Neutrophil-lymphocyte Ratio Ratio Research Articles

Association of baseline neutrophil-to-lymphocyte ratio and prognosis in melanoma patients treated with PD-1/PD-L1 blockade: a systematic review and meta-analysis.

Immunotherapy treatments that target programmed cell death receptor-1 (PD-1) or its ligand (PD-L1) have revolutionized the treatment of metastatic melanoma and currently represent the standard first-line treatment for this type of cancer. However, it is still not entirely clear which biomarkers are cost-effective, simple, and highly reliable. This systematic review and meta-analysis aims to analyze the predictive value of the baseline neutrophil-lymphocyte ratio (NLR) regarding disease progression and overall survival of patients with metastatic melanoma undergoing treatment with PD-1/PD-L1 blockade. PubMed, Scopus, and Web of Science were searched for studies comparing high versus low NLR. We performed the meta-analysis using RStudio v4.4.2 software. A total of 20 studies and 2691 patients were included, all with diagnoses of melanoma. The majority of the individuals were male 2278 (84, 65%). The median overall survival (OS) and progression-free survival (PFS) ranged from 5.0 to 44.4 and from 1.8 to 15.0 months, respectively. Compared with the high NLR ratio, the low exposure group achieved better rates of OS [hazard ratio (HR), 2.07; 95% CI, 1.73-2.48; P < 0.00001; I² = 47%]. Regarding PFS, there was a statistically significant difference between groups with tendencies toward the low NLR exposure group (HR, 1.59; 95% CI, 1.39-1.81; P < 0.00001; I²=31%]. This systematic review and meta-analysis revealed significant lower OS in melanoma patients treated with PD-1/PD-L1 blockade who had elevated baseline NLR values. Furthermore, an increased PFS was observed in patients with a lower baseline NLR value. This study highlights NLR as an important prognostic biomarker for patients with metastatic melanoma who are candidates for treatment with PD-1 and PD-L1.

Can the neutrophil-to-lymphocyte ratio be used as an early marker of small fetuses for gestational age? A prospective study.

Small-for-gestational-age (SGA) fetuses are at increased risk of mortality and morbidity, and less than 30% will be detected by any ultrasound scan within 4 weeks before delivery. Our aim was to evaluate the relationship between neutrophil/lymphocyte ratio (NLR) in the first trimester of pregnancy and SGA fetuses. We performed a prospective study between June 2021 and August 2022, to evaluate the relationship between the neutrophil to lymphocyte ratio in maternal blood in the first trimester of pregnancy, with the birth of an SGA fetus. One hundred ninety-four participants with singleton pregnancies between 11 + 1 and 13 + 6 weeks of gestation were recruited. Pregnancies affected with diagnosed fetal chromosomal abnormalities, or chronic pathologies were excluded. SGA was defined as birthweight less than the 10th centile (N = 42) and severe SGA as birthweight less than the 3rd centile for gestation (N = 10) according to a locally derived descriptive charts. The NLR value measured in the first trimester was compared between these two groups and controls. We found no statistically significant difference in NLR, (3.5 +/-1.2 vs. 3.4+/-1.2, p-value of 0.78) when comparing the SGA less than the 10th centile group to the control group. NLR was also not different between severe SGA and controls (3.6+/-1.4 vs. 3.4+/-1.2 p-value of 0.78). We found no association between first-trimester NLR ratio and SGA.

Is It Possible to Use Inflammatory Markers as Potential Biomarkers for Chronic Urticaria?

Background: This study aimed to determine whether the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) at admission affect the transition of pediatric patients diagnosed with acute spontaneous urticaria to chronic urticaria. Methods: This study included 390 patients who presented to the Department of Pediatrics at Akdeniz University Hospital with acute spontaneous urticaria between January 2020 and December 2022. A statistical comparison was made between the hematological parameters of patients who developed chronic urticaria and those who did not. Neutrophil, lymphocyte, and platelet counts, as well as NLR, PLR, and SII ratios, were used for the comparison. Results: It was observed that acute urticaria progressed to chronic urticaria in 5.8% (n = 23) of the patients. No significant differences in lymphocyte, hemoglobin, and platelet counts were observed between the group progressing to chronic urticaria and the control group (P > 0.05). However, the chronic urticaria group had higher leukocyte and absolute neutrophil counts (P = 0.009 and P < 0.001, respectively). In addition, the NLR was significantly higher in the chronic urticaria group (P = 0.029), whereas no statistically significant difference was observed in the PLR (P = 0.180). The chronic urticaria group had a significantly higher SII than the control group (P = 0.011). Conclusion: Hematological parameters, particularly NLR and SII, may be useful indicators of the transition from acute to chronic urticaria in pediatric patients. The early identification of these markers could help monitor patients and guide treatment decisions. Further comprehensive studies are required to validate these findings.

