Neutrophil-to-lymphocyte Ratio Ratio Research Articles

Microwave Ablation of Benign Thyroid Nodules: Effects on Systemic Inflammatory Response

To explore the alterations of neutrophil-to-lymphocyte ratio (NLR) as a systemic inflammatory marker after microwave ablation for benign thyroid nodules. Study Design: A descriptive study. Department of Radiology, Antalya Training and Research Hospital, from December 2018 to June 2019. Demographic data of the patients, ultrasonographic features of the nodules, thyroid function tests of the patients, leukocyte, neutrophil, lymphocyte values, and thyroid nodule volumes of the patients before and after the procedure were recorded. NLR and volume reduction ratio (VRR %) of 35 patients with thyroid nodules were compared before and after microwave ablation therapy of the thyroid nodules. The nodule volume decreased from 23.89 ±15.44 cc to 11.57 ±8.65 cc at two months and to 7.79 ±5.74 cc at six months. The VRR% increased from 38.65 ±16.82 to 63.16 ±14.19 at three months and to 68.29 ±11.80 at six months. The mean value of NLR decreased from 2.28 ±0.86 to 1.78 ±0.54. ROC curve analysis suggested that the optimum pre-NLR cut-off point for 50% VRR success was 2.50 with the specifity and sensitivity of 0.67 and 0.50. After ultrasound-guided microwave ablation of benign thyroid module, VRR percentage increased significantly, while the inflammatory marker NLR value decreased. Key Words: Biomarker, Inflammation, Microwaves, Neutrophil-to-lymphocyte ratio, Thyroid nodule.

The predictive value of mean platelet volume, neutrophil lymphocyte ratio and platelet lymphocyte ratio in acute middle cerebral artery infarction patients

Objective: The aim of this study was to determine the predictive value of mean platelet volume (MPV), neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) in patients with acute middle cerebral artery (MCA)branch infarction. Method: This examination was performed on the files of 50 patients followed up at the Anesthesia and Reanimation ICU of Onsekiz Mart University Hospital between April 2017 and September 2019 for acute occlusion in the MCA branch, with no previous history of an ischemic stroke. These patients were assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Score (mRS). The ratios of the neutrophil and platelet countsto the lymphocyte count (NLR and PLR ratios) within the first hour of the stroke and MPV were compared to a control group. Results: The study included 50 patients with the acute ischemia of the MCA branch, of which 28 (56%) were female. The control group consisted of 50 healthy people, and 24 (48%) of these were female. The mean NIHSS score of the patients was 11.4 ± 2.6, and their mean mRS was 2.5 ± 1.5. Conclusions: In our study with patients who had acute middle cerebral artery infarction, we found that the NLR, PLR, and MPV levels within the first hour of stroke were higher in the patient group in comparison to the control group ona statistically significant level. However, multicenter studies with larger subject groups are needed for the use of hematological parameters as biomarkers in an ischemic stroke

Neutrophil-lymphocyte score: A novel prognostic scoring system that utilized the dynamic change of neutrophil, lymphocyte, and albumin and its comparison to other indices.

