Neutrophil-to-lymphocyte Ratio Levels Research Articles

Serum inflammation biomarkers level in cystoid and diffuse diabetic macular edema.

To assess serum inflammatory biomarker levels in patients with different subtypes of diabetic macular edema (DME). We retrospectively analyzed 50 eyes from 37 treatment-naïve DME patients who underwent intravitreal injection therapy between June and December 2023. Based on the morphological characteristics of macular edema in optical coherence tomography (OCT), the eyes were categorized into the cystoid macular edema (CME) group (n = 25) and diffuse retinal thickening (DRT) group (n = 25). Additionally, 25 eyes with diabetes retinopathy but without DME served as the control group. Comprehensive clinical data were reviewed, including best-corrected visual acuity (BCVA), central macular thickness (CMT), macular cube volume (VOL) and hematological examination. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated. NLR and SII levels were significantly higher in the CME group compared to the DRT group and control group (all P < 0.01). The optimal ROC cutoff value of NLR for CME was 2.27, with 88.0% sensitivity and 68.0% specificity. The optimal ROC cutoff value of SII for CME was 447.33, with 84.0% sensitivity and 60.0% specificity. After initial intravitreal injection therapy, BCVA and VOL significantly improved in each group (all P < 0.01). However, no significant correlation was found between systemic inflammatory marker levels and postoperative changes in BCVA, CMT and VOL (all P > 0.05). Our study suggests that elevated NLR and SII levels are significantly associated with CME. Elevated serum inflammatory biomarkers may indicate a higher incidence of CME in these patients.

Predictive Factors of Amputation in Diabetic Foot

Background: Diabetic foot ulcers are a common complication of diabetes mellitus, often leading to progressive sensory deficits, impaired vascularization, and a predisposition to ulceration and gangrene. Untreated ulcers may cause recurrent infections that endanger a patient’s life. Amputation of part of the limb up to a well-vascularized level is one of the treatments employed for untreated ulcers. Objectives: Laboratory data were analyzed with the aim of identifying risk factors related to surgical amputation treatment of diabetic foot. We believe it is useful to identify risk factors that can be altered from a reversible condition in the clinical decision-making of treatment, thus manifesting themselves in a timely manner to provide the patient with an alternative to surgical amputation of the lower limb. Methods: Our retrospective study was conducted by the Department of Orthopedics and Traumatology at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. We recruited 200 patients who underwent lower limb amputation for diabetic foot between 2017 and 2021 and had blood tests both 30 days and within 5 days before the first surgery. Results: This case–control study revealed a significant negative correlation between hemoglobin (Hb) levels and the occurrence of leg amputations. In contrast, C-reactive protein (CRP) levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) showed significant positive correlations with leg amputations. A 3-year follow-up of the cases also revealed a significative positive correlation between age, white blood cells (WBC) count, NLR, PLR, and death at 3 years. Conclusions: Our findings suggested that lower Hb levels and elevated CRP, NLR, and PLR levels in patients with diabetic foot disease may be associated with a higher risk of lower-limb amputation. Unexpectedly, this study also demonstrated that elderly age, WBC, CRP, NLR and PLR levels may be associated with a negative prognosis for these patients. These findings highlighted the importance of monitoring these laboratory values in diabetic patients to identify individuals at higher risk of leg amputations and implement appropriate interventions to prevent or minimize the occurrence of this severe complication.

Diagnostic significance of neutrophil-to-lymphocyte ratio in non-arteritic anterior ischemic optic neuropathy: a meta-analysis.

We aimed to determine the association of neutrophil-to-lymphocyte ratio (NLR) with non-arteritic anterior ischemic optic neuropathy (NAION). We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus and Web of Science were searched from the establishment of the database to May 5, 2022 to find the relevant studies. The quality of the included literature was evaluated with the Newcastle-Ottawa scale (NOS). The results are reflected in the form of standard mean difference (SMD) and 95% confidence interval (CI). Finally, six articles were included in our study. Compared with healthy controls, patients' NLR levels were significantly higher (SMD = 0.47; CI 95% = 0.30-0.65, p<0.001). The included studies were not statistically heterogeneous (I2 = 0.0%, p = 0.60); thus, the analysis used the fixed-effect model. The pooled sensitivity of NLR was 0.69 (95% CI 0.60-0.67), and the pooled specificity was 0.59 (95% CI 0.50-0.67). The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) of NLR were 1.71(95%CI 1.48-1.98), 0.50 (95%CI 0.41-0.62), and 3.38 (95%CI 2.57-4.44), respectively. Our findings suggest NLR to be a potential marker of NAION, while also implicating a role for inflammation in underlying pathophysiology.