Abstract PO1-02-12: Nutritional guidance effect on anthropometric and inflammatory parameters in young women with breast cancer

Abstract Background Young women with breast cancer (YWBC) debut with more aggressive and advanced diseases; it may be related to chronic inflammation caused by the tumor. However, in Latin America, breast cancer is also related to malnutrition conditions such as obesity. Malnutrition is commonly associated with physiological adaptations to stress and inflammation resulting in muscle catabolism and loss of functionality, which may affect oncology outcomes. Our research group had previously reported that YWBCs in Mexico are overweight or obese at diagnosis. Although they received educational support, this malnutrition prevalence continues or increases during the follow-up. A limitation of this previous study is that we only have data such as weight and height and miss other anthropometric parameters to measure the metabolic impact of weight gain. Body composition assessment is valuable for measuring malnutrition, obesity, and sarcopenia. The body composition assessment with Bioimpedance analysis (BIA) provides valuable parameters such as phase angle (PhA), which correlates with nutritional status, disease prognosis, inflammation, cell health, and metabolic activity. BC patients with a PhA &amp;gt;5.6 show a better survival rate. Another accessible tool to evaluate systemic inflammation is the neutrophil-lymphocyte ratio (NLR). Higher NLR (&amp;gt;2.12) is associated with worse disease-free and overall survival. This pilot study aims to measure the importance of PhA and NLR in YWBC with early breast cancer at diagnosis and at 12 months to evaluate the effects of personal nutritional guidance on these parameters. Methods Patients included in the “Joven &amp; Fuerte (J&amp;F) navigator program” of the National Institute of Cancerology (INCan) from 2021 to 2022 were invited to participate in this observational study. To evaluate the efficacy of personal nutritional guidance in anthropometric and NLR parameters, basal and 12-month BIA and anthropometric measures such as the Waist-Hip index were assessed, and NLR was obtained from the patient's records. Results Eleven early breast patients agreed to participate in the pilot intervention. The median age of the participants was 37 years. The majority had local advanced disease (54.5%), regarding molecular subtype luminal was the more frequent subtype (45.5%), followed by HER2 (36.4%), triple-negative (18.2%). According to BMI at diagnosis, 18.2% had normal-weight, 63.6% were overweight, and 18.2% had obesity. At follow-up, 9.1% had normal-weight, 63.6% were overweight, and 27.3% had obesity. A significant change in body composition parameters was observed, the percentage of patients with excess adipose tissue increased from 54.5% at baseline to 81.1%. All patients exhibited cardiovascular risk, as indicated by a Waist-Hip ratio greater than 0.80, and maintained a PhA (5.2 at baseline, 5.5 final) associated with overall survival risk. No significant changes were observed in the NLR ratio (2.14 baseline, 2.34 final), maintaining the related risk for this parameter. Conclusions This pilot analysis suggests that a nutritional intervention based only in nutritional guidance and support seems inefficient in impacting nutritional or inflammatory parameters. A multidisciplinary intervention involving multidisciplinary healthcare teams, including rehabilitation, and psychology, may be required to achieve therapeutic effectiveness in this population. Further studies with larger sample sizes are necessary to confirm these findings and determine the most effective strategies to improve the nutritional status, cardiovascular health, and clinical outcomes of YWBC. Anthropometric and inflammatory parameters a The values presented as median and interquartile range, Wilcoxon. b The values presented as mean and standard deviation, paired t-test. Citation Format: Aline Barranco-Cortés, Fernanda Sarahi Fajardo-Espinoza, Ana Lorena Espadas-Vargas, Dana Aline Pérez-Camargo, Sara Aileen Cabrera-Nieto, Marlid Cruz-Ramos, Alejandro Mohar, Lucero Itzel Labra Alvarado, Cynthia Mayté Villarreal Garza. Nutritional guidance effect on anthropometric and inflammatory parameters in young women with breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-02-12.

The Potential of Leukocyte Ratio to Differ Pediatric Tuberculosis from Bronchopneumonia

Introduction: Differentiating between TB and pneumonia is crucial to avoid treatment delays. Delayed diagnosis can result in reduced patient survival rates, increased treatment expenses and prolonged treatment durations. Several leukocyte ratios such as Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) will be compared to confirm whether it can be used to distinguished pulmonary tuberculosis from community-acquired pneumonia. Material and Methods: Retrospective study of 100 children aged 1-12 years who were treated at RSUD Dr. Haryoto Lumajang, period 1 January 2019 – 1 January 2023. Data on age, gender, diagnosis and laboratory results were obtained from medical records. Results: Of the 100 children included 50 had TB disease and 50 had pneumonia. The mean of neutrophil counts was significantly higher in the control group compared to the case group. NLR and MLR ratio were statistically significant. NLR were both statistically significant in both &lt;5 years old and &gt;5 years old, but MLR were not significantly different in both age groups. A significant but weak positive correlation was found between tuberculosis (case) group, pneumonia (control) group, and age of children (r=0.132; p=0.048). Younger children (less than 5 years old) had 0.571-fold odds for tuberculosis infection compared to the older children. Conclusion: NLR hold promise as readily accessible diagnostic biomarkers for distinguishing children with TB disease from those with pneumonia.

