Neutrophil-to-lymphocyte Ratio Research Articles

P-129. Evaluation of the Mannheim Peritonitis Index, the Neutrophil/Lymphocyte Ratio, and the Platelet/Lymphocyte Ratio as Predictive Parameters of Clinical Outcomes of Patients with Intra-Abdominal Infection in a Teaching Hospital in Nicaragua

Abstract Background Intra-abdominal infections are associated worldwide with relatively high mortality. Decisions in patient management and clinical outcomes may be determined by specific risk factors that can be assessed in the form of scores or indices, and ratios. The objective of this study was to evaluate the Mannheim Peritonitis Index (MPI), the Neutrophil/Lymphocyte Ratio (NLR), and the Platelet/Lymphocyte Ratio (PLR) as predictors of mortality and other clinical outcomes in this type of patients at a teaching and referral hospital (Dr. Fernando Vélez Paiz Hospital) in Managua, Nicaragua.Table 1.Mannheim Peritonitis Index and Surgical Reintervention, Admission to ICU, and Mortality Methods This is a retrospective, cross-sectional, analytical study. Patients hospitalized for complicated intra-abdominal infection (cIAI)an between November 2021 and November 2023 were included. The relationship of MPI, NLR, and PLR with mortality and other clinical outcomes as need for reoperation, requiring admission to intensive care unit, and length of hospital stay was analyzed. The cut-off points of previous reference studies for MPI (≥ 26 points), NLR (≥ 11), and PLR (≥ 222) were used. Sensitivity, specificity and a ROC curve (AUC) were calculated for each of the predictive instruments evaluatedTable 2.Neutrophiles/Lymphocytes Ratio and Surgical Reintervention, Admission to ICU, and Mortality Results 102 patients with cIAI were included in the study. The mean age was 56.05 ± 21.25 years-old. The most common etiology was acute appendicitis (39.2%). Overall mortality was 34.3%. The need for surgical reintervention was observed in 72.7% of patients with MPI ≥ 26 points, 31.3% of patients with NLR ≥ 11, and 45.0% of patients with PLR ≥ 222. Regarding requiring admission to the intensive care unit, it was observed in 84.0% of patients with MPI ≥ 26 points, 57.8% of patients with NLR ≥ 11, and 27.5% of patients with PLR ≥ 222. Mortality in patients with MPI ≥ 26 points was 75.0%, and 46.9% in patients with NLR ≥ 11 (Table 1 and 2). Theand specificity of MPI for mortality was 94.3% and 47.9% respectively, with an AUC of 0.95. The sensitivity and specificity of NLR for mortality were 85.7% and 49.3% respectively (Table 3).Table 3.Sensitivity and Specificity of MPI and NLR for Mortality Prediction. Conclusion The MPI ≥ 26 points predicts mortality, a higher probability of surgical reoperation, ICU admission, and prolonged hospital stay. In the population of this study, the cut-off point with the best diagnostic reliability was MPI ≥ 25 points. The NLR ≥ 11 points is also a significant predictor of mortality. Disclosures All Authors: No reported disclosures

The Prognostic Value of Inflammatory Indices in Acute Pulmonary Embolism

Background: Acute pulmonary embolism (PE) is a condition with increased morbidity and mortality. It is important to identify patients with high mortality risk. Inflammation and thrombosis are interconnected in the pathophysiology of PE. The aim of the study was to investigate the prognostic value of multiple blood cellular indices such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte platelet ratio (NLPR), systemic immune–inflammation index (SII), systemic inflammation response index (SIRI) and aggregate index of systemic inflammation (AISI) in acute PE. Methods: A total of 157 patients with acute PE confirmed by chest computed tomographic angiography (CTPA) were enrolled. These patients were divided into two categories according to the simplified pulmonary embolism severity index (sPESI): high risk and low risk. Results: Univariate logistic regression analysis showed that right ventricle dysfunction, NLR, SII and SIRI were significantly associated with high risk of acute PE. NLR of 4.32 was associated with high-risk PE with a sensitivity of 57.4% and specificity of 65.7% (AUC = 0.635). SII of 1086.55 was associated with high-risk PE with a sensitivity of 55.7% and specificity of 71.4% (AUC = 0.614). SIRI of 2.87 was associated with high-risk PE with a sensitivity of 59% and specificity of 62.9% (AUC = 0.624). Multivariate logistic regression analysis demonstrated that right ventricle dysfunction, NLR, PLR and NLPR are independent predictors of high-risk acute PE. Secondly, NLR, NLPR, SII and SIRI were significantly correlated with in-hospital mortality of acute PE. Based on receiver-operating characteristic (ROC) curve values of 7.66 for NLR (AUC 0.911, sensitivity of 85.7% and sensibility of 83%), 0.02 for NLPR (AUC 0.871, sensitivity of 85.7% and sensibility of 70%), 1542.71 for SII (AUC 0.782, sensitivity of 71.4% and sensibility of 72%) and 5.72 for SIRI (AUC 0.788, sensitivity of 71.4% and sensibility of 73%) could predict in-hospital mortality. Conclusions: The blood cellular indices (NLR, NLPR, SII and SIRI) are associated with high-risk acute PE and in-hospital mortality. Right ventricular dysfunction, NLR and NLPR are independent predictors for high-risk acute PE.

