Neutrophil-lymphocyte Ratio Levels Research Articles

Lower omega-3 status associated with higher erythrocyte distribution width and neutrophil-lymphocyte ratio in UK Biobank cohort

High red blood distribution width (RDW) is associated with decreased red blood cell deformability, and high neutrophil-lymphocyte ratio (NLR) is a biomarker of systemic inflammation and innate-adaptive immune system imbalance. Both RDW and NLR are predictors of chronic disease risk and mortality. Omega-3 index (O3I) values have previously been shown to be inversely associated with RDW and NLR levels. Our objective was to determine if total plasma long chain omega-3 fatty acids (Omega3%) measured in the UK Biobank cohort were associated with RDW and NLR values. RDW- and NLR- relationships with Omega3% were characterized in 109,191 adults (58.4% female). RDW- and NLR-Omega3% relationships were inversely associated with Omega3% (both p < 0.0001). These cross-sectional associations confirm previous findings that increasing RDW and NLR values are associated with low O3I. The hypothesis that RDW and/or NLR values can be reduced in individuals with less-than optimal long chain omega 3 values need to be tested in randomized controlled intervention trials using EPA and/or DHA.

Correlation between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and postoperative cognitive dysfunction in elderly patients with esophageal cancer.

The present study intends to investigate the correlation between neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and postoperative cognitive dysfunction (POCD) in elderly patients with esophageal cancer. Elderly patients >65 years old with esophageal cancer in our department from October 2017 to June 2021 were included in the study. The cognitive function of the patients was assessed by the mini-mental state examination (MMSE) Scale at 1day, 3 days, and 7days after surgery. POCD was considered when the scores were <27 points, and the remaining patients were included in the control group. A total of 104 elderly patients with esophageal cancer were included in this study, and 24 patients developed POCD, with an incidence of 23.1%. The expression of NLR and PLR in both 2 groups was increased on the 1st postoperative day compared with that before surgery. There was no significant difference in the expression of NLR and PLR between the 2 groups before operation, but the expression of both in the POCD group was significantly higher than that in the control group after operation (P < .05). Logistic regression analysis showed that smoking, postoperative NLR and postoperative PLR were independent risk factors for POCD. Spearman test showed that NLR was negatively correlated with MMSE scores at postoperative 1 day and 3 days (P < .05), while PLR was negatively correlated with MMSE scores at postoperative 1 day, 3 days and 7 days (P < .05). The Area Under receiver operating characteristic curve (AUC) of postoperative NLR for predicting POCD in elderly patients with esophageal cancer was 0.656, and the AUC of postoperative PLR was 0.722. After combination of NLR and PLR, the AUC increased to 0.803 with the sensitivity of 66.7% and specificity of 82.5%. The expression level of postoperative NLR and PLR in elderly patients with esophageal cancer combined with POCD is significantly increased, which is associated with postoperative cognitive impairment. Moreover, the combination of NLR and PLR has a good predictive ability for POCD, which could be used as a potential biomarker for early diagnosis of POCD.

Importance of hematological markers in familial Mediterranean fever in terms of disease severity and amyloidosis.

There are limited follow-up parameters for familial Mediterranean fever (FMF) related to disease severity and amyloidosis. Some hematological markers are emerging to assess inflammation. In this study, we hypothesized that some hematological parameters could be used to determine disease severity and amyloidosis in FMF. We included 274 adult FMF patients, and evaluated the relationship between neutrophil lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR), platelet counts and leukocyte counts, mean erythrocyte haemoglobin concentration (MCHC) and mean erythrocyte haemoglobin (MCH) with disease severity and amyloidosis. First, we classified patients according to disease severity and presence of amyloidosis. We then compared the parameters within the groups. In addition, we determined predictive cut-off values with ROC analysis. Finally, we correlated the change in ISSF scores with the change in hematological parameters of 52 patients with follow-up hematological indices after six months. The patients with severe-moderate group had higher CRP levels (p < 0.001), white blood cell (p = 0.002) and neutrophil counts (p = 0.004) and, conversely, lower MCHC levels (p = 0.001) than patients with mild disease severity. FMF patients with amyloidosis had higher neutrophil (p = 0.04) and monocyte count (p = 0.02), increased NLR (p = 0.01) and lower MLR (p = 0.02) levels than those without. In addition, MCHC levels were also lower in the severe-moderate group in the follow-up analyses after sixth months (p = 0.03). MCHC, neutrophil and monocyte counts, NLR, MLR may be associated with poor prognosis in FMF patients. These parameters can be used in conjunction with acute phase reactant and clinical features to assess disease status.

