Neutrophil-to-lymphocyte Ratio Values Research Articles

Preoperative neutrophil-to-lymphocyte ratio (NLR) value as a predictor of recurrence of non-muscle-invasive bladder cancer.

To predict oncological outcomes and select appropriate treatments for non-muscle-invasive bladder cancer (NMIBC), pre-treatment predictors such as neutrophil-to-lymphocyte ratio (NLR) are being used. This study aims to evaluate whether NLR is an independent predictor of disease and disease recurrence in NMIBC patients. In this prospective clinical study, from March 2018 to March 2023, preoperative NLR values were monitored in 99 patients newly diagnosed with NMIBC, who were initially treated with trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical therapy. To evaluate the best NLR cutoff points to predict recurrence, the ROC (receiver operating characteristic) curve and the Youden index were used. The monitoring period was 24 months. With the cutoff value of NLR = 1.73, there is a statistically significant correlation (p = 0.008) between the NLR value and the increased risk of recurrence. Univariate and multivariate Cox regression analyses show the significant prognostic impact of NLR on the recurrence of the disease. The value of NLR > 1.73 is a significant preoperative predictor in risk assessment and will help with proper selection of treatment in the high- and intermediate-risk groups of patients.

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.

The Relationship Between Neutrophil-to-Lymphocyte Ratio and Clinical Outcomes in Pediatric Patients After Cardiopulmonary Bypass Surgery: A Retrospective Study

Objectives: This study aimed to evaluate the prognostic utility of the neutrophil-to-lymphocyte ratio (NLR) and the perioperative change in NLR [Neutrophil Change Index (NCI)] in pediatric patients undergoing surgery with cardiopulmonary bypass (CPB) and to assess their correlations with clinical outcomes. Methods: A retrospective observational study was conducted with 416 patients from Children’s Medical Center in Tehran, Iran, spanning November 2021 to November 2022. Perioperative neutrophil and lymphocyte counts were collected, along with data on the presence or absence of complications. The prognostic value of NLR and NCI was evaluated concerning the length of ICU stay and mechanical ventilation among three groups: A no-complications survival group, a complications survival group, and a mortality group. Results: All patients showed an average rise in NLR postoperatively. The postoperative NLR magnitude did not significantly differ among the groups (P = 0.237) and was only correlated with mechanical ventilation duration (P = 0.0497), not with ICU stay length. However, the NCI was significantly lower in the mortality group compared to both the no-complication and surviving-complication groups (P &lt; 0.001 and P = 0.032). Neutrophil Change Index also showed a statistically significant correlation with ICU stay and mechanical ventilation duration (P = 0.004 and P = 0.002). ROC analysis indicated that NCI had some ability to discriminate mortality cases, with an AUC of 0.734. Conclusions: While NLR showed perioperative changes, its magnitude alone was not correlated with clinical outcomes. In contrast, the NCI demonstrated a significant relationship with outcomes, with surviving-complication patients having a higher perioperative NCI than those in the mortality group. A higher NCI was associated with shorter ICU stays, reduced mechanical ventilation time, and lower mortality risk in pediatric patients undergoing CPB surgery. Overall, NCI proved to be a more effective tool than NLR in predicting adverse outcomes in this patient population.

Onset age moderates the associations between neutrophil-to-lymphocyte ratio and clinical symptoms in first-episode patients with schizophrenia

Patients with schizophrenia with early onset age have been shown to exhibit more severe negative symptoms. Genetic, biomarker, postmortem brain, and imaging studies indicate the involvement of immune abnormalities in the pathophysiology of schizophrenia. In this study, we examined the moderating role of early onset on the associations between clinical symptoms and neutrophil-to-lymphocyte ratio (NLR) in medication-naïve first-episode schizophrenia (MNFES). A total of 97 MNFES patients were recruited. Neutrophil (NEU), LYM, and NLR values were compared between early-onset (EO) and non-early-onset (non-EO) patients with schizophrenia to explore the potential influence of EO on the correlations between NLR and symptoms. The results showed no differences in NEU and NLR values between the EO and non-EO groups. In the EO group, NEU and NLR values significantly correlated with general psychopathology and total score (all p < 0.05), whereas lymphocyte counts were not correlated with symptoms of schizophrenia. NEU and NLR were not associated with symptoms in the non-EO group. Linear regression analysis in the EO group revealed that NEU or NLR values were a predictive biomarker for the clinical symptoms. Our study indicates that EO patients had greater severe negative symptoms compared with non-EO patients. In addition, onset age mediates the relationships of NEU and NLR values with clinical symptoms, suggesting that an immune disturbance, particularly increased innate immune response in EO patients, may be involved in the psychophysiology of schizophrenia.