Use of the Neutrophil-to-Lymphocyte Ratio Improves the Accuracy of Outcome Prediction in Patients with Acute Traumatic Subdural Hematoma Undergoing Surgical Treatment.

Traumatic brain injury is a major cause of disability and mortality worldwide. Acute traumatic subdural hematoma (TSDH) accounts for a large proportion of all traumatic brain injury cases. However, factors to predict postoperative prognosis in patients with acute TSDH are limited. Recently, it has been reported that inflammatory markers increase the accuracy of prognosis in various diseases. The neutrophil-to-lymphocyte ratio (NLR) is a marker for inflammation, which is easy to test, inexpensive, and can be performed quickly. However, the prognostic value of NLR in patients with acute TSDH remains controversial. This study therefore aimed to assess the predictive value of the admission and postoperative NLR in patients with acute TSDH who underwent surgical treatment. We retrospectively identified patients who underwent surgery for acute TSDH at our institute between April 2010 and August 2023. The NLR was calculated as the ratio of the absolute neutrophil count to the absolute lymphocyte count. Multivariable logistic regression analysis was subsequently applied to assess the independent predictors of 30-day mortality. In logistic regression analysis, multivariate analysis was performed using the backward elimination method for all P value<0.05 in the univariate analysis. Receiver-operating characteristic curve analysis was used to assess the predictive abilities of the postoperative 48-hour NLR and determine the cutoff values. A total of 131 patients were enrolled, among whom the mortality within 1month was 47.3% (62 patients). Initial NLR (P value=0.905) was not strongly associated with mortality in patients with acute TSDH who underwent surgery. Only the postoperative 48-hour NLR (odds ratio, 1.103; 95% confidence interval, 1.051-1.157; P < 0.001) and Glasgow Coma Scale score at admission (odds ratio, 0.855; 95% confidence interval, 0.756-0.967; P=0.012) were independent factors for 1-month mortality in the multivariate logistic analysis. The optimal cutoff value of the postoperative 48-hour NLR to distinguish between survival and nonsurvival was 15.786. Initial NLR was not strongly associated with 1-month mortality in patients with acute TSDH who underwent surgery. However, the postoperative 48-hour NLR was associated with 1-month mortality.

Prognostic scores for predicting overall survival in patients with metastatic renal and urothelial cancer undergoing immunotherapy - which one to use?

PurposeEvaluation of the prognostic significance of four different scoring systems in a real-world cohort of patients with metastatic urothelial carcinoma (mUC) or renal cell carcinoma (mRCC) undergoing immunotherapy (IO).MethodsFor 120 patients with mUC (n = 67) and mRCC (n = 53) who received IO between July 2016 and December 2020 at the tertiary Urological University Medical Centre Mannheim, the following scores were recorded at pre-treatment baseline: modified Glasgow prognostic score (mGPS), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-eosinophil ratio (NER). Overall survival (time between the beginning of IO until the patients’ death or last contact) was determined for every patient.ResultsKaplan-Meier analyses revealed that high baseline mGPS, SII (> 979) and NLR (> 3) were associated with poor overall survival (OS) (p < 0.05). Cox proportional hazards regression analyses showed that baseline mGPS and NLR had a significant independent prognostic influence on OS (p < 0.05), of which mGPS had a greater significance (p < 0.001, mGPS Score 2 vs. Score 0: HR 4.1, 95% CI 1.9–8.8). Although a high baseline NER (63.9) was associated with poor OS, it did not reach statistical significance. Baseline NER was also not identified as a significant score in the regression analyses.ConclusionmGPS, SII and NLR are scoring systems that are easy to record in routine clinical practice. As they provide good prediction of OS in patients with mUC and mRCC under IO, they may allow identification of patients at high-risk and monitor them more cautiously in addition to imaging.

P-776. Value Of Neutrophil/Lymphocyte Ratio In Predicting Relapse In Multifocal Tuberculosis