Kovid-19 Hastalarında NLR, D-Dimer ve MPV Değerleri Mortaliteyi ve Klinik Ciddiyeti Öngörebilir Mi?

Objective: In this study, we aim to determine the relationship between neutrophil/lymphocyte ratio (NLR), D-dimer, and mean platelet volume (MPV) parameters with mortality and clinical severity in Covid-19 patients. Materials and Methods: This retrospectively planned study included Covid-19 patients admitted to the emergency department between March 2020 and September 2020. Sociodemographic characteristics, laboratory parameters, and imaging results of the patients were obtained. The patients were grouped according to the development of mortality and clinical follow-up. Results: Seven hundred patients were included in the study and the mean age of the patients was 49.1±18.2 years. Mortality developed in 5.4% (n=38) of the patients. NLR, D-dimer, and MPV levels of patients who developed mortality were higher than those who survived (p&amp;lt;0.001; p &amp;lt;0.001 and p=0.035, respectively). In ROC analysis, &amp;gt;6 NLR levels, &amp;gt;8.45 MPV levels, and &amp;gt;0.57 D-dimer levels were found to be predictive for mortality (p&amp;lt;0.001; p=0.019; p &amp;lt;0.001, respectively). Conclusions: The high NLR, D-dimer, and MPV levels obtained at the time of admission in Covid-19 patients can be used as an indicator of mortality. Elevated NLR and D-dimer levels are useful in determining the severity of the disease and clinical follow-up.

Neutrophil to Lymphocyte Ratio as a Denotative of Type II Diabetes Mellitus

Introduction: The neutrophil-lymphocyte ratio (NLR) is an economically accessible tool useful in cases of Type II Diabetes Mellitus (T2DM). It can be utilized as a laboratory index, indicating systemic inflammation. The sensitivity of NLR to HbA1c must be validated to utilize for its prognostic potential. Correlation of HbA1c with NLR and other parameters have been analyzed to assess the utility of NLR in chronic cases of T2DM, thereby evaluating the utility of NLR as a marker of systemic inflammation in diabetes. Place and Duration of study: Department of Pathology, Saveetha Medical College, Chennai, One year. Objectives: 1. To compare levels of NLR and other parameters in diabetics with those of healthy people and observe the nature of correlation between HbA1c and other parameters.2. To find the linear relationship between HbA1c and other parameters in the diabetic population. Material and methods: An observational study conducted at our Institute from January to October 2020. Blood profiles of 240 T2DM patients and 100 healthy controls were recorded. Results: The NLR (5.35) of T2DM group was significantly elevated (p 0.001) compared to NLR of control group (2.16). Urea and creatinine levels had positive regression coefficients with HbA1c indicating susceptibility of diabetic patients to diabetic nephropathy. Conclusion: NLR showed significance in T2DM. Increased NLR is associated with elevated HbA1c and poor glycemic control in patients with T2DM. It can be used as a prognostic tool during the follow up of diabetic patients.

Predictive value of neutrophil-to-lymphocyte ratio and neutrophil-to-monocyte ratio in severe traumatic brain injury: a retrospective cohort.

The neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), the lymphocyte-monocyte ratio (LMR), the neutrophil-monocyte ratio (NMR) and the systemic immune inflammation index (SII) are associated with clinical outcomes in oncological diseases, cardiovascular diseases, infectious / inflammatory diseases, endocrinological, pulmonary and brain injuries. Here, we investigate its association with hospital mortality in patients with severe traumatic brain injury. We retrospectively reviewed clinical data from patients with severe traumatic brain injury (sTBI) who were treated in our department between January 2015 and December 2020. NLR, PLR, NMR, LMR and SII data were collected between admission and day 3, as well as other indicators related. The relationship between hematological ratios and in-hospital mortality were analyzed. A total of 96 patients were included in study, hospital mortality was 40.6% (N.=39). The levels of NLR on admission (D0), NLR day 1 (D1), NLR day 2 (D2), NLR day 3 (D3), NMR day 1 (D1) and NMR day (2) remained significantly higher in patients with death intra-hospital (P=0.030; P=0.038; P=0.016; P=0.048; P=0.046 and P=0.001, respectively). Multivariate logistic analysis showed that higher NLR values at admission and day 2 NMR were associated with in-hospital mortality (OR=1.120, P=0.037; and OR=1.307, P=0.004, respectively). Analysis of the recipient operating characteristic (ROC) curve showed that the NLR on admission had a sensitivity of 59.0% and a specificity of 66.7% (area under the curve 0.630, P=0.031, Youden's Index 0.26) and the NMR of day 2 had a sensitivity of 67.7% and a specificity of 70.4% (area under the curve 0.719, P=0.001, Youden's index 0.38) to predict mortality intra-hospital based on the best threshold. Our analysis indicates that higher NLR levels on admission and day 2 NMR are independent predictors of in-hospital mortality in patients with sTBI.

