Neutrophil-lymphocyte Ratio Values Research Articles

Do the ınflammatory markers have a prognostic role in an elderly patient population diagnosed with non-muscle ınvasive bladder cancer?

To evaluate whether the systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De-Ritis ratio (DRR) are determinants of progression-free survival (PFS), recurrence-free survival (RFS) and overall survival (OS) in patients aged ≥ 70 years diagnosed with non-muscle invasive bladder cancer (NMIBC). The study included 173 elderly patients diagnosed with NMIBC between January 2015 and March 2022. The clinical and pathological data of the patients were examined. Cox regression analysis was performed. The patient's mean age was 75.6 ± 4.57 years. A statistically significant correlation was determined between higher mean NLR, PLR, and SII values and PFS (p = 0.04, p = 0.009, and p = 0.007, respectively) and OS (p = 0.001, p = 0.003, and p < 0.001, respectively). The multivariate analysis results showed that tumor size (≥ 3 cm) and PLR (> 144.6) were independent risk factors for PFS (HR: 2.09, p = 0.03; HR:3.2, p = 0.01, respectively), the presence of multiple tumors for RFS (HR: 1.73, p = 0.01), and comorbid diseases for OS (HR: 2.18, p = 0.006). Inflammatory parameters were found to have no independent effects on RFS and OS in patients of advanced age with NMIBC, and only PLR could be used to predict PFS.

Sensitivity and Specificity of the Neutrophil Lymphocyte Ratio (NLR) in Diagnosing Late Onset Neonatal Sepsis in NICU Patients

Objective: To compare the sensitivity and specificity of the neutrophil lymphocyte ratio in diagnosing late onset neonatal sepsis in NICU patients at a tertiary care center Study Design and Setting: Prospective observational study at Department of Pediatrics, Combined Military Hospital, Lahore from February 2024-July 2024 Methodology: After admission into the NICU for suspected late onset neonatal sepsis, complete blood count, C-reactive protein and blood cultures were sent before changing or starting broad spectrum anti-biotic therapy for 350 patients included in the study. Primary variables observed were sensitivity and specificity of the neutrophil lymphocyte ratio in diagnosing late onset sepsis once co-related with the culture results. Results: Blood panel parameters showed mean absolute neutrophil count to be 5928.19796.05/mm3versus 7032.80166.02/mm3 between the suspected and confirmed patients’ groups (p&lt;0.001). Similarly, mean absolute lymphocyte count was 2745.32394.53/mm3 versus 3223.60278.90/mm3 between both groups (p&lt;0.001). Median value for NLR was 1.70 (1.00) versus 2.20 (1.00) between the suspected and confirmed culture groups (p&lt;0.001). Assessment of receiver operating characteristics (ROC) for NLR when compared with suspected and confirmed sepsis showed area under the curve being 0.644 (CI=95%) with sensitivity of 74.6%, specificity of 55.6%, positive predictive value being 57.3% and negative predictive value being 73.3% with a cut-off value for NLR being 2.05. Conclusion: We conclude that neutrophil lymphocyte ratio with a cut-off value of 2.05 is a reliable method to diagnose late onset neonatal sepsis with good sensitivity

The impact of systemic immune inflammation index and neutrophil/lymphocyte ratio on mortality in patients undergoing surgery for infective endocarditis

Aims: Infective endocarditis (IE) is a severe cardiac pathology associated with high morbidity and mortality. Early identification of disease severity and mortality risk using simple, rapid, and cost-effective tests can significantly improve clinical outcomes. This study aims to provide clinicians with valuable information on the prognostic importance of SIII and NLR in the management of IE patients and to guide potentially more effective perioperative interventions. Methods: This study retrospectively investigates the relationship between the Systemic Immune Inflammation Index (SIII), Neutrophil/Lymphocyte Ratio (NLR), and mortality in patients who underwent surgical treatment for IE between March 2020 and November 2023. A total of 100 patients over the age of 18 were included in the study. Data were collected on various clinical parameters, and statistical analyses were performed using SPSS 26.0. Results: Patients who experienced mortality had significantly higher mean SIII (1953.6 vs. 1352.4, p=0.003) and NLR (8.5 vs. 5.7, p=0.007) values than those who survived. These high indices in the mortality group suggest a stronger inflammatory response and immune dysregulation, making SIII and NLR useful indicators for assessing the prognosis of patients with infective endocarditis. Conclusion: The study underscores the potential of these indices as reliable markers for predicting mortality and disease severity in IE, ultimately aiding in better patient stratification and management.

The Importance of the Neutrophil-Lymphocyte Ratio (NLR) and the Platelet-Lymphocyte Ratio (PLR) as Biomarkers for Differentiating Complicated and Uncomplicated Appendicitis.