Abstract Background Multifocal tuberculosis remains a life-threatening disease. The involvement of two non-contiguous extrapulmonary sites makes the prognosis difficult to predict. Neutrophil-lymphocyte ratio (NLR) is a useful biomarker for predicting outcome in various clinical setting. We aimed to study the value of NLR in predicting relapse in multifocal tuberculosis. Methods We conducted a retrospective study including all patients hospitalized in the infectious disease department for multifocal tuberculosis between 1998 and 2022. The NLR was defined as the number of neutrophils divided by the number of lymphocytes in whole blood. Receiver operating characteristic curves and areas under the curves (AUC) were calculated to evaluate the predictor value of NLR. Results We encountered 94 cases, among whom 64 were females (68.1%). Relapse was noted in 9 cases (9.6%). The NLR was significantly higher among relapsing multifocal tuberculosis cases (4.1[2.5-8.5] vs 2.4[1.6-3.7] ; p=0.031). The optimal cut-off of NLR for predicting relapse among multifocal tuberculosis cases was 3.7, with a sensitivity of 62.5% and a specificity of 75.4%. The AUC was 0.737 and the 95% confidence interval ranged from 0.575 to 0.899. Conclusion The NLR was a useful biomarker in predicting relapse among multifocal tuberculosis cases. Such patients require a close follow-up in order to promptly diagnose relapse. Disclosures All Authors: No reported disclosures

Prognostic Value of Preoperative Albumin-to-Alkaline Phosphatase Ratio for Survival in Colorectal Cancer Patients Undergoing Surgery

Background and Objectives: This study aimed to evaluate the prognostic significance of the pre-treatment albumin-to-alkaline phosphatase ratio (AAPR) in early-stage colorectal cancer patients and to compare it with the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) within the same patient cohort. Materials and Methods: This retrospective study included 540 patients who were followed up after a diagnosis of early-stage colorectal cancer and whose albumin (ALB), alkaline phosphatase (ALP), neutrophil, platelet, and lymphocyte values were measured before treatment. Results: In the receiver operating characteristic (ROC) curve analysis for overall survival (OS), the AAPR index Area Under Curve (AUC):0.560, (p = 0.018), NLR index (p = 0.079), and PLR index (p = 0.692) were evaluated. In the ROC analysis for OS, a cut-off value of the AAPR index of ≤0.423 was found. In the AAPR-low group, the relapse and death rates were higher than in the AAPR-high group (p = 0.004 and p = 0.001, respectively). As the AAPR index decreased, the NLR and PLR indexes increased (p = 0.027 and p = 0.003, respectively). Median disease-free survival (DFS) was worse in the AAPR-low group (128 versus 156) months (p = 0.015). The AAPR index significantly affected OS with hazard ratio (HR):0.42 (95%CI, 0.18–0.97) (p = 0.044). At 5 years, 68% of the patients in the AAPR-low group and 79% of the patients in the AAPR-high group were alive (p = 0.005). In a multivariate analysis, low AAPR, patient age at diagnosis, TNM stage, and recurrence status were independent factors affecting OS (p = 0.022, p &lt; 0.001, p = 0.002, and p &lt; 0.001, respectively). Conclusions: In early-stage colorectal cancer patients, the OS was worse in the AAPR-low group than in the AAPR-high group. The AAPR index demonstrated significant prognostic value for OS compared to the NLR and PLR in the same patient cohort.

Peripheral blood immunoinflammatory biomarkers: prospective predictors of postoperative long-term survival and chronic postsurgical pain in breast cancer

BackgroundTumor progression and chronic postsurgical pain (CPSP) in patients with breast cancer are both significantly influenced by inflammation. The associations between immunoinflammatory biomarkers and long-term survival, as well as CPSP, remain ambiguous. This study examined the predictive value of immunoinflammatory biomarkers for both long-term survival and CPSP.MethodsData on the clinicopathological characteristics and perioperative peripheral blood immunoinflammatory biomarkers of 80 patients who underwent breast cancer surgery were retrospectively collected. Optimal cut-off values for preoperative immunoinflammatory biomarkers, including the preoperative systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and pan-immune-inflammation value (PIV), were established via receiver operating characteristic (ROC) curves. Kaplan−Meier curves and Cox regression analysis were used to evaluate the relationships between preoperative immunoinflammatory biomarkers and long-term survival. The relationships among the perioperative neutrophil count (NEU), monocyte count (MONO), lymphocyte count (LYM), platelet count (PLT), SII, SIRI, NLR, PIV, dynamic changes in peripheral blood cell counts, and CPSP were further assessed using logistic regression analysis.ResultsKaplan−Meier curves revealed a considerable prolongation of disease-free survival (DFS) and overall survival (OS) in the low preoperative SII, SIRI, NLR, and PIV groups. Multivariate Cox regression analysis revealed that only an elevated preoperative SIRI was an independent risk factor for postoperative DFS (HR=8.890, P=0.038). The incidence of CPSP was 28.75%. Univariate logistic regression analysis revealed that body mass index (BMI), postoperative NEU, MONO, SIRI, and PIV were negatively correlated with the occurrence of CPSP, whereas subsequent multivariate logistic regression analysis revealed that only BMI was independently associated with CPSP (OR=0.262, P=0.023).ConclusionElevated preoperative SIRI was an independent risk factor for poor DFS in breast cancer patients after surgery. In contrast, perioperative immunoinflammatory biomarkers had limited potential for predicting CPSP in patients who underwent breast cancer surgery.