Evaluating the prognostic impact of inflammatory markers on treatment outcomes in patients with intrahepatic cholangiocarcinoma undergoing radioembolization.

Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive malignancy with limited treatment options, often diagnosed at advanced stages. Radioembolization has emerged as a promising therapy, but its efficacy varies among patients, necessitating reliable biomarkers to predict treatment response. This study evaluates the prognostic impact of systemic inflammatory response markers on treatment outcomes in patients with iCCA undergoing radioembolization. This retrospective study included 70 patients with iCCA treated with radioembolization between January 2016 and December 2023. Inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were measured from peripheral blood samples. Treatment response was assessed using the modified RECIST criteria, and survival analyses were performed using the Kaplan-Meier method and Cox proportional hazards regression. Patients with lower NLR, PLR, and SII values exhibited significantly higher objective response rates (P = 0.032, P = 0.016, and P = 0.001, respectively). High levels of NLR, PLR, and SII were associated with shorter overall survival (12 vs. 16 months, P = 0.007; 12 vs. 16 months, P = 0.004; and 10 vs. 22 months, P < 0.001, respectively) and progression-free survival (3 vs. 7 months, P = 0.046 for SII). Multivariate analysis identified high SII (P = 0.040), lymph node metastasis (P = 0.042), and high serum total bilirubin (P = 0.013) as significant independent prognostic factors. Systemic inflammatory markers such as NLR, PLR, and SII are valuable prognostic indicators for patients with iCCA undergoing radioembolization. These markers can aid in identifying patients likely to benefit from personalized treatment strategies, potentially improving clinical outcomes. The clinical significance of this study lies in its demonstration that systemic inflammatory markers (NLR, PLR, and SII) serve as valuable prognostic indicators for predicting treatment outcomes in patients with iCCA undergoing radioembolization, thus aiding in the identification of patients who may benefit from personalized treatment strategies and potentially improving clinical outcomes.

Associations of HMGB1, sTNFR-1 and NLR with Premature Delivery Secondary to Infection in Pregnant Women Undergoing Cervical Cerclage

Background: Although cervical cerclage has improved with the rapid development of medical technology, there remains a distinct probability of adverse pregnancy outcomes. To investigate the associations of changes in the high mobility group box 1 (HMGB1), soluble tumor necrosis factor receptor 1 (sTNFR-1) and peripheral blood neutrophil-to-lymphocyte ratio (NLR) with premature delivery secondary to infection in pregnant patients undergoing cervical cerclage. Methods: Sixty-seven pregnant patients with premature delivery after cervical cerclage, who were treated at the Affiliated Matern &amp; Child Care Hospital of Nantong University from January 2022 to October 2023, were enrolled, including 43 with premature delivery secondary to infection (infectious group) and 24 with idiopathic premature delivery (non-infectious group). The pre-delivery serum levels of HMGB1, sTNFR-1 and the peripheral blood level of NLR were compared between the 2 groups. Further, the clinical value of these 3 indicators in predicting premature delivery secondary to infection among pregnant patients undergoing cervical cerclage was assessed by receiver operating characteristic (ROC) curve analysis. Results: The infectious group exhibited significantly higher serum levels of HMGB1, sTNFR-1 and peripheral blood level of NLR compared to those in the non-infectious group, demonstrating significant differences (p &lt; 0.05). Logistic regression analysis revealed that HMGB1 and NLR were independent influencing factors for premature delivery (p &lt; 0.05). According to the ROC curve analysis results, the changes in HMGB1, sTNFR-1 and NLR levels may reflect the risk of premature delivery secondary to infection among pregnant patients undergoing cervical cerclage. The area under the curve (AUC), sensitivity and specificity of combined detection were all markedly higher than those of independent detection. Conclusions: HMGB1, sTNFR-1 and NLR levels are risk factors for third-trimester premature delivery among pregnant patients undergoing cervical cerclage. Timely combined detection of serum HMGB1, sTNFR-1 and peripheral blood NLR during the third trimester can improve the clinical diagnostic acumen, which enables early prevention to help lower the risk of premature delivery.

Sorafenib vs chemotherapy in the treatment of locally advanced or metastatic, radioactive iodine-refractory differentiated thyroid cancer: real-world data from Turkey

Managing locally advanced, or metastatic radioactive iodine-refractory differentiated thyroid cancers (RAIR-DTC) poses substantial challenges, with few available treatment options. The aim of this study was to evaluate clinical outcomes of patients receiving sorafenib as first line treatment. In addition, prognostic markers affecting progression-free survival (PFS) were identified. This retrospective, 6 centers study included 62 patients with locally advanced or RAIR-DTC treated 2008-2023. The median PFS was 16.5 months. The presence of liver metastases was strongly associated with a lower PFS (3.1 months (p < 0.001)). The use of sorafenib as initial treatment resulted longer PFS compared to chemotherapy, with a median of 25.5 vs 4.7 months respectively (p = 0.01). Increased neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with worse outcomes (p = 0.01; p = 0.009, respectively). In conclusion, sorafenib has demonstrated significant PFS benefits when used as first-line treatment. It has been shown that the presence of liver metastases and higher levels of NLR and PLR are associated with a more unfavorable prognosis.

