Value Of Neutrophil-lymphocyte Ratio In Patients Research Articles

The Association of the Neutrophil-Lymphocyte Ratio With Diabetes Mellitus and Diabetic Foot Ulcer: A Review Article

Introduction: Diabetes mellitus (DM) is inappropriately elevated blood glucose levels. Diabetic foot ulcer (DFU) is the most common complication of diabetes mellitus. Many research studies was found that neutrophil lymphocyte ratio (NLR) have positive correlation with HBA1C, blood glucose, and outcome of diabetic foot ulcer. Methods: The literature searches using online databases such as PubMed, ScienceDirect Elsevier, and Google Schoolar. Result: After doing an online search, we found 39 articles were relevant for this review topic. Analysis: Many research studies have found increased HbA1C (≥6,5) and increased blood glucose (random blood glucose ≥ 200mg/dL and/or fasting blood glucose ≥126 mg/dL) in patients with diabetes mellitus have a positive correlation with increased NLR. And there was increased NLR values in patients with diabetic foot ulcer and NLR values was higher (NLR≥6) in non-healing ulcers than in healing ulcers. Conclusion: NLR can be used as screening tool for determining evaluation of diabetes mellitus and as screening tool for determining outcome of diabetic foot ulcers.

Comparison of RDW and PLR values with CRP and NLR values in patients with postoperative leakage and abscess after pancreatectomy

AIM: New studies show red cell distribution width (RDW) to be altered by inflammatory cell wall changes in acute pancreatitis, sepsis and critical illness. We aimed to evaluate the efficacy of RDW, platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) values in patients who underwent pancreatectomy. MATERIALS AND METHODS: Fifty patients who underwent pancreatectomy were retrospectively compared. The study group consisted of patients who were followed up with clinical or laboratory evidence of either leakage or infection, with proof of infection being culture positivity and associated fever, tachycardia, and elevated laboratory values. The control group, on the other hand, comprised of 25 patients with uneventful postoperative course. RDW, neutrophil, platelet (PLT), aspartate aminotransferase (AST), alanine transaminase (ALT), C reactive protein (CRP), PLR and NLR values of the patients were compared among and between groups at 4 different time points (1: admission, 2: postoperative first week prior to infection, 3: at the time of infection and 4: discharge). RESULTS: Statistically significant results were obtained for ALT, CRP, neutrophil, and PLR ratios (p=0.003, p=0.002, p=0.028, p=0.032, respectively). Significant differences were also observed in RDW 2, RDW 3 and RDW 4 (p=0.034, p=0.010, p=0.031, respectively). Regarding CRP levels, significant differences were found for CRP 1 and CRP 3 levels (p=0.001, p=0.025, respectively). A significant difference was detected only for the PLR 4 value (p=0.009). CONCLUSIONS: In patients who underwent pancreatic resection and were suspected of having infection that progressed to a septic state, the levels of RDW, CRP, PLT, and PLR were observed to be correlated with infection and increased at various intervals before the culture results and evidence of infection emerged. Due to their association with the emergence of infections, these parameters have been proven to be effective and affordable tools in clinical decision-making.

Neutrophil/Lymphocyte, Platelet/Lymphocyte, and Monocyte/Lymphocyte Ratios in Mood Disorders.

Major depressive disorder (MDD) and bipolar disorders (BDs), the most severe types of mood disorders (MDs), are considered as among the most disabling illnesses worldwide. Several studies suggested that inflammatory neuroinflammation might be involved in the pathophysiology of MDs while reporting increasing data on the relationships between these processes and classical neurotransmitters, hypothalamus-pituitaryadrenal axis (HPA), and neurotrophic factors. The assessment of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR) in peripheral blood represents a simple method to evaluate the inflammatory status. The aim of the present paper was to review the literature on the possible relationships between NLR, PLR, and MLR in MDs and to comment on their possible wider use in clinical research. Thirty-five studies were included in the present review. The majority of them had higher values of these parameters, particularly NLR values in patients with MDs when compared to healthy subjects. The increase would appear more robust in patients with BD during a manic episode, thus indicating that it could be considered as both state and trait markers. In addition, increased NLR and PLR levels seem to represent prognostic elements for the early discovery of post-stroke depression. The findings of the present review would indicate the need to carry out further studies in this field. In particular, NLR, PLR, and MLR seem to be promising tools to detect economically and easily the activation of the inflammatory system and to perhaps evaluate the etiology and course of MDs. Again, they could suggest some information to better understand the relationship between inflammatory and cardiovascular disease and MDs, and thus, to provide clinical implications in terms of management and treatment.