Abstract 770: The innate immune system response to malignancy- under the radar

Abstract It has become clear that many cancers evade detection by, for example, silencing of immune checkpoints. Re-activation of the immune armamentarium by checkpoint inhibitors has improved survival in many types of cancer. However, we still are unable to gauge the response of the innate immune system (InImS) to incipient malignancy. The InImS is likely both a sentient early warning system and an immediately deployed cancer combatant. We describe a potential marker that quantifies the innate immune system response to multiple deadly tumors. Methods: We obtained a database of patients at high risk of colorectal neoplasia and prospectively noted those who contracted cancer on follow up. We contrasted the historic, premorbid biomarker response from the time of enrolment, primarily using the FERAD ratio. This was obtained by dividing the ferritin blood concentration by the denominator of fecal shedding of a Paneth cell marker, p87. We also compared the FERAD response to the absolute neutrophil:lymphocyte ratio (NLR), a known prognostic biomarker, and also the available, known PDL-1 response for each group of cancers. Results: We found that certain groups of cancers historically had very low FERAD ratios while others were high. Using FERAD ratios for lung, gastric, non-Hodgkin’s lymphoma, melanoma, thyroid, renal, and head and neck cancers, there is a significant inverse correlation between survival and FERAD (r=-0.8;p&amp;lt;0.025) which is similar to that of NLR (r=-0.7;p&amp;lt;0.035). For prostate cancer, breast, colorectal cancer (CRC), leukemia/MDS, there is a direct correlation between survival and FERAD (r=0.99;p&amp;lt;0.002). There is also an inverse relationship between NLR and PDL-1 response rates (r=-0.8;p&amp;lt;0.04). An observed mild positive trend for FERAD PDL-1 response rates may bode well for melanoma, lung, head and neck and renal cancers. Conclusions: Since p87 could be manipulated by dietary means to affect the FERAD ratio favorably, this could be incorporated into more effective chemotherapy regimens and result in better cancer treatment outcomes. Hepatocellular cancer (HCC) and CRC-liver metastasis appear to be immunological outliers. This will need an additional unique approach such as TIGIT intervention therapy (Zheng et al.. Immune checkpoint targeting TIGIT in HCC. Am J Transl Res. 2020). This may allow modulation of the immune response based on FERAD, NLR ratios, and other considerations of mutational burden and genetic mutations, in patients with selected cancers. Citation Format: Martin Tobi, Harvinder Talwar, Benita McVicker. The innate immune system response to malignancy- under the radar [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 770.

Sterile Inflammatory Response and Surgery-Related Trauma in Elderly Patients with Subtrochanteric Fractures.

Sterile inflammation is a natural response of the organism in the absence of microorganisms, which is triggered in correspondence with the degree of tissue damage sustained after a surgical procedure. The objective of this study was to explore the values of postoperative hematological-derived biomarkers in assessing the sterile inflammatory response magnitude related to the invasiveness of the surgical reduction technique used for subtrochanteric fractures (STFs) treatment. A retrospective, observational cohort research was conducted between January 2021 and October 2023 that included a total of 143 patients diagnosed with acute subtrochanteric fractures who underwent long Gamma Nail (LGN) fixation. According to the surgical reduction technique used, they were divided into two groups: group 1, which consisted of those with a closed reduction and internal fixation (CRIF); and group 2, which consisted of those with an open reduction internal fixation (ORIF). Between groups, statistically significant differences (p < 0.05) were found in relation to days to surgery, length of hospital stay (LOHS), duration of surgery, postoperative hemoglobin (HGB) levels, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI). The receiver operating characteristics (ROC) curve analysis revealed that all ratios presented a high diagnostic ability (p < 0.0001) with NLR > 6.95 being the most reliable (sensitivity 94.8% and specificity 70.6%). Moreover, the multivariate regression model confirmed that sterile immune response after orthopedic interventions can be assessed in an almost equal and non-dependent manner using these biomarkers. Postoperative NLR, PLR, MLR, SII, SIRI, and AISI ratios are closely correlated to the sterile inflammatory response magnitude, due to the extent of surgical dissection performed during internal fixation procedures of subtrochanteric femur fractures.

Neutrophil-to-Lymphocyte Ratio and Thrombocyte-to-Lymphocyte Ratio as a Predictor of Severe and Moderate/Mild Acute Respiratory Distress Syndrome Patients: Preliminary Results.

