Neutrophil-to-lymphocyte Ratio Research Articles

Diagnostic Value of Neutrophil-to-Lymphocyte Ratio (NLR) in Intrahepatic Cholestasis of Pregnancy.

Aims/Background Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse perinatal outcomes, yet the correlation between ICP and the neutrophil-to-lymphocyte ratio (NLR) remains unclear. This study aims to investigate the diagnostic value of NLR in ICP. Methods In this retrospective case-control study, 113 patients with ICP treated in Beilun District People's Hospital from January 2020 to December 2022 were recruited and categorized as the ICP group, and 209 healthy pregnant women treated during the same period were selected as the control group. The levels of NLR and mean platelet volume (MPV) were compared between the two groups. The NLR of patients with different ICP severity were compared. Logistic regression model was used to analyze the relationship between relevant indicators and ICP. The capability of NLR in predicting ICP was evaluated using receiver operating characteristic (ROC) curves. Results There were significant differences in age, neutrophil count, lymphocyte count, platelet count, MPV, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), NLR, and serum total bile acid (sTBA) among all groups (p < 0.05). The NLR in the severe ICP group was significantly higher than that in the mild ICP group (p < 0.05). Logistic regression analysis showed that MPV (odds ratio [OR] = 1.247) and NLR (OR = 1.885) were independent factors influencing the occurrence of ICP (p < 0.05). ROC curve analysis showed that the area under the curve (AUC) for both mild ICP and severe ICP was 0.679 and 0.869, respectively, substantiating the diagnostic value of NLR. Conclusion NLR can be used as an auxiliary indicator in the diagnosis of ICP and has important clinical value in predicting adverse pregnancy outcomes in ICP patients.

Associations between metabolic syndrome and depression, and the mediating role of inflammation: Based on the NHANES database.

Individuals with metabolic syndrome (MetS) are at a higher risk of developing depressive symptoms, with inflammation hypothesized to mediate this association. This study used data from the National Health and Nutrition Examination Survey (NHANES) (2015-2020) to investigate the relationship between MetS and depression and assess the mediating role of inflammatory markers. This cross-sectional study included 20,520 participants. MetS was defined using the NCEP ATP III criteria. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), with scores ≥10 indicating clinical significance. Inflammatory markers evaluated included C-reactive protein (CRP), white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR), among others. Multivariable linear and logistic regression models were applied to examine associations, and mediation analysis was conducted to evaluate the potential mediating effects. Overall, 7.64 % of participants exhibited depressive symptoms. MetS was associated with an increased risk of depression in both females (OR: 1.49, 95 % CI: 1.28-1.74) and males (OR: 1.32, 95 % CI: 1.09-1.60) after adjusting for confounders. Among MetS components, central obesity, hypertension, and dyslipidemia demonstrated the strongest associations with depression. Inflammatory markers mediated 26.79 % of the MetS-depression relationship, with CRP contributing the largest proportion (17.24 %). MetS and its components significantly increase the risk of depressive symptoms, with the relationship partially mediated by inflammatory markers. Chronic inflammation may play a critical role in linking MetS to depression, underscoring the importance of integrated management strategies targeting both metabolic and mental health.

Correlation Between Preoperative Neutrophil-to-Lymphocyte Ratio and Clinicopathological Characteristics of Papillary Thyroid Carcinomas: Toward a Preoperative Biomarker.

Introduction: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, with considerable variability in its clinical presentation and prognosis. Recent studies have focused on the relationship between its clinicopathological characteristics and inflammatory biomarkers, particularly the preoperative neutrophil-to-lymphocyte ratio (NLR). Our aim was to investigate the correlation between NLR and the clinicopathological features of PTC. Methods: This was a retrospective study. We involved patients who underwent surgery for PTC over a 5-year period from January 2016 to December 2021. Based on the mean NLR value, the study population was divided into 2 groups, with Group 1 corresponding to patients with an elevated NLR. Results: Our study included 102 patients aged between 20 and 83 years. All patients were euthyroid. The mean preoperative NLR was 2.01 ± 0.62, with 53% of patients classified into Group 1. On ultrasound, most nodules were classified as EU-TIRADS 5, and 38% had a Bethesda category 6 cytology. Final histopathological analysis revealed microcarcinoma in the majority of cases. PTC was multifocal in 35 cases and bilateral in 38, with an aggressive histological variant observed in 45 cases. Multivariate analysis demonstrated a statistically significant correlation between NLR and extrathyroidal invasion, lymph node metastasis, aggressive histological subtypes, and multifocality. Conclusion: NLR is a readily accessible and cost-effective preoperative biomarker. Its use could improve risk stratification and support personalized therapeutic strategies. However, prospective studies with larger, multicenter cohorts are required to validate NLR as a reliable predictive biomarker.