Prognostic implication of neutrophil-lymphocyte ratio (NLR) in myocarditis: results from a multicentre, multinational study

Abstract Background Neutrophil–lymphocyte ratio (NLR) is an accessible inflammatory biomarker. Recently, baseline NLR has been shown to be independently associated with incident cardiovascular (CV) events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated. The aim of the present study was to investigate the prognostic value of NLR in patients with AM. Methods All consecutive patients with a diagnosis of AM admitted to three tertiary referral cardiac centres in two countries between October 2006 and June 2020 were included in the study. Diagnosis was confirmed by either cardiac magnetic resonance or endomyocardial biopsy. The outcome measure was all-cause mortality. Patients were divided into two groups according to NLR value defined in previous studies (i.e., 2.5). Results A total of 287 patients with AM were included in the study. Baseline characteristics were comparable in both groups. Approximately two thirds of patients were males (n=194, 68%) with a mean age of 39±16 years. The main clinical presentation was predominantly infarct-like (n=215, 75%), followed by heart failure (HF) (n=46, 16%) and arrhythmic (n=26, 9%). Patients admitted with a HF presentation were more prevalent in the group with elevated NLR, while no difference was found in the other clinical presentations. For all patients, ECG features were comparable between groups. However, patients with elevated NLR presented with slightly higher LVEF (55±11% vs 50±13% respectively, p=0.003). Over a median follow-up of 54 months, higher NLR was associated with worse prognosis (Figure 1, p=0.02). Patients with high NLR have a 7-fold higher risk of adverse events during follow-up (Hazard Ratio 7.83, 95% confidence interval 1.02–59.89, p=0.047). Conclusions NLR is a promising and accessible inflammatory biomarker. In patients with AM, elevated NLR is associated with worse prognosis. Further research is advocated to confirm these data in larger populations. Funding Acknowledgement Type of funding sources: None.

Do immune inflammatory markers correlate with anal dysplasia and anal cancer risk in patients living with HIV?

People living with HIV (PLWH) are at an elevated risk for developing anal cancer. As screening is invasive, markers predicting those at highest risk for anal cancer could guide individualized screening. Neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and prognostic nutritional index (PNI) are surrogate inflammatory/immune markers known to correlate with cancer outcomes. This study aims to assess whether these markers correlate with anal cancer risk in PLWH. This is a retrospective single-institution cohort study of PLWH at a single academic medical center who were diagnosed with or screened for anal dysplasia between 2001 and 2019. Aforementioned markers collected within one year of diagnosis were recorded. Regression modeling was used to estimate odds of anal cancer. Receiver operating characteristic analysis was utilized to determine optimal cutoff for screening values. Five-hundred-fourteen patients were included. NLR and PNI were significantly associated with cancer risk on univariate (p = 0.03, p = 0.001) and multivariate analyses (p = 0.03, p = 0.01). NLR increased across all grades of dysplasia. PLR was not associated with cancer risk. A NLR of ≥ 1.64 can be utilized to capture 76% of cancer patients in our cohort. NLR values in patients living with HIV correlate with risk of anal cancer and increasing grades of dysplasia. A cutoff NLR of ≥ 1.64 can be used to help capture those at risk. NLR is a promising marker of risk of anal cancer and progression of anal dysplasia in patients with HIV infection and could be used to risk-stratify screening and surveillance intervals.