Combined use of CA125, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for the diagnosis of borderline and malignant epithelial ovarian tumors

BackgroundThe mortality rate of ovarian cancer ranks first among three common gynecological malignant tumors due to insidious onset and lack of effective early diagnosis methods. Borderline epithelial ovarian tumor (BEOT) is a type of low malignant potential tumor that is typically associated with better outcomes than ovarian cancer. However, BEOTs are easily confused with benign and malignant epithelial ovarian tumors (EOTs) due to similar clinical symptoms and lack of specific tumor biomarkers and imaging examinations. Notably, a small subset of BEOTs will transform into low-grade serous ovarian carcinoma with a poor prognosis. Therefore, searching for potential biomarkers that can be easily obtained and accurately identify malignant epithelial ovarian tumors (MEOTs) as well as BEOTs is essential for the clinician. Cancer antigen 125 (CA125) is a commonly used biomarker for the diagnosis of EOTs in the preoperative scenario but has low sensitivity and specificity. Nowadays, inflammatory biomarkers including inflammatory cell counts and derived ratios such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been proved to be associated with tumor progression and poor prognosis, and were considered to be the most economically potential surrogate biomarkers for various malignancies. The purpose of this study was to find appropriate combinations of inflammatory and tumor biomarkers to improve the diagnostic efficiency of EOTs, especially the BEOTs.ResultsCA125, NLR and PLR increased steadily among benign, borderline and malignant EOTs and tended to be higher in advanced (stage III-IV) and lymph node metastasis MEOT groups than in early stage (stage I-II) and non-lymph node metastasis MEOT groups. CA125, NLR and PLR could be used separately in the differentiation of EOTs but could not take into account both sensitivity and specificity. The combined use of CA125, NLR and PLR was evaluated to be more efficient, especially in the identification of BEOTs, with both high sensitivity and high specificity.ConclusionsThe levels of CA125, NLR and PLR were closely related to the nature of EOTs and malignant progression of MEOTs. The combination of CA125, NLR and PLR was more accurate in identifying the nature of EOTs than either alone or double combination, especially for BEOTs.

Comparing the predictive values of procalcitonin/albumin ratio and other inflammatory markers in determining COVID-19 severity.

To examine the relationship between COVID-19 severity and procalcitonin/albumin ratio (PAR) and compare the PAR with oft-reported inflammatory markers, including procalcitonin, white blood cell (WBC), neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP). In this retrospective research study conducted at Sanliurfa Training and Research Hospital during May to September 2020; total, 577 adult subjects diagnosed with COVID-19 were included and categorized into two groups based on place of hospitalization: the intensive care unit (ICU) group (n=151) and the general ward (GW) group (n=426). Laboratory test results and demographic characteristics of the subjects were recorded. PAR, NLR, CRP, WBC, neutrophil and procalcitonin values were markedly higher in the ICU group than in the GW group. On the contrary, lymphocyte count and albumin level were markedly lower. PAR showed positive correlations with WBC, NLR, and CRP. Multivariate analysis showed that advanced age, presence of hypertension, elevated PAR, WBC, NLR, urea and lactate dehydrogenase levels were independent risk factors associated with the need for intensive care in COVID-19 subjects. Among them, the PAR showed the highest odds ratio (5.564) for ICU admission. Additionally, the area under the ROC curve of the PAR (0.888) was markedly greater than that of WBC (0.777), NLR (0.822), CRP (0.842) and procalcitonin (0.870). This study revealed that PAR was superior to procalcitonin, WBC, NLR and CRP in determining COVID-19 severity. PAR was an important predictor of ICU requirement in COVID-19 cases.