Association between platelet-to-lymphocyte ratio and immune checkpoint inhibitor-induced thyroid dysfunction.

To investigate the relationship between platelet-to-lymphocyte ratio (PLR) or neutrophil-to-lymphocyte ratio (NLR) and Immune checkpoint inhibitor (ICI)-induced thyroid dysfunction. This was a single-center retrospective observational study of patients with solid tumors receiving ICI therapy. Clinical characteristics of patients were assessed at baseline and during ICI therapy. Logistic regression was implemented to assess the association of PLR and NLR with thyroid dysfunction. Kaplan-Meier method was used to analyze the difference in time between the onset of hypothyroidism and thyrotoxicosis. A total of 355 patients with solid tumors were included in our study. Sixty-nine (19.44%) patients developed ICI-induced thyroid dysfunction after receiving ICI therapy, with a median (IQR) time to onset of 91(34-203.5) days. Patients with high PLR (H-PLR) had an increased risk of ICI-induced thyroid dysfunction (OR = 1.87, 95% CI 1.07-3.28, P = 0.028) compared to those with low PLR (L-PLR). Specifically, H-PLR was associated with ICI-induced thyrotoxicosis but not hypothyroidism (OR = 2.40, 95% CI 1.09-5.29, P = 0.030). Meanwhile, NLR was not correlated with ICI-induced thyroid dysfunction as a continuous (P = 0.699) or categorical variable (P = 0.914). The sensitivity analysis showed that H-PLR remains positively correlated with ICI-induced thyroid dysfunction. PLR rather than NLR was associated with the occurrence of ICI-induced thyroid dysfunction. Furthermore, PLR may serve as a predictive biomarker for ICI-induced thyroid dysfunction.

Neutrophil-to-lymphocyte ratio at diagnosis predicts colonoscopic activity in pediatric inflammatory bowel diseases (pIBD).

Neutrophil-to-lymphocyte ratio (NLR) is a novel biomarker studied in several autoimmune diseases including inflammatory bowel diseases (IBD) in adults, but poorly characterized in pediatric IBD (pIBD). We aimed to primarily investigate the relationship between NLR and pIBD endoscopic disease severity. We also examined whether NLR predicted hospitalization, surgery, and therapy response by 52 weeks. We used the Canadian children IBD Network (CIDsCaNN) prospective inception cohort including patients<18 years old with baseline data from 2013-2022. We excluded patients with concurrent diseases affecting NLR. Both Mayo endoscopic score (MES) and simple endoscopic scale for Crohn Diseases (SES-CD) were dichotomized as low (quiescent-mild), and high activity (moderate-severe). For therapy responses, we examined year-1 steroid- and biologic-free remission. We used logistic regression for binary outcomes. 580 UC and 1081 CD patients were included. High NLR was associated with high activity MES and SES-CD in both univariate and multivariable analyses (OR=1.45, 95%CI= 1.07-1.97, p-value=0.016; and OR=1.42, 95%CI= 1.04-1.94, p-value=0.026, respectively). We also calculated the best NLR cutoff point to predict MES (1.90, sensitivity=68%, specificity=67%, AUC=0.67, AUC 95%CI= 0.59-0.74) and SES-CD (2.50, sensitivity=63%, specificity=69%, AUC=0.66, AUC 95%CI= 0.59-0.75) high activity. NLR did not predict therapy response in either UC or CD. pIBD patients with high baseline NLR are more probable to have worse endoscopic disease at diagnosis. This highlights NLR potential as a reliable non-invasive biomarker of disease activity. The predictive power of NLR is based mostly on neutrophils and the balance between neutrophils and lymphocytes.

Chronic inflammation in a radium dial painter cohort: elevated neutrophil to lymphocyte ratio and radiation-induced hearing loss.

