Platelet-to-neutrophil Ratio Research Articles

Association of platelet-to-white blood cell ratio and platelet-to-neutrophil ratio with the risk of fatal stroke occurrence in middle-aged to older Chinese

BackgroundWhite blood cell (WBC) and neutrophil (NEUT) counts, which are commonly inflammatory markers, have been related to an increased risk of fatal stroke. However, it is unclear whether platelet-to-white blood cell ratio (PWR) and platelet-to-neutrophil ratio (PNR) are related to the risk of fatal stroke in middle-aged to older populations.MethodIn total, 27,811 participants without a stroke history at baseline were included and followed up for a mean of 14.3 years (standard deviation = 3.2), and 838 stroke deaths were recorded. The Cox proportional hazards regression was used to assess the relationships between the PWR and the PNR and the risk of fatal strokes.ResultsCompared to the 1st quartile, an increased risk of fatal all stroke showed among the participants in the highest quartiles of both the WBC (adjusted hazard ratio (aHR) = 1.35, 95% confidence interval (CI) 1.09–1.66) and the NEUT (aHR = 1.45, 95% CI 1.18–1.79). The restricted cubic splines showed decreased trends in associations of the PWR and the PNR with the risk of fatal all stroke. A decreased risk of fatal all stroke showed in those with the highest quartiles for both the PWR (aHR = 0.73, 95% CI 0.53–1.00) and the PNR (aHR = 0.74, 95% CI 0.54–1.01). The participants with the 2nd, the 3rd and the 4th change quartiles for the PWR and the PNR had weak decreasing trends for the risk of fatal all stroke, compared to those in the 1st change quartile, and the significant associations were observed in those with an increase of 20% for the PWR with the risk of fatal haemarragic stroke (aHR = 0.47, 95% CI 0.22–0.95) and a decrease of 20% for the PNR with the risk of fatal all stroke (aHR = 1.33, 95% CI 0.99–1.79), compared to those with stable dynamic changes.ConclusionsHigher neutrophil count and platelet-to-neutrophil ratio were associated with a contrary risk of fatal stroke, with an increased for the former and a decreased for the later. A potentially chronic inflammation should be paid close attention to stroke occurrence in relatively healthy middle-aged to older populations.

Infarct size, inflammatory burden, and admission hyperglycemia in diabetic patients with acute myocardial infarction treated with SGLT2-inhibitors: a multicenter international registry

BackgroundThe inflammatory response occurring in acute myocardial infarction (AMI) has been proposed as a potential pharmacological target. Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) currently receive intense clinical interest in patients with and without diabetes mellitus (DM) for their pleiotropic beneficial effects. We tested the hypothesis that SGLT2-I have anti-inflammatory effects along with glucose-lowering properties. Therefore, we investigated the link between stress hyperglycemia, inflammatory burden, and infarct size in a cohort of type 2 diabetic patients presenting with AMI treated with SGLT2-I versus other oral anti-diabetic (OAD) agents.MethodsIn this multicenter international observational registry, consecutive diabetic AMI patients undergoing percutaneous coronary intervention (PCI) between 2018 and 2021 were enrolled. Based on the presence of anti-diabetic therapy at the admission, patients were divided into those receiving SGLT2-I (SGLT-I users) versus other OAD agents (non-SGLT2-I users). The following inflammatory markers were evaluated at different time points: white-blood-cell count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR), and C-reactive protein. Infarct size was assessed by echocardiography and by peak troponin levels.ResultsThe study population consisted of 583 AMI patients (with or without ST-segment elevation): 98 SGLT2-I users and 485 non-SGLT-I users. Hyperglycemia at admission was less prevalent in the SGLT2-I group. Smaller infarct size was observed in patients treated with SGLT2-I compared to non-SGLT2-I group. On admission and at 24 h, inflammatory indices were significantly higher in non-SGLT2-I users compared to SGLT2-I patients, with a significant increase in neutrophil levels at 24 h. At multivariable analysis, the use of SGLT2-I was a significant predictor of reduced inflammatory response (OR 0.457, 95% CI 0.275–0.758, p = 0.002), independently of age, admission creatinine values, and admission glycemia. Conversely, peak troponin values and NSTEMI occurrence were independent predictors of a higher inflammatory status.ConclusionsType 2 diabetic AMI patients receiving SGLT2-I exhibited significantly reduced inflammatory response and smaller infarct size compared to those receiving other OAD agents, independently of glucose-metabolic control. Our findings are hypothesis generating and provide new insights on the cardioprotective effects of SGLT2-I in the setting of coronary artery disease.Trial Registration: Data are part of the ongoing observational registry: SGLT2-I AMI PROTECT. ClinicalTrials.gov Identifier: NCT 05261867.