Laboratory findings predictive of critical illness in hospitalized COVID-19 patients in Tunisia

Background COVID-19 disease has spread rapidly worldwide, causing high mortality. Accessible biomarkers capable of early identification of patients at risk of severe form are needed in clinical practice. The aim of the study was to determine the biological markers that predict a critical condition. Methods Retrospective study including patients with confirmed COVID-19 hospitalized between September 2020 and June 2021. The primary endpoint was progression to critical status within 7 days from admission. We defined two groups: Critical group: Patients who developed a critical condition or died or transferred to the ICU before or at 7th day. Non-critical group: Patients who remained in non-critical respiratory status until 7th day or discharged before or at 7th day. Results Our study included 456 patients, with a sex ratio of 1.32 and an average age of 62 years. At the 7th day of hospitalization, 115 (25.2%) patients were in the critical group and 341 (74.8%) patients were in the non-critical group. The univariate logistic regression indicated that laboratory findings between non-critical and critical groups showed that C-reactive protein (CRP) (p=0.047), D-Dimer (p=0.011), creatinine (0.026), creatine kinase (p=0.039), lactate dehydrogenase (p=0.04), and troponin (p=0.001) were all higher among patients in critical group. However, lymphocyte (p&lt;0.001) and platelet (p&lt;0.001) counts were significantly lower among the critical group. Multivariate logistic regression model, identified four independent risk factors: lymphopenia (OR=2.771, 95%CI=1.482-5.181, p=0.001), Neutrophil to Lymphocyte Ratio (NLR) (OR=2.286, 95%CI=1.461-3.578, p&lt;0.001), thrombocytopenia (OR=1.944, 95%CI=1.092-3.459, p=0.024), and CRP&gt;71.5 (OR=1.598, 95% CI=1.042-2.45, p=0.032) were associated to critical group. Conclusions Our results show the predictive value of lymphopenia, thrombocytopenia, high NLR and CRP levels to evaluate the prognosis of COVID-19 pneumonia. A prognostic score could be proposed for guiding clinical care and improving patient outcomes.

Exploring the predictive factors in the gastrointestinal involvement of patients with immunoglobulin A vasculitis.

Immunoglobulin A vasculitis (IgAV), the most common systemic vasculitis in children, typically presents with gastrointestinal (GI) symptoms in about half of cases. This study aimed to analyze the clinical and laboratory findings of patients with IgAV regarding GI involvement. We compared the GI involvement data of the patients diagnosed with IgAV. Of the 210 patients (60.5% female and 39.5% male), 101 had GI involvement, with abdominal pain being the predominant symptom (n=98). White blood cell, neutrophil, monocyte, and platelet counts, C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were significantly elevated in patients with GI involvement (p<0.001, p<0.001, p=0.01, p=0.005, p=0.002, p<0.001, p=0.03, p=0.001, p<0.001, p<0.001, respectively). The cutoff values for SII (>1035.7), SIRI (>1.65), NLR (>2.73), and MLR (>0.28) were determined, yielding respective sensitivities of 46%, 59%, 47%, and 53%, specificities of 83.1%, 69.1%, 81.3%, and 71.9%. Corresponding areas under the curve were 0.658, 0.668, 0.649, and 0.634, respectively (all p<0.001). Although IgAV is a self-limiting disease, GI involvement can lead to serious consequences. Systemic inflammatory indices such as SII and SIRI may be indicative in identifying patients with GI involvement.

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.