Evaluation of NAPLES Prognostic Score to Predict Long-Term Mortality in Patients with Pulmonary Embolism

Background/Objectives: Acute pulmonary embolism (APE) is a clinical syndrome characterized by the obstruction of blood flow in the pulmonary artery, whose main pathophysiological features are respiratory and circulatory dysfunction. Acute pulmonary embolism is associated with a high mortality rate. Diagnostic and therapeutic delays can exacerbate mortality and result in prolonged hospitalization. With the increasing understanding that APE is associated with inflammation, various indices based on systemic inflammation have been shown to predict prognosis in patients with APE. The NAPLES Prognostic Score (NPS) is a new scoring system that indicates the inflammatory and nutritional status of the patient based on albumin (ALB) levels, total cholesterol (TC) levels, lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR). Our study aimed to examinate the effect of NPS on APE prognosis, so the relationship between NPS and APE prognosis was evaluated in our study. In addition, this study seeks to lay the groundwork for further investigations into this association and expand the existing body of knowledge. Methods: The clinical data of patients who applied to the Dicle University Faculty of Medicine and were diagnosed with APE between March 2014 and April 2024 were evaluated retrospectively, with 436 patients aged 18 years and over included in the study. Patients were divided into two groups according to NPS. It was statistically investigated whether there was a significant difference in long-term mortality between the two groups. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Survival was found to be statistically significantly lower in patients with NPS 3–4 (p &lt; 0.05). In the multivariate regression analyses, no statistically significant effect of NPS or other parameters except lactate on 3-month mortality was found (p &gt; 0.05). The short-term prognostic value of the NPS has been found to be equivalent to that of the sPESI score. It may be considered that APE patients with high NPS scores should be monitored more frequently. Conclusions: Increased NPS was found to be associated with poor APE prognosis in our study.

Association between airway microbiota and systemic inflammation markers in non-small cell lung cancer patients

Growing evidences have suggested the airway microbiota may participate in lung cancer progression. However, little was known about the relationship between airway microbiota and lung cancer associated systemic inflammation. Here we aimed to explore the association between sputum microbiota and systemic inflammation in lung cancer. The microbiota of spontaneous sputum samples from 51 non-small cell lung cancer (NSCLC) patients and 6 patients with lung benign nodules were sequenced via 16 S rRNA sequencing. Neutrophil-lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and C reactive protein (CRP) were used to represent systemic inflammation. Patients were divided into 2 groups based on level of inflammatory biomarkers respectively (CRP_low versus CRP_high; NLR_low versus NLR_high; PLR_low versus PLR_high). α-diversity was significantly decreased in CRP_high and NLR_high patients. β diversity analysis based on weighted unifrac distance indicated that microbial community structure differed significantly between patients with different inflammation status. Lefse identified genera Porphyromonas, Selenomonas, Moryella, Megasphaera, Corynebacterium were enriched in CRP_low group. Compared with NLR_high, genera Veillonella, Neisseria, Bulleidia, Moryella were enriched in NLR_low group. For patients with different PLR level, genera Veillonella, Prevotella, Moryella, Selenomonas were increased in PLR_ low patients. Function analysis identified propionate metabolism pathway was significantly enriched in CRP_low and PLR_low groups. Moreover, RDA analysis showed that compared with PLR, NLR and CRP had strongest association with microbial community. Airway microbial structure differed between lung cancer with different systemic inflammation status. Patients with relative high inflammation status were associated with alteration of specific airway genera and microbial metabolic function.

Predictors of cytomegalovirus infection in patients with connective tissue disease treated by pulsed methylprednisolone therapy: a multicenter retrospective cohort study

BackgroundCytomegalovirus (CMV) can cause life-threatening diseases in immunosuppressed patients. Some of the patients with connective tissue disease develop CMV infection, and approximately half of this group has been reported to have received pulsed-methylprednisolone (p-MPSL) therapy. This study aimed to identify predictors of the onset of CMV infection in patients receiving p-MPSL therapy for connective tissue disease.MethodsThis was a retrospective, multicenter cohort study. We included patients who received p-MPSL therapy for connective tissue disease and had CMV antigenemia measured between April 2011 and December 2020. Peripheral blood cell data before the start of p-MPSL therapy and at the start of steroid tapering were collected in addition to baseline characteristics, including age, sex, and body mass index. CMV infection was defined as detection of one or more CMV antigen-positive cells (CMV-positive). The study examined and compared the CMV-positive group with the CMV-negative group. Logistic regression analysis was used to explore the factors associated with CMV antigen positivity. Receiver operating characteristic curve analysis was used to identify the cut-off values for the factors associated with CMV antigen sensitivity.ResultsOf the 200 patients included, 87 had antigen positivity. Logistic regression analysis showed that age ≥ 65 years [adjusted odds ratio (aOR): 2.75, 95% confidence interval (CI): 1.54–4.92] and platelet count less than 30.20 × 104 /µL [aOR: 4.38, 95%CI: 2.21–8.68] at baseline were significantly associated with CMV antigen positivity. Lymphocyte count < 1440 /µL [aOR: 5.36, 95% CI: 1.96–14.65], neutrophil-to-lymphocyte ratio (NLR) ≥ 3.42 [aOR: 7.31, 95% CI: 2.52–21.22], and platelet-to-lymphocyte ratio (PLR) ≥ 145.28 [aOR:6.10, 95% CI: 2.24–16.64] at the start of steroid tapering also increased the OR for CMV infection. The areas under the receiver operating characteristic curves for lymphocytes, NLR, and PLR were 0.742, 0.693, and 0.673 respectively.ConclusionPlatelet count, lymphocyte count, NLR, and PLR may be crucial predictors of the onset of CMV infection in patients with connective tissue disease. These easily obtainable factors may be clinically useful as predictors of CMV infection. A potential research area would be to validate the parameters in a prospective patient population.