Association Between Neutrophil-Lymphocyte Ratio and All-Cause Mortality in Critically Ill Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study.

BACKGROUND Neutrophil-lymphocyte ratio (NLR) is related to increased mortality risk in many diseases. However, there is limited research on critically ill patients with chronic obstructive pulmonary disease (COPD). A retrospective cohort study was performed to investigate whether NLR can be used as a biomarker to predict the mortality of critically ill COPD patients. MATERIAL AND METHODS In the research, the data were gathered from the database of the Medical Information Mart for Intensive Care-IV. The 28-day mortality was defined as the primary outcome, while the secondary outcomes were in-hospital and 90-day mortality. Through the application of the Kaplan-Meier curves and the multivariate Cox regression analysis, the potential association between NLR and mortality for critically ill patients with COPD was evaluated. For subgroup analysis, age, sex, ethnicity, mean blood pressure, and comorbidities were considered. RESULTS We extracted data on 2650 patients, of which 53.7% were male. A higher level of NLR was correlated with higher 28-day mortality risk. Compared to the lower quartile (NLR<4.56), HR (95% CI) of the upper quartile (NLR>16.86) was 1.75 (1.21-2.52) in the multivariate Cox regression model when adjusted for confounders (P=0.003). A similar tendency was found in the 90-day mortality (HR=1.59, 95% CI=1.16-2.19, P=0.004) and the in-hospital mortality (HR=1.71, 95% CI=1.22-2.42, P=0.002). Subgroup analyses showed that the correlation between NLR and 28-day mortality was stable. CONCLUSIONS The higher level of NLR is likely to be correlated with the increase of the all-cause mortality risk in critically ill patients with COPD, but this needs to be validated in future prospective research.

Identification of Neutrophil/Lymphocyte Ratio as a Unique Biomarker for Migraine Follow-up

Aim: As in many chronic pain syndromes, self-reported pain is the main criterion used by clinicians assessing patients with migraine. However, it is subjective, and there is no reliable marker for follow-up, and it hinders adequate follow-up and treatment. Therefore, in this study, we aimed to investigate the correlation of the NLR (neutrophil-lymphocyte ratio) level, which is increased due to the neuroinflammatory process and oxidative stress, with the clinical and demographic characteristics of the patients, and to investigate its feasibility as an objective marker during follow-ups.Materials and Methods: Our study included one hundred migraine patients without aura who met the “The International Classification of Headache Disorders 3rd edition” (ICHD-3) criteria. The demographic characteristics of all patients and the clinical features of migraine pain were obtained. In addition, blood NLR level and its correlation to these features were examined.Results: There was a significant and positive correlation between NLR level with disease duration and pain severity (r=0.43 p&amp;lt;0.001, r=0.76 p&amp;lt;0.001, respectively), however, it was independent of age, gender, and migraine subtypes (episodic/chronic) (p=0.48, p=0.14, p=0.13, respectively).Conclusions: Our study found a significant correlation between the NLR level and the clinical features of migraine patients, indicating that this easily accessible parameter may be a promising marker that can be used during the follow-up period.

C-reactive protein, but not neutrophil-lymphocyte ratio, is inversely associated with muscle strength only in older men: NHANES 1999–2002

To evaluate the association of inflammation (C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) levels) with muscle strength in older adults. We also aimed to evaluate whether these associations are sex-specific. A cross-sectional study was performed with data from the National Health and Nutrition Examination Survey (NHANES) 1999–2000 and 2001–2002. A total of 2387 individuals over 50 years of both sexes were evaluated, according to the eligibility criteria for the strength test. Muscle strength was measured by Kinetic Communicator isokinetic dynamometer; while the NLR was obtained by the ratio of the total neutrophil for lymphocyte count and CRP was quantified by latex nephelometry. Linear regression analyses, crude and adjusted for confounders, were used to estimate the coefficients and 95 % confidence intervals for peak strength (muscle strength) by tertiles of NLR and CRP. There was no association between NLR and peak strength for both sexes. CRP levels were inversely associated with peak force in men [2nd tertile β = −3.33 (−15.92; 9.25); 3rd tertile β = −24.69 (−41.18; −8.20), p for trend = 0.005], but not in women [2nd tertile β = −3.22 (−15.00; 8.56); 3rd tertile β = −9.23 (−28.40; −9.94), p for trend = 0.332]. In conclusion, NLR levels were not associated with muscle strength in both sexes. CRP levels were inversely associated with muscle strength in older men, but not in women, suggesting that the association between inflammation and muscle strength in older adults can be sex-specific.