Significance of the geriatric nutritional risk index and neutrophil-to-lymphocyte ratio as prognostic indicators in older patients with gastric cancer: a retrospective cohort study

BackgroundThe number of older patients with cancer is increasing with the progression of aging societies. In the current study, we sought to clarify the prognostic values of the geriatric nutritional risk index (GNRI) as a nutritional index and the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory index in older patients with gastric cancer.MethodsBetween January 2007 and December 2016, a total of 197 consecutive gastric cancer patients aged ≥ 75 years who underwent radical gastrectomy were enrolled in this study. The prognostic values of preoperative GNRI and NLR were assessed using time-dependent receiver operating characteristic curve analysis, log-rank tests, and Cox regression analysis.ResultsThe areas under the curve (AUCs) predicting 5-year overall survival (OS) were 0.668 for GNRI and 0.637 for NLR. The 5-year OS rates in the groups with low GNRI and NLR were 40.1% and 74.1% (p < 0.001), and those with high GNRI and NLR were 70.7% and 41.5% (p < 0.001), respectively. Multivariate analysis showed that GNRI (hazard ratio (HR): 0.584; 95% confidence interval (CI): 0.356–0.960; p = 0.034) and NLR (HR: 2.470; 95% CI: 1.503–4.059; p < 0.001) were independent predictors for OS. The GNRI–NLR score constructed with GNRI and NLR had a higher AUC (0.698) than those of GNRI or NLR alone and was an independent prognostic factor (HR, 0.486; 95% CI: 0.363–0.651; p < 0.001).ConclusionsGNRI and NLR are useful prognostic biomarkers in older patients with gastric cancer aged ≥ 75 years. The GNRI–NLR score could contribute to a more personalized and holistic approach to cancer treatment in this patient population.

The Impact of Systemic Inflammation on Recurrence in Patients with Congenital Nasolacrimal Duct Obstruction.

Background/Objective: Congenital nasolacrimal duct obstruction (CNLDO) is commonly treated by probing, but recurrence remains a clinical issue. This study investigates the potential role of inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR), in predicting recurrence after probing in children with CNLDO. Methods: This retrospective cohort study included 172 patients who underwent initial probing for unilateral CNLDO. The patients were then categorized into two groups: those who experienced the complete resolution of symptoms after primary probing, and those who required Ritleng tube intubation due to recurrence following primary probing. Blood samples for calculating inflammatory biomarkers in all subjects were collected during general anesthesia preparation prior to initial probing. NLR, MLR, and PLR values were compared between the groups using the independent samples t-test. The predictive performance of the inflammatory biomarkers for recurrence was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 110 patients were included in the probing group, while 62 patients were in the recurrence group. The mean age at the time of the initial probing procedure was 15 ± 4.06 months in the probing group and 15.83 ± 4.02 months in the recurrence group. There was no difference in the duration of the probing procedure between the groups. The mean age at the time of Ritleng tube intubation in the recurrence group was 37.80 ± 13.34 months. The recurrence group exhibited significantly higher values in all analyzed inflammatory markers compared to the probing group, including the NLR (1.12 ± 0.56 vs. 0.86 ± 0.39, p = 0.002), MLR (0.16 ± 0.06 vs. 0.14 ± 0.06, p = 0.005), and PLR (95.13 ± 24.34 vs. 82.23 ± 22.77, p < 0.001). ROC curve analysis indicated that these inflammatory biomarkers demonstrated moderate performance in predicting recurrence. Conclusions: Recurrence following probing in children with CNLDO was associated with complete blood cell count-derived inflammatory biomarkers. The preoperative assessment of these biomarkers may aid in the individualization of disease management and inform the development of new therapeutic strategies.

Neutrophil-to-lymphocyte ratio (NLR) at diagnosis in essential thrombocythemia: A new promising predictor of thrombotic events.