Acute respiratory distress syndrome (ARDS) represents a major cause of mortality in the intensive care unit (ICU). The inflammatory response is escalated by the cytokines and chemokines released by neutrophils, therefore the search for quantifying the impact of this pathophysiological mechanism is imperative. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are indicators of systemic inflammation, widely accessible, inexpensive, and uncomplicated parameters. We conducted a prospective study between March 2023 and June 2023 on patients which presented Berlin criteria for the diagnosis of ARDS during the first 24 hours from admission in the ICU. We included 33 patients who were divided into two groups: one group of 11 patients with severe ARDS and the second group of 22 patients with moderate/mild ARDS. The study evaluated demographic characteristics, leukocyte, lymphocyte, neutrophil, and platelet counts, as well as NLR and PLR values from complete blood count, and severity scores (APACHE II score and SOFA score). We investigated the correlation of NLR and PLR in the two main groups (severe and moderate/mild acute respiratory distress syndrome patients). For the NLR ratio statistically significant differences between the two groups are noted: Severe ARDS 24.29(1.13-96) vs 15.67(1.69-49.71), p=0.02 For the PLR ratio, we obtained significant differences within the group presenting severe ARDS 470.3 (30.83-1427) vs. the group presenting mild/moderate ARDS 252.1 (0-1253). The difference between the two groups is statistically significant (0.049, p<0.05). The cut-off value of NLR resulted to be 23.64, with an Area Under the Curve (AUC) of 0.653 (95% CI: 0.43-0.88). The best cut-off value of PLR was performed to be 435.14, with an Area Under the Curve (AUC) of 0.645 (95% CI: 0.41-0.88). Our study showed that NLR and PLR ratios 24 hours in patients with moderate/severe ARDS diagnosis can be a good predictor for severity of the disease. These biomarkers could be used in clinical practice due to their convenience, inexpensiveness, and simplicity of parameters. However, further investigations with larger populations of ARDS patients are necessary to support and validate these current findings.

Preoperative Neutrophil–Lymphocyte Ratio and Serum Carcinoembryonic Antigen as Predictive Factors of Colorectal Cancer Survival

Introduction. Colorectal cancer is the second leading cause of death worldwide, with a high mortality rate. This study investigates the predictive value of the neutrophil–lymphocyte ratio (NLR) and carcinoembryonic antigen (CEA) in predicting the survival rates of colorectal cancer patients in Indonesia. Method. This retrospective cohort study enrolled the colorectal cancer stage I–IV patients treated at Cipto Mangunkusumo General Hospital (CMGH). The independent variables are NLR and CEA, while the dependent variable is the five–year survival of colorectal cancer. The log rank test proceeded to find a correlation between NLR and CEA with 5–year survival, and the Cox proportional hazard regression proceeded to analyze the predictive value. Results. Of the ninety–six subjects who met the inclusion and exclusion criteria who were enrolled, 6.25% had high NLR, and 66.6% had high CEA levels. The overall five–year survival rate was 35.4%. However, the proportion of subjects with normal NLR had a higher five–year survival rate compared to those with high NLR, and the same pattern was observed for CEA levels. Subgroup analysis based on the cancer stage showed a significant association between high NLR and increased risk of mortality in TNM stages I–II. Still, no significant difference in survival based on NLR was observed in stages III–IV. Conclusion. The preoperative NLR ratio and preoperative CEA did not show a predictive role in colorectal cancer survival. However, when stratifying by cancer stage, there was a significant difference in preoperative NLR levels between the deceased and non–deceased groups in patients with stage I–II colorectal cancer.

Biomarker array for prediction of acute kidney injury after percutaneous coronary intervention for patients who had acute ST segment elevation myocardial infarction

Acute kidney injury (AKI) is a common complication after Percutaneous Coronary Intervention (PCI) for ST segment elevation myocardial infarction (STEMI) and is associated with poor outcomes. AKI is diagnosed by the dynamic change of serum Cr, but it could not predict AKI. This study aimed to evaluate a biomarker array that may fulfill this shortage. Setting: Cardiology Department, Tanta University Hospital. Design: Prospective interventional study included 280 acute STEMI patients who underwent emergency PCI. Serial samples of blood and urine were obtained at the time of admission to the hospital (T0) and PCI unit (T1) and at 12 h and 72 h (T12 and T72) after coronary revascularization to estimate levels of serum Cr, creatine phosphokinase, and heart-type fatty acid-binding protein (H-FABP) and calculation of neutrophil/lymphocyte ratio (NLR) and urinary liver-type FABP (L-FABP). AKI was diagnosed according to the recommendations of the European Renal Best Practice as the times of increased serum Cr concerning baseline level. 85 patients developed AKI. Regression analyses defined a high NLR ratio in the T0 sample as the most significant predictor for early AKI diagnosed at T1 time, while high NLR and serum H-FABP levels in T1 samples as the significant predictors for AKI defined at T12 time. However, high urinary L-FABP levels in T12 samples and high NLR are significant predictors for AKI at T72 time. Combined estimations of serum H-FABP and urinary L-FABP with the calculation of NLR could predict the oncoming AKI and discriminate its pathogenesis. The study protocol was approved by the Local Ethical Committee at Tanta Faculty of Medicine by approval number: 35327/3/22. For blindness purposes, the authors will be blinded about the laboratory results till the end of 72 h after revascularization and the clinical pathologist will be blinded about the indication for the requested investigations.