Neutrophil-lymphocyte ratios in blood to distinguish children with asthma exacerbation from healthy subjects.

Airway inflammation is a prominent feature of asthma and may play an important role in disease pathophysiology. Despite the increasing incidence of asthma worldwide, reliable diagnostic biomarkers are lacking and widely lead to asthma misdiagnosis. Neutrophil-lymphocyte ratio (NLR) is a biomarker of systemic inflammation, in addition to NLR-alanine aminotransferase ratio (NAR) and NLR-albumin ratio (NBR). The aim of this study was to evaluate associations of NLR, NAR, and NBR with diagnosis of childhood asthma to determine if they can aid clinical childhood asthma diagnosis. This retrospective case-control study included 89 children with asthma and 53 healthy children from the Wuxi Children's Hospital affiliated with Nanjing Medical University. We applied various statistical tests to the dataset: Mann-Whitney U test to compare characteristics of the case and control groups; chi-squared test to compare categorical variables; Kruskal-Wallis test to compare statistical differences of asthma indicators among groups; receiver operating characteristic (ROC) curves to assess the diagnostic value of indices; and Spearman correlation analysis to evaluate relationships between NLR and lactate dehydrogenase, albumin, aspartate transaminase, and alanine transaminase levels. Compared with controls, the asthma case group had significantly higher white blood cell (p < 0.01), neutrophil, lactate dehydrogenase, C-reactive protein, and NLR levels (p < 0.01) and significantly lower lymphocyte (p = 0.001), platelet (p = 0.039), and albumin levels (p = 0.04). We determined optimal cutoff levels for several metrics: 1.723 for NLR, with sensitivity of 0.73 and specificity of 0.906; 0.135 for NAR, with sensitivity of 0.685 and specificity of 0.887; and 0.045 for NBR, with sensitivity of 0.674 and specificity of 0.906. The areas under the curve (AUCs) were 0.824 for NLR, 0.788 for NAR, 0.818 for NBR, and 0.83 for the combination of NLR + NAR + NBR. The combination of NLR, NAR, and NBR biomarkers distinguished asthmatic ones suffering from exacerbation of the condition from healthy children. Thus, our results indicate NLR + NAR + NBR could be used as a clinical biomarker for asthma in children.

Inflammatory Markers in Lung CancerA Comparative Cross-sectional Study

Introduction: Lung cancer is the most common cause of cancer mortality worldwide, principally because of its late diagnosis. Chronic inflammation plays a significant role in tumour growth and progression via increasing the levels of inflammatory markers in blood. Inflammatory markers are expected to be valuable prognostic biomarkers in cancer. Markers like Absolute Neutrophil Count (ANC), Absolute Lymphocyte Count (ALC), platelet count, Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) may aid in assessing prognosis of lung cancer. Aim: To study the inflammatory markers (ANC, ALC, Platelet count, NLR and PLR) in lung cancer and correlate these markers with cancer stage and histopathological type. Materials and Methods: A hospital-based cross-sectional study was conducted in lung cancer patients at Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan, India. Sixty patients with lung cancer and sixty controls were included. The clinical characteristics, ANC, ALC, platelet count, NLR and PLR of cases and controls were assessed and compared. Also, the comparison of these inflammatory markers with Tumor, Nodes and Metastases (TNM) staging and histopathological type of lung cancer were documented and results were interpreted. The data analysis was done with the use of Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, (Ver.) 26. Results: Mean age (years) of the case and control groups was 60.17 and 61.03, respectively. Distribution of gender in cases and controls was comparable. The major histology of lung cancer was Non-Small Cell Lung Cancer (NSCLC, 81.66%) out of which squamous cell carcinoma constituted 55.00% and adenocarcinoma 21.67%, followed by small cell carcinoma at 18.33%. Overall, 46.67% of the patients belonged to TNM staging IVA followed by IIIB (25.00%). The levels of ANC, platelet count, NLR and PLR were significantly elevated and ALC was decreased in cases as compared to control. There was no statistically significant association between the inflammatory markers ANC, ALC, platelet counts, NLR and PLR with the histopathological type of lung cancer. Mean ANC, platelet count, NLR and PLR were found to be significantly elevated in late stages of lung cancer, whereas, ALC had no such association with the stages of lung cancer. Conclusion: Inflammatory markers (ANC, platelet count, NLR, PLR, ALC) can serve as valuable prognostic biomarkers in lung cancer and can easily be used in resource-limited areas.