The Neutrophil-Lymphocyte Ratio as an Early Predictive Marker of the Severity of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Background and objectives: Factors predictive of severe non-iatrogenic acute pancreatitis have been investigated, but few studies have evaluated prognostic markers of severe post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). The neutrophil–lymphocyte ratio (NLR) has been studied for predicting severe acute pancreatitis. We examined the predictive value of NLR in patients with PEP. Materials and Methods: From January 2012 to August 2021, 125 patients who developed PEP were retrospectively evaluated. The NLR was measured before, and on days 1 and 2 after, ERCP. PEP was categorized as mild, moderate, or severe according to consensus guidelines, based on the prolongation of planned hospitalization. Patients were divided into two groups, mild-to-moderate vs. severe PEP. Results: We analyzed 125 patients with PEP, 18 (14.4%) of whom developed severe PEP. The baseline NLR was similar between the two groups (2.26 vs. 3.34, p = 0.499). The severe PEP group had a higher NLR than the mild/moderate PEP group on days 1 (11.19 vs. 6.58, p = 0.001) and 2 (15.68 vs. 5.32, p < 0.001) post-ERCP. The area under the curve of the NLR on days 1 and 2 post-ERCP for severe PEP was 0.75 (95% confidence interval (CI), 0.64–0.86)) and 0.89 (95% CI, 0.81–0.97), respectively; NLR on day 2 had greater power to predict severe PEP. The optimal cutoff value of the NLR on days 1 and 2 after ERCP for prediction of severe PEP was 7.38 (sensitivity, 72%; specificity, 69%) and 8.17 (sensitivity, 83%; specificity, 83%), respectively. In a multivariate analysis, a Bedside Index of Severity in Acute Pancreatitis score ≥3 (odds ratio (OR) 9.07, p = 0.012) and NLR on day 2 > 8.17 (OR 18.29, p < 0.001) were significantly associated with severe PEP. Conclusions: The NLR on day 2 post-ERCP is a reliable prognostic marker of severe PEP.

Evaluasi Rasio Netrofil Limfosit (RNL) untuk diagnosis COVID-19 pada Pasien di RS Tadjuddin Chalid, Makassar, Indonesia

Abstract. The neutrophil lymphocyte ratio (NLR) is one of the variables related to the severity of COVID-19 disease. Therefore, we evaluated the value of NLR in COVID-19 patients and its relation to the symptoms and severity of COVID-19 at Tadjuddin Chalid Hospital, Makassar. We recruited patients visiting Tadjuddin Chalid Hospital Makassar who were willing to take part in the study in April to August 2021. Demographic, clinical and laboratory data were recorded through interviews and medical records. The severity of the disease is classified according to the guidelines from the association of Indonesian pulmonary doctors, Indonesian internal medicine doctors, Indonesian pediatricians, anesthesiologists and intensive care doctors, and the Indonesian cardiologist association. NLR data was obtained by calculating the ratio between neutrophil levels and lymphocyte levels in the blood. A total of 130 patients took part in the study, between 19-72 years old. There were 77 subjects (59.2%) with mild symptoms, 28 (21.6%) with moderate symptoms, and 25 (19.2%) with severe symptoms. There were 89 subjects with NLR &lt;3.5 (68.5%) and 41 (10.8%) with NLR &gt; 3.5. NLR values in patients with severe and moderate disease were significantly different from NLR in patients with mild disease (p =0.0002 dan p&lt;0.0001, respectively). However, no significant difference was found in NLR between patients who neither have cough nor fever with those who had one or both of those symptoms. The presence of clinical or radiological symptoms of pneumonia accompanied by an NLR &gt; 3.5 can be used as an indicator for a suspected moderate or severe COVID-19 diagnosis.Keywords: COVID-19, neutrophil lymphocyte ratio (NLR), pneumonia, disease severity, diagnostic tool

Comparison of stroke cases with other neurological diseases on the basis of haemogram parameters