This specific study evaluates the accuracy of two ratios, Neutrophil-to-Lymphocyte (N/L) and Platelet-to-Lymphocyte (P/L), as inflammatory markers on differentiating simple and complicated appendicitis preoperatively. The medical records of 341 children, up to 16 years old, with suspected acute appendicitis (AA) who underwent appendectomy, laparoscopic or open, between January 2020 and December 2022, in our department, were retrospectively reviewed. Routine blood exams and the demographic details were obtained. The area under the curve (AUC), sensitivity, and specificity of the above-mentioned markers regarding the differentiation of simple and complicated appendicitis, based on the statistical program SPSS, were calculated. From the total of 341 patients, a percentage of 27.5% were related to perforated appendicitis, such as necrosis or the rupture of the appendiceal wall. A significant association was observed between perforated appendicitis and NLR values > 7.92, with concomitant sensitivity 62.5% and specificity 74.2%. Retrospectively, for PLR values > 180.57, the sensitivity was 61.1% and specificity 68.9%. For these models, the areas under the curve were 0.736 and 0.696. Our study revealed a significant association of N/L and P/L ratios with acute perforated appendicitis. Future studies should validate the use of these markers on this disease.

Prognostic Impact of Neutrophil-to-Lymphocyte Ratio in Ischemic Stroke.

Background/objective: Studies suggest that the neutrophil/lymphocyte ratio (NLR) may be a prognostic marker for different diseases with inflammatory components. This study aimed to quantify the NLR in individuals affected by different subtypes and severities of ischemic stroke and associated it with risk factors and treatment, and compared the results with data from healthy individuals. Methods: Clinical and laboratory data from medical records of patients over 18 years of age, victims of ischemic stroke, were collected. Data included leukocyte count and subtype, topography, risk factors, treatment and severity of stroke. For comparison, the number of leukocytes in healthy individuals was also quantified. NLR was determined by dividing the number of neutrophils by the number of lymphocytes. Results: A total of 218 patients were included, 194 stroke patients and 24 healthy individuals. Among all stroke patients, 45% had NLR values > 4 and 35% had values between 2 and 4; otherwise, 71% of healthy individuals had NRL < 2. The data also showed that the greater the severity of the stroke, measured by the NIHSS scale, the higher the NLR, at 24 and 72 h after the stroke. Among the stroke subtypes evaluated, the one with the lowest NLR values was small vessel stroke. Finally, the risk factors for stroke, its topography and treatment were not associated with NLR values. Conclusions: NLR is associated with stroke severity but does not correlate with stroke risk factors, topography, and treatment. The NLR may serve as a marker of stroke severity.

Efficacy of novel haemogram parameters in the evaluation of inflammation in acute ischemic stroke

Objective: Inflammation in ischemic brain tissue is the primary factor contributing to the pathogenesis of acute ischemic stroke (AIS). This study aimed to investigate the role of new inflammatory parameters—immature granulocyte count (IGc) and the systemic immune-inflammation index (SII)—in determining the presence of inflammation and the subtype, severity, and prognosis of AIS. Methods: This retrospective study was conducted using data from 124 patients with AIS and 126 healthy controls. The severity at stroke onset and the functional outcome after at least 3 months of follow- up were determined. Patients with AIS were subdivided into subgroups according to aetiology. The following haemogram parameters were compared between the AIS and control groups: haemogram parameters; white blood cell (WBC) count, haemoglobin (Hgb), haematocrit (HCT), mean platelet volume (MPV), platelet count (PLT), PCT (plateletcrit), lymphocyte and neutrophil count, RDW-CV (red cell distribution width coefficient of variation), neutrophil/lymphocyte ratio (NLR), MPV/PLT ratio, PLT/lymphocyte ratio (PLR), WBC/MPV ratio (WMR), IGc and IG percentage (IG%), and SII values. Results: The parameters WBC, IGc, IG%, RDWCV, neutrophil count, NLR, WMR, and SII values were significantly higher in the AIS group than in the control group. We found significant correlations between high SII value and high clinical NIHSS scores at stroke onset, mRS obtained after at least a 3-month follow-up period. Conclusion: IGc and SII may be new parameters to evaluate the presence of inflammation in patients with AIS. A higher SII was associated with higher stroke severity, and it may be useful for predicting adverse clinical outcomes.

Evaluation of the immature granulocyte count in idiopathic sudden sensorineural hearing loss

Aims: The purpose of our study was to show whether the immature granulocyte count (IGC) can be used as a prognostic marker in idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: This study is a retrospective case-control clinical study. Patients presenting to our clinic between June 2019 and June 2022, diagnosed with ISSNHL, and receiving the same treatment protocol were investigated. Preoperative complete blood count values of 40 normal individuals with normal hearing who presented to our clinic due to nasal septum deviation were adopted as the control group. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) (platelet × neutrophil / lymphocyte) values were calculated in addition to IGC values in complete blood counts from the patient and control groups. The patient group was classified into treatment-responsive and non-responsive subgroups according to the results of audiological examinations performed after one month based on Siegel’s criteria. IGC, SII, NRL