Differentiating Kawasaki Disease and Multisystem Inflammatory Syndrome in Children Using Blood Composite Scores: Insights into Clinical Outcomes and Predictive Indices.

The study sought to assess the clinical utility of complete blood count-derived composite scores, suggesting their potential as markers of inflammation and disease severity in Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) with Kawasaki-like features. This retrospective study analyzed data from 71 KD and 73 MIS-C patients and 70 healthy controls. The KD group showed a higher rate of coronary involvement (26.7% vs. 10.9%), while the MIS-C group had a higher intensive care unit (ICU) admission rate (34.2% vs. 2.8%). Platelet counts, lymphocyte counts, mean platelet volume (MPV), MPV/Lymphocyte (MPVLR), and MPV/Platelet (MPVPR) ratios demonstrated the highest specificities in distinguishing MIS-C than KD (84.5%, 83.1%, 91.1%, 88.7%, and 88.7%, respectively). Monocyte counts, MPV, and MPVPR demonstrated the highest specificities to predictive ICU admission in the MIS-C group (83.3%, 89.6%, and 89.6%, respectively). Lymphocyte counts, platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), MPVLR, and Systemic Immune-Inflammation Index (SII) parameters were found to have high negative predictive values for predicting KD patients without coronary artery lesions (CALs) (85.7%, 86.1%, 87.1%, 87.1%, and 85.7%, respectively)., Systemic Inflammation Response Index (SIRI), MPVPR, and CRP were independently predictive of ICU admission in the MIS-C group, and lymphocyte count and IVIG resistance were also identified as significant predictors of CALs in the KD group. NLR, MPVLR, MPVPR, and NPR indices effectively differentiate MIS-C from KD and predict ICU admission in MIS-C. NLR, PLR, MPVLR, and SII are valuable in excluding CALs in KD with high negative predictive values. In addition, SIRI and MPVLR were independent predictors of ICU admission in MIS-C, and lymphocyte count was identified as an independent predictor of CALs in KD.

Leukocytosis in Cushing's syndrome persists post-surgical remission and could predict a lower remission prognosis in patients with Cushing's disease.

Leukocytosis frequently noted in Cushing's syndrome (CS), along with other blood cell changes caused by direct and indirect cortisol effects. Assess baseline white blood cell (WBC) profile in CS patients compared to controls and WBC changes pre- and post-remission after surgical treatment for CS. A comparative nationwide retrospective cohort study. Data from Clalit Health Services database. 297 patients (mean age 51 ± 16.1 years, 73.0% women) with CS and 997 age-, sex-, body mass index-, and socioeconomic status-individually matched controls. Ectopic CS or adrenal cancer patients were excluded. Mean WBC, neutrophils, and neutrophil-to-lymphocyte ratio (NLR) two-years before and after pituitary or adrenal surgery. WBC and neutrophils are expressed as Kcells/µl. At baseline, leukocytosis was observed in 21.5% of patients with CS vs. 8.9% of controls (P < 0.001). Patients with CS had significantly higher WBC (8.8 ± 2.88 vs. 7.54 ± 2.45, p < 0.0001), neutrophils (5.82 ± 2.38 vs. 4.48 ± 1.97, p < 0.0001), and NLR (3.37 ± 2.63 vs. 2.27 ± 1.86, p < 0.0001) compared to controls, regardless of pituitary or adrenal source of hypercortisolemia. Post-surgery, patients with CS experienced significant decreases in mean WBC (-0.57 ± 2.56, p < 0.0001), neutrophils (-0.84 ± 2.55, p < 0.0001), and NLR (-0.63 ± 2.7, p < 0.0001). Despite achieving disease remission, patients with CS still had higher WBC (8.11 ± 2.4 vs. 7.46 ± 2.17, p = 0.0004) and neutrophils (4.71 ± 2.10 vs. 4.41 ± 1.87, p = 0.03) compared to controls. Patients with CD and baseline leukocytosis had lower remission rate than those with normal WBC (36.7% vs. 63.9%, p = 0.01). At diagnosis, CS patients have elevated WBC, neutrophils, and NLR compared to controls. Remission does not normalize WBC levels in all patients, and baseline leukocytosis predicts a poorer remission prognosis in CD.