This study aimed to examine the haemogram parameters, including the neutrophil/lymphocyte ratio (NLR), which is fast, easy and practical to determine, in stroke patients who present with more physiological stress and inflammation and compare them with patients presenting other neurological diseases. The demographic, laboratory and imaging features of all patients who were admitted to the neurology clinic within a three-year period and met the study criteria were retrospectively analysed. A haemogram from peripheral venous blood samples was taken at the time of admission, and its parameters was calculated. A total of 3152 patients, 1604 of whom were women (50.9%), with a mean age of 66.1±14 (18-100) years who were hospitalised in the neurology clinic from 1 January 2015 to 1 January 2018, comprised the study's sample. Mean age, mean leukocyte-neutrophil count and NLR were significantly higher in stroke patients than in those without stroke (P<.001, P<.001 and P<.001, respectively), but mean red blood cell, platelet and lymphocyte counts, and haemoglobin and haematocrit values were found to be significantly lower (P<.001, P<.001, P<.001, P<.001 and P<.001, respectively). When the haemogram parameters were compared according to stroke type, red blood cell, haemoglobin, haematocrit and NLR values in patients with haemorrhagic stroke (P=.019, P=.002, P=.002 and P=.001, respectively) and platelet and lymphocyte values in ischaemic stroke patients were found to be significantly higher (P=.002 and P<.001, respectively). In this study, significant data obtained by comparing the haemogram parameters of those with stroke and other neurological diseases are presented. All neurological diseases, especially acute stroke and its types, should be examined in future prospective, randomised and controlled studies with all haemogram parameters, especially the NLR. However, it should be noted that haematological parameters are more useful for group studies rather than determining the diagnosis of an individual patient.

Predictive Value of Neutrophil/Lymphocyte Ratio (NLR) on Cardiovascular Events in Patients with COVID-19.

BackgroundThe research on the association between coronavirus disease 2019 (COVID-19) and cardiovascular disease (CVD) is still insufficient.AimThis study aimed to investigate the association between neutrophil/lymphocyte ratio (NLR) and risk of cardiovascular events in patients with COVID-19.MethodsOur study included 159 patients with COVID-19 who were measured for NLR value within the first 24 hours of admission. They were followed up for 6 months after discharge and then the relationship between levels of NLR and risk of cardiovascular events was assessed.ResultsIn all included patients with COVID-19, NLR values in patients with cardiovascular events [16.28 (4.95–45.18)] were significantly higher than patients without cardiovascular events [4.75 (2.60–7.47)]. A multivariate logistic regression model revealed that elevated NLR value [increased per SD, 2.41 (1.43–4.29), P<0.001; increased 1 of NLR, 2.05 (1.33–4.01), P=0.010] was significantly and independently associated with increased risk of CVD history on admission after adjustment of related confounding factors. Then, Cox regression analysis revealed that elevated NLR value had a significant association with increased risk of cardiovascular events [increased per SD, 2.36 (1.42–4.36), P<0.001; Increased 1 of NLR, 2.00 (1.30–3.97), P=0.014] after adjustments of these same confounding factors. Furthermore, the ROC curve suggested that NLR value (AUC=0.803, 95% CI=0.731–0.875, P<0.001, sensitivity 81.2%, and specificity 82.6%) has a good predictive value for cardiovascular events during follow-up.ConclusionHigh NLR value was clinically associated with elevated risk of cardiovascular events in patients with COVID-19, which might be a potential biomarker for predicting cardiovascular events in the current COVID-19 pandemic.

The systemic cell apoptotic-based neutrophil–lymphocyte ratio: Experience in children diagnosed with ADHD and Autism Spectrum Disorder

Objective: In recent years, the rate of Neutrophil/Lymphocyte ratio (NLR) has been shown to be a marker of systemic inflammation and is associated with prognosis in many diseases like malignancies and chronic inflammatory diseases. Based on previous studies, there is not any finding that the NLR and cellular morphological mechanism studied together in inflammation-related diseases; attention deficit hyperactivity disorder(ADHD) and autism spectrum disorders(ASD). We assessed the effect and association of these parameters on the etiopathogenesis of neurodevelopmental disorders. Material and Method: 30 healthy and 30 patients who were diagnosed with ADHD and ASD were evaluated in the psychiatry department at a tertiary hospital. In whole groups, the hemogram profile have been analyzed. NLR number was statistically compared. However, the apoptotic stage of cells were stained with 2 different methods. Apoptotic mechanisms of ADHD, ASD and control group were comparably displayed. Results: NLR values in patients diagnosed with ADHD and ASD were significantly higher compare to control; lymphocyte count was found significantly lower level in patient groups. Apoptotic morphology becomes evident as the degree of disease increment. Conclusion: This parameter can be used as an easily applicable method is estimated to be at risk for psychiatric diseases. The positive association of NLR with apoptotic imaging indicates a marker of cellular degradation with neurodegenerative disorders.