The role of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in determining the severity of pre-eclampsia in antenatal women: A case control study

Pre-eclampsia (PE) remains a significant global health concern, affecting 2-8% of pregnancies and contributing to maternal and perinatal morbidity and mortality. Characterized by hypertension and proteinuria after 20 weeks of gestation, PE often involves systemic inflammation and endothelial dysfunction. Its exact etiology is multifactorial, involving immune dysregulation and vascular abnormalities. Early identification of high-risk pregnant women is crucial to mitigate adverse outcomes. In India, PE affects 8-10% of pregnancies.Inflammatory markers such as the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) have emerged as potential indicators of systemic inflammation. Elevated NLR and PLR levels in PE suggest a role in the disorder's pathophysiology, reflecting immune responses to placental ischemia and pro-inflammatory cytokine release.This study aims to compare NLR and PLR levels between PE patients and normotensive pregnant women, evaluate their association with PE severity, and discuss their potential as predictive biomarkers. A case-control study was conducted with 84 participants, following eligibility criteria via convenient sampling. Demographic characteristics, obstetric history, and CBC-derived biomarkers were assessed.Among 84 pregnant women, 42 had preeclampsia (PE) and 42 were normotensive. The PE group had significantly higher Neutrophil-to-Lymphocyte Ratios (5.11 ± 2.88 vs. 2.74 ± 0.78) and Platelet-to-Lymphocyte Ratios (108 ± 46.7 vs. 85.4 ± 29.4) compared to controls. PE incidence peaked between 34-38 weeks. Higher PLR and NLR values were linked to severe PE. ANC booking was lower in the PE group. Obesity trends were not statistically significant.Significant associations were found between elevated NLR and PLR and PE severity, highlighting their potential clinical utility.Our findings indicate NLR and PLR as valuable biomarkers for predicting and managing PE. Integration of these markers into routine prenatal care could enhance clinical management and improve maternal and fetal outcomes.

The Roles of Vitamin D Levels, Gla-Rich Protein (GRP) and Matrix Gla Protein (MGP), and Inflammatory Markers in Predicting Mortality in Intensive Care Patients: A New Biomarker Link?

Identifying reliable biomarkers to predict mortality in critically ill patients is crucial for optimizing management in intensive care units (ICUs). Inflammatory and metabolic markers are increasingly recognized for their prognostic value. This study aims to evaluate the association of various inflammatory and metabolic markers with ICU mortality. This prospective observational study was conducted from January 2023 to January 2024 in the City Hospital's ICU. A total of 160 critically ill patients were enrolled. Laboratory parameters, including white blood cell (WBC) count, red cell distribution width (RDW), platelet count, neutrophil count, mean platelet volume (MPV), monocyte count, lymphocyte count, procalcitonin (PCT), C-reactive protein (CRP), calcium (Ca++), and vitamin D levels, were analyzed. Additionally, ratios such as the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory index (SII), and pan-immune-inflammation value (PIV) were calculated. Plasma levels of Gla-rich protein (GRP) and dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) were measured using ELISA. The mean age of the patients included in the study was 60.5 ± 15.8 years. Cardiovascular disease was present in 72 patients (45%), respiratory system disease in 58 (36%), and chronic kidney disease (CKD) in 38 (24%). Additionally, 61 patients (38%) had diabetes, and 68 (42%) had hypertension. Inflammatory markers, including PLR, NLR, and PIV, were all significantly higher in non-survivors, while calcium and vitamin D levels were lower (p < 0.05). Higher WBC, RDW, neutrophil count, PLR, NLR, PIV, CRP, procalcitonin, GRP, and dp-ucMGP levels were positively correlated with longer hospital stays and increased mortality. In contrast, platelet and lymphocyte counts were negatively correlated with both outcomes (p < 0.05). Vitamin D levels showed an inverse relationship with both hospital stay and mortality, indicating that lower levels were associated with worse outcomes (p < 0.05). In multiple logistic regression analysis, elevated WBC count (OR = 1.20, p = 0.02), RDW (OR = 1.35, p = 0.01), neutrophil count (OR = 1.25, p = 0.01), MPV (OR = 1.20, p = 0.02), PLR (OR = 1.30, p = 0.01), NLR (OR = 1.40, p = 0.001), PIV (OR = 1.50, p = 0.001), CRP (OR = 1.32, p = 0.01), procalcitonin (OR = 1.45, p = 0.001), GRP (OR = 1.40, p = 0.001), and dp-ucMGP (OR = 1.30, p = 0.001) levels were significantly associated with increased mortality. Inflammatory and metabolic markers, particularly NLR, PLR, PIV, GRP, and dp-ucMGP, are strong predictors of mortality in ICU patients. These markers provide valuable insights for risk stratification and early identification of high-risk patients, potentially guiding more targeted interventions to improve outcomes.