Prognostic significance of platelet-to-lymphocyte and platelet-to-neutrophil ratios in patients with mechanical thrombectomy for acute ischemic stroke.

ObjectiveThe present study aimed to analyze the correlation between platelet-to-lymphocyte ratio (PLR) and platelet-to-neutrophil ratio (PNR) with prognosis of patients who underwent mechanical thrombectomy (MT).MethodsA total of 432 patients was included, PLR and PNR were calculated from laboratory data on admission. Prognosis was evaluated with a modified Rankin Scale at 3 months after MT. Using receiver operating characteristic (ROC) analysis, optimal cutoff values of PLR and PNR were identified to predict the prognosis after MT. Multivariate analyses were performed to identify the relationship of PLR and PLR with prognosis of MT.ResultsPatients with favorable outcomes had a lower mean PLR (135.0, standard deviation [SD] 120.3) with a higher mean PNR (47.1 [SD] 24.6) compared with patients with unfavorable outcomes (167.6 [SD] 139.3 and 35.4 [SD] 22.4) (p<0.001 and <0.001, respectively). In ROC analyses, the optimal cutoff value of PLR and PNR to predict the 3 months prognosis were 145 and 41, respectively (p=<0.001 and p=0.006). In multivariate analysis, PLR less than 145 (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.06–2.06; p=0.016) and PNR greater than 41 (OR 1.22, 95% CI 1.10–1.62; p=0.022) were predictors of favorable outcome at 3 months.ConclusionsIn patients with MT, PLR and PNR on admission could be predictive factors of prognosis and mortality at 3 months. Decreased PLR and increased PNR were associated with favorable clinical outcome 3 months after MT.

The value of diagnostic model on COVID-19 by Comparing the Features between SARS-COV-2 and other viral infections

With the expansion of 2019 novel coronavirus disease(COVID-19), large of suspected cases were reported. This essay compares the clinical features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and other viral infections among the suspected COVID-19 patients, and attempts to explore an ideal diagnostic model of COVID-19. 60 viral pneumonia patients from 86 suspected patients were enrolled and grouped into two: the COVID-19 group (19 cases) and other viral infections group (41 cases). Compare and analyze the blood test results, biochemical indicators and chest CT scan changes of patients. 60 patients were mainly young and middle-aged men, of which 60%were infected with influenza virus, and 31.6%were infected with SARS-COV-2 according to pathogenic distribution. And we found statistic differences among blood cell counts and blood biochemistry between the two groups. The COVID-19 patients' chest CT showed that the lung lesions were mainly bilateral nodule or appeared to be patchy and ground glass shadowed. While most of the lung lesions caused by other virus were mainly unilateral patchy shadow (P＜0.05). We found a new multi-marker PTG, which composed of platelet-to-neutrophil ratio(PNR), total bilirubin(TBIL) and ground-grass density, The area sunder curves(AUC)of PTG was 0.908, the sensitivity was 73.17%and the specificity was 94.44%. The ratio of blood RT to its sub-group and chest CT were considered as important reference in differential diagnosis. The PTG, with extremely high specificity and sensitivity in early differential diagnosis of COVID-19 and other viral pneumonia, had a significant clinical value.

Inflammatory Indexes for Assessing the Severity and Disease Progression of Ulcerative Colitis: A Single-Center Retrospective Study.