High neutrophil-lymphocyte ratio in schizophrenia independent of infectious and metabolic parameters

Background: Immunological and inflammatory mechanisms play an important role in schizophrenia. In the literature, there are studies investigating neutrophil-lymphocyte ratio (NLR) association with schizophrenia.Aims: The purpose of this study was to compare NLR values between patients with schizophrenia and healthy controls. In addition, the study aimed to investigate the relationship between NLR and disease severity and some metabolic/inflammatory parameters.Methods: Fifty-two patients diagnosed with schzophrenia and 53 healthy controls were included in the study. A socio-demographic information form was filled out by the clinician. Height, body weight, waist and hip circumference and blood pressure values of each patient were measured. Severity of disease was assessed by positive and negative syndrome scale (PANSS) and clinical global impression-severity scale (CGI-S). Complete blood count was performed to both patient and control groups. Fasting blood glucose, insulin, HbA1c, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, total cholesterol and C-reactive protein (CRP) were measured.Results: The number of leukocytes, neutrophils, monocytes and NLR values in patients with schizophrenia was significantly higher than in the control group. There was no significant relationship between NLR values and the number of hospitalisation, duration of ilness or disease severity in patients. There was no correlation between other laboratory findings and NLR values.Conclusion: NLR levels are high in schizophrenia independent of metabolic parameters according to the results. So, it can be considered that inflammatory processes may play a role in the etiology of the disease.

Neutrophil to lymphocyte ratio associated with prognosis of lung cancer.

Many studies recently focus on complicated and expensive genomic tests, but the prognostic values of biochemical markers which are easily obtained in clinics are largely overlooked and without further exploration. This study assesses the association of neutrophil-lymphocyte-ratio (NLR) with prognosis of lung cancer patients. In 1032 patients with histologically confirmed lung cancer, the association of pretreatment NLR values with overall survival (OS) was evaluated using a Cox proportional hazards model and the temporal relationship of longitudinal NLR was assessed using a mixed effects model. Compared to the patients with a low pretreatment NLR value, those with elevated NLR exhibited a statistically significant worse OS with a hazard ratio (HR) of 1.50 (P<0.0001) after adjusting for age, gender, race, smoking status, drinking status, tumor stage, tumor grade, histology, and treatments. A significant trend of increasing HRs along with increasing NLR values was observed. The increased risk of death conferred by pretreatment NLR values reached a peak level around 2years after diagnosis. Moreover, in longitudinal analysis, we observed a trend of dramatically increased NLR values in patients who died during follow-up, but stable NLR values in those who were still alive, with a significant interaction of death-alive status with follow-up time (P<0.0001). Elevated NLR is a potential biomarker to identify lung cancer patients with poor prognosis and should be validated in a future clinical trial.

Influence of neutrophil-lymphocyte ratio on radiosensitivity and prognosis in patients with nasopharyngeal carcinoma

Objective To investigate the influence of neutrophil-lymphocyte ratio (NLR) on radiosensitivity and prognosis, the relationship between NLR and clinical features, and the clinical value of NLR in patients with nasopharyngeal carcinoma (NPC). Methods 2006 to 2011 in the cancer center of Zhongshan University admitted to the newly diagnosed nasopharyngeal cancer patients in 266 cases. The association of pretreatment NLR with radiotherapy doses 20, 40, and 60 Gy and therapeutic effect at 3 months after radiotherapy was analyzed, as well as the influence of NLR on overall survival (OS), local recurrence-free (LRF), and distant metastasis-free (DMF) rates. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis. Results NLR showed differences across patients with different T stages and sexes (P=0.039, 0.032). The patients with NLR≤3 had significantly higher OS, LRF, and DMF rates compared with those with NLR>3(P=0.004, 0.025, 0.045). As NLR increased, the radiosensitivity in patients with NPC was reduced gradually, and radiosensitivity showed a significant difference between sensitive group and moderately sensitive group (P=0.043). When the radiotherapy dose was 40 Gy, the tumor regression group had a lower NLR than the residual tumor group (P=0.025). Conclusions In patients with NPC, an increased pretreatment NLR is an adverse prognostic factor, and NLR can be used as a simple and convenient method to evaluate the prognosis of patients with NPC. Key words: Neutrophil-lymphocyte ratio; Nnasopharyngeal neoplasms; Radiosensitivity; Prognosis