Neutrophil-to-lymphocyte ratio as a prognostic indicator of mortality in Polycythemia Vera: insights from a prospective cohort analysis

We analyzed the neutrophil-to-lymphocyte ratio (NLR) in 1508 patients with PV and found that those with an NLR ≥ 5 were generally older, had a longer disease history, and had higher cardiovascular risk factors, more arterial thrombosis, and more aggressive blood counts, indicating a more proliferative disease. NLR was an accurate predictor of mortality, with patients with NLR ≥ 5 having significantly worse overall survival and more than twice the mortality rate compared to those with NLR < 5. Multivariable models confirmed that increasing age, previous venous thrombosis and NLR ≥ 5 were strong predictors of death, further influenced by cardiovascular risk factors. We examined the interaction between NLR and the number of cardiovascular risk factors and found a progressive trend of increased mortality risk for NLR values ≥ 5 in addition to the presence of more than one risk factor. In conclusion, patients with NLR ≥ 5 require careful monitoring and management of cardiovascular risk factors because they increase mortality when associated with progressive levels of NLR.

The clinical significance of the Neutrophil-to-Lymphocyte Ratio as a novel inflammatory biomarker for assessing the severity of intervertebral disc degeneration.

Inflammation is integral to the pathogenesis of intervertebral disc degeneration, yet the role of systemic inflammatory markers in this process remains underexplored. This study aims to explore the association between the Neutrophil-to-Lymphocyte Ratio (NLR) and the severity of disc degeneration. A retrospective analysis was conducted on 375 patients diagnosed with lumbar disc degeneration between April 2018 and May 2021. All patients underwent a complete blood cell count examination. We applied the Pfirrmann grading system for cumulative disc grading, stratifying patients into two groups: a high-score group (cumulative grade > 17) and a low-score group (cumulative grade ≤ 17), based on the median cumulative grade. The association between the NLR and and the severity of disc degeneration was further analyzed using correlation analysis and logistic regression models. Furthermore, the predictive capacity of the NLR for lumbar disc degeneration was assessed using the Receiver Operating Characteristic (ROC) curve. We found a significant positive correlation between high NLR levels and severe disc degeneration. The high-score group exhibited a significantly higher NLR compared to the low-score group [2.63 (1.91-4.18) vs. 2.04 (1.38-2.74), respectively, p < 0.001]. Significant correlations were found between NLR and patient characteristics (including age, BMI, VAS, NSAIDs usage, hemoglobin) and the cumulative grading. Logistic regression analysis identified age and NLR as independent predictors of the severity of disc degeneration. The ROC curve analysis demonstrated a good predictive capability of NLR for lumbar disc degeneration. NLR could serve as a promising biomarker for assessing the severity of lumbar disc degeneration and offer potential benefits in both early diagnosis and treatment strategies.

Prognostic value of neutrophil-to-lymphocyte ratio and cardiac troponin I in patients with immune checkpoint inhibitors-related myocarditis