BackgroundActive and severe ulcerative colitis (UC) and non-response to 5-aminosalicylic acid (5-ASA) are related to poor outcomes and should be accurately identified. Several integrated inflammatory indexes are potentially useful to assess the disease severity in patients with acute or critical diseases but are underexplored in patients with UC.MethodsPatients with UC consecutively admitted to our hospital between January 2015 and December 2020 were retrospectively grouped according to the activity and severity of UC and response to 5-ASA. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), neutrophil-to-platelet ratio (NPR), platelet-to-albumin ratio (PAR), C-reactive protein-to-albumin ratio (CAR), and C-reactive protein-to-lymphocyte ratio (CLR) were calculated. The areas under receiver operating characteristic curves (AUC) were calculated.ResultsOverall, 187 patients with UC were included, of whom 151 were active, 55 were severe, and 14 were unresponsive to 5-ASA. The active UC group had significantly higher NLR, PLR, SII, and PAR levels. SII had the greatest predictive accuracy for active UC, followed by PLR, PAR, and NLR (AUC = 0.647, 0.641, 0.634, and 0.626). The severe UC group had significantly higher NLR, PLR, SII, PAR, CAR, and CLR levels. CLR had the greatest predictive accuracy for severe UC, followed by CAR, PLR, SII, NLR, and PAR (AUC = 0.732, 0.714, 0.693, 0.669, 0.646, and 0.63). The non-response to the 5-ASA group had significantly higher CAR and CLR levels. CAR had a greater predictive accuracy for non-response to 5-ASA than CLR (AUC = 0.781 and 0.759).ConclusionSII, CLR, and CAR may be useful for assessing the severity and progression of UC, but remain not optimal.

One Year Analysis of Hematological and Inflammatory Parameters to Predict the Severity of COVID-19 Infection in Pregnant Women

Objective: The study aims to demonstrate the usability of admission hematological parameters in the prognosis of COVID-19 infection in pregnant population and to introduce the cut-offs values of these parameters for pregnant women.Methods: The cohort of this retrospective study consisted of 71 COVID-19 PCR positive pregnant women who were hospitalized in Ordu University Medical Faculty Training and Research Hospital between 1 May 2020 and 1 May 2021. The pregnant women were divided into two groups based on the severity of the disease.Results: White blood cell count, neutrophil count and C-reactive protein (CRP) levels was significantly higher (p=0.000, p=0.000), whereas red blood cell count and lymphocyte count were significantly lower (p=0.002, p=0.002) in severe group. High NLR (neutrophil-to-lymphocyte ratio) (p=0.000), dNLR (derived neutrophil-to-lymphocyte ratio) (p=0.000), MLR (monocyte-to-lymphocyte ratio) (p=0.004), PLR (platelet-to-lymphocyte ratio) (p=0.008), NPR (neutrophil-to-platelet ratio) (p=0.005), NLRNPR (neutrophil-to-lymphocyte ratio/neutrophil-to-platelet ratio) (p=0.008) and SII (Systemic immune inflammation index) (p=0.000) were found in severe group.Conclusion: This paper revealed that severe COVID-19 disease in pregnant women is mainly associated with hematological parameters. Among these parameters NLR, dNLR and SII have largest AUC in ROC, with cutoff values 5.3, 3.52 and 994.8 respectively. Further investigations regarding the use of hematologic tests as prognostic factor of COVID-19 disease severity in pregnant women are needed to assess the risk of serious disease, to predict the prognosis of COVID-19 and to reduce perinatal and maternal morbidity/mortality.

Association between Platelet to Neutrophil Ratio (PNR) and Clinical Outcomes in STEMI Patients after Successful pPCI: A Secondary Analysis Based on a Cohort Study.