THE CLINICAL SIGNIFICANCE OF COMPLETE BLOOD COUNT, NEUTROPHIL-TO-LYMPHOCYTE RATIO, AND MONOCYTE-TO-LYMPHOCYTE RATIO IN GESTATIONAL DIABETES MELLITUS.

To investigate the association between inflammatory factors, such as complete blood count (CBC) components, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and gestational diabetes mellitus (GDM). A total of 635 pregnant women with GDM and 296 with normal pregnancies at 7-13 weeks of gestation who underwent prenatal examinations in the obstetrics department were enrolled (June 2020-December 2020). CBC parameters, including WBC, neutrophil, lymphocyte (LYM), monocyte (MON), red blood cell (RBC), hemoglobin (HGB), mean corpuscular volume (MCV), platelet (PLT), platelet accumulation (PCT), mean platelet volume (MPV), NLR, MLR, PLR, alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), and other parameters were assessed. The receiver operating characteristic (ROC) curve was used to analyze the screening effects of the variables on the development of GDM. There were significant differences in the blood levels of WBC, NEU, LYM, MON, RBC, HGB, PCT, ALT, AST, GGT, NLR, and MLR between the GDM and control groups (P<0.05). The diagnostic level of MON was the highest among all factors. Inflammatory factors (WBC, NEU, LYM, MON, NLR, and MLR counts) were correlated with GDM.

Subclinical inflammation markers in Abortus Imminens and their relation with obstetric outcomes. A case-control study

Background: In recent years, studies reveal that subclinical inflammatory markers can be used as an indicator of the inflammatory process in many diseases. Few studies have evaluated indicators of inflammation and postpartum outcomes in abortion immune patients. Objectives: The aim of the study is to investigate the relationship of subclinical inflammatory factors (Platelet crit (PCT), Neutrophil-lymphocyte ratio(NLR), Monocyte-lymphocyte ratio(MLR), Platelet-lymphocyte ratio(PLR)) obtained from complete blood count(CBC) with Abortion Immunes(AI) and obstetric results.. Material method: The study was conducted between January 2020 and January 2021. A total of 429 pregnant women, 203 of whom were pregnant with AI and 226 were healthy, were included in the study. Results: PCT, NLR, and MLR values were significantly higher and PLR values were low in the AI group (p&lt;0.05). PCT &gt; 0.22, NLR &gt; 2.29, and MLR &gt; 0.20 were significantly associated with increased risk of AI (P&lt;0.05). PLR value above 135.5 was associated with the normal group. There was a significant difference between the group whose pregnancy was terminated by abortion and the group who gave birth in terms of PCT, NLR, MLR, and PLR values. PCT, NLR, and MLR values were high in the abortion group, and PLR values were low (p&lt;0.05). Premature birth was developed in 11.3% (n=15) of AI patients. There was a significant difference between the preterm and term pregnancy in terms of PCT, NLR, MLR, and PLR levels (p&lt;0.005). PCT, NLR, and MLR values were high and PLR levels were low in pregnant women who gave birth prematurely. Conclusion: We think that close follow-up of abortion imminence patients with high levels of these inflammatory factors is appropriate.

Clinical characteristics of incidental adrenal masses and relationship with hematological indices as indicators of inflammation