Abstract Background Over the past decade, immune checkpoint inhibitors (ICIs) have significantly transformed cancer treatment. However, ICIs inevitably may cause a spectrum of immune-related adverse events, among which cardiovascular toxicity, particularly myocarditis, while infrequent, has garnered increasing attention due to its high fatality rate. Purpose We executed a multicenter study aimed at characterizing ICI-related myocarditis and risk factors influencing its prognosis. Methods The study included patients with ICIs-associated myocarditis at four medical centers in China from January 28, 2019 to June 15, 2023. Logistic regression was performed to explore the risk factors for the development of severe myocarditis. Receiver operating characteristic curves were conducted to assess the diagnostic abilities of biomarkers to distinguish severe myocarditis, and the performance and calibration were evaluated using Hosmer-Lemeshow test. Cox regression analysis was employed to investigate the influential risk factors affecting the prognosis of ICI-related myocarditis. Kaplan-Meier survival curve analyses were conducted to assess the differences in survival times among different myocarditis groups. Results 35 ICIs-associated myocarditis patients were identified. 21 patients (60%) were classified as severe myocarditis, and they presented higher cardiac troponin I (cTnI) levels (P=0.013), higher N-terminal pro-B-type natriuretic peptide levels (P=0.031), higher creatine kinase (CK) levels (P=0.018), higher CK-MB levels (P=0.026), and higher neutrophil to lymphocyte ratio (NLR) levels (P=0.016) compared to non-severe myocarditis patients. Multivariate logistic regression showed that cTnI (adjusted odds ratio: 1.021, 95% confidence interval (CI): 1.002-1.039, P=0.03) and NLR (adjusted odds ratio: 1.890, 95% CI: 1.026-3.483, P=0.041) were the independent risk factors of ICI-associated severe myocarditis. The receiver operating characteristic curve showed an area under curve of 0.765 (95% CI: 0.601 to 0.929, P=0.013) for cTnI, and 0.773 for NLR (95% CI: 0.597 to 0.948, P=0.016). Multivariate COX regression showed that NLR (adjusted hazard ratio: 1.189, 95% CI: 1.028-1.376, P=0.020) and pneumonitis (adjusted hazard ratio: 8.142, 95% CI: 1.191-55.651, P=0.032) were the independent prognostic risk factor associated ICI- related myocarditis. Further Kaplan-Meier survival curve analysis showed that the survival rate among patients without pneumonitis and with low level of NLR significantly outstripped that of patients with pneumonitis (P=0.015) and high level of NLR (P=0.024). Conclusions As independent risk factors for the development of ICI-associated severe myocarditis, cTnI and NLR demonstrated a promising predictive utility for the identification of ICI-associated severe myocarditis. NLR and the presence of pneumonitis were identified as independent risk factors that significantly impacted the prognosis of ICI-related myocarditis.

The role of interleukin-20 and vascular endothelial growth factor-A biomarkers in the detection of renal impairment in patients with multiple myeloma

ABSTRACT Background Multiple myeloma (MM) is a malignant incurable disease characterized by monoclonal plasma cell increase associated with renal impairment. Evaluation of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), hemoglobin/red cell distribution width (HB/RDW), interleukin-20 (IL-20), and vascular endothelial growth factor-A (VEGFA) in patients with MM (with or without renal impairment) as prognostic and severity indicators. Research design and methods A cross-sectional study was conducted on sixty MM patients with renal impairment, sixty MM patients without renal impairment, and sixty subjects (control group). Complete blood count, IL-20 immunoassay, and gene expression of IL-20, and VEGFA were evaluated. Results Higher levels of NLR, MLR, and IL-20, moreover lower levels of PLR, HB/RDW, as well as upregulation of IL-20, and VEGFA gene expression were detected in MM patients especially renal impairment. Receiver operating characteristic curves analysis of NLR, MLR, PLR, and IL-20 showed high sensitivity and specificity in the diagnosis of MM and disease stages. Conclusions NLR, MLR, PLR, HB/RDW, IL-20, and VEGFA may be implicated in the inflammatory process of MM and renal impairment pathogenesis. NLR, MLR, and IL-20 can be used as prognostic markers in MM stages.

Evaluation of Inflammatory Markers in Predicting Coronary Complexity: Insights from the SYNTAX II Score in NSTEMI Patients.

Objectives: Non-ST-elevation myocardial infarction (NSTEMI) is characterized by the absence of pathological ST segment elevation but an increase in biological markers. The SYNTAX II score (SS-II) is calculated to evaluate the complexity of coronary artery disease and to guide treatment decisions between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The aim of this study is to evaluate the relationship of socio-demographic data and biochemical markers with SS-II in NSTEMI patients. Materials and Methods: Six hundred patients who were admitted to the private Aktif International Hospital cardiology clinic between January 2020 and January 2024 and were diagnosed with NSTEMI were included in the study. Severity, extent, and clinical evaluation of atherosclerosis were determined using risk factors, laboratory tests, and coronary angiography. Patients were divided into two groups according to their SS-II score: low (≤ 22) and high SS-II (> 32). Socio-demographic data, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and monocyte-to-HDL-C ratio (MHR) were compared between the two groups. Results: Group 1 (SS-II ≤ 22) included 380 patients, and group 2 (SS-II > 32) included 220 patients. There was a statistically significant difference in HDL, creatine value, white blood cell, troponin I, hs-TnT, and monocyte values in group 2 compared with group 1 (p = 0.001, p = 0.018, p = 0.031, and p = 0.001, respectively). NLR, MLR, MHR, and SS values were statistically significantly higher in group 2 compared with group 1 (p = 0.015, p = 0.002, p = 0.001, and p = 0.001, respectively). The risk factors were found to be significantly associated with high-risk NSTEMI (SS-II > 32) in a logistic regression analysis and included peripheral artery disease (PAD) (OR: 3.028, p = 0.040), troponin I (OR: 3.575, p = 0.015), hs-TnT (OR: 4.221, p = 0.010), NLR (OR: 1.528, p = 0.024). MLR (OR: 5.248, p = 0.012), and MHR (OR: 7.122, p = 0.010). ROC analysis revealed that NLR (AUC: 0.691, p = 0.016), MLR (AUC: 0.731, p = 0.004), and MHR (AUC: 0.824, p = 0.003) had higher predictive power than other parameters in patients with high-risk NSTEMI (SS-II > 32). Conclusions: We found that NLR, MLR, and MHR levels are associated with the severity of coronary artery disease. We think that adding these easily and quickly measurable parameters to routine laboratory results may support the clinician in evaluating the complexity of coronary artery disease and guiding treatment decisions in NSTEMI patients.