Purpose This study was aimed at investigating whether the platelet-to-neutrophil ratio (PNR) is independently related to the prognosis of patients with ST-elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (pPCI). Methods This was a secondary analysis of data retrieved from the DATADRYAD database, which was a prospective cohort study. A total of 464 STEMI patients who underwent successful pPCI were recruited between January 2010 and October 2014. The target-independent variable, PNR, was measured at the baseline. The dependent variable in the current study was the occurrence of major adverse cardiovascular events (MACEs) during the 30-month follow-up. Results Two patients were excluded from the final analysis because their platelet counts were unavailable. The average age of the 462 participants was 63 ± 11.92 years, and approximately 76.6% were male. After adjusting for age, sex, anterior wall myocardial infarction (MI), history of MI, apelin-12, apelin-12 change rate, left ventricular end-diastolic diameter, peak cardiac troponin I, pathological Q wave, Killip classification grade, fasting blood glucose, albumin, GENSINI score, and estimated glomerular filtration rate, a nonlinear relationship was found between the PNR and MACEs in the included cohort. The threshold value of the PNR for MACEs was 23.1. Over this cutoff value, the incidence rate of MACEs increased by 43% per 10-unit change in PNR (95% CI: 1.16–1.75, p = 0.0006). Conclusion There was a threshold relationship between PNR and MACEs in patients with STEMI who underwent successful pPCI. The incidence of MACEs was positively associated with the PNR when the PNR exceeded 23.1.

Value of neutrophil-to-platelet ratio, immature granulocyte-to-lymphocyte ratio, red blood cell distribution width-to-lymphocyte ratio in differentiating complicated acute appendicitis.

The discovery that medical treatment could be successful in cases with uncomplicated acute appendicitis (UCAA) has revealed the need for successfully differentiating cases with complicated acute appendicitis (CAA). The present study exam-ined the usability of neutrophil-to-platelet ratio (NPR), immature granulocyte-to-lymphocyte ratio, and red blood cell distribution width-to-lymphocyte ratio (RDWLR) in the CAA/UCAA differentiation. A retrospective evaluation was made of patients undergoing appendectomy between January 2019 and December 2020. According to pathological and clinical findings, the patients were divided into negative appendectomy, CAA and UCAA groups. Labo-ratory parameters and associated ratios were evaluated by comparing the groups. The study included 348 patients. Of the patients, 11.2% had CAA, 81.6% had UCAA, and 7.2% had negative appendec-tomy. The neutrophil-to-lymphocyte ratio (AUC=0.742), platelet-to-lymphocyte ratio (AUC=0.707), immature granulocyte-to-lym-phocyte ratio (AUC=0.782), monocyte-to-lymphocyte ratio (AUC=0.720), and RDWLR (AUC=0.711) were found significant in the differentiation between complicated and uncomplicated AA. The NPR (AUC=0.789) was found to be significant in the differentiation between positive and negative appendectomy. It was concluded that the immature granulocyte-to-lymphocyte ratio, NPR, monocyte-to-lymphocyte, and RD-WLR, which have not been previously studied in patients with acute appendicitis (AA), could be used to differentiate between com-plicated and uncomplicated AA groups.

Predictive Value of Systemic Immune-Inflammation index and Neutrophil-to-Lymphocyte Ratio in Patients with Severe COVID-19.

Objective: It was initially reported that a novel coronavirus (COVID-19) had been identified in Wuhan, China, in December 2019.To date, COVID-19 is still threatening all humanity and has affected the public healthcare system and the world economic situation. Neutrophil-to-lymphocyte ratio (NLR) has also been demonstrated that associated with severity of COVID-19, but little is known about systemic immune-inflammation index (SII) relation with COVID-19. Methods: One hundred and twenty-five patients with diagnosed COVID-19 including non-severe cases (n = 77) and severe cases (n = 48) were enrolled in this study. Each patient of clinical characteristic information, blood routine parameters, and the haemogram-derived ratios were collected, calculated, and retrospectively analyzed. Receiver operating characteristics (ROC) was performed to investigate whether these parameters could be used to the predictive value of patients with severe COVID-19. Results: White blood cell count (WBC), neutrophil count (NEU), red cell volume distribution width (RDW), NLR, Platelet to lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR), and SII were significantly higher in the severe groups than in the non-severe group (p < 0.01).Conversely, the severe group had a markedly decreased lymphocyte count, basophil (Baso#) count, red blood cell count (RBC), Hemoglobin (HGB), hematocrit (HCT), and lymphocyte-to-monocyte ratio (LMR) (P < 0.01).ROC curve analysis showed the AUC, optimal cut-off value, sensitivity, specificity of NLR and SII to early predict severe-patients with COVID-19 were 0.867, 7.25, 70.83%, 92.21% and 0.860, 887.20, 81.25%, 81.82%, respectively. Conclusion The results suggest that the SII and NLR is a potential new diagnosed biomarker in severe-patients with COVID-19.