Correlation Between Rheumatoid Arthritis Activity with Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio: A Case-Control Study

Background: Patients with Rheumatoid arthritis (RA) may suffer from joint deformity, due to the inflammatory process in active disease. Inflammation may lead to disability in patients with RA. The neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) have been emerged as markers of many inflammatory diseases including RA. The aim of this study was to evaluate the role of NLR and PLR ratios in the evaluation of RA activity and their relation with DAS-28 that is already used for the assessment of RA disease activity. Our patients were divided into group A (patients with active disease, DAS-28 &gt; 2.6) and group B (patients with remission, DAS-28 &lt; 2.6). The patients with active disease were subdivided into three subgroups (patients with high disease activity with DAS-28 &gt; 5.1, moderate disease activity patients with DAS-28 &gt; 3.2, and low disease activity patients with DAS-28 &lt;3.2 and &gt;2.6). Results: NLR and PLR are significantly higher in patients with RA than in healthy people and higher in patients with active disease than those in remission and significantly positively correlated with RA activity. Conclusion: Both NLR and PLR are two inflammatory markers that are useful in evaluating RA disease activity as they are simple, cheap, and objective markers.

Predictive Factors Associated with Delayed Graft Function Following Renal Transplantation: A Retrospective Cohort Study

Kidney transplantation has become a routine procedure for end-stage renal disease. Although improvement in short term graft patency has been achieved, delayed graft function (DGF) is one of the important complications following kidney transplantation. DGF results from ischemia-reperfusion injury and involves a multitude of contributing elements including donor characteristics and etiology of the end-stage renal disease. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are easily applicable methods for evaluation of systemic inflammation. We hypothesized that these parameters could refine the detection of the patients with DGF in post- renal transplantation and guide management. To test our hypothesis, we investigated whether the NLR, PLR, and creatinine reduction ratio CRR could serve as prognostic indicators for identifying patient cohorts at an elevated risk of negative treatment outcomes following renal transplantation. We also assessed demographic and clinical factors as an independent predictor to detect negative early graft function outcomes in patients after renal transplantation. This single center retrospective cohort trial comprising 55 patients who received a kidney graft from deceased or living donors was performed in Northern Cyprus Ministry of Health’s Dr. Burhan Nalbantoglu State Hospital, over a 6 year period. The demographic and clinical variables included age, gender, body mass index, the etiology of end-stage renal disease, kidney graft from living or deceased donors, NLR, PLR and CRR. DGF was defined as GFR&lt;60 on the 21th day following renal transplantation. Of the patients included in this study, 26 (47.3%) and 29 (52.7%) received deceased and living donor kidney transplantation, respectively. On the 21st day following transplantation, 27 patients (49%) had an eGFR&lt;60, whereas 28 patients (51%) had an GFR≥60. None of the patients had undergone dialysis within the first week after transplantation. There were no significant differences in demographic and clinical characteristics between the patients with eGFR 60 and eGFR 60. In logistic regression analysis, none of the predictors including etiology of the end-stage renal disease, source of donor, or demographic baseline characteristic were associated with DGF. We suggest that the NLR and PLR parameters are not associated with the presence of DGF after renal transplantation. Keywords: Renal transplantation, Delayed graft function, Renal failure, Glomerular filtration rate, End-stage renal disease.

Role of hemogram parameters as predictive markers for propofol injection pain in reproductive and postmenopausal women: a prospective study

Aims: In clinical practice, propofol injection pain (PIP) is a frequent condition that clinicians could face every day. The aim of this prospective study was to investigate the correlation between PIP and hemogram parameters in reproductive and postmenopausal women.&#x0D; Methods: In this prospective study, 40 reproductive and 40 postmenopausal female patients who underwent elective surgery were enrolled. Baseline data including age, weight, height, hemogram parameters, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune inflammatory score (SII) were recorded preoperatively. The pain was classified as 0: no pain, 1: mild pain, 2: moderate pain, 3: severe pain. Patients were previously informed about the questioning of pain scores during propofol.&#x0D; Results: The proportion of patients experiencing PIP in postmenopausal (n=16;40%) group was significantly higher than those in the reproductive group (n=6;15%) (p=0.009). When reproductive and postmenopausal groups were compared according to the presence or absence of pain, no difference was found between the groups in terms of hemogram ratios and platelet indices (p&gt;0.05). The NLR, PLR and SII ratios were not significant in predicting the presence of PIP. &#x0D; Conclusion: The findings of our study showed that the occurrence of PIP in postmenopausal women was higher compared to women in reproductive age. Hemogram values, NLR platelet, PLR and SII ratios were not significantly associated with the presence of PIP.