Myeloproliferative neoplasms represent a heterogeneous group of acquired hematopoietic stem cell diseases in which chronic inflammation is essential for both clonal evolution and thrombotic complications. The neutrophil-to-lymphocyte ratio (NLR), reflecting the imbalance between systemic inflammation and immunity, is emerging as a prognostic biomarker in several diseases, including hematological ones. A total of 473 patients with essential thrombocythemia (ET), the relationship between NLR value at diagnosis and the risk of thrombotic events in the follow-up, in addition to conventional clinical and biological variables, were retrospectively analyzed. A total of 78 thrombotic events were reported for an incidence rate of 1.8 × 100 patients/year. In multivariate analysis, NLR value≥4 at diagnosis was associated with higher cumulative thrombotic risk (hazard ratio [HR], 2.05; 95% CI, 1.29-2.28; p=.0001) as well International Prognostic Score for Thrombosis in Essential Thrombosis score intermediate-high (HR, 2.69; 95% CI, 1.27-5.72; p=.01) and diabetes (HR, 2.49; 95% CI, 1.23-3.05; p=.010). Concerning arterial thrombotic events, in multivariate analysis, NLR value at diagnosis ≥4 was predictive for thrombosis (HR, 2.13; 95% CI, 1.31-4.04; p=.001 as well diabetes (HR, 2.44; 95% CI, 1.05-5.68; p=.04) and hypertension (HR, 2.46; 95% CI, 1.05-5.68; p=.01). About venous thrombotic events, NLR value≥5 was a marker predictive for venous thrombosis (HR, 2.99; 95% CI, 2.45-6.48; p=.01) as well age >60 years old (HR, 2.26; 95% CI, 1.0-5.10; p=.05). NLR value is a simple, cost-effective, and easy-to-obtain inflammatory marker that can predict a diagnosis the risk of thrombosis in ET. Our results suggest that NLR value could be integrated into conventional cardiovascular risk scores, to better classify high-risk patients who are candidates for cytoreductive therapy. Further larger and prospective studies are warranted.

Prognostic value of neutrophil to lymphocyte ratio and lymphocyte counts before durvalumab consolidation after radio-chemotherapy in locally advanced non-small cell lung cancer

BackgroundDurvalumab, an anti-PD-L1 immune checkpoint inhibitor, after radio-chemotherapy (RCT) has changed the management of locally advanced non-small cell lung cancer (LA NSCLC). A series of retrospective studies have investigated different cut-off of lymphocyte count (LyC) and neutrophil-to-lymphocyte ratio (NLR) to predict survival in LA NSCLC. None of these studies has validated their threshold in an independent group of patients. We wanted to assess the OS prognostic value of NLR and LyC in patients with LA NSCLC treated by RCT and durvalumab, with threshold determination and their validation in an external cohort.MethodsPatients were enrolled in four institutions between Oct. 2017 and Jan. 2022. Pre durvalumab LyC, neutrophils count (NC) and NLR were collected. To define NLR and LyC cut-off value predicting survival event, time dependent Receiver Operating Characteristics (ROC) curves was performed. Survival outcomes were estimated by the Kaplan-Meier method and differences were compared using univariate and multivariate Cox proportional hazard models.ResultsWe included 76 patients in the training set and 85 in the test set. The best cut off were 2,94 for NLR and 0,61 G/l for LyC to predict OS in the training set. For patients with NLR > 2,94, univariate analysis showed no significant deterioration in OS in either the training set (p = 0,066) or the test set (p = 0,12). Patients with LyC > 0,61 G/L, in univariate analysis, had longer OS in training set (p = 0,030) and in test set (p = 0,0062). This OS increase was not found in multivariate analysis (p = 0,057) in training set but was confirmed in test set (0,039).ConclusionLyC > 0,61 G/l is associated with longer OS for LA NSCLC patient’s treated with RCT and durvalumab in univariate analysis. In this context, a particular expectation for organs at risk sparing during RT to avoid lymphopenia seems important.Trial registrationRetrospectively registered.

Prognostic value of neutrophil to lymphocyte ratio and platelet indices in cats with feline panleukopenia

The aim of this study was to ascertain the prognostic significance of the neutrophil to lymphocyte ratio (NLR) and platelet indices during hospital admission in cats with feline panleukopenia (FPV). A prospective observational study was conducted on 24 cats diagnosed with FPV. The results of the study demonstrated a significant decrease in NLR, platelet count (PLT), and platelet concentration (PCT) in the FPV survivor group compared to the control group. Furthermore, these parameters exhibited a notable decline in the FPV non-survivor group when compared to both the control group and the FPV survivor group. In contrast, mean platelet volume (MPV) and platelet distribution width (PDW) were significantly elevated in the FPV non-surviving cats compared to the control group. Moreover, receiver operating characteristic (ROC) curve analysis was employed to identify a prognostic cut-off value for predicting the prognosis of cats with FPV. The positive predictive values (PPVs) for survival were determined to be 90 %, 95 %, 85 %, 85 %, 85 %, and 75 %, respectively, using cut-off values of NLR (≤ 0.29), PLT (≤ 202.5 ×10³/µL), PCT (≤ 0.19 %), MPV (≥ 10.3 fL), and PDW (≥ 34.9 %). Based on the sensitivity, specificity and positive predictive values obtained from the ROC analysis, it was concluded that the NLR, MPV, and PLT are excellent biomarkers for determining prognosis in cats with FPV. Nevertheless, the PLT level is of greater significance, exhibiting a higher AUC.