Supervised Learning Based Systemic Inflammatory Markers Enable Accurate Additional Surgery for pT1NxM0 Colorectal Cancer: A Comparative Analysis of Two Practical Prediction Models for Lymph Node Metastasis.

PurposePredicting lymph node metastasis (LNM) after endoscopic resection is crucial in determining whether patients with pT1NxM0 colorectal cancer (CRC) should undergo additional surgery. This study was aimed to develop a predictive model that can be used to reduce the current likelihood of overtreatment.Patients and MethodsWe recruited a total of 1194 consecutive CRC patients with pT1NxM0 who underwent endoscopic or surgical resection at the Gezhouba Central Hospital of Sinopharm between January 1, 2006, and August 31, 2021. The random forest classifier (RFC) and generalized linear algorithm (GLM) were used to screen out the variables that greatly affected the LNM prediction, respectively. The area under the curve (AUC) and decision curve analysis (DCA) were applied to assess the accuracy of predictive models.ResultsAnalysis identified the top 10 candidate factors including depth of submucosal invasion, neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), platelet-to-neutrophil ratio(PNR), venous invasion, poorly differentiated clusters, tumor budding, grade, lymphatic vascular invasion, and background adenoma. The performance of the GLM achieved the highest AUC of 0.79 (95% confidence interval [CI]: 0.30 to 1.28) in the training cohort and robust AUC of 0.80 (95% confidence interval [CI]: 0.36 to 1.24) in the validation cohort. Meanwhile, the RFC exhibited a robust AUC of 0.84 (95% confidence interval [CI]: 0.40 to 1.28) in the training cohort and a high AUC of 0.85 (95% CI: 0.41 to 1.29) in the validation cohort. DCAs also showed that the RFC had superior predictive ability.ConclusionOur supervised learning-based model incorporating histopathologic parameters and inflammatory markers showed a more accurate predictive performance compared to the GLM. This newly supervised learning-based predictive model can be used to determine an individually tailored treatment strategy.

Platelet-to-Neutrophil Ratio is Related to Hemorrhagic Transformation in Patients With Acute Cerebral Infarction.

As a common complication of cerebral infarction, hemorrhagic transformation (HT) often indicates a worse clinical outcome. The aim of this study was to explore the relationship between the platelet-to-neutrophil ratio (PNR) and HT in patients with acute cerebral infarction. Patients with HT after acute cerebral infarction were enrolled in the HT group. Matched patients with acute cerebral infarction without HT were enrolled at the same time. All patients included in this study did not receive reperfusion therapy. The PNR was obtained on the second day of admission. Multivariate logistic analysis was used to evaluate the relationship between the PNR and HT. We collected data from a total of 137 patients: 61 patients with HT and 76 patients without HT. After adjusting for confounders, the PNR was independently associated with HT (odds ratio=0.922, 95% confidence interval: 0.891-0.955, P <0.05). The receiver operating characteristic curve demonstrated that the PNR could better predict HT (area under the curve=0.808, 95% confidence interval: 0.735-0.882, P <0.05). When the cut-off value of the PNR was 50.4765, the sensitivity was 70.5%, and the specificity was 82.9%. After stratifying the PNR to 50.4765, logistic analysis was performed again. The risk of HT in patients with a low PNR was 12.995 times that of patients with a high PNR. In patients without atrial fibrillation, the PNR was still independently related to HT. The PNR is a predictor of HT, and patients with a low PNR have a higher risk of HT.

Platelet-to-Lymphocyte Ratio as an Independent Factor Was Associated With the Severity of Ankylosing Spondylitis.