Adrenal incidentaloma (AI) is being diagnosed more frequently due to the increase in use of imaging modalities. Inflammatory processes can play a role in the development and prognosis of numerous diseases. We aimed to investigate the clinical and endocrinological characteristics of adrenal adenoma and its relationship with inflammatory markers. The present study retrospectively analysed 111 patients with adrenal incidentaloma who underwent radiological and clinical examinations between January 2018 and January 2022. Patients diagnosed with Cushing’s syndrome, pheochromocytoma or primary aldosteronism were classified as functional. Inflammation was assessed using neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), glucose lymphocyte ratio (GLR), systemic immune-inflammation index (SII) and prognostic nutritional index (PNI). Of the 111 patients included, 76.6% (n=85) had nonfunctional adenomas and 23.4% (n=26) had functional adenomas. Of the patients with functional adenomas, 50% (n=13) had Cushing’s syndrome, 26.9% (n=7) had pheochromocytoma and 23% (n=6) had primary aldosteronism. The median duration of follow-up was 22.0 (2.0–60.0) months. During the follow-up, two (2.4%) of the 85 patients with non-functional adenomas gained functionality and were diagnosed with Cushing’s disease. Functionality was not significantly associated with NLR, PLR, GLR, SII and PNI levels. There was a negative correlation between cortisol level after the overnight 1 mg dexamethasone suppression test and PNI (r:-0.207, p=0.030). Inflammatory hemogram parameters levels were not significantly different between patients with functional and non-functional adenomas. There was a significant negative correlation between the PNI level and cortisol secretion. PNI, which can be easily calculated by serum albumin level and absolute lymphocyte count, can be a useful guide for clinicians in the follow-up for the prognosis of functional adenoma.

Can neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, prognostic nutrition index, and albumin be used to predict cholecystectomy morbidity in super-elderly patients?

This study aimed to evaluate the usability of neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic nutritional index (PNI), and serum albumin level in predicting cholecystectomy morbidity in elderly patients (85 years and older) who underwent cholecystectomy for acute cholecystitis. This retrospective study included super-elderly patients who underwent cholecystectomy due to acute cholecystitis at a tertiary health centre between January 2010 and January 2021. The patients were divided into two groups according to the presence of postoperative complications (morbidity). The differences between the two groups were evaluated. In addition, the role of NLR, PLR, PNI, and serum albumin level in predicting cholecystectomy morbidity for acute cholecystitis in super-elderly patients was assessed via ROC analysis. Of 30 patients who met the study criteria, 22 (73.3%) were female, and the mean age of all patients was 87.43±2.66 years (range 85-94 years). 7 (23.3%) patients had at least one comorbid disease during the preoperative period. The mean value of NLR, PLR, albumin, and PNI were 8.31, 153.76, 3.45, and 48.37, respectively. The morbidity rate of the study was 23.3%. The area under the curve (AUC) for NLR was 0.466 ([95% confidence interval [CI]: 0.259-0.672]; P=0.787), and the AUC for PLR was 0.429 ([95% CI: 0.201-0.656]; P=0.573). These two factors were not suitable for predicting morbidity. The AUC for PNI was 0.780 ([95% CI: 0.568-0.991]; P=0.027), and the AUC for albumin was 0.894 ([95% CI: 0.770-1.000]; P=0.002). At the cut-off value of 3.05 g/dL, the sensitivity and specificity of albumin were 91.3% and 71.4%, respectively, while the sensitivity and specificity of PNI at the 41.70 cut-off value were 82.6% and 71.4%, respectively. This study found that PNI and albumin can be used as predictive factors with high sensitivity and specificity for predicting cholecystectomy morbidity for acute cholecystitis in super-elderly patients. However, NLR and PLR had no significance in predicting cholecystectomy morbidity.

The significance of neutrophil/lympocyte ratio and platelet/lymphocyte ratio in predicting diabetic polyneuropathy and neuropathic pain severity as inflammatory factors.

<p>Neuropathic pain may appear as one of the first symptoms that take the patient to the physician in type 2 diabetes, which can be asymptomatic for years. Although it is accepted that diabetes is a trigger for vascular inflammation, it has been suggested that inflammation itself may trigger diabetes. In our study, we aimed to investigate the relationship between diabetic polyneuropathy and neuropathic pain and inflammatory markers.</p>. <p>The study included 44 healthy controls, 46 diabetic patients with normal electroneuromyography (ENMG) and 44 diabetic patients with polyneuropathy detected in ENMG. Sedimentation, C-reactive protein (CRP), Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLO) and mean platelet volume (MPV) values were recorded in the sera of the patients. The Douleur Neuropathic 4 (DNP4) Questions was used to evaluate the presence of neuropathic pain in the patients, and the Visual Analogue Scale (VAS) was used to evaluate the severity of pain.</p>. <p>NLR, CRP, sedimentation levels were statistically significantly higher in the DMP+ and DMP&ndash; patient groups compared to the control group. PLO and MPV levels were significantly higher in the DMP+ patient group compared to both the DMP&ndash; patient group and the control group.&nbsp;<br>The means of VAS and DN4 scores were statistically significantly higher in the DMP+ patient group than in the DMP&ndash; patient group. In the DMP&ndash; patient group, the NLR levels of those with neuropathic pain according to the DN4 scale were statistically significantly higher than those without neuropathic pain.</p>. <p>Diabetic neuropathy is one of the common complications of diabetes, affecting about half of patients. Our study shows that NLR, PLO, MPV values can be used as parameters to help us make an easy and fast diagnosis in diabetic polyneuropathy. However, their reliability in the diagnosis of diabetic polyneuropathy should be evaluated with studies to be conducted with larger patient and control groups.</p>.