A Comparison of Established Diagnostic Criteria for Cachexia and Their Impacts on Prognostication in Patients with Oesophagogastric Cancer

Background: Cachexia is common in patients with oesophagogastric cancer. The syndrome is characterised by tissue wasting (muscle and fat), anorexia, and reduced physical function, which result from complex interactions between the tumour and its host. Heterogeneity in the diagnostic criteria used for cachexia has hindered their clinical utilisation. This study aimed to compare the two established cachexia definitions (Fearon’s consensus definition and the Global Leadership Initiative on Malnutrition [GLIM] criteria) and their relationships with survival in patients with oesophagogastric cancer. Methods: Consecutive patients newly diagnosed with oesophagogastric cancer (January 2019 to December 2020) were identified from a prospective regional database. Involuntary weight loss, BMI, CT body composition analyses, and neutrophil–lymphocyte ratios were recorded at clinical staging. These data were used to assess patients for cachexia according to Fearon and GLIM diagnostic criteria. The primary outcome of interest was overall survival. Results: Overall, 465 patients (66.9% male, median 71 years) were diagnosed with oesophagogastric cancer during the 2-year study period. Cachectic proportions differed between definitions (Fearon: 59.1% vs. GLIM: 44.1%), and only 49.1% of the 322 patients who met one set of diagnostic criteria were cachectic according to both. Patients who met the GLIM criteria were significantly more comorbid and had a poorer performance status; however, no such difference was evident when using the Fearon definition. Those patients who met either set of diagnostic criteria had shorter survival than those who met neither (p &lt; 0.001). Following adjustment for confounders, GLIM-defined cachexia was more strongly associated with reduced survival (aHR: 1.57 [95% CI: 1.25–1.96], p &lt; 0.001) than Fearon-defined cachexia (aHR: 1.41 [95% CI: 1.13–1.76], p = 0.002). Patients who only met the Fearon diagnostic criteria had prolonged survival (median: 363 days) when compared to those who met only GLIM (median: 158 days) or both definitions (median: 120 days). A secondary analysis of those patients who met the GLIM diagnostic criteria (n = 205) compared the three potential phenotypical criteria used in this definition. Only reduced muscle mass, and not low BMI or weight loss, was associated with poorer survival (aHR: 1.88 [95% CI: 1.15–3.07], p = 0.012) in this group. Conclusions: Cancer cachexia is strongly associated with shortened survival in patients with oesophagogastric cancer. Classification using the GLIM criteria provides more effective prognostication and this definition should be utilised in multidisciplinary patient care.

The Importance of Laboratory Parameters in the Differential Diagnosis of Graves' Disease and Subacute Thyroiditis

Abstract Introduction Graves' disease and subacute thyroiditis (SAT) are two of the most common causes of thyrotoxicosis. free T3 to free T4 ratio (fT3/fT4), neutrophil to lymphocyte ratio (NLR) and mean platelet volume (MPV) have not been analysed in detail for diagnosis in previous studies. Materials and Methods A total of 141 patients with subacute thyroiditis, 133 with Graves' disease and 126 healthy volunteers were included in the study. Thyroid stimulating hormone (TSH), fT3, fT4, C-reactive protein (CRP), MPV, NLR, erythrocyte sedimentation rate (ESR) and TSH receptor antibody (TRAb) levels were recorded. The laboratory parameters were compared between the two groups. ROC analysis was performed to evaluate fT3/fT4 ratio, ft4/TSH ratio, NLR and MPV to aid diagnosis, as well as cut-off values, sensitivity and specificity. Results The fT3/fT4 ratio was significantly different between the subacute thyroiditis (SAT) and Graves' disease groups (2.45 ± 0.68 vs. 3.48 ± 1.8, p &lt; 0.01). The MPV was lowest in the SAT group (8.83 ± 1.29). The NLR ratio was highest in the SAT group (2.84 ± 1.48 p &lt; 0.01). The fT4/TSH ratio was highest in the Graves group (461.85 ± 536.2 p &lt; 0.01).The AUC of ft3/ft4 ratio for estimating Graves' disease was 0.773, the specificity was 77.9%, the sensitivity was 66.2% (p &lt; 0.01), and the cut-off value was 2.95. The AUC of the NLR ratio for the assessment of SAT was 0.742, the specificity was 80% and the sensitivity was 50% (p = 0.02). Conclusions The ratio of fT3 to fT4, fT4/TSH ratio, MPV and NLR differ significantly between SAT and Graves’ disease and can provide helpful information in the differential diagnosis.

