSA) levels, prostate volumes, NLR, disease stages, and Gleason scores of 59 low-risk prostate cancer patients who underwent radical prostatectomy and met active surveillance criteria were evaluated in our clinic. The patients were examined in four groups according to their postoperative pathology specimens. Accordingly, the patients with upgrading Group 1, while those without formed Group 2. Similarly, Group 3 consisted of the cases with upstaging and the patients with no upstaging were determined as Group 4.Results: Median age, PSA levels, prostate volumes, neutrophil and lymphocyte counts of the patients were 69.0 (63.0-72.0) years, 7.24 (5.50-8.90) ng/dL, 65.0 (60.0-65.0) cc, 6.40 (4.87-8.73) K/uL, and 2.50 (1.60-3.10) K/uL, respectively. Prostate volume and age distribution were similar between the groups. PSA levels were higher in Group 1 and Group 3 than those in Group 2 and Group 4 (p=0.012 and p=0.049, respectively). NLR was 3.54 (1.89-5.45) and 1.94 (1.68-3.76) in groups 1 and 2, respectively. Although these values were low in Group 2, a statistically significant relationship could not be established (p=0.266). NLR in groups 3 and 4 was 2.46 (1.52-5.45) and 2.24 (1.68-4.35), respectively. The NLR level in Group 3 was high; however, the difference was not statistically significant (p=0.953).Conclusion: The study let us to conclude that NLR alone is not sufficient to predict the clinical course of patients with low-risk prostate cancer.

The Potential Effect of Metformin Therapy on Neutrophil-Lymphocyte Ratio in Patients with Type II Diabetes Mellitus: A New Horizon

The Potential Effect of Metformin Therapy on Neutrophil-Lymphocyte Ratio in Patients with Type II Diabetes Mellitus: A New Horizon

Study of absolute neutrophil count and neutrophil-lymphocyte ratio in patients with type 2 diabetes mellitus and its correlation with diabetic nephropathy

Background and Objectives: Diagnostic markers to detect diabetic nephropathy at the early stage are important as early intervention can slow the loss of kidney function. Currently, there are very few diagnostic markers available. Micro-albuminuria is an accepted sign of early renal injury. Measurement of other markers such as neutrophil gelatinase-associated lipocalin and cystatin C, etc., is costly, and their utility is still under the research. Diabetic nephropathy in type 2 diabetes mellitus is thought to have elevated cytokines. However, their measurement is not easy. Absolute neutrophil count (ANC) and neutrophil-lymphocyte ratio (NLR) can act as a surrogate marker for the same. There is limited research concerning the correlation between ANC, NLR, and diabetic nephropathy. ANC is a very simple and inexpensive laboratory parameter. There are only a few studies done previously studying the association between ANC and albuminuria in the Indian population with type 2 diabetes mellitus. Subjects and Methods: This cross-sectional study was conducted in the hospitals attached to Bangalore Medical College and Research Institute. One hundred and forty-five Type II diabetes patients who gave consent for the study and satisfy the inclusion criteria were included in the study. Data were collected using semi-structured questionnaire, clinical examination, and relevant investigations. Statistical analysis was performed using the SPSS software. P

Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer.

BACKGROUNDGastric cancer (GC) is one of the most common malignant tumors in the world. Although in recent years tremendous progress has been made in its early detection, the postoperative overall survival (OS) of GC patients remains extremely low. A number of studies have shown that age, to varying degrees, affects the prognosis of patients with GC. Therefore, this study retrospectively analyzed the clinical and pathologic data of patients with GC to explore the differences in the clinical characteristics and prognostic factors in different age groups.AIMTo explore the difference in clinicopathological characteristics and prognostic factors in GC patients in different age groups.METHODSIn this retrospective study, we analyzed 1037 GC patients admitted to Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2010 to January 2013. The patients were divided into two groups based on age: Younger group (less than 70 years old) and older group (no less than 70 years old). In the younger group, we subdivided the patients in two subgroups by a cut-off value of 45 years. The clinical features and prognostic factors were analyzed in both groups. Subsequently, we retrieved studies that evaluated the predictive role of neutrophil-lymphocyte ratio (NLR) by searching two medical databases, PubMed and EMBASE, to conduct a meta-analysis. Random-effects model was used to pool the data.RESULTSIn the retrospective study, the mean OS time of the younger group (64.7 mo) was significantly longer than that of the older group (48.1 mo) (P < 0.001). Among patients under 70 years of age, hospitalization time, tumor–node–metastasis (TNM) stage, vascular invasion, and preoperative low pre-albumin were independently associated with OS (P < 0.005). In patients aged 70 years and above, TNM stage, esophageal invasion, histological type, and preoperative NLR were independent factors for OS (P < 0.05). The OS of these older patients was also significantly shorter (P < 0.05). In the meta-analysis, 19 retrieved studies included a total of 8312 patients, among whom 3558 had elevated NLR values. The results showed that high NLR value was a risk factor for the prognosis of GC (P < 0.01).CONCLUSIONThe OS of elderly patients is significantly worse than that of younger patients. There are significant differences in clinicopathological characteristics and prognostic factors between younger and older patients. NLR is a convenient, inexpensive, and reproducible marker that can be used as an important predictor of the prognosis of GC.