3048 Background: Indications for immune checkpoint inhibitor (ICI) in cancer care are expanding rapidly. There is increasing need for accurate decision tool to better guide treatment. We have constructed a new prognostic scoring system, neutrophil-lymphocyte score (NRS), based on the nonlinear dynamic change of neutrophil to lymphocyte ratio (NLR) in relation to survival over the first cycle of ICI treatment. We compared this novel system to existing indices such as NLR, lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), Advanced Lung Cancer Inflammation Index (ALI), and Systemic Immune-inflammation Index (SII). Methods: This is a retrospective analysis of 837 patients at Ohio State University from 2011-18. Neutrophil (ANC), lymphocyte (ALC), platelet (plt), monocyte (AMC), albumin (alb), and body mass index (BMI) were collected at baseline. Repeat labs were collected at cycle 2. NLR = ANC/ALC, ALI = BMI x alb / NLR, LMR = ALC/AMC, SII = platelet x NLR, PLR = plt/ALC. NLR Ratio = baseline NLR / repeat NLR. Based on the association between NLR and the overall survival, we assigned 1 point (p) for baseline NLR < 0.7, 6p for 0.7 to < 2, 5p for 2 to < 3, 4 p for 3 to < 4, 3 for 4 to 5, 2p for 5 to < 9, and 1p for ≥9. We also assigned 1p for NLR ratio < 0.6, 2p for 0.6 to < 0.8, 3p for 0.8 to < 1.2, 5p for 1.25 to < 1.4, 3p for 1.4 to < 1.6, and 2p for ≥1.6. NLS = sum of these 2 scores . NLS_A = NLS*alb. Time-dependent receiver operator characteristic (ROC) curves with integrated time-dependent area under the curve (TD AUC) values were used to evaluate the predictive accuracy of each index for survival. Results: For baseline and repeat values, all indices were statistically significant (P < 0.001) in predicting survival. Baseline integrated TD AUC were: ALI 0.704, NLR 0.692, SII 0.663, LMR 0.645, and PLR 0.612. All of the repeat indices at cycle 2 had higher prognostic value than their baseline counterparts. Integrated TD AUC for indices at cycle 2 were: ALI 0.740 (with baseline BMI), NLR 0.729, SII 0.694, LMR 0.671, and PLR 0.652. NLS_A was a composite score based on the dynamic change of NLR from cycle 1 to 2 and the treatment alb with integrated TD-AUC at 0.754. Conclusions: Indices constructed from ANC, ALC, AMC, Plt, alb, and BMI can be obtained inexpensively and provide great prognostic value for pts on ICI. We have constructed a novel scoring system (NLS_A) and demonstrated its improvement over the current prognostic indices. Studies with a larger cohort are needed to further improve and validate this system.

The usefulness of neutrophil to lymphocyte ratio in febrile seizure

Background: Febrile seizure is an event in infancy or childhood, usually occurring between 3 months and 5 years of age associated with fever but without evidence of intracranial infection. The aim of the study was to estimate the usefulness of neutrophil-to-lymphocyte ratio (NLR) in patients with simple and complex febrile seizures.Methods: Retrospective case control study was done in a paediatric in patients admitted to tertiary care hospital. Study period was from January 2017 to December 2019. 200 children were analysed in the study. 100 out of 200 were under control group (febrile children without seizure). Remaining 100 were under case group (children with febrile seizure), 54 out of 100 children had complex febrile seizure, 46 out of 100 had simple febrile seizure. NLR ratio was done in all children.Results: Total 200 children were analysed in this study. High NLR ratio was noted among the cases (87 out of 100) compared to control (30 out of 100) p value = <0.001. Among the cases CFS had high NLR ratio compared to SFS, however p value was not significant (0.072).Conclusions: Children with febrile seizure had high NLR ratio compared to those without seizures. However no significant difference was noted between those with simple febrile seizure and complex febrile seizure However, larger trials are required to assess whether higher NLR can be taken as an independent risk factor for febrile seizure.

Neutrophil to Lymphocyte Ratio in Early Diabetic Kidney Disease among Patients with Type 2 Diabetes Mellitus

Background: Few data are available about the role neutrophil to lymphocyte ratio (NLR) as an inflammatory marker in the early diabetic kidney disease (DKD). Methods: An observational study involving 416 adult patients with type 2 diabetes mellitus (DM) from one center. The study aimed at investigating the relationship between NLR and urine albumin creatinine ratio (uACR) as a marker of early DKD. Results: Among the 416 patients with type 2 DM (Median age 57 [11] years, 40% men and median duration of DM 10 [IQR: 5, 15] years), 169 patients developed albuminuria (Proportion 0.41; 95% CI 0.36, 0.45). The NLR levels were significantly higher among diabetic patients with albuminuria as compared to those without albuminuria; median 1.5 (IQR: 1.1, 2) vs 1.2 (IQR: 1, 1.9), p value 0.004. The receiver operating characteristic analysis of NLR revealed area under the curve of 0.58 (95% confidence interval 0.528 to 0.638; p 0.004). On multivariable analysis; the rate of albuminuria was found higher among patients with HTN (AOR 1.97, 95% CI 1.3 to 2.99; p 0.001); patients with A1c >7 (AOR 2.08, 95% CI 1.21 to 3.59; p 0.008) and patients with NLR score >1.25 (AOR 2.1, 95% CI 1.39 to 3.18; p <0.001). Conclusion: NLR was found to be an independent predictor of albuminuria in patients with type 2 DM.