The radium dial painters (RDP) are a well-described group of predominantly young women who incidentally ingested 226Ra and 228Ra as they painted luminescent watch dials in the first part of the twentieth century. In 1974 pathologist Dr. William D. Sharpe published complete clinical and autopsy results for 42 former radium dial painters evaluated in the New Jersey Radium Research Project (NJRRP). This was an important paper due to the completeness of the observations. Surprisingly, in this study, clinicians noted a 35.5% incidence of hearing loss, both conductive and mixed etiologies. Since the 1974 publication, there has developed a considerable literature on radiation-induced hearing loss in patients undergoing radiotherapy for head and neck cancers. It is expected that hearing loss would also be associated with systemic inflammation. Recently, the neutrophil to lymphocyte ratio (NLR) has been shown in many cancer and non-cancer studies to be a nonspecific marker of inflammation. In prior collaborative efforts with the United States Transuranium and Uranium Registries (USTUR) and with the NCRP Million Person Study, it has been possible to evaluate NLR from medical records of a cohort of 166 former radium dial painters previously evaluated at Argonne National Laboratory. In addition, NLR was available in historic medical records of the sarcoma and nasopharyngeal cancer patients described in Rowland's summary of the Argonne studies. . Using elevation of the neutrophil to lymphocyte ratio (NLR) as a non-specific marker of inflammation, chronic inflammation has been observed in all cohorts with significant dose. The RDP cohort has had a unique exposure to radium, but the incidence of radiation-induced hearing loss here is uncertain. Due to cosmic radiation dose to astronauts in space flight, there is a significant interest in high LET radiation dose to the brain, including the auditory system. &#xD.

Association between inflammatory indices and preoperative deep vein thrombosis in patients undergoing total joint arthroplasty: a retrospective study

BackgroundTo investigate the association between inflammatory indices-systemic immune-inflammation index (SII), monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and preoperative deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA).MethodsWe created the receiver operator characteristic (ROC) curve using the ratios of SII, MLR, NLR, PLR to DVT before TJA, divided the enrolled patients into groups based on the cut-off value, and then analyzed risk factors for DVT before TJA in the multivariate binary logistic regression analysis.ResultsA total of 2125 patients were enrolled and preoperative DVT occurred in 110 cases (5.18%). Based on the ROC curve, we determined that the cut-off values for SII, MLR, NLR, and PLR were 470*109 /L, 0.306, 2.08, and 127; and the areas under the curve (AUC) were 0.623, 0.601, 0.611, and 0.62. Multivariate binary regression analysis revealed that the risk of preoperative DVT in TJA patients with SII ≥ 470*109/L, MLR ≥ 0.306, PLR ≥ 127, and NLR ≥ 2.08 increased by 2.26 (P < 0.001, 95% confidence interval (CI) [1.52–3.37]), 1.92 (P = 0.002, 95% CI [1.28–2.9]), 2.1 (P < 0.001, 95% CI [1.4–3.16]), and 1.94 (P = 0.002, 95% CI [1.29–2.92]) times, respectively. Age, P < 0.001, odds ratio (OR) = 1.08, 95%CI [1.05–1.10]; corticosteroid use, P = 0.002, OR 3.8, 95% CI [1.94–9.22]).ConclusionWe found that higher SII, MLR, NLR, and PLR levels, age, and corticosteroid use were independent risk factors for preoperative DVT in patients undergoing TJA.Clinical trial registrationChiCTR2100054844; Registration Date: 2021.12.28.

Exploring and validating associations between six systemic inflammatory indices and ischemic stroke in a middle-aged and old Chinese population

BackgroundInflammation and maladaptive immune mechanisms have been substantiated as integral components in the critical pathological processes of the injury cascade in ischemic stroke (IS). This study aimed to explore the associations between six systemic inflammatory indices and IS in a Chinese population.MethodsThis was a case-control study based on the retrospective review of electronic medical records from two hospitals in Shandong Province, China. Systemic inflammatory indices, including the systemic inflammation response index (SIRI), systemic immune inflammation index (SII), pan-immune-inflammation value (PIV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR), were calculated. Logistic regression models and classification analyses were employed to evaluate associations and discriminatory abilities.ResultsIn total, 9392 participants aged 40–83 years old were included in the discovery (3620 pairs of IS-present cases and healthy controls) and validation (1076 pairs of IS-present cases and IS-absent controls with IS mimics) datasets. After adjusting for potential confounding factors, IS was found to be associated with all six systemic indices in the discovery dataset, including SIRI (odd ratio [OR] 8.77, 95% confidence interval [CI] 7.48–10.33), SII (1.03, 1.01–1.04), PIV (1.01, 1.01–1.01), NLR (2.23, 2.08–2.39), PLR (1.01, 1.01–1.01), and LMR (0.77, 0.75–0.78). Notably, only LMR exhibited significant associations with IS in both discovery and validation datasets (0.88, 0.83–0.93), suggesting an independent protective role of this index. SIRI, SII, PIV, NLR, and LMR showed good discriminative ability between IS patients and healthy controls in the discovery dataset (AUCs > 0.70). However, they performed poorly in distinguishing IS patients from IS mimics in the validation dataset (AUCs < 0.60).ConclusionThis study provides valuable insights into the associations between systemic inflammatory indices and IS, offering potential implications for risk stratification. While these inflammatory indices are potential indicators for distinguishing IS from healthy conditions, additional biomarkers may be needed when differentiating IS from other chronic inflammatory conditions in clinical practice.