Evaluation of Neutrophil/Lymphocyte Ratio, Low-Density Lipoprotein/Albumin Ratio, and Red Cell Distribution Width/Albumin Ratio in the Estimation of Proteinuria in Uncontrolled Diabetic Patients.

Introduction Diabetic nephropathy associated with end-stage renal disease (ESRD) is a significant public health problem due to its high morbidity and mortality. We aimed to improve the estimation of proteinuria in diabetic patients and potentially enhance risk stratification and clinical management strategies with the assessment of the correlation of the neutrophil/lymphocyte ratio (NLR), low-density lipoprotein/albumin ratio (LAR), and red cell distribution width/albumin ratio (RAR) with the proteinuria in the uncontrolled diabetes patient population. Methods This was a retrospective study including 327 patients with uncontrolled diabetes (HbA1c > 10%) seen in an outpatient clinic. The study enrolled patients over 18 years old, excluding those with active infections, malignancies, immunodeficiency, hematological diseases, pregnancy, breastfeeding, or type I diabetes. Patients using specific drugs affecting proteinuria or lipid levels were also excluded. Data from patients were retrospectively obtained, including gender, age, blood parameters, glucose, creatinine, albumin, cholesterol, triglyceride, and HbA1c levels, as well as spot urine protein and creatinine levels. Proteinuria was assessed using a spot urine protein/creatinine ratio (>0.30 indicated proteinuria). Patients were divided into two groups: group 1 (non-proteinuric with uncontrolled diabetes) and group 2 (proteinuric with uncontrolled diabetes). Demographics, laboratory results, and LAR, NLR, and RAR values were compared between the groups with univariate and multivariate analyses. All statistical analyses were performed using IBM SPSS Statistics for Windows software. For the statistical significance level, p<0.05 was accepted as meaningful. Results Among 327 patients with uncontrolled diabetes, 33.03% were proteinuric. Patients with proteinuria were significantly older (median age 65 vs. 61 years) and had higher NLR and RAR values. There were no significant differences observed in terms of LAR values between groups. Serum albumin levels were lower and urea levels were higher in the proteinuric group. A multivariate analysis was done to identify variables for the prediction of proteinuria. NLR and RAR were found to be independent predictors of proteinuria even after adjusting for potential confounders in the multivariate analysis. The model achieved a 71.9% correct classification rate. An NLR cutoff of 1.93 increased the likelihood of proteinuria 1.93-fold, while a RAR cutoff of 3.30 increased the likelihood 1.63-fold. Conclusions We found that the LAR ratio cannot be used to predict proteinuria in patients with HbA1C levels above 10, but the NLR and RAR ratios can guide the clinician regarding proteinuria and potentially enhance risk stratification and clinical management strategies before a detailed workup.

A biomarker predicting unfavorable prognosis in malignant pleural mesothelioma: systemic immune–inflammation index

Aim: Malignant pleural mesothelioma (MPM) is an extremely mortal condition. Only a few prognostic biomarkers have been described for MPM. Our study looked into the association between patient survival and the Systemic Immune Inflammation Index (SII).&#x0D; Material and Method: A total of 158 patients who were admitted to our hospital between January 2013 and December 2022, and had a histopathologically confirmed diagnosis of MPM were included in the study. Before treatment, hematological parameters and SII were determined. A Spearman's correlation analysis was performed to analyze the correlation of mean survival with hematological parameters.&#x0D; Results: The study involved 158 patients in all. 70 patients had a history of smoking, the median age was 63 years, the mean survival time was 15.3 months, and 57.6% of the participants were men. The epithelioid type (84.2%) was the most prevalent histological subtype, and 29 patients had stage 4 illnesses. Of the participants, 84% had received chemotherapy, and 22% had received radiotherapy before. Among the 39 patients who had surgery, 5 had an extrapleural pneumonectomy. SII mean±sd was (1427.2±1207.3). The patients with stage 4 disease had significantly shorter survival (p=0.001). The patients who had surgery survived significantly longer (p=0.01). Hemoglobin (Hb) (r:0.21, p:0.01) and Hematocrit (Hct) (r:0.18, p:0.03) values showed weak positive correlations with mean survival. It was evident that mean survival got shorter as SII (r:-0.17, p:0.04) and neutrophil-lymphocyte ratio (NLR) (r:-0.19, p:0.02) values got higher. On the other hand, there was a strong positive association between mean survival and the lymphocyte-monocyte ratio (LMR) (r:0.21, p:0.01). When the parameters that had statistically significant differences among the groups were taken as control variables and the statistical analysis was re-performed, it was found that Hgb and Hct values as well as NLR and LMR ratios lost their significant correlations with survival. However, the SII ratio was still negatively correlated with survival (r:-0.16, p:0.04). &#x0D; Conclusion: Pretreatment SII is a noninvasive and easy-to-calculate biomarker that predicts the prognosis of MPM. It is negatively correlated with mean survival regardless of the tumor stage and surgical management.