Neutrophil-to-lymphocyte ratio: A potential new peripheral biomarker of suicidal behavior.

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have emerged as important peripheral inflammatory biomarkers. Recent data suggest a possible role of the immune system in the pathophysiology of suicidal behavior (SB). The aim of this study is to evaluate the association among NLR, MLR, and PLR and SB in patients with major depressive disorder (MDD), and to test its validity as a biomarker for suicidality. We evaluated 538 patients with MDD (mean age [standard deviation]=43.87 [14.36] years; females: 68.8%). A logistic regression model was estimated to determine the independent factors associated with suicide risk in patients with and without a history of suicide attempt (SA). Three hundred ninety-three patients (74.7%) had a personal history of SA. Patients with a previous SA were more frequently female (71.9% vs. 59.6%; p=0.007), significantly younger (41.20 vs. 51.77years; p<0.001), had lower depression severity at enrolment (15.58 vs. 18.42; p<0.000), and significantly higher mean NLR and PLR ratios (2.27 vs. 1.68, p=0.001; 127.90 vs. 109.97, p=0.007, respectively). In the final logistic regression model, after controlling for age, sex, and depression severity, NLR was significantly associated with SB (β=0.489, p=0.000; odds ratio [95% confidence intervals]=1.631 [1.266-2.102]). We propose a cut-off value of NLR=1.30 (sensitivity=75% and specificity=35%). Our data suggest that NLR may be a valuable, reproducible, easily accessible, and cost-effective strategy to determine suicide risk in MDD.

Effect of cardiac rehabilitation on neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in ST elevation myocardial infarction patients

Objectives: Cardiac rehabilitation is known to have positive effects on the inflammatory processes. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) were found to be indicative of inflammation. The purpose of this study is to determine the effects of cardiac rehabilitation on the NLR and PLR ratios of ST elevation myocardial infarction (STEMI) patients. Methods: The study includes 101 STEMI patients that underwent primary percutaneous coronary intervention (PCI). The patients were randomized into two groups: the cardiac rehabilitation group (CR group, n = 68), and the control group (n = 33). One month after primary PCI, cardiac rehabilitation was applied to CR group with cycle ergometer for 8 weeks (30 sessions). The NLR and PLR parameters were calculated from the complete blood count results from before and after the cardiac rehabilitation application for both groups. Results: When the baseline values of the two groups were evaluated, the hemoglobin value of the control group (13.10 ± 1.52 g/dL vs. 13.79 ± 1.26 g/dL; p = 0.03) and the PLR value of the CR group (122.50 ± 43.89 vs. 92.41 ± 23.70; p = 0.001) were significantly higher. The post-cardiac rehabilitation complete blood count parameters, and the NLR and PLR values were similar in both groups. The NLR (3.11 ± 1.95 vs 2.39 ± 1.03; p = 0.003) and PLR (122.50 ± 43.89 vs. 108.68 ± 41.83; p = 0.025) parameters significantly decreased after the cardiac rehabilitation application in the CR group, whereas there wasn't a change in the control group. Conclusion: It was found that cardiac rehabilitation applied in STEMI patients caused a significant decrease in NLR and PLR parameters, which are indicators of inflammation.

Does a Relationship Exist Between Neutrophil-to-Lymphocyte Ratio, Platelet-toLymphocyte Ratio and Sarcopenia in Alzheimer’s Disease?