The study was aimed to determine the association of the platelet-lymphocyte ratio (PLR) with the disease activity of ankylosing spondylitis (AS). A total of 275 patients, including 180 AS patients and 95 non-AS patients, participated in the study. We assessed a full blood count for each participant. Platelet to monocyte ratio (PMR), monocytes to lymphocyte ratio (MLR), monocyte to neutrophil ratio (MNR), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and platelet to neutrophil ratio (PNR) were calculated. LASSO and logistic regression analyses were performed to establish the nomogram. Receiver operating characteristic (ROC) analysis was performed to evaluate the clinical value of the nomogram. We constructed a novel nomogram, which incorporated easily accessible clinical characteristics like sex, PLR, WBC, EOS, and ESR for AS diagnosis. The AUC value of this nomogram was 0.806; also, the calibration curves indicated a satisfactory agreement between nomogram prediction and actual probabilities. Furthermore, PLR was positively correlated with the severity of AS. PLR was identified as an independent factor for the diagnosis of AS and was associated with the severity of AS.

Nomogram based on neutrophil-to-platelet ratio to predict in-hospital mortality in infective endocarditis.

Aim: To develop a nomogram based on neutrophil-to-platelet ratio (NPR) to predict in-hospital mortality in infective endocarditis (IE) patients. Methods: We retrospectively analyzed 294 consecutive patients classified as survivors or nonsurvivors according to hospitalization outcome. Logistic regression analyses were performed to identify independent predictors for in-hospital mortality. A nomogram based on them was established and assessed by receiver operating characteristic (ROC) curve analysis. Results: Admission NPR (odds ratio [OR] = 1.095, 95% CI: 1.037-1.156), positive blood culture (OR = 9.220; 95% CI: 1.478-57.521) and left-sided endocarditis (OR = 5.099; 95% CI: 1.104-23.553) independently predicted in-hospital mortality in IE. The area under the ROC curve for the nomogram based on these predictors was 0.832. Conclusion: The nomogram based on NPR could be used for early risk stratification of IE patients.

Predictors of full functional recovery in endovascularly treated patients with aneurysmal subarachnoid hemorrhage

Background/aim The knowledge of factors influencing functional outcomes after aneurysmal subarachnoid hemorrhage (ASH) has significantly increased in recent decades, still not enough. We aimed to identify the predictors of full functional recovery (FFR) in endovascularly treated patients with ASH.Materials and methods A retrospective review was performed of adult patients who underwent endovascular treatment for ASH in a 5-year period. The association was evaluated of variables with FFR, defined as a modified Rankin Scale score of 0 or 1 at a 3-month follow-up.Results This study included 204 patients with a percentage of FFR of 62.7%. On univariate analysis, the following variables were associated with FFR: younger age, male sex, no history of hypertension, posterior circulation aneurysm, better modified-Fisher grade (mFG), better Hunt-Hess grade, better Glasgow Coma score, lower platelet-to-lymphocyte ratio (PLR), lower neutrophil-to-lymphocyte ratio (NLR), and higher platelet-to-neutrophil ratio (PNR). On multivariate analysis, younger age (OR = 0.95, 95% Cl = 0.92–0.98, p = 0.003), better mFG (OR = 0.66, 95% Cl = 0.48–0.97, p = 0.03), lower PLR (OR = 0.993, 95% Cl = 0.990–0.997, p = 0.001), lower NLR (OR = 0.89, 95% Cl = 0.83–0.95, p = 0.01) and higher PNR (OR = 1.08, 95% Cl = 1.01–1.10, p = 0.01) showed the strongest association with FFR.Conclusion With the administration of endovascular treatment, most of the patients with ASH can return to a normal productive life. Younger age, better mFG, lower PLR and NLR, as well as higher PNR, increase the likelihood of FFR.