Impact of enhanced recovery after surgery on postoperative neutrophil-lymphocyte ratio in patients with colorectal cancer.

ObjectiveTo investigate the impact of enhanced recovery after surgery (ERAS) on the postoperative neutrophil–lymphocyte ratio (NLR) in patients with colorectal cancer.MethodsA total of 200 patients with colorectal cancer who underwent surgery between January 2015 and November 2018 were enrolled in the study. They were divided into a traditional treatment group (n=100) and an ERAS group (n=100). The traditional treatment group underwent radical laparoscopic colorectal surgery, and the ERAS group underwent traditional treatment plus the ERAS protocol (preoperative improvement of glucose tolerance, unconventional indwelling stomach and urinary tubes, intraoperative body temperature management, fluid management, postoperative pain management, early oral feeding, and early activities). Clinical data were collected for all patients. NLR levels before and after surgery, and complications were compared between the two groups.ResultsPostoperative NLR was significantly lower in the ERAS compared with the traditional treatment group. The incidence of complications, including anastomotic leakage, pulmonary infection, urinary tract infection, and cardiopulmonary dysfunction were also significantly lower in the ERAS group.ConclusionEnhanced recovery after surgery can reduce the increase in postoperative NLR and reduce the occurrence of postoperative complications, which results will be of clinical value.

Neutrophil-Lymphocyte Ratio in Patients with Acute Heart Failure Predicts In-Hospital and Long-Term Mortality.

The application of a simple blood test to predict prognosis in acute heart failure (AHF) patients is not well established. Neutrophil-lymphocyte ratio (NLR) is inexpensive and easy to obtain in hospitalized patients using a routine blood test. We evaluate the prognostic implications of NLR as an independent predictor of in-hospital and long-term mortality in AHF patients. Among 5625 patients enrolled in the Korean Acute Heart Failure registry, 5580 patients were classified into quartiles by their NLR level, and analyzed for in-hospital and post-discharge three-year mortality. Patients in the highest NLR quartile had the highest in-hospital and post-discharge three-year mortality. The same results were seen by dividing the aggravating factor into the infection or ischemia group and the non-infection or non-ischemia group. For patients aggravated from infection or ischemia, a cut-off NLR value was 7.0 that increase the risk of in-hospital and post-discharge three-year mortality. In subgroups of patients not aggravated from infection or ischemia, a cut-off NLR value was 5.0 that increase the risk of in-hospital and post discharge three-year mortality. Elevated NLR in AHF patients at the index hospitalization is an independent predictor for in-hospital and post-discharge three-year mortality. Taken together, NLR is a marker for risk assessment of AHF patients.

Prognostic significance of neutrophil lymphocyte ratio in patients of carcinoma cervix treated with radiotherapy

Background: The elevated neutrophil-to-lymphocyte ratio (NLR) has been identified as a poor prognostic indicator in various malignancies. The progression of malignancies is manifested as alteration in blood counts which can be used as the prognostic markers. Aim: The aim of the present study is to analyze the effect of pretreatment NLR and other hematological variables on progression-free survival (PFS) and overall survival (OS) among cervical cancers patients. Materials and Methods: The present retrospective study enrolled 303 cervical cancer (Stage IIB–IVA) patients treated by radical radiotherapy from January 2016 to December 2018. The pretreatment values of NLR, absolute neutrophil count, and absolute lymphocyte count (ALC) were recorded for each patient and their associations with the clinicopathologic variables, PFS, and OS were analyzed. Results: The optimal cutoff value of NLR was 3.0. The median follow-up period was 19 months. On univariate analysis, PFS rates during the follow-up period were significantly lower in NLR-high versus NLR-low group (P = 0.042) and in low-ALC versus high-ALC group (P = 0.018). Multivariate Cox-proportional hazards model identified NLR and ALC as the strongest prognostic factors for PFS. On univariate analysis, OS was better for patients with the International Federation of Gynecology and Obstetrics Stage IIB versus III–IVA (P = 0.046) and ALC >2000/c.mm versus ≤2000/c.mm (P = 0.050), respectively. None of the hematological variables remained significant for OS on the multivariate analysis. Conclusion: High-NLR is associated with worse survival outcomes in cervical cancer patients. NLR and ALC are the independent prognostic factors for PFS in cervical cancer patients.