The Effect of Virus-Specific Vaccination on Laboratory Infection Markers of Children with Rotavirus-Associated Acute Gastroenteritis

Rotavirus (RV) is one of the most common and important causes of acute gastroenteritis (AGE) in newborns and children worldwide. The aim of this study was to evaluate the effect of the RV vaccine on the natural history of RV infections using the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune inflammatory index (SII) as hematological indexes, clinical findings, and hospitalization. Children aged 1 month to 5 years who were diagnosed with RV AGE between January 2015 and January 2022 were screened, and 630 patients were included in the study. The SII was calculated by the following formula: neutrophil × platelet/lymphocyte. Fever and hospitalization were significantly higher and breastfeeding was significantly lower in the RV-unvaccinated group than in the RV-vaccinated group. The NLR, PLR, SII, and CRP were significantly higher in the RV-unvaccinated group (p < 0.05). The NLR, PLR, and SII were significantly higher both in the non-breastfed group than in the breastfed group and in the hospitalized group than in the not hospitalized group (p < 0.05). CRP was not significantly different in either the hospitalization group or the breastfeeding group (p > 0.05). SII and PLR were significantly lower in the RV-vaccinated group than in the RV-unvaccinated group in both the breastfed and non-breastfed subgroups. For NLR and CRP, while there was no significant difference according to RV vaccination status in the breastfed group, there was a significant difference in the non-breastfed group (p value: <0.001; <0.001). Despite the low level of vaccine coverage, the introduction of RV vaccination had a positive impact on the incidence of RV-positive AGE and related hospitalizations in children. These results showed that breastfed and vaccinated children were less prone to inflammation because their NLR, PLR, and SII ratios were lower. The vaccine does not prevent the disease 100%. However, it can prevent severe disease with exsiccation or death.

NEUTROPHIL-LYMPHOCYTE RATIO: A PREDICTOR OF COMPLICATIONS IN TYPE 2 DIABETES MELLITUS PATIENTS

Background: Chronic inflammation plays a potential role in development of diabetes related complications in type 2 diabetes mellitus (T2DM). Neutrophil-lymphocyte ratio (NLR) is one of the potential markers of systemic inflammation. The objective of this study was to examine an association between NLR and T2DM associated complications.&#x0D; Methods: A cross sectional study was conducted at Sheikh Zayed Medical College &amp; affiliated hospital in Rahim Yar Khan from June - September 2022. About 360 patients were divided in to three groups. Group A were comprised of T2DM patients without diabetic complications while group B and C were T2DM patients with micro- and macro-vascular complications respectively. Micro- and macrovascular complications were assessed by history, physical examination and medical records. Association of diabetes related compilations with NLR value was done using regression analysis with SPSS version 25.&#x0D; Results: The baseline demographic characteristics of three study groups did not show statistically significant difference. However TLC count is significantly elevated in group B (with microvascular complications) and group C T2DM with macrovascular complications (P&lt;0.001) respectively compared to control group A. Similarly NLR ratio was significantly higher (4.8±2.0 &amp; 5.0±1.8) in group B and group C respectively, compared to group A (2.2±0.8 with P&lt;0.001). Regression analysis showed that NLR was positively correlated with diabetes related micro and macrovascular complications (OR: 4.62, 95% CI: 2.51-7.26, p&lt;0.001) along with HbA1c (OR: 1.732, 95% CI: 1.82-2.22, P=0.002).&#x0D; Conclusion: High NLR ratio is associated with diabetes related micro and macro vascular complications. It should be routinely measured in T2DM patients for prevention of diabetes related complications.

Correlation Between Neutrophil-Lymphocyte Ratio, Platelets-Lymphocyte Ratio, and High-Resolution CT in Patients with COVID-19

Background: COVID-19 is a highly infectious disease that necessitates simple and rapid methods for recognising severe patients. Aims: To correlate between chest lesions in CT, neutrophil-lymphocyte ratio (NLR), and platelets-lymphocytes ratio in patients with COVID-19, and to detect their cut-off values as an early warning of severe COVID-19 in Egyptian patients. Subjects and Methods: A cross-sectional study included 100 adult patients with COVID-19 attending Ahmed Maher Teaching Hospital, Cairo, Egypt. Clinical, laboratory, and radiological assessments were done. They were classified according to their CT grades into three groups: seven patients with a normal chest CT, 45 non-severe cases, and 48 severe cases. Results: Dyspnoea was the most common symptom among the severe cases (79.2%) and fever among non-severe cases (71.1%), while cough (85.7%) was the most common among cases with a normal CT. The age, NLR, C-reactive protein (CRP), and D-dimer of severe cases were significantly the highest, while the absolute lymphocytes were significantly the lowest. Highly significant positive correlations were found between CT grades with D-dimer, NLR, and CRP; significant positive correlation was found with age; and significant negative correlation with CT. Using receiver operating characteristic analysis, areas under the curve of D-dimer, NLR, age, CRP, ferritin, and platelet-lymphocyte ratio were 0.760, 0.698, 0.640, 0.627, 0.614, and 0.595, respectively. The optimal cut-off value of NLR was 2.50 with 0.74 specificity, 0.61 sensitivity, and 67.5 accuracy. Conclusion: NLR is a reliable and easy-to-use predictor of COVID-19 severity. NLR (&gt;2.5) should prompt prescription of a chest CT as it could reveal essential lesions that influence further management.