Clinical significance of platelet to neutrophil ratio and platelet to lymphocyte ratio in patients with aneurysmal subarachnoid hemorrhage

The aim of study was aimed to investigate associations of platelet-to-neutrophil ratio (PNR) and platelet-to-lymphocyte ratio (PLR) on admission with clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH). A retrospective analysis was performed on patients who were treated for aSAH. Unfavorable clinical outcome was defined as Modified Rankin Scale (mRS) score of 3–6 at 90-days. Receiver operating characteristic curve analysis was performed to detect optimal cutoff values of PNR and PLR for predicting clinical outcomes. Logistic regression was used to explore associations of PNR and PLR with clinical outcomes. A total of 544 patients with aSAH were enrolled. Of them, 152 (29.9%) had unfavorable clinical outcome. Optimal cutoff values of PNR and PLR to predict clinical outcomes at 90 days after aSAH were 25 and 130, respectively (P < 0.001 and <0.001, respectively). In multivariate logistic regression analysis, PNR <25 and PLR ≥ 130 were associated with unfavorable clinical outcome at 90 days after aSAH (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.23–3.69; P = 0.018 and OR: 1.56; 95% CI: 1.18–2.62; P = 0.031, respectively). PNR and PLR as novel inflammatory biomarkers could predict the clinical outcome after aSAH. PNR <22 and PLR ≥ 130 were associated with unfavorable clinical outcome at 90 days after aSAH.

Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis.

Background and PurposeMounting researches have illuminated that the neutrophil-related ratios were related to the prognosis of acute ischemic stroke (AIS). However, few have compared their predictive value and accuracy. To make such comparison and identify the best indicator on the 90-day outcome, we investigated biomarkers including neutrophil ratio (Nr), neutrophil count (Nc), lymphocyte (L), neutrophil-to-lymphocyte ratio (NLR), platelet (P or PLT), platelet-to-neutrophil ratio (PNR), NLR-to-platelet ratio (NLR/PLT), eosinophil (E), neutrophil-to-eosinophil ratio (NER), monocyte (M), and monocyte-to-neutrophil ratio (MNR).MethodsThis retrospective study recruited 283 AIS and 872 healthy controls (HCs) receiving intravenous thrombolysis (IVT). Blood samples were collected after 24 h of admission before IVT. Propensity Score Matching (PSM) was used to explore whether these ratios differentiated AIS and HCs. We applied univariate and multivariate analyses to evaluate the prediction effect of these ratios separately or added in the model and figured out a clinical prediction model. To estimate the discrimination and calibration of the new models, the receiver operating characteristics (ROC) curve analysis, DeLong method, and likelihood ratio test (LR test) were utilized.ResultsPSM showed that Nr, Nc, NLR, P, PNR, NLR/PLT, NER, and MNR facilitates the differentiation of the HCs and AIS. Among the eight biomarkers, PNR and MNR could differentiate the 90-day outcome, and it was found out that PNR performed better. Univariate regression analysis demonstrated that PNR was the only independent predictor which needs no adjustment. Besides, the multivariate regression analysis, Delong method, and LR test indicated that among the neutrophil-related ratios, NLR, PNR, NLR/PLT, NER, and MNR exerted little influence on the discrimination but could enhance the calibration of the base model, and NER proved to work best.ConclusionLow PNR was the best indicator among the neutrophil-related ratios tin predicting a poor 90-day outcome of AIS patients. Moreover, high NER performed best when predicting the 90-day outcome to improve the calibration of the base model.

Causes and predictors of mortality from lupus nephritis in Southern Hunan, China

Objectives The objective of the study was to explore the causes and predictors of mortality in a cohort of LN with LN in southern Hunan, China. Methods We analyzed 236 patients with biopsy-proven LN during 2010–2018. Demographic data, laboratory data, SLEDAI scores, treatment strategies, and comorbidity were collected. Cox regression analysis was carried out to determine the independent predictors of mortality. Results The patients had mean disease duration of 67.9 ± 28.2 months. Class IV LN was the predominant biopsy class within the cohort (38.1%). After 1 year therapy, the majority of patients achieved complete remission (72.9%) and 44 (18.6%) patients achieved partial remission. The 5- and 10-years survival rates for our cohort were 94.4 and 85.2%, respectively. There were 18 deaths (7.6%), of which the main causes were infection (50%) alone and cardiovascular diseases (27.8%). Independent predictors of mortality in our cohort were: platelet-to-neutrophil ratio (PNR) [hazard ratio (HR) 5.910; confidence interval (CI) 1.253–27.875], onset age (HR 1.090; CI 1.035–1.147), and SLEDAI scores (HR 1.258; CI 1.068–1.482). Conclusion We firstly revealed that PNR might be a promising predictor of mortality and reported the causes and prognostic predictors of mortality in LN from southern Hunan, China.