Neutrophil to platelet ratio predicts in-hospital mortality in patients with acute myocardial infarction.

Acute myocardial infarction (AMI) is a critical medical emergency worldwide and a leading cause of mortality. This study aims to investigate the predictive utility of the neutrophil-to-platelet ratio (NPR) in identifying AMI patients at an increased risk of in-hospital mortality. We enrolled 664 patients, including 421 with ST-elevation myocardial infarction (STEMI) and 243 with non-ST-elevation myocardial infarction (NSTEMI), at Zhongshan Hospital, Fudan University, from January 2020 to September 2023. NPR was calculated as the neutrophil count divided by the platelet count. The primary outcome was defined as in-hospital mortality. The overall in-hospital mortality among AMI patients was 6.78%. Mortality was notably higher in the high NPR group compared to the low NPR group. Univariate analysis identified several variables significantly associated with in-hospital mortality, including age, left ventricular ejection fraction (LVEF), neutrophil-to-lymphocyte ratio (NLR), and NPR. NPR demonstrated a strong independent association with in-hospital mortality following adjustment for potential confounders. Receiver operating characteristic (ROC) curve analyses were performed to assess the discriminative power of NPR and NLR in predicting in-hospital mortality. NPR exhibited an area under the curve (AUC) of 0.755 (95% CI, 0.682-0.829, p < 0.001), indicating good discriminative ability. Similarly, NLR showed a discriminative AUC of 0.674 (95% CI, 0.586-0.762, p < 0.001). The optimal cutoff values for predicting mortality were determined as 0.042 for NPR (sensitivity 80%, specificity 62.2%) and 8.02 for NLR (sensitivity 62.2%, specificity 67.5%). Bootstrap validation with 1000 iterations confirmed the robustness of these findings, with validated AUCs of 0.755 (95% CI, 0.681-0.826) for NPR and 0.674 (95% CI, 0.587-0.766) for NLR. This study identifies NPR as an independent and valuable predictor of in-hospital mortality among AMI patients, The findings underscore NPR's potential utility in clinical practice for risk stratification and early intervention strategies aimed at reducing mortality rates in this high-risk patient population.

Nomogram for prognosis prediction in metastatic pancreatic cancer patients undergoing intra-arterial infusion chemotherapy: incorporating immune-inflammation scores and coagulation indicators

BackgroundPancreatic cancer is one of the most malignant tumors with an inferior prognosis. This study aims to determine the prognostic significance of immune-inflammatory scores and coagulation indices in patients with metastatic pancreatic cancer(MPC) and develop a predictive nomogram.MethodsThis study retrospectively analyzed the clinical data of 384 patients with MPC who underwent intra-arterial infusion chemotherapy (IAIC). Patients were randomly divided into training and validation cohorts. Firstly, the optimal cutoff values for continuous variables were obtained in the training cohort. Then, survival analysis was performed to evaluate the impact of immune-inflammatory scores neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and coagulation indicators prothrombin time (PT), fibrinogen (FIB), and D-dimer on the overall survival (OS) of patients. Next, univariate analysis was utilized to identify prognostic factors, and a stepwise regression method was employed for variable selection to construct a nomogram based on the Cox proportional hazards model. Additionally, the predictive performance of the nomogram was assessed by the concordance index (C-index), the area under the ROC curve (AUC), and calibration curves. Finally, patients were stratified into risk groups based on the total score of the nomogram.ResultsThe Kaplan–Meier survival curves indicated that immune-inflammatory scores NLR, PLR, SII, and coagulation indicators PT, FIB, and D-dimer were associated with OS. Through Cox regression analysis, a nomogram was ultimately constructed incorporating NLR, PLR, PT, alkaline phosphatase (ALP), carbohydrate antigen 125 (CA125), age, and ablation. The model demonstrated good discriminative ability, with a C-index of 0.722, and the AUC values at 6- and 12-month OS predictions were 0.828 and 0.851 in the training cohort, while in the validation cohort, the corresponding AUC values were 0.754 and 0.791, respectively. The calibration curves showed a good fit, confirming the stability of the model. A cutoff value of 353.3 was identified as optimal for risk stratification, with a statistically significant difference in OS between the high- and low-risk groups.ConclusionThe nomogram based on immune-inflammatory scores, coagulation indicators, and other clinicopathological factors can effectively predict the OS of patients with MPC.