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.

Associations Between Preoperative Inflammatory Indices and Residual or Recurrent Cervical Intraepithelial Neoplasia Post Loop Electrosurgical Excision Procedure.

High-grade cervical intraepithelial neoplasia (CIN2/3) is a precursor to invasive cervical cancer, necessitating effective management. While the Loop Electrosurgical Excision Procedure (LEEP) is a successful treatment, recurrence remains a significant concern. This study evaluates the predictive value of preoperative immune-inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII), in assessing the risk of residual or recurrent CIN post-LEEP. A retrospective analysis was performed on 423 women who underwent LEEP for CIN2/3 at Cangzhou Central Hospital between 2016 and 2020. Cox proportional hazards regression models with restricted cubic splines were used to evaluate linear and non-linear associations between immune-inflammatory indices and recurrence risk. Multivariate models were adjusted for confounding factors, and subgroup analyses were conducted to test the robustness of the associations. Threshold non-linear fitting and saturation effect analyses were also performed to identify inflection points influencing residual or recurrent disease risk. Significant differences in age, menopausal status, TCT results, HPV status, degrees of CIN and margin status were observed between recurrence and non-recurrence groups. NLR demonstrated a U-shaped relationship with recurrence risk, with a threshold effect. NLR values below 3.15 were associated with a reduced recurrence risk, while higher values increased the risk. PLR and SII showed a modest protective effect below their respective thresholds. Systemic inflammation plays a key role in CIN recurrence following LEEP. NLR serves as a valuable prognostic marker, highlighting the potential for personalised follow-up strategies. Further research is needed to confirm these findings and elucidate the underlying mechanisms.

Neutrophil-to-lymphocyte ratio predicts poor prognosis in patients with chronic kidney disease-related pulmonary hypertension: A retrospective study.

Inflammation plays a crucial role in chronic kidney disease (CKD) and pulmonary hypertension (PH). Considering that the neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a powerful predictor of adverse outcomes in many chronic diseases, we aimed to investigate the association between NLR and all-cause mortality in patients with CKD-related PH. A total of 176 hospitalized patients with predialysis CKD-related PH were recruited retrospectively from January 2012 to June 2020 by reviewing electronic medical records. The NLR and clinical characteristics of the patients were included in the current analysis. The Kaplan-Meier method and univariate and multivariate Cox regression analyses were performed to identify the association between NLR and the incidence of all-cause mortality. Baseline NLR values were associated with hemoglobin, estimated glomerular filtration rate and C-reactive protein. During a median follow-up period of 32.5 (11.3-53.0) months, 23 patients died. Regardless of whether the NLR acted as a continuous variable with a hazard ratio of 1.408 (95% confidence interval: 1.124-1.763) or a categorical variable (NLR ≤4.3 vs NLR >4.3) with a hazard ratio of 3.100 (95% confidence interval: 1.299-7.402), an elevated NLR was significantly associated with all-cause mortality in different models. A greater NLR at baseline was remarkably associated with a higher all-cause mortality in hospitalized patients with CKD-related PH.

The association of the perioperative neutrophil-to-lymphocyte ratio with wound healing in patients with Wagner grade 3 and 4 diabetic foot ulcers after tibial cortex transverse transport surgery: a prospective observational cohort study.