Hematological Biomarkers, Mortality, Transfusion and Acute Heart Disease

BackgroundPatients hospitalized with acute heart disease [acute myocardial infarction (MI); heart disease exacerbation] may require red blood cell (RBC) transfusion. These patients are at increased risk for morbidity and mortality. Hematological biomarkers may help to identify increased mortality risk. The aim of the study was to evaluate the association between hematological biomarkers and survival in these patients. MethodsA historical cohort study of all patients admitted to an internal medicine department, who were diagnosed with acute heart disease and requiring RBC transfusion, was carried out in a tertiary medical center between 2009-2014. The association between hematological biomarkers and 30-, 90-day and 5-year mortality was studied. ResultsA total of 254 patients (median age 80 years, IQR 74-86.25; 40.9% females; acute MI 24.8%), were included. During the 5-year follow-up 212(83.5%) patients died. In a multivariate analysis the lower platelet to neutrophil ratio (PNR) was significantly associated with increased 30-, 90-day and 5-year mortality (p<0.001, 0.041, 0.003 respectively). A higher red cell distribution width (RDW) was significantly associated with 30- and 90-day mortality (p=0.003, 0.023 respectively), while higher neutrophil to lymphocyte ratio (NLR) was associated with increased 30-day and 5-year mortality (p= 0.036, 0.033 respectively). ConclusionsHematological biomarkers may help to identify increased mortality risk of acute heart disease patients, receiving RBC transfusions in an internal medicine department.

Prediction of lymph node metastasis in oral tongue squamous cell carcinoma using the neutrophil-to-lymphocyte ratio and platelet-to-neutrophil ratio.

BackgroundLymph node metastasis in a variety of tumors is associated with systemic inflammatory markers. However, this association has not been reported in oral tongue squamous cell carcinoma (OTSCC). This study aimed to investigate how the preoperative neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐neutrophil ratio (PNR) in OTSCC patients correlated with the occurrence of OTSCC and lymph node metastasis.MethodsThe data of 73 patients with primary OTSCC who underwent surgical resection were retrospectively analyzed. Patients with other malignant tumors, patients who had received radiotherapy or chemotherapy before surgery, and patients with active inflammation were excluded. The enrolled patients were divided into groups N0 (no early‐stage lymph node metastasis) and N1 (early‐stage lymph node metastasis). Venous blood samples were collected before surgery and at the third week after surgery and subjected to complete blood counting in a blood analyzer. Eighty‐seven healthy people were included as a control group. In addition, the NLR and PNR in OTSCC patients were compared with those in the controls, and the postoperative NLR and PNR of group N0 were compared with those of group N1.ResultsThe NLR was significantly higher in the OTSCC patients than the controls (p < 0.05). The area under the receiver operating characteristic curve was 0.595. Further comparison of the NLR and PLR between group N0 and group N1 showed that when NLR was ≤1.622, and the probability of early‐stage lymph node metastasis in OTSCC patients was 73.3%, and when PNR was >60.889, the probability was 86.7%. In re‐examination 3 weeks postoperatively, the NLR and PNR were not significantly different between groups.ConclusionThe NLR has certain reference value for the diagnosis of OTSCC. The preoperative NLR and PNR can be used to predict early‐stage lymph node metastasis in patients with histopathologically confirmed OTSCC.

Hemogram as marker of in-hospital mortality in COVID-19

The clinical impact of COVID-19 disease calls for the identification of routine variables to identify patients at increased risk of death. Current understanding of moderate-to-severe COVID-19 pathophysiology points toward an...