Assessing the clinical utility of pre-operative neutrophil-lymphocyte ratio as a predictor of clinicopathological parameters in patients being treated for primary breast cancer.

There is a paucity of data supporting the role of neutrophil-lymphocyte ratios (NLR) to determine clinicopathological parameters in patients being treated for primary breast cancer. To evaluate the association between pre-operative NLR and clinicopathological parameters in patients diagnosed with breast cancer. A retrospective cohort study was performed. This included consecutive patients indicated to undergo surgery for primary breast cancer at University Hospital Limerick between January 2010 and June 2017. NLR was expressed as a continuous variable. Univariable and multivariable linear regression analyses were used to determine the correlation between NLR and clinicopathological data. Data analytics was performed using SPSS v29.0. 673 patients met the inclusion criteria. Overall, the median preoperative NLR is 2.63 (standard deviation: 1.42). At univariable analysis, patient age (beta coefficient: 0.009, 95% confidence interval (CI) 0.001-0.017, P = 0.027), tumour size (beta coefficient: 0.013, 95% CI 0.005-0.021, P = 0.001), and human epidermal growth factor receptor-2 status (beta coefficient: -0.370, 95% CI -0.676-0.065, P = 0.017) were all predicted using NLR. However, at multivariable analysis, tumour size was the sole parameter predictable by NLR (beta coefficient: 0.011, 95% CI 0.002-0.019, P = 0.013). This study demonstrates that pre-operative NLR may serve as an independent predictor of tumour size in patients being treated with primary breast cancer. Ratification of these preliminary findings is warranted before robustly adopted into clinical practice.

Hematological parameters in pediatric pulmonary and extrapulmonary tuberculosis in Vietnam: a prospective observational study

BackgroundTuberculosis in children remains a significant public health issue in Vietnam. This study aims to describe the clinical and paraclinical characteristics of children with pulmonary and extrapulmonary tuberculosis and to evaluate the value of certain hematological parameters in differentiating between these two forms.MethodsThis prospective observational study was conducted on 36 children diagnosed and treated for tuberculosis at Hue Central Hospital. Clinical and paraclinical characteristics were compared between pulmonary and extrapulmonary tuberculosis. The ROC curve, sensitivity, and specificity were used to compare the diagnostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and Systemic Immune-Inflammation Index (SII) in differentiating pulmonary from extrapulmonary tuberculosis.ResultsOf the 36 children with tuberculosis in the study group, 58.3% had pulmonary tuberculosis and 41.7% had extrapulmonary tuberculosis. There were significant differences between pulmonary and extrapulmonary tuberculosis in terms of gender distribution (p = 0.037), family history (p = 0.008), fever (p = 0.001), malnutrition (p = 0.008), and night sweats (p = 0.027). Pulmonary tuberculosis had significantly higher levels of inflammatory markers such as white blood cells, neutrophils, ESR, and CRP compared to extrapulmonary tuberculosis. The NLR and SII indices showed good discriminatory value, while the PLR index showed acceptable discriminatory value when comparing pulmonary and extrapulmonary tuberculosis. The SII index had the best diagnostic value with an AUC of 0.832, sensitivity of 66.7%, and specificity of 86.7%.ConclusionsHematological indices calculated from the complete blood count (NLR, PLR, SII) have good value in differentiating between pulmonary and extrapulmonary tuberculosis in children, with the SII index having the best value.

The effect of SARS-CoV-2 Omicron BA. 5.2 infection on perioperative physiological indicators in orthopedic patients