Diabetic foot ulcers (DFUs) are severe complications of diabetes, involving multiple etiological factors including neuropathy, vascular insufficiency, and impaired wound healing. The global burden of DFUs is substantial, with significant morbidity and high management costs. Recent advancements have introduced the tibial cortex transverse transport (TTT) technique, which has shown promising results in the management of severe DFUs by promoting angiogenesis and immunomodulation. This prospective cohort study enrolled patients with Wagner grade 3 and 4 DFUs, treated using the TTT technique from May 2022 to September 2023 at MianYang Central Hospital. The study assessed the influence of TTT on the perioperative neutrophil-to-lymphocyte ratio (NLR), an established biomarker of systemic inflammation, and its correlation with wound healing outcomes. A total of 82 patients were enrolled, with 66 completing the study. The survival analysis revealed that patients with a lower preoperative NLR experienced significantly faster wound healing compared with a high NLR (log rank test P< 0.05; hazard ratio (HR) = 0.46; 95% CI: 0.26-0.83). The optimal NLR cutoff values (4.25) were established to predict wound healing times for DFUs. The median NLR was significantly different before TTT surgery, 3 days after TTT surgery, and 1 month after TTT surgery (P<0.05). The TTT technique significantly influences the perioperative NLR and is associated with improved wound healing in DFU patients. The perioperative NLR serves as an effective predictive biomarker for wound healing outcomes, highlighting the significance of interventions targeting NLR values in perioperative management strategies and postoperative monitoring protocols for the treatment of diabetic foot ulcers (DFUs) in clinical practice.

Novel predictor of thrombosis after left atrial appendage closure -Neutrophil to Lymphocyte Ratio (NLR), platelet to LymPhocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR)-

Abstract Background Cardiogenic embolism by left atrial thrombi is one of the most important atrial fibrillation (AF)-related clinical problems. In a previous survey, 91% of nonrheumatic AF-related left atrial thrombi was originated in the left atrial appendage (LAA). The WATCHMAN device was developed as a permanent implantable device to seal off the LAA to prevent cardiogenic embolism. It has been used in Japan since September 2019. The WATCHMAN family is the only left atrial appendage closure (LAAC) device in Japan. After percutaneous left atrial appendage closure (LAAC), DRT is an important issue in some cases. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) are known as cancer prognostic factors and indicators of immune status. There are few reports on the predictor for device related thrombosis (DRT), transient ischemic attack (TIA), and ischemic stroke. Finding novel biomarkers could help clinical decision in antithrombotic therapy post LAAC and follow-up intervals. Purpose To investigate the association of NLR, PLR, and LMR with device related thrombosis, transient ischemic attack, and ischemic stroke in patients with LAAC. Methods Our database of LAAC was respectively analyzed. All LAAC cases were performed between January 2020 and September 2023. Blood cell counts were sampled in three days before LAAC. Postoperative antithrombotic therapy was individualized based on the patient’s background. We examined their background and clinical events. Results A total of 116 consecutive patients underwent LAAC in our institution excepting for one case that could not be performed due to a huge LAA (follow-up period, 610±37 days; age, 75±1 years; male sex, 73%; left ventricular ejection fraction, 58±1%; CHAD2S2-VASc, 4.6±0.1; HAS-BLED, 3.4±0.1). The results are shown in the Figure. Receiver-operating characteristic curve analysis confirmed the best cut-off value of NLR, PLR, and LMR for composite of DRT, TIA, and ischemic stroke (AUC = 0.69; 0.70; 0.67). In the univariate analysis, NLR&amp;lt;1.88, PLR&amp;lt;144, and LMR&amp;gt;3.40 are the independent predictor for the combination of DRT, TIA, and ischemic stroke (p-value = 0.02; 0.04; 0.05, respectively). Conclusion Low NLR, low PLR, and high LMR are the independent predictor for the combination of DRT, TIA, and ischemic stroke. These parameters can be useful in routine use because they can be easily calculated without additional costs.

Neutrophil-to-lymphocyte ratio can predict the clinical prognosis of patients with primary adosteronism

Abstract Background Excess aldosterone-mediated inflammatory response is thought to be a factor in the high risk of cardiovascular events in patients with primary aldosteronism (PA). Leucocyte related inflammatory parameters, especially NLR, were significantly independent of aldosterone (PAC) in PA patients. However, the impact of NLR on the long-term prognosis of PA patients is unclear. Objective To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) on the long-term prognosis of patients with primary aldosteronism (PA). Methods The data for this study were derived from the Tianjin Health and Medical Big Data Super platform, comprising a retrospective cohort of patients discharged from 72 hospitals in our city from 2010 to 2023. According to the inclusion and exclusion criteria, 570 patients were ultimately included in the statistical analysis. Each patient had laboratory measurements, including blood cell counts, taken after admission and before interventional treatment. The primary endpoint was major cardiovascular events (MACEs), defined as cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke. Results During a mean follow-up period of 5 years, 125（21.9%）MACEs were recorded. ROC curve analysis displayed that the best cut-off value of NLR for predicting MACEs was 4.87. The MACEs of the high NLR group at 1 year, 3 years, and 5 years were higher than those of the low NLR group（25.0% vs 9.4%，40.3% vs17.1% 和 40.3% vs 19.3%；P＜0.05).Kaplan-Meier survival curve analysis showed that the survival rate of the low NLR group was higher than that of the high NLR group (P&amp;lt;0.001). The results of multivariate Cox proportional hazards regression analysis showed that NLR was an independent risk factor affecting the prognosis of PA patients, and the difference was statistically significant (P&amp;lt;0.05). Conclusions Elevated NLR is associated with adverse prognosis in patients with PA. NLR can serve as a simple and practical indicator to evaluate the long-term prognosis of PA patients. These findings warrant external validation, preferably in a prospective design.