Neutrophil-Lymphocyte Ratio in Patients with Adenoidectomy.

Obstructive Sleep Apnea syndrome (OSA) is the most serious consequence of adenoid hypertrophy (AH) and it is one of the most common reasons of nocturnal hypoxia in children. There is some information about the relationship between childhood OSA and atherosclerosis or cardiac diseases. In this study, we evaluated the relationship between, neutrophil-lymphocyte ratio (NLR) and AH which is the most frequent cause leading OSA in children. Thus we aimed to contribute about subject of preoperative and postoperative NLR values in patients undergoing adenoidectomy that there is limited information. The study group comprised 76 children undergoing adenoidectomy. A preoperative and 3(rd)-month postoperative complete blood cell count was performed to calculate the NLR values in all patients. The NLR values were calculated as the ratio of neutrophils to lymphocytes in peripheral blood. Data analysis was performed using SPSS 15. The mean NLR (min - max) was 1.0 (0.16-3.57) preoperatively and 1.06 (0.35-4.95) 3 months postoperatively (p = 0.052> 0.05). Haemoglobin 12.9 ± 0.95 (preop) 12.94 ± 0.91 (postop) (p= 0.522), WBC (min-max) 7.75 (3.90-14.99) 7.8 (4-15.64) (p= 0.297 <0.005), platelet 344.5 ± 98.7 328.4 ± 68.9 (p<0,005). There is limited information in the English literature. This study has investigated the association between the NLR and adenoidectomy. The results of the present study demonstrate that the NLR is not a statistically significant inflammatory factor. So, NLR values do not appear related to stage of upper airway obstruction.

Relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus patients.

BackgroundInsulin resistance (IR) plays a vital role in the pathogenesis of Type 2 Diabetes Mellitus (T2DM). The mechanism of IR may be associated with inflammation, whereas the neutrophil-lymphocyte ratio (NLR) is a new indicator of subclinical inflammation. Scholars have rarely investigated the relationship between IR and NLR. This study aims to evaluate the relationship between IR and NLR, and determine whether or not NLR is a reliable marker for IR.MethodsThe sample consists of a total of 413 patients with T2DM, 310 of whom have a HOMA-IR value of > 2.0. The control group consists of 130 age and BMI matched healthy subjects.ResultsThe NLR values of the diabetic patients were significantly higher than those of the healthy control (P < 0.001), and the NLR values of the patients with a HOMA-IR value of > 2.0 are notably greater than those of the patients with a HOMA-IR value of ≤ 2.0 (P < 0.001). Pearson correlation analysis showed a significant positive correlation of NLR with HOMA-IR (r = 0.285) (P < 0.001). Logistic regression analysis showed that the risk predictors of IR include NLR, TG and HbA1c. NLR (P < 0.001, EXP(B) = 7.231, 95% CI = 4.277–12.223) levels correlated positively with IR. The IR odds ratio increased by a factor of 7.231 (95% CI, 4.277–12.223) for every one unit increase in NLR.ConclusionsIncreased NLR was significantly associated with IR, and high NLR values may be a reliable predictive marker of IR.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-015-0002-9) contains supplementary material, which is available to authorized users.

Increased neutrophil-lymphocyte ratio in patients with idiopathic sudden sensorineural hearing loss.