Relationship Between Systemic Inflammatory Response Exponents, Levels of ADAM10, ADAM17 Proteins and Selected Clinical Parameters in Patients with Colorectal Cancer: Original Research Study

Chronic inflammation is a confirmed risk factor for colorectal cancer (CRC). Indicators of systemic inflammatory response (SIR), such as neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR), are easily accessible indicators of the generalized inflammatory response. At the molecular level, inflammation-related carcinogenesis involves proteins from the adamalysin family: ADAM10 and ADAM17. The aim of the study was to assess NLR and PLR and their relationship with selected clinical parameters in CRC patients, as well as the correlation between ADAM10 and ADAM17 in tumor tissue and matched surgical margins with NLR and PLR values. Tumor tissue material matched surgical margins, and blood was collected from 66 patients who underwent surgery because of CRC. The concentrations of ADAM10 and ADAM17 in the collected material were tested using the enzyme-linked immunosorbent assay (ELISA) method. SIR parameters (NLR, PLR) were also determined. The results were statistically analyzed and compared with selected clinical parameters. Results: The study showed that PLR was lower in patients with comorbid cardiovascular diseases (CVD). In patients who underwent preoperative treatment, both the NLR and PLR values were higher than in patients who underwent primary surgery. There was also a negative correlation between ADAM17 concentrations in the surgical margin and PLR values. In conclusion, the presence of additional diseases such as CVD or diabetes mellitus type 2 (DMT2) or the use of preoperative treatment should be taken into account when assessing SIR parameters in CRC patients. Moreover, no clear correlations have been found between ADAM10 and ADAM17 and SIR parameters.

Diagnostic implications of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammatory index for gastric carcinoma.

The diagnosis of gastric carcinoma (GC) is essential for improving clinical outcomes. However, the biomarkers currently used for GC screening are not ideal. To explore the diagnostic implications of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII) for GC. The baseline data of 133 patients with GC and 134 patients with precancerous gastric conditions admitted between January 2022 and December 2023 were retrospectively analyzed. The information on peripheral blood platelet, neutrophil, and lymphocyte counts in each patient was collected, and the NLR, PLR, and SII levels of both groups were calculated. Additionally, multivariate logistic regression analysis was conducted, and the diagnostic implications of NLR, PLR, and SII in differentiating patients with precancerous gastric conditions, compared with those with GC, were analyzed through receiver operating characteristic (ROC) curves. The data indicated that NLR, PLR, and SII had abnormally increased levels in the patients with GC. Gender and body mass index were risk factors for the occurrence of GC. ROC data revealed that the areas under the curve of three patients with precancerous gastric conditions, who were differentiated from those with GC, were 0.824, 0.787, and 0.842, respectively. NLR, PLR, and SII are all abnormally expressed in GC and have diagnostic implications, especially when used as joint indicators, in distinguishing patients with precancerous gastric conditions from those with GC.

Neutrophil-to-lymphocyte ratio as a prognostic factor in patients with castration-resistant prostate cancer treated with docetaxel-based chemotherapy: a meta-analysis

BackgroundIn recent years, many studies have illustrated that the neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor of metastatic castration-resistant prostate cancer (mCRPC), but their conclusions are controversial. The aim of this study was to assess the prognostic value of the NLR in patients with mCRPC treated with docetaxel-based chemotherapy.MethodsDatabase searches were conducted in PubMed, EMBASE and the Cochrane Library to retrieve relevant published English-language literature up to 20 February 2023. RevMan 5.4.1 was used to summarize the hazard ratio (HR) and its 95% confidence interval (CI) for overall survival (OS) and progression-free survival (PFS) with subgroup analysis. Finally, Stata software was adopted for sensitivity analysis, and Egger’s test was used to calculate the results of stability to determine whether there was publication bias.ResultsA total of 1,983 mCRPC patients from 14 retrospective cohort studies were included in this meta-analysis. The combined results showed that elevated NLR was significantly associated with worse OS (HR = 1.86, 95% CI: 1.55–2.23, P < 0.00001) and PFS (HR = 1.96 (95% CI: 1.52–2.53), P < 0.00001) in patients with mCRPC treated with docetaxel-based therapy. For subgroup analysis of high NLR, studies performed in Asia and cutoff value > 3 were associated with poorer OS, while cutoff values > 3 were associated with poorer PFS.ConclusionOur results suggest that the neutrophil-to-lymphocyte ratio may be a prognostic factor in patients with mCPRC with docetaxel-based chemotherapy.

Can pretreatment lactate dehydrogenase to albumin ratio predict pathological complete response after neoadjuvant chemotherapy in breast cancer patients?