Actinomyces status and inflammatory biomarkers in post-tonsillectomy hemorrhage cases

Background The presence of Actinomyces can be associated with complications. Aims This study aimed to determine the frequency of post-tonsillectomy hemorrhage (PTH), the presence of Actinomyces in palatine tonsils and serum inflammatory biomarker levels in PTH. Material and methods The cases who underwent tonsillectomy at a single center were included in the study. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII) and systemic inflammation response index (SIRI) values were calculated from the complete blood count test. The presence of Actinomyces was recorded from histopathological tonsillectomy material. Results A total of 1137 patients were included in the study. Actinomyces was detected in 93 (8.18%) patients. Bleeding complications were encountered in 65 cases (5.72%). No relationship was detected between the presence of Actinomyces and PTH rates (p = 0.433). While a relationship was found between age, NLR, and SIRI values and Actinomyces status (respectively, p < 0.001, p = 0.017, p = 0.038), no statistically significant relationship was found between tonsil size, PLR, and SII (p > 0.05). Conclusion and significance According to the data in our study, NLR and SIRI values were elevated in subjects with Actinomyces. Our findings suggest that this entity has a systemic manifestation. Serum inflammatory biomarkers and the presence of Actinomyces were not found to be associated with PTH.

The association of neutrophil-to-lymphocyte ratio with cardiovascular and all-cause mortality among the metabolic syndrome population

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) has emerged as a novel inflammatory marker related to disease prognosis, this study aimed to evaluate the association between NLR and mortality in metabolic syndrome (MetS) patients.MethodsThis study used data from 13,156 participants with MetS, derived from the National Health and Nutrition Examination Survey from 1999 to 2020. The NLR was calculated, and its associations with cardiovascular disease (CVD) mortality and all-cause mortality were assessed by multivariate Cox regression, restricted cubic spline and Kaplan-Meier curves. The study performed subgroup analyses to validate the robustness of the findings in different populations. The predictive ability of NLR was evaluated using time-dependent receiver operating characteristic curve. The indirect impact of eGFR was explored by mediation analysis.ResultsAs NLR values increased, there was an obvious rise in the risk of mortality in MetS. The fully adjusted continuous model revealed a 16.0%, 14.4% elevated risk of CVD mortality (HR = 1.160; 95% CI: 1. 090-1.234, p < 0.0001) and all-cause mortality (HR = 1.144; 95% CI: 1. 086-1.206, p < 0.0001), respectively, with each one-unit increment in NLR. Comparing the highest to the lowest quartile of NLR, the top quartile exhibited a significantly increased risk of CVD mortality (HR = 2. 447; 95% CI: 1. 561-3. 836, p < 0.0001), and all-cause mortality (HR = 1. 53; 95% CI: 1. 188-1. 972, p = 0.001) among individuals with MetS. Subgroup analyses substantiated the stability of these associations in most populations. The curve under area for the 3, 5, and 10 years were 0.650, 0.716, and 0.645 for CVD mortality, and 0.746, 0.688, and 0.635 for all-cause mortality. Significantly, the eGFR acted as an intermediary in the relationship of NLR with CVD mortality and all-cause mortality, accounting for 9.85% and 9.86% of the effect, respectively.ConclusionThe NLR served as a significant indicator for assessing the risk of mortality in the MetS population. Consequently, we recommended the regular assessment of NLR in MetS populations as a potentially advantageous method for evaluating their risk of mortality.