Systemic immuno-inflammatory index in patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma.

In recent years, the role of some hematological parameters used as chronic inflammation markers in the pathogenesis of many ocular and systemic diseases has been investigated. For ocular diseases such as uveitis, keratoconus, and retinal vein occlusion, the neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII) have been reported to be useful inflammatory biomarkers. It has also been reported that low-grade chronic inflammation plays a role in the formation of pseudoexfoliation. To evaluate the NLR, SII, and platelet-lymphocyte ratio (PLR) in patients with pseudoexfoliation syndrome (PEXS) and pseudoexfoliative glaucoma (PEXG). This was a retrospective case-control study. This study evaluated the clinical and laboratory data of 34 patients with PEXS, 33 patients with PEXG, and 33 control patients. Detailed eye examination notes in patient files and blood count measurements were recorded. SII values were the highest in the PEXS group, followed by the PEXG and control groups (582.01 ± 339.9, 478.14 ± 211.7, and 413.98 ± 129.5, respectively) (p = 0.043). In paired comparisons, the SII values of the PEXS group were significantly higher than the control group (p = 0.011). The mean NLR rate was highest in the PEXS group, followed by the PEXG and the control groups (2.46 ± 1.6, 2.17 ± 0.8, and 1.69 ± 0.4, respectively) (p = 0.023). In paired comparisons, the mean NLR levels were higher in the PEXS and the PEXG groups than in the control group (p = 0.03 and p = 0.01, respectively). There was no significant difference between the groups in terms of PLR. According to receiver operating characteristic curve analysis, the optimal cut-off value for estimating PEXS was found as >449.4 for SII and 1.78 for NLR (p = 0.011 and p = 0.031, respectively). In PEXS patients, both SII and NLR were significantly higher, albeit in a small group of patients, and SII may be a helpful and supportive parameter for NLR in risk estimation in these patients. There was a statistically significant difference only in NLR in patients with PEXG when compared with the control group. However, these results need to be supported by future longitudinal and larger studies to identify any possible link between hematological inflammatory markers and pseudoexfoliation.

Neutrophil-Lymphocyte Ratio as a Screening Test for Preeclampsia in the First and Early-Third Trimesters of Pregnancy: A Cohort Study

Background: Preeclampsia (PEC), affecting 5-10% of all pregnancies, is a multisystem disease diagnosed by hypertension (HTN) and protein in the urine or multi-organ problems without signs of proteinuria occurring after 20 weeks of gestation. PEC is the most common cause of maternal death and can lead to premature delivery. The current study aimed to investigate the accuracy of neutrophil-lymphocyte ratio (NLR) for predicting PEC in the first and early-third trimesters of pregnancy in a normal population in the south of Iran. Materials and Methods: A large-scale cohort study was performed from early pregnancy onward during November 2018-2019 in a normal population from Fars province, Southwest Iran. Four hundred forty-nine pregnant women were followed prospectively, and normal blood pressure (normotensive), gestational HTN, and PEC groups were compared in terms of white blood cells (WBC) count, neutrophil, lymphocyte, and NLR. Results: The serum levels of WBC count, neutrophil, and NLR significantly increased from the first to the early-third trimesters of pregnancy (P&lt;0.05); however, lymphocytes decreased (P&lt;0.05). The NLR cut-off points for predicting PEC were 2.79 (sensitivity=86.7% and specificity=92.6%) in the first and 3.2 (sensitivity=90.5% and specificity=79.4%) in the early-third trimesters. Conclusion: Our findings revealed that NLR could be an accurate predictive factor for PEC in the first and early-third trimesters of pregnancies; however, more studies are needed to investigate the immunomodulatory drugs for the prevention of PEC.