The aim of this study was to determine whether neutrophil-lymphocyte ratio (NLR) levels are elevated in patients with idiopathic sudden sensorineural hearing loss (ISSHL) compared with healthy controls. Moreover, we aimed to find out whether there is a correlation between NLR levels and the severity of hearing loss. The study group consisted of 40 subjects with ISSHL and 40 control subjects with no evidence of ear pathology. Severity of hearing loss in the ISSHL patients was classified as mild (<40 dB loss for any frequency), moderate (up to 80 dB), and severe (profound, >80 dB). The mean ± SD NLR values were 5.53 ± 1.72 in the ISHHL patients and 2.73 ± 0.81 in the control group. The mean NLR values in the patients with ISHHL were significantly higher than in the control group (P = 0.0001). The mean ± SD NLR values in the patients with mild (group A), moderate (group B), and severe (group C) sensorineural hearing loss were 5.53 ± 1.72, 5.29 ± 1.81, and 5.82 ± 1.72, respectively. The mean NLR values in the patients with severe sensorineural hearing loss were significantly higher than in the other groups (P = 0.0001). Nevertheless, there was no correlation between NLR values and severity of hearing loss. There is no previous study that investigated the association between NLR and ISSHL in the literature. High NLR values in ISSHL patients may be a predictor of other ishemic conditions such as coronary or cerebral ischemia. Thus, the otorhinolaryngologist would then refer the patient to cardiology and then neurology specialists for the appropriate examinations.

Neutrophil-Lymphocyte Ratio

The aim of this study was to investigate whether neutrophil-lymphocyte ratio (NLR) levels are elevated in patients with Bell palsy (BP). Moreover, we aimed to find out whether there is a correlation between NLR levels and the severity and prognosis of BP. The study group consisted of 25 subjects who presented with BP and 25 control subjects with no evidence of facial nerve pathology. The subjects underwent a general physical examination; an assessment of laboratory blood parameters; and a cranial magnetic resonance imaging, using gadolinium as a contrast medium. The mean (SD) NLR values were 2.16 (0.80) in the patients with BP and 1.36 (0.48) in the control group. The mean NLR values in the patients with BP were significantly higher than in the control group (P = 0.0001). There was a positive correlation between NLR values and grade of facial paralysis (r = 0.661, P = 0.0001). The mean (SD) NLR values in the grades III, IV, V, and VI BP groups were 1.40 (0.54), 1.78 (0.44), 3.00 (0.63), and 2.60 (0.54), respectively. The mean NLR values in the grade V BP group were significantly higher than in the other groups (P = 0.0001). In addition, there was a positive correlation between NLR values and prognosis of facial paralysis (r = 0.239, P = 0.251). There is no previous study that investigated the association between NLR and BP in the literature. Higher NLR values in patients with BP may be a predictor of worse prognosis.

Mean Platelet Volume, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Severe Preeclampsia

The aim of the study was to compare the changes in the values of leukocytes, neutrophils, lymphocytes, mean platelet volume (MPV), and systemic inflammatory response (SIR) markers (neutrophil-lymphocyte ratio/ platelet-lymphocyte ratio) in patients with severe preeclampsia (PE) of healthy pregnant and non-pregnant women. Hematological parameters including MPV and SIR markers [neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR)] were compered between the between three groups comprising of women with severe PE, healthy pregnant women and healthy non-pregnant women. MPV and PLR did not show statistically significant differences between the three groups (p=0.081, p=0.098). NLR showed a statistically significant difference between the three groups (p=0.000). NLR values of patients with severe PE were statistically significantly higher than healthy non-pregnant women (p=0.000). No statistically significant difference was found between patients with severe PE and healthy pregnant women (p=0.721). The cut-off value of the leukocyte number for severe PE was 7.6 x 10(3)/ml, with 76.7% sensitivity and 60.6% specificity. The cut-off value of neutrophil number was 6.4 x 10(3)/ml for the group with severe PE, with 76.7% sensitivity and 69% specificity. Our results showed that MPV level did not differ among patients with severe PE, healthy pregnant women and non-pregnant women. NLR cannot be used to identify patients with severe PE. PLR measured before termination of pregnancy is not an effective marker for severe PE, either.