ObjectiveThe aim of this study was to investigate the effect of SARS-CoV-2 Omicron BA. 5.2 (hereafter referred to as Omicron BA. 5.2) infection on perioperative physiological indices and to provide clinical considerations for the precautions needed for patients who tested negative for SARS-CoV-2 infection perioperatively.MethodsPatients who underwent time-limited surgery (surgery that must be performed within a certain time) at the Department of Orthopedics of our hospital from September 1, 2022, to March 31, 2023, were divided into an observation group (those with Omicron BA 5.2 and a negative nucleic acid test after December 7, 2022, n = 100) and a control group (those negative for SARS-CoV-2 infection before December 7, 2022, n = 100). Changes in the following factors were compared within and between the two groups: heart rate, mean arterial pressure, oxygenation index at the time of entry into the operating room, incision of the skin and exit from the operating room and the neutrophil‒lymphocyte ratio (NLR), platelet‒lymphocyte ratio (PLR), systemic immune inflammation index (SII), D-dimer level, and fibrinogen degradation product (FDP) level. Changes in interleukin-6 and calcitonin levels were assessed the day after surgery, and multivariate regression analysis of the meaningful results was conducted.ResultsHeart rate, mean arterial pressure, oxygenation index, NLR, PLR, SII, interleukin-6 and calcitonin were similar between the two groups (P > 0.05). The observation group had higher postoperative D-dimer and FDP levels (P < 0.05). Multivariate regression analysis revealed that Omicron BA 5.2 infection, older age and a history of cerebral infarction were associated with increased D-dimer and FDP levels, and their odds ratios (ORs) and confidence intervals are 3.339 [95% CI, 1.372–8.419], P = 0.008; OR, 1.080 [95% CI, 1.023–1.139]; P = 0.005; OR, 10.644 [95% CI, 1.352–83.320], P = 0.025, respectively.ConclusionOmicron BA. 5.2 Infection affects the perioperative coagulation function of orthopedic patients, thereby inducing a hypercoagulable state characterized by significant elevations in D-dimer and FDP levels and increasing the risk of venous thrombosis. This infection had no obvious effect on other physiological indices. Early surgery is feasible, but thrombotic events need to be considered.

Role of Hb to RDW ratio in metastatic renal cell carcinoma patients treated with first-line immunotherapy combinations.

The present study aimed to investigate the prognostic and predictive roles of Hb/RDW ratio in patients with mRCC treated with first-line immunotherapy combinations (TKI plus ICI or ICI plus ICI). We performed a sub-analysis of a multicenter retrospective observational study (ARON-1 project) involving patients with mRCC treated with first-line immunotherapy combinations. Three hundred and twenty-nine patients were enrolled, 244 males and 85 females. Median age was 65.5 years. The prognostic impact of the Hb/RDW ratio on PFS and OS was observed in the whole population examined. Hb/RDW ratio had a correlation with neutrophil-to-lymphocyte ratio (NLR), a blood inflammatory parameter. Hb/RDW ratio is a new inflammatory prognostic factor, easy to use in daily clinical practice.

Prediction of Prostate Cancer From Routine Laboratory Markers With Automated Machine Learning.

In this study, we attempted to select the optimum cases for a prostate biopsy based on routine laboratory test results in addition to prostate-specific antigen (PSA) blood test using H2O automated machine learning (AutoML) software, which includes many common machine learning algorithms. The study included 737 patients (46-88 years old). Routine laboratory measurements were used to train machine learning models using H2O AutoML. We created a model that classifies prostate biopsy results as malignant or benign. The performance of the best model was evaluated using the area under the receiver operating characteristic curve (AUC), log-loss metric, F1 score, positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity. The model's performance was evaluated through the SHapley Additive exPlanations (SHAP) analysis feature-based interpretation method applied to comprehend the machine learning model. The gradient boosting machine model was the most successful. The best result was obtained in the model with 11 parameters, including PSA, free PSA, free PSA to PSA, hemoglobin, neutrophils, platelets, neutrophil-to-lymphocyte ratio (NLR), glucose, platelet-to-lymphocyte ratio (PLR), lymphocytes, and age. The AUC of this model was 0.72, the specificity was 0.84, the PPV was 0.65, the NPV was 0.69, and the accuracy was 0.68. Our results suggest that adding only routine laboratory parameters to the PSA test and developing machine learning algorithms can help reduce the number of unnecessary prostate biopsies without overlooking the diagnosis of PCa.

EXPLORING THE UTILITY OF CELLULAR INDICES IN THE DIAGNOSIS OF ULCERATIVE COLITIS.