Background: The aim of this study is to evaluate the predictive significance of platelet lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), lymphocyte monocyte ratio (LMR), systemic immune-inflammation (SII), prognostic nutritional index (PNI), The hemoglobin, albumin, lymphocyte, and platelet (HALP) score and lactate dehydrogenase to albumin ratio (LAR) for pCR in breast cancer with neoadjuvant chemotherapy (NACT). Methods: A total of 121 patients who received NACT between February 2012 and November 2021 were included. LAR, NLR, PLR, MLR, SII, PNI and HALP were calculated according to formulas. The cut-off value for markers were obtained by Receiver operating characteristic curve (ROC) analyses. Independent predictive factors for pCR were determined using multivariate regression analysis. Results: The pCR rate was achieved in 31.4% of patients. Median values of NLR, PLR, MLR, SII, PNI and HALP were similar in pCR (+) and pCR (-) (p &gt; 0.05). Median LAR value was significantly higher in pCR (+) than pCR (-) (50.80 vs 42.62, respectively (p=0.002)). The optimal cutoff value of LAR was 46.27. Multivariate analysis showed that LAR ³46.27 and HER-2 positivity were the independent predictive factors for pCR [OR = 2.851 (95% CI = 1.142-7.119, P = .025), OR = 3.431 (95% CI = 1.163-10.123, P = 0.026), respectively]. Conclusion: LAR is a simple, inexpensive, and convenient method for predicting pCR in breast cancer with NACT.

Comparative Analysis of 4NQO- and Ethanol-Induced Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma in Male and Female Mice: Association With Peripheral Blood Inflammatory Markers.

Considering that peripheral blood biomarkers are prognostic predictors for several human tumors, this study aimed to comparatively analyze the association of hematological alterations with the incidence of epithelial dysplasia (ED) and oral squamous cell carcinoma (OSCC) in male and female mice treated with 4-nitroquinoline-N-oxide (4NQO) and ethanol (EtOH). 120 C57Bl/6J mice (60 males and 60 females) were allocated to four groups (n = 15). They were treated firstly either with 5 mg/mL propylene glycol (PPG) or 100 μg/mL 4NQO in the drinking water for 10 weeks, followed by sterilized water (H2O) or 8% EtOH (v/v) for 15 weeks, as follows: PPG/H2O, PPG/EtOH, 4NQO/H2O, and 4NQO/EtOH (CEUA-UFU, #020/21). After killing, tongues were collected for histopathological analysis of ED and OSCC. Blood samples were processed for complete blood count and calculation of neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII). The incidence of OSCC in females from the 4NQO/EtOH group (60%) was lower when compared to males (93%). Neutrophils, NLR, and SII increased from control animals (PPG/H2O and PPG/EtOH) to ED and OSCC-bearing male and female mice (4NQO/H2O and 4NQO/EtOH), while lymphocytes decreased. Females from the 4NQO/H2O group with ED also had higher neutrophils, NRL, and SII values than females with normal tongues. The low incidence of 4NQO- and ethanol-induced OSCC in females indicates that the sex bias in OSCC may not be associated with extrinsic risk factors alone. Neutrophil and lymphocyte counts, NRL, and SII were significantly altered during multistep carcinogenesis and thus could be explored as biomarkers for ED and OSCC development.

The evolving landscape of COVID-19: factors associated with in-hospital COVID-19 related mortality during the 2023–2024 phase of JN.1 subvariant dominance

BackgroundCOVID-19 remains a complex health challenge. We analysed the characteristics and outcomes of COVID-19-related hospitalisations during JN.1 variant dominance.MethodsConducted in a hospital serving a socioeconomically deprived population, this study included all adults hospitalised with COVID-19 from 1st November 2023 to 31st August 2024. The primary outcome was in-hospital mortality, analysed in relation to demographic, clinical, and laboratory parameters.ResultsAmong 122 individuals (median age 76 years, 58.2% males, median comorbidity index 5), 114/122 (93.4%) had received ≥ 1 SARS-CoV-2 vaccination, with a median of 23 months elapsed since the last dose. Fever (67/122, 54.9%) and dyspnoea (49/122, 40.2%) were common presenting symptoms, with 78/122 (64%) showing CT evidence of SARS-CoV-2 pneumonia; 25/122 (20%) had purely neurological presentations. Treatment included remdesivir (115/122, 94.3%) and/or nirmatrelvir/ritonavir (9/122, 7.4%), sotrovimab (15/122, 12.3%), corticosteroids (61/122, 50.0%), and oxygen supplementation (76/122, 62.3%). Whereas 107/122 (87.7%) were discharged after a median of seven days, in-hospital mortality was 15/122 (12.3%) after a median of 16 days. Baseline factors associated with mortality were neutrophil-lymphocyte ratio > 8, D-dimer ≥ 1800 ng/mL, procalcitonin ≥ 1.0 ng/mL, and albumin < 3.2 g/dL; during admission, nasopharyngeal SARS-CoV-2 antigen positivity persisting for > 12 days, hospitalisation for ≥ 10 days, higher oxygen requirements with the resulting corticosteroid use, and healthcare-associated bacteraemia were associated with increased odds of mortality.ConclusionsBaseline laboratory parameters and persistent SARS-CoV-2 antigen positivity despite antiviral therapy offer readily available prognostic insights for patients hospitalised with COVID-19. It is imperative to advocate for up-to-date COVID-19 vaccination among older people and other vulnerable groups.