Aim: The prevalence of sarcopenia is higher in Alzheimer’s disease (AD) when compared with subjects with normal cognition. Easy-to-use screening tools can make it easier to reach the diagnosis. We aimed to evaluate inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in AD cases with or without sarpcopenia. Materials and Methods: Seventy-four possible AD cases who were resident in nursing home were included in to cross-sectional study. Body mass index (BMI), fat mass index (FMI), muscle mass index (MMI), and fat free mass index (FFMI) were assessed with electronic body composition analyzer. Short physical performance battery (SPPB), mini-nutritional assessment (MNA) and hand grip strength test were used for mobile patients. Calf circumference and mid-arm circumference were used for immobile patients. A diagnosis of sarcopenia was established according to the ‘European Working Group on Sarcopenia in Older People’ criterias. NLR and PLR were calculated as the ratio of the neutrophil count to lymphocyte count, and platelet count to lymphocyte count, respectively. Findings of AD cases with and without sarcopenia were compared according to NLR and PLR ratios. Results: The sarcopenia rate was found to be 48%. Significantly higher NLR and PLR values were found in sarcopenic group. NLR were found to be negatively correlated with FFMI, while PLR were found negativeliy correlated with both FFMI and MNA. Conclusion: It was found that NLR and especially PLR values are significantly related to sarcopenia in AD. Evaluation of NLR and PLR may be useful for sarcopenia screening.

Prognostic value of neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratio ratios in patients operated on due to non-small cell lung cancer.

The aim of the study was to determine a prognostic value of the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio (PLR) and the lymphocyte to monocyte ratio (LMR) ratios for survival of patients, operated on due to non-small cell lung cancer (NSCLC). The study was conducted on 532 patients, operated on due to NSCLC, in stages IA-IIIA. A total of 174 females and 358 males, aged 36-84 years (the mean age: 63.6 years) were included in the study. The following factors were subject to a statistical analysis, conducted for determination of potential prognostic values of NLR, PLR and LMR ratios: age, sex, nicotinism, the number of leukocytes, neutrophils, monocytes, platelets, histopathological diagnosis, T category, N category, the Charlson comorbidity index (CCI), kind of surgery, patient survival. The single-factor analysis revealed a relationship between NLR, PLR and LMR values, CCI values, the number of monocytes and the length of survival. The multi-factor analysis confirmed that for patients with expected 2-year survival, PLR above 138 (P=0.0008) is another negative prognostic factor, apart from the stage of the neoplastic disease and CCI above 4. For 5-year survival, such a relationship was not observed. The PLR ratio is an independent and significant prognostic factor for expected, over 2-year survival of patients operated on due to NSCLC.

Prognostic value of rise in neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting the mortality in paediatric intensive care

Background: When the body is stressed in diverse pathological conditions, it responds by mounting an inflammatory response. Predictive biomarkers reflecting the response may serve as guide to management. Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio has been frequently used in adult patients as an indicator for mortality. However, no study has looked into their use within pediatric population. The objective of the study is to assess the prognostic value of rise in NLR and PLR in pediatric intensive care as markers of mortality.Methods: A retrospective study based on 3 year data from HIMS and G-HEALTH data systems of AJ Institute of Medical Science, of all patients admitted to PICU after excluding those in whom all the study parameters were not retrievable, were postoperative patients and/or stay was less than 5 days. NLR and PLR ratios were determined and compared to PELOD 2 using SPSS version 17.0.Results: The demographic data was matched. PELOD 2 (&gt;20) predicted mortality in 72.2% of the patients, while NLR increase predicted in 61.1% and PLR increase in 77.8%. A decreasing trend in NLR and PLR were both closely related to better survival. Among the 3, Rise in PLR had higher sensitivity, specificity, PPV, NPV, and overall accuracy of 72.73% (p &lt;0.001) to predict mortality.Conclusions: The study gives an insight into the fact that simple and inexpensive markers such as rise in NLR and PLR helps in predicting the mortality in the pediatric intensive care which is comparable to PELOD 2 score.

Anemia and neutrophil-to-lymphocyte ratio in laryngeal cancer treated with induction chemotherapy.