To describe the usefulness of cellular indices in the diagnosis of ulcerative colitis (UC). Diagnostic study of patients under 15 years of age undergoing colonoscopy ± esophagogastroduodenoscopy for suspected inflammatory bowel disease between 2015-2022 in a pediatric hospital. Patients with normal biopsy and anatomopathological diagnosis of UC were included. Using the area under the ROC curve, the values of platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), calculated by dividing the number of platelets, neutrophils, and monocytes by the number of lymphocytes, respectively, were compared to establish the sensitivity, specificity, predictive values and Odds Ratio of each parameter in the diagnosis of UC. Twenty-six patients were included: 14 with normal biopsy and 12 with UC. PLR and MLR values were significantly higher in patients with UC (p <0.05). The sensitivity, specificity, and negative predictive value of PLR, NLR and MLR for diagnosing UC were 58%, 83% and 91%; 85%, 35% and 50%; 70%, 71% and 87%, respectively. The biomarker with the highest diagnostic performance was MLR with a cutoff point of 0.235, area under the curve of 0.735 and Odds Ratio of 11 (95%CI 1.1-109.6; p= 0.041). MLR has a high sensitivity, negative predictive value, and Odds Ratio in the pre-endoscopic diagnosis of ulcerative colitis. These findings, although exploratory, suggest that MLR could be useful in clinical practice in the initial diagnostic workup of UC, and perhaps in the future in the prioritization of endoscopic studies according to MLR values.

Cross-sectional and longitudinal associations between serum vitamin D and continuous metabolic syndrome score among children and adolescents: roles of levels of inflammation in peripheral blood

BackgroundSerum vitamin D deficiency is intricately linked to metabolic disorders, however, evidence on its association with continuous metabolic risk in children and adolescents remains insufficient. This study aims to elucidate the relationship between serum vitamin D levels and continuous metabolic risk.MethodsThe cross-sectional analysis involved 4490 participants aged 6 ~ 18, and the longitudinal investigation included 1398 individuals aged 6 ~ 12 years. Serum 25(OH)D concentrations were quantified using liquid chromatography-mass spectrometry. Continuous Metabolic syndrome risk score (CMSRS), incorporating waist, blood pressure, blood lipid levels, and glucose metabolism as four components, utilizes age- and gender-specific Z scores to evaluate metabolic risk. Restricted cubic splines (RCS) were used to visualize dose–response relationships and generalized linear models (GLM) were used to estimate potential associations. Mediation analysis was used to evaluate the mediating role of levels of Neutrophil-to-lymphocyte ratio (NLR).ResultsThe RCS indicated a negative linear association between serum 25(OH)D levels and CMSRS (P-overall = 0.0066, P-nonlinear = 0.1393). GLM revealed that compared to Q1, with the quartiles of serum 25(OH)D concentrations increase, the β value ranged from 0.028 (95% CI: − 0.093, 0.037) to 0.001(95%CI: − 0.067, 0.069), and then to -0.074 (95%CI: -0.146, -0.003, P for trend = 0.0659). For every 10 ng/mL increase in serum 25(OH)D concentration corresponded to the β value change -0.058 (95%CI: -0.098, -0.017). This association was more pronounced in younger or overweight/obese individuals. Furthermore, in the longitudinal study, as the baseline quartile of serum 25(OH)D concentration increased, the estimated change of subsequent CMSRS indicated a decreasing trend, ranging from -0.085 (95%CI: -0.203, 0.032) to -0.166 (95%CI: − 0.285, − 0.046), and then to − 0.174 (95%CI: − 0.296, -0.053, P for trend = 0.0031). The mediating proportion of levels of NLR was 7.2%.ConclusionsHigher serum 25(OH)D concentration is significantly associated with reduced CMSRS in children and adolescents, and adequate serum vitamin D levels play a prominent role in preventing long-term metabolic disorders, partly meditating by inflammation in peripheral blood.

Inflammatory Markers and Severity in COVID-19 Patients with Clostridioides Difficile Co-Infection: A Retrospective Analysis Including Subgroups with Diabetes, Cancer, and Elderly.