Systemic immuno-inflammatory index in patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma.

In recent years, the role of some hematological parameters used as chronic inflammation markers in the pathogenesis of many ocular and systemic diseases has been investigated. For ocular diseases such as uveitis, keratoconus, and retinal vein occlusion, the neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII) have been reported to be useful inflammatory biomarkers. It has also been reported that low-grade chronic inflammation plays a role in the formation of pseudoexfoliation. To evaluate the NLR, SII, and platelet-lymphocyte ratio (PLR) in patients with pseudoexfoliation syndrome (PEXS) and pseudoexfoliative glaucoma (PEXG). This was a retrospective case-control study. This study evaluated the clinical and laboratory data of 34 patients with PEXS, 33 patients with PEXG, and 33 control patients. Detailed eye examination notes in patient files and blood count measurements were recorded. SII values were the highest in the PEXS group, followed by the PEXG and control groups (582.01 ± 339.9, 478.14 ± 211.7, and 413.98 ± 129.5, respectively) (p = 0.043). In paired comparisons, the SII values of the PEXS group were significantly higher than the control group (p = 0.011). The mean NLR rate was highest in the PEXS group, followed by the PEXG and the control groups (2.46 ± 1.6, 2.17 ± 0.8, and 1.69 ± 0.4, respectively) (p = 0.023). In paired comparisons, the mean NLR levels were higher in the PEXS and the PEXG groups than in the control group (p = 0.03 and p = 0.01, respectively). There was no significant difference between the groups in terms of PLR. According to receiver operating characteristic curve analysis, the optimal cut-off value for estimating PEXS was found as >449.4 for SII and 1.78 for NLR (p = 0.011 and p = 0.031, respectively). In PEXS patients, both SII and NLR were significantly higher, albeit in a small group of patients, and SII may be a helpful and supportive parameter for NLR in risk estimation in these patients. There was a statistically significant difference only in NLR in patients with PEXG when compared with the control group. However, these results need to be supported by future longitudinal and larger studies to identify any possible link between hematological inflammatory markers and pseudoexfoliation.

Evaluation of the Diagnostic Value of Hematologic Parameters and Ratios in SARS-CoV-2 VOC-202012/01 Mutant Population.

IntroductionIn this study, we set out to study possible differences between individuals with and without VOC 202012/01 variant by using less costly complete blood count analytes and quickly analyzing the samples and ratios derived from these analytes. For this purpose, we assessed neutrophil, lymphocyte, platelet, and Red Blood Cell Distribution Width-Standard Deviation (RDW-SD) levels among complete blood count parameters (CBC) (identification and count of red blood cell, neutrophil, eosinophil, basophil, lymphocyte, monocyte, platelet) as well as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR).MethodsA retrospective cross-sectional study was performed over the course of two months (from May to June 2021) on 212 patients who presented to the emergency department of a tertiary hospital with Covid-19 symptoms and took SARS-CoV2 PCR and CBC tests. The polymerase chain reaction (PCR)-confirmed SARS-CoV2 positive patients and their hospitalization data were gathered from the public health management system. Their VOC-202012/01 mutation status was also confirmed by this system.ResultsRDW-SD, RDW, NLR, and PLR indexes, as well as C-reactive protein (CRP), and lactate dehydrogenase (LDH) values, were higher in the patients with VOC-202012/01 mutation (p<0.0001) than those without mutation, while hemoglobin and hematocrit counts and ratio, as well as eosinophil and lymphocyte counts, remained lower in the patients with mutation (p<0.0001).ConclusionNLR and RLP ratios derived from hematological parameters and models based on these ratios and RDW-SD are cheaper and more widely used. Our study suggests that the hematological analytes, the ratios obtained from these analytes, and the models created through these ratios in patients presenting to the ED with COVID-19-like symptoms and having positive reverse transcription polymerase chain reaction (RT-PCR) test results were significantly different in those with and without the VOC-202012/01 mutation. The bottom line is that they can serve as reliable predictors in the assessment of patients with the VOC-202012/01 mutation.