We studied the influence of the neutrophil-to-lymphocyte ratio (NLR) and anemia on the response to induction chemotherapy (IC) and survival outcomes in laryngeal cancer patients treated with a preservation protocol. Retrospective single-center case series. We analyzed patients with T3 laryngeal cancer treated with IC using a preservation protocol. The NLR and hemoglobin levels were assessed before treatment and after IC. The response to chemotherapy was assessed using Response Evaluation Criteria in Solid Tumours 1.1 and World Heath Organization standards. The oncological endpoints were overall survival (OS) and disease-free survival (DFS). Sixty-eight patients were analyzed. The median NLR and hemoglobin levels before and after IC were 2.76 and 14.5 g/dL, and 2.01 and 11.6 g/dL, respectively. The NLR and anemia before treatment were not correlated, and they were not associated with the response to chemotherapy. However, an NLR > 5 and anemia before treatment were both associated with shorter OS and DFS. Notably, they were the only factors found to be significantly associated with survival outcomes. In laryngeal cancer, patients treated with a preservation protocol, a high NLR ratio, and anemia before IC were associated with shorter survival, independently of the response to chemotherapy. 4 Laryngoscope, 130:E144-E150, 2020.

Prognostic Impact of Neutrophil-To-Lymphocyte Ratio in Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Estimate prognosis and clinical outcome of patients with localized or metastatic renal cell carcinoma (RCC) is an important issue which drive our medical decisions. We carried out a meta-analysis of available clinical studies exploring neutrophil-to-lymphocyte ratio (NLR) in RCC in order to evaluate if this ratio could be correlated to overall survival (OS) and progression-free survival (PFS) of patients with localized/metastatic RCC. In overall population higher NLR resulted in worst OS and PFS (OS pooled hazard ratio of 1.80;95% CI: 1.61-2.00;I2 45%; PFS pooled hazard ratio of 1.69; 95% CI: 1.42-2.01; I2 81%), this negative correlation was also confirmed in both metastatic and nonmetastatic patients. The NLR ratio is a variable correlated to prognosis in RCC patients.

Inflammatory markers as prognostic indicators in pancreatic cancer patients who underwent gemcitabine-based palliative chemotherapy.

Background/AimsPatients with pancreatic cancer (PC) generally have poor clinical outcomes. Early determination of their prognosis is crucial for developing a therapeutic strategy. Recently, various inflammatory markers have been validated as prognostic indicators for many cancers, including PC. However, few studies have evaluated these markers together. Thus, the purpose of this study was to comprehensively evaluate the value of inflammatory markers as prognostic indicators in patients with advanced PC treated with gemcitabine-based chemotherapy as the first line regimen.MethodsThis was a single-center retrospective study evaluating 302 patients with advanced PC who began first line treatment between November 2004 and August 2016. These patients were monitored until June 2017. Survival rates were assessed with univariate and multivariate analyses. Continuous variables were separated using the normal range or ideal cut-off levels determined by receiver operating curve analyses.ResultsAmong inflammatory markers evaluated, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and C-reactive protein (CRP) to albumin ratio (CRP-albumin ratio) were independent predictors of overall survival (hazard ratio, 1.712, 1.345, and 1.454, respectively). Difference in survival rates was significant (p < 0.001) among three groups divided by the number of marker-related risks.ConclusionsBaseline inflammatory markers including NLR, PLR, and CRP-albumin ratio are useful in predicting survival rates in patients with PC. Combining these three markers is proven to be valuable.

Post-treatment changes in hematological parameters predict response to nivolumab monotherapy in non-small cell lung cancer patients.

BackgroundThe absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC) and neutrophil to lymphocyte ratio (NLR) are known markers of inflammation. We evaluated whether ANC, ALC, AMC and NLR, both before and after treatment with nivolumab, are indicative markers of overall survival (OS) and evaluated change in NLR as a predictive marker of response in non -small cell lung cancer (NSCLC) patients treated with nivolumab.MethodsA total of 109 patients with advanced NSCLC treated with nivolumab were included. ANC, ALC, AMC and NLR were examined at initiation of nivolumab therapy and after two cycles. The prognostic role of ANC, ALC, AMC and NLR with OS and changes in NLR ratio were examined with Kaplan-Meier curves and proportional hazard model.ResultPost-treatment NLR ≥5 after two cycles of nivolumab was associated with poor OS (median OS in NLR = <5 vs NLR = ≥5 was 29.1 (16.2–40.9) vs 24.2(16.1–36.2) months respectively, p<0.001). In addition NLR increased in non-responders after two cycles of nivolumab by 6.6±21.8 as compared to responders (p = 0.027).ConclusionsPost-treatment ANC, ALC and NLR are independent prognostic factors in NSCLC patients treated with nivolumab. Changes in NLR can be an early biomarker for response in NSCLC patients treated with nivolumab.