The interplay of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and Clostridioides difficile infection (CDI) poses a critical clinical challenge. The resultant inflammatory milieu and its impact on outcomes remain incompletely understood, especially among vulnerable subgroups such as elderly patients, those with diabetes, and individuals with cancer. This study aimed to characterize inflammatory markers and composite inflammatory severity scores-such as Acute Physiology and Chronic Health Evaluation II (APACHE II), Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65), National Early Warning Score (NEWS), and the Systemic Immune-Inflammation Index (SII)-in hospitalized Coronavirus Disease 2019 (COVID-19) patients with and without CDI, and to evaluate their prognostic implications across key clinical subgroups. We conducted a retrospective, single-center study of 240 hospitalized adults with Reverse Transcription Polymerase Chain Reaction (RT-PCR)-confirmed COVID-19 between February 2021 and March 2023. Of these, 98 had concurrent CDI. We collected baseline demographics, comorbidities, and laboratory parameters including C-reactive protein (CRP), Interleukin-6 (IL-6), ferritin, neutrophil and lymphocyte counts, albumin, platelet counts, and calculated indices (C-reactive protein to Albumin Ratio (CAR), Neutrophil-to-Lymphocyte Ratio (NLR), Prognostic Nutritional Index (PNI), SII). Patients were stratified by CDI status and analyzed for inflammatory marker distributions, severity scores (APACHE II, CURB-65, NEWS), and outcomes (Intensive Care Unit (ICU) admission, mechanical ventilation, mortality). Subgroup analyses included diabetes, elderly (≥65 years), and cancer patients. Statistical comparisons employed t-tests, chi-square tests, and logistic regression models. Patients with CDI demonstrated significantly higher CRP, IL-6, SII, and CAR, coupled with lower albumin and PNI (p < 0.05). They also had elevated APACHE II, CURB-65, and NEWS scores. CDI-positive patients experienced increased ICU admission (38.8% vs. 20.5%), mechanical ventilation (24.5% vs. 12.9%), and mortality (22.4% vs. 10.6%, all p < 0.05). Subgroup analyses revealed more pronounced inflammatory derangements and worse outcomes in elderly, diabetic, and cancer patients with CDI. Concurrent CDI intensifies systemic inflammation and adverse clinical trajectories in hospitalized COVID-19 patients. Elevations in inflammatory markers and severity scores predict worse outcomes, especially in high-risk subgroups. Early recognition and targeted interventions, including infection control and supportive measures, may attenuate disease severity and improve patient survival.

Changes in Neutrophil-to-Lymphocyte Ratio During Venoarterial Extracorporeal Membrane Oxygenation.

Mortality remains elevated during venoarterial extracorporeal membrane oxygenation support (VA-ECMO) for cardiogenic shock and the role of inflammation is uncertain. By using the neutrophil-to-lymphocyte ratio (NLR), we investigated inflammatory dynamics during VA-ECMO and their relation to clinical outcomes. A single-center, retrospective cohort study was conducted. Patients receiving steroids or on-device support for less than 48 hours were excluded. Patients were grouped as those who did and did not have a persistent rise in NLR during the 24-48 hour interval after VA-ECMO placement. Overall, 253 patients comprised the study cohort. In-hospital mortality was 56%. Neutrophil-to-lymphocyte ratio was higher at 24 hours after VA-ECMO placement compared to pre-ECMO (Δ4.36, interquartile range [IQR]: -0.23 to 8.61, p < 0.001). Persistent increase in NLR during the 24-48 hour interval after VA-ECMO placement was associated with higher in-hospital mortality (adjusted hazard ratio [aHR]: 1.51, 95% confidence interval [CI]: 1.02-2.25, p = 0.04). The magnitude of this rise in NLR was incrementally related to greater in-hospital mortality (Δ0-5: 72%, aHR: 1.61, 95% CI: 1.03-2.54, p = 0.039; Δ>5: 79%, aHR: 1.64, 95% CI: 1.03-2.63, p = 0.037) in comparison 52%, for those with a drop in NLR. Venoarterial extracorporeal membrane oxygenation exacerbates inflammation, as evident by a rise in NLR, which is progressively higher in nonsurvivors.

Neutrophil-to-Lymphocyte Ratio (NLR) and Mean Platelet Volume (MPV) to Platelet Count Ratio in the Prognosis of Neonatal and Pediatric Sepsis.

To calculate and assess the role of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV)/ platelet count (PLT) ratios and their trends as prognostic indicators in neonates and children with sepsis. This prospective observational study was planned over a period of two years at a tertiary care teaching hospital. Two hundred seventy children with clinical suspicion of or diagnosed as sepsis were enrolled. Serial hemograms (day 1, 4, 7, 10) and trends of NLR and MPV/PLT ratios were reviewed. NLR on day 10 of hospital stay had maximum sensitivity of 65% and specificity of 62%. Day 1 MPV was significantly higher in the mortality group. There was a significant correlation between lower Pediatric Sequential Organ Failure Assessment (p-SOFA) score and MPV in the survival group. MPV/PLT ratio on day 7 had maximum sensitivity of 85% and specificity of 74% in prediction of mortality. Serial decreasing trend of NLR (2.88-1.16) and MPV/PLT from day 1 to 10 (8.58-8.48) were associated with improved outcome (p < 0.001). High NLR, MPV and MPV/PLT on admission are associated with increased mortality in neonatal and pediatric sepsis. Serial decreasing trends in NLR, MPV and MPV/PLT ratio are associated with improved prognosis.