LDH and NLR, as inflammatory markers, the independent risk factors for COVID-19 complicated with respiratory failure in elderly patients.

Lactate dehydrogenase (LDH) is an enzyme that is responsible for the production of lactic acid, which is a necessary byproduct when the body does not have enough oxygen. LDH levels in the blood can be used as a marker to predict mortality in patients with ARDS, severe COVID-19, and cancer. To analyze the clinical characteristics of COVID-19 in the elderly and the correlation between LDH and respiratory failure in COVID-19 patients, to improve the identification and management of this type of pneumonia by clinicians. This was a single-center retrospective study. We performed routine laboratory tests in 105 COVID-19 patients admitted to the affiliated hospital of Qingdao University (Qingdao, China) from October 1, 2022 to February 1, 2023. The diagnosis of respiratory failure was established based on the results of blood gas analysis upon admission. The median age was 79 years. Among all univariable parameters, LDH, neutrophil to lymphocyte ratio (NLR) and Prothrombin Time (PT) were significantly independent risk factors of RF in elderly COVID-19 patients. LDH (AUC=0.829) also had a maximum specificity (96.5%), with the cutoff value of 280.5. The levels of LDH, NLR, and PT may serve as potential indicators for elderly COVID-19 patients combined with respiratory failure. LDH, NLR and PT assays can be beneficial for patients who need closer respiratory monitoring and more aggressive supportive care to prevent a negative prognosis.

Comparison of Trends of Procalcitonin and Neutrophil to Lymphocyte Ratio in Patients of Sepsis in Intensive Care Unit.

This study examines the trends of procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and sequential organ failure assessment (SOFA) scores in intensive care unit (ICU) sepsis patients from different infection sources. Elevations in PCT and NLR reflect infection severity and predict sepsis prognosis. Combining them may enhance diagnostic accuracy and prognostic capabilities, despite variations in cut-off values. The study emphasizes the significance of these biomarkers in improving sepsis management and patient outcomes. This was a prospective observation study of ICU sepsis patients from different infection sources. Procalcitonin and NLR levels were measured on days 0, 2, and 4 of admission. Sequential organ failure assessment scores on these days were also analyzed. The cut-off values were obtained for predicting the prognosis of sepsis ICU patients. The study included 100 sepsis patients with an equal distribution of males and females and a mean age of 72 years. Procalcitonin showed a significant decrease over time, while NLR initially increased before decreasing on day 4, and SOFA scores showed no significant changes. Deceased patients had significantly higher PCT and SOFA scores on days 2 and 4. Receiver operating characteristic curve analysis showed promising predictive results for PCT on day 4 and SOFA scores on days 2 and 4. Understanding the trends of PCT and NLR concerning the infection source can provide deeper insights into their diagnostic and prognostic capabilities. This comparative analysis of PCT, NLR, and SOFA score trends contributes to the improvement of patient outcomes through accurate assessment of sepsis severity and progression, early diagnosis, and timely intervention. Jayara A, Mascarenhas J, Gandhi B, Nimbolkar J. Comparison of Trends of Procalcitonin and Neutrophil to Lymphocyte Ratio in Patients of Sepsis in Intensive Care Unit. Indian J Crit Care Med 2024;28(10):942-951.

Relation between peripheral blood inflammatory indices and severity of central retinal artery occlusion.