Change in the Neutrophil-to-Lymphocyte Ratio (NLR) Pre and Post Stereotactic Body Radiation Treatment (SBRT) for Stage I Non-Small Cell Lung Cancer (NSCLC): Is There a Clinical Significance?

Pre-treatment systemic inflammatory markers such as elevated neutrophil-to-lymphocyte ratio (NLR) have previously been shown to be poor indicators in various cancers including NSCLC. However, there is a poor understanding of the effect of SBRT on post-treatment NLR and lymphocyte nadir and its prognostic implication, if any. The purpose of this study was to assess the effects of SBRT on NLR and lymphocyte nadir, and the predictive value of post-SBRT NLR and lymphocyte nadir on tumor response and progression-free survival in stage I NSCLC patients. From our institutional database between 2015-2016, we identified 43 patients with AJCC Stage I NSCLC who underwent definitive SBRT treatment with a median dose of 50 Gy (range 50-55 Gy) over a 2-week period. We collected demographic and clinical data including: age, gender, baseline and post-treatment (last day of treatment) bloodwork (platelet, neutrophil, and lymphocyte counts), initial response to SBRT, and 1-year progression-free-survival (PFS). Median age of patients was 76.4 (range 42.5-96.4). Median follow up for patients was 11.8 months. Of the 43 patients, at 1 year, 91% of patients did not show any progression, while 9.0% patients demonstrated distant progression. Median pre-SBRT NLR was 3.9 (mean 5.2) and median post-SBRT NLR was 5.2 (mean 6.4), demonstrating a 33.3% increase in NLR post-SBRT treatment (p<.05) on their last day of treatment. Median lymphocyte count pre-SBRT was 1.31 (mean 1.29) and median post-SBRT lymphocyte nadir was 0.83 (mean 0.87), demonstrating a 36.6% decrease (p<.001). There was a significant difference in pre-SBRT NLR (6.28 vs. 3.96, p<.01) and post-SBRT NLR (7.47 vs. 5.41, p<.05) in patients demonstrating a partial vs. complete response to SBRT. Lymphocyte nadir changes were nonsignificant in patients demonstrating partial and complete response. Additionally, there were significant differences in pre-SBRT NLR (4.15 vs. 8.71, p<.005) and post-SBRT NLR (6.02 vs. 9.24, p<.01) in patients who did not progress at 1 year and those progressed at 1-year. Pre-SBRT lymphocyte nadir (1.91 vs. 1.20, p<.001) and post-SBRT lymphocyte nadir (0.92 vs 0.71, p<.01) was also decreased in patients with progression compared to those without progression at 1 year. Pre and post-SBRT NLR and lymphocyte nadir was not associated with increased toxicity. SBRT resulted in a statistically significant increase in NLR ratio and decreased lymphocyte nadir. Furthermore, our study indicates increased NLR and decreased lymphocyte nadir both pre-SBRT and post-SBRT can help predict tumor response to SBRT and progression outcomes. Clinical significance of this sudden change following SBRT treatment needs further study.

Relationship between neutrophil-lymphocyte, platelet-lymphocyte ratio and disease activity in rheumatoid arthritis treated with rituximab.

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) may be used as indicators of inflammatory markers and disease activity due to inflammatory changes in neutrophils, platelets and lymphocytes. Our aim is to investigate the relationship between NLR, PLR ratio and disease activity in RA patients treated with rituximab. Thirty-eight patients (8 male, 30 female, mean age 56.8±11.8years) diagnosed with RA and 30 healthy controls were included in the study. Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR), lymphocyte, neutrophil, platelet counts, ESR, C-reactive protein (CRP), PLR, and NLR were evaluated before and after rituximab in RA patients. The relationship between all parameters was assessed by Pearson's correlation, Wilcoxon signed-rank, Mann-Whitney U and paired t tests. The levels of CRP, ESR, and DAS28-ESR decreased significantly at 6months of rituximab treatment compared to pre-treatment. NLR and PLR ratios were higher in patients with RA than the control group. The median levels were 33.5mm/hour, 5.7mg/dL, and 3.7 respectively after 6months of rituximab treatment. And, the levels were lower than baseline treatment. There was a significant correlation between the levels of DAS28-ESR and NLR, DAS28-ESR and PLR before and after treatment. The NLR and PLR were higher than healthy controls and correlated with DAS28-ESR in patients with RA. These parameters which are indicative of disease activity decrease with rituximab and correlate with disease activity at 6months. The NLR and PLR may be useful indices to evaluate RA disease activity treated with rituximab.

High baseline neutrophil-to-lymphocyte ratio predicts worse outcome in patients with metastatic BRAF-positive melanoma treated with BRAF and MEK inhibitors.

Neutrophil-to-lymphocyte ratio (NLR) has been shown to be prognostic in several solid malignancies. There are limited data regarding its value during novel therapies in patients with melanoma. The aim of the study was to assess the practical utility of this ratio in patients with BRAF-mutant melanoma treated with a combination of BRAF and MEK inhibitors (BRAFi/MEKi). We included 215 patients with inoperable or metastatic melanoma who underwent BRAFi/MEKi treatment between October 2015 and June 2017. Baseline NLR and other complete blood count-derived inflammatory markers were tested for association with overall survival and progression-free survival in univariate and multivariate models. On-treatment NLR was also assessed for relationship with these outcomes using the time-dependent Cox's proportional hazard model. Prognostic model based on NLR and lactate dehydrogenase (LDH) levels was also developed. Patients with NLR values more than four had poorer progression-free survival (P<0.001, 1-year rates 51.6 vs. 26.7%) and overall survival (P<0.001, 1-year rates 77.3 vs. 53.1%). In a multivariate model adjusted for LDH levels, metastatic sites and age baseline NLR ratio and delay in starting MEKi were deemed statistically significant (hazard ratio: 1.81; 95% confidence interval: 1.16-2.85; P=0.009 and hazard ratio: 2.06; 95% confidence interval: 1.24-3.44, P=0.005 respectively). In a model based on NLR and LDH, 1-year survival rates were 57, 40 and 23%, respectively if zero, one or both factors were elevated. Our results demonstrate the usefulness of NLR and a predictive model based on combinations of NLR and LDH as a prognostic markers during BRAFi/MEKi treatment. Our real-world data confirm the efficacy of BRAFi/MEKi therapy showed in the clinical trials.

Blood neutrophil-to-lymphocyte ratio is associated with prognosis in advanced gastrointestinal stromal tumors treated with imatinib.

Neutrophil-to-lymphocyte ratio (NLR) was shown to be prognostic in several solid malignancies. There are limited data about predictive/prognostic value of NLR during targeted therapy of patients with advanced gastrointestinal stromal tumors (GIST). The aim of this study was to asses a clinical value of this ratio in patients with advanced GIST. Between 2001 and 2016, 385 patients with metastatic/unresectable GIST treated initially with imatinib were included in the analysis. In all patients, the NLR was assessed at the baseline, after 3 months of treatment, and upon disease progression (or last observation). The cutoff values for NLR were set at 2.7 and 5.4. Kaplan-Meier survival probability estimation with log-rank test and Cox proportional hazards model were used for analysis. Median progression-free survival (PFS) on imatinib treatment was 44.8 months, 5-year rate 43%; median overall survival (OS) 87.2 months, 10-year rate 36.3%. NLR >2.7 at baseline was significantly associated with poorer OS and PFS: median OS was 89.3 months (95% confidence interval [CI] 80.2-115) for NLR ratio ≤2.7 vs 59.4 months (95% CI 48.6-82) for NLR >2.7 (p < .001); median PFS was 59.4 vs 32.7 (p < .001), respectively. In multivariate model adjusted for mitotic index and driver mutation in the tumor (KIT exon 11 mutation versus other), NLR ratio was proven to be statistically significant (hazard ratio 1.09; 95% CI 1.01-1.19; p = .030). Among patients with disease progression, NLR >2.7 assessed at the third month of treatment was linked with significantly shorter median time to progression (7.5 vs 19 months). Our results demonstrate the usefulness of NLR as a prognostic and predictive marker as well as a marker for treatment monitoring in patients with advanced GIST treated with imatinib.