Central retinal artery occlusion (CRAO) has been identified as an acute emergency resulting in vision loss, with its pathogenesis potentially involving systemic inflammation and abnormal lipid metabolism. Over recent years, it has been established that peripheral blood inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), the systemic immunoinflammatory index (SII), and the monocyte-to-high-density lipoprotein ratio (MHR), play significant roles in assessing systemic inflammation and lipid metabolism. However, the role of these indices in assessing the severity of CRAO has rarely been explored. This study aimd to investigate the relationship between these inflammatory indices and the severity of CRAO. This was a retrospective clinical study with a total of 49 CRAO patients and 50 age- and sex-matched controls involved. The patients with CRAO were divided into three groups (13 with incomplete CRAO, 16 with subtotal CRAO and 20 with total CRAO). Data were compared across these groups, and additionally, correlation analysis, restricted cubic spline plots, and receiver operating characteristic curve analysis were performed. The values of NLR, SII and MHR were significantly higher in the CRAO group compared to controls (NLR: 2.49(1.71,3.44) vs 1.60(1.24,1.97), P<0.001; SII: 606.46(410.25,864.35) vs 403.91(332.90,524.31), P=0.001; MHR: 0.33(0.26,0.44) vs 0.25(0.21,0.34), P<0.001). MHR was also significantly higher in total CRAO than in incomplete CRAO and subtotal CRAO (0.41(0.32,0.60) vs 0.29(0.21,0.43), P=0.036; 0.41(0.32,0.60) vs 0.29(0.23,0.38), P=0.017). Significant positive associations were found between MHR, NLR, SII and both the incidence (all P<0.001) and severity (P<0.001, P<0.001, P=0.003, respectively) of CRAO. MHR had a linear relationship with both the occurrence and severity of CRAO (P-overall=0.013, P-non-linear=0.427 and P-overall=0.013, P-non-linear=0.825). Combining MHR and NLR significantly improved diagnostic efficacy for CRAO and total CRAO, with area under the curve of 0.816 and 0.827, respectively, compared to using MHR alone (0.705 and 0.816). Elevated levels of peripheral blood NLR, SII, and MHR are positively associated with CRAO incidence, highlighting their potential as early predictive markers. The combined NLR and MHR index further enhances diagnostic accuracy and may facilitate timely assessment of CRAO severity by ophthalmologists and internists.

The diagnostic value of systemic inflammation indices in pregnant women with acute appendicitis and their relationship with the duration of hospital stay

Aim: Physiological and anatomical changes occurring during pregnancy can complicate the diagnosis of acute appendicitis (AA). This study aimed to evaluate the diagnostic performance of systemic inflammation indices in distinguishing AA in pregnant women and to assess their relationship with hospital stay duration. Material and Methods: This retrospective study encompassed 32 pregnant patients who underwent appendectomy and 32 healthy pregnant (control group). Systemic inflammation indices were calculated based on neutrophil (N), platelet (P), and lymphocyte (L) levels as follows: The neutrophil-to-lymphocyte ratio (NLR) = N/L; the platelet-to-lymphocyte ratio (PLR) = P/L; systemic immune-inflammation index (SII) = (N×P)/L. Results: The AA group had higher median levels of PLR (30.9 vs. 22.4, p = 0.035), NLR (6.1 vs. 3.5, p &lt; 0.001), and SII (1370 vs. 807, p &lt; 0.001) compared to the control group. Systemic inflammation indices showed a positive correlation with the Alvarado score and the length of hospital stay. SII values demonstrated superior diagnostic performance in predicting AA compared to NLR and PLR values. The threshold value for SII in predicting AA was identified as &gt;1316, with a sensitivity of 85.8% and a specificity of 72.5%. Conclusions: Systemic inflammation indices, particularly SII, demonstrate strong diagnostic value in distinguishing AA in pregnant women. SII demonstrated superior accuracy over NLR and PLR, correlating with both the Alvarado score and hospital stay, suggesting its utility as a diagnostic and prognostic marker.

The Role of Monocyte Distribution Width in the Early Prediction of Sepsis in Patients Undergoing Cardiovascular Surgery: A Cross-Sectional Study.

Background and Objectives: This is the first study to examine the role of monocyte distribution width (MDW) in predicting sepsis after cardiovascular surgery. Methods: This study included 43 consecutive patients who had undergone cardiovascular surgery between July 2021 and July 2022. All patients were examined at the following three time points (TPs): preoperative period (TP1), postoperative at 24 h (TP2), and discharge (TP3). SOFA score, leukocyte count, neutrophil-to-lymphocyte ratio (NLR), MDW, C-reactive protein (CRP), and procalcitonin (PCT) levels were tested at each TPs. The Sepsis-3 criteria were used to diagnose patients with sepsis. Results: The mean values of all variables (leukocyte count, NLR, MDW, CRP, and PCT levels) were significantly higher at TP2 and TP3 than at TP1 (p < 0.05). All these values were significantly higher at TP2 than at TP3 (p < 0.05). Patients with sepsis had significantly higher mean values for leukocyte count, NLR, MDW, CRP, and PCT levels than those without sepsis (p < 0.05). There was a significant correlation between MDW and inflammatory markers (CRP, PCT, and NLR) during the three time periods (p < 0.05). According to the ROC analysis, the optimal MDW cutoff value with the highest sensitivity and specificity for predicting sepsis in the postoperative period was 20.5. Conclusions: Our findings indicate that elevated MDW levels may be a valuable predictor of sepsis in patients following cardiovascular surgery.