Does the neutrophil-to-lymphocyte ratio have any importance between subjects with obstructive sleep apnea syndrome with obesity and without obesity?

An increase in the incidence of OSAS (obstructive sleep apnoea syndrome) has been seen due to the reported association between OSAS and obesity. Subjects are predisposed to cardiovascular disease due to systemic inflammation caused by the interactions between obesity and OSA. Inflammatory markers could be used to predict the degree of systemic inflammation, which could be a prognostic factor for future adverse events such as metabolic risks. One marker that has recently started being used as an indicator of systemic inflammation is neutrophil-to-lymphocyte ratio (NLR). The aim is to evaluate NLR, which is a easily measured parameter of systemic inflammation in OSAS subjects with and without obesity. 155 subjects were assigned to four different groups according to their body mass indices. Comparisons of white blood cell, neutrophil, lymphocyte, NLR values and anthropometric measurements were done for each group. The NLR and neutrophil counts of group 4 were statistically significant and higher than those of groups 1, 2 and 3. The lymphocyte counts of group 4 were the lowest amongst all groups, these values were lower than the lymphocyte counts of groups 1, 2 and 3 with statistically significant differences (p< 001). A positive correlation was found between the body mass index and lymphocyte count values of obese OSAS subjects (r= 0.027, p= 353). The NLR ratio was found to be increasing by obesity grade and reveals that the associated inflammatory response also increases. The NLR ratio might be used as an inflammatory marker in obese OSAS subjects.

ARV7/AR ratio and neutrophil-to-lymphocyte ratio (NLR) as predictors of docetaxel benefit in metastatic castration-resistant prostate cancer patients (mCRPC).

254 Background: The constitutively active androgen receptor (AR) variant 7 (ARV7) has been associated to AR inhibitors resistance, but its role in taxane-benefit has not been stablished. Moreover, the neutrophil-to-lymphocyte ratio (NLR) has been associated with poor outcome in prostate cancer.The PBMC population may contain circulating tumor cells (CTCs) but is mainly constituted by lymphocytes and monocytes, that also express the AR. Here we studied the expression of ARV7 and AR in peripheral blood mononuclear cells (PBMC) and its correlation with NLR and clinical outcome in mCRPC treated with docetaxel. Methods: ARV7 and AR mRNAs were tested by quantitative reverse-transcription PCR. Baseline neutrophil and lymphocyte values and PBMC samples were prospectively collected before treatment initiation. Patients were stratified according to NLR ratio (low NLR: ≤3; high NLR:&gt;3) and to ARV7/ARFL ratio expression (Maxstat Cutoff 1.99). Correlation between NLR and PSA progression-free (PSA-PFS) and overall survival (OS), were measured from the start of docetaxel treatment and calculated by log rank test. Results: Fifty patients were included:25 (50%) had low NLR. Thirty-eight patients (76%) expressed high ARV7/ARFL. No significant correlation between NLR with ARV7, AR and ARV7/AR was observed. High ARV7/ARF ratio correlated to a better PSA-PFS (median PSA-PFS 7.47; HR 0.38, 95%CI 0.17-0.85; P=0.0179) , but not OS. High NLR was associated to a lower OS [Median OS was 9.2 months versus 30.17 months in those with low NLR (HR 2.19, 95% CI 1.17-4.09, p= 0.01)]. When both parameters were combined, high NLR and low ARV7/ARFL ratio were associated to a worse PSA-PFS in comparison with low NLR and high ARV7/ARFL ratiogroup(median PSA-PFS: 4.9 vs. 7.5; p=0.008 and HR 5.08, 95% CI 1.33-19.41, p= 0.08) and OS (median OS: 7.4 vs. 30.5; p=0.001 and HR 22.79, 95% CI 4.29-121.17, p= 0.00). Conclusions: The combination of low ARV7/ARFL high NLR and ratio evaluated in PBMC prior to docetaxel treatment has a predictive impact on response and survival in mCRPC patients.