Clinical characteristics and prognostic factors of pulmonary and extrapulmonary cryptococcosis

BackgroundCryptococcosis is progressively acknowledged among people, irrespective of the human with or without immunodeficiency virus (HIV). This change in epidemiology has been recorded in recent years, prompting closer examination and a broader understanding of the disease manifestations and risk factors.MethodsThe data of cryptococcal infections in China during 11 years were retrospectively analyzed. According to the position of infection, the patients were categorized into the pulmonary infection group and extrapulmonary infection group. The composition of the two groups was compared, and the potential risk factors of disseminated infection were analyzed. Logistic regression was used to analyze the prognostic risk factors of the disease.ResultsA total of 165 patients were enrolled. 113 (68.5%) were male, and the age was 47.49 (18–82) years. 101 cases (61.2%) had a normal immune function and 64 cases (38.8%) had impaired immune function. 45 patients had extrapulmonary infection, involving the central nervous system, bone and joint, skin and bloodstream, and 120 patients had simple pulmonary infection. The mortality of the extrapulmonary infection group (48.9%) was significantly higher than that of the pulmonary infection group (0.8%). According to univariate logistic regression analysis, immune status (hazard ratio [HR], 4.476; 95% confidence interval [CI], 1.725–11.618; P = 0.002), infection position ([HR], 113.826; [CI], 14.607-886.967; P < 0.001), white blood cell count, ([HR],1.209;[CI], 1.054–1.386; P = 0.007), hemoglobin ([HR], 0.970; [CI], 0.955–0.986; P < 0.001), platelet count ([HR], 0.993; [CI], 0.987–0.999; P = 0.026), neutrophil percentage ([HR], 1.115; [CI], 1.065–1.168; P < 0.001), lymphocyte percentage ([HR], 0.875; [CI], 0.827–0.927; P < 0.001), neutrophil-to-lymphocyte Ratio (NLR) ([HR], 1.144; [CI], 1.072–1.221; P < 0.001), monocyte percentage ([HR], 0.752; [CI], 0.618–0.915; P = 0.004) were related to the prognosis. Multivariate logistic regression analysis showed that the infection position was remained related to the prognosis with statistical significance ([HR], 0.018; [CI], 0.001–0.384; P = 0.001).ConclusionExtrapulmonary infection of Cryptococcosis is an important risk factor for prognosis. High levels of neutrophils and NLR, and low levels of lymphocytes and monocytes may lead to disseminated infection of Cryptococcosis. Further studies are needed to reduce the occurrence rate of extrapulmonary infection and mortality.

The Role of Zinc Supplementation in Alleviating Inflammatory Biomarkers in Patients Undergoing Hemodialysis: A Randomized Placebo Controlled, Crossover Trial

Background: Chronic kidney disease (CKD), which progresses to end-stage renal disease (ESRD) and requires maintenance hemodialysis (MHD), is a global health issue. Inflammation in MHD patients is associated with increased mortality and cardiovascular events. Zinc, essential for immune function and possessing anti-inflammatory properties, is frequently deficient in these patients and could potentially help mitigate inflammation. Objectives: This study aims to assess the impact of zinc supplementation on inflammatory biomarkers, specifically (CRP) and the neutrophil-to-lymphocyte ratio (NLR), in MHD patients. Methods: In a double-blind, randomized controlled crossover trial conducted at Labafinejad Hospital, Tehran, MHD patients with zinc deficiency were initially allocated to either a zinc supplementation group or a placebo group. After 30 days, the groups were crossed over, with patients initially receiving zinc now receiving a placebo and vice versa. The primary outcome was changes in serum zinc levels, while secondary outcomes focused on CRP and NLR levels. Results: Significant changes in serum zinc levels were observed in both groups from baseline to Month 2 (drug-placebo group: Mean change -15.9±10.33 µg/dL, P &lt; 0.05; placebo-drug group: Mean change -14.70 ± 12.58 µg/dL, P &lt; 0.05). A significant initial reduction in CRP levels at Month 1 (P = 0.045) was not sustained at Month 2 (P = 0.812). No statistically significant changes in NLR were noted. Improvements in quality of life, including reductions in muscle pain and skin dryness, were significant in the drug-placebo group (P &lt; 0.05). Conclusions: Zinc supplementation in MHD patients significantly improved serum zinc levels and initially reduced CRP levels, highlighting its potential role in managing inflammation. Although the impact on NLR was not significant, overall patient outcomes and quality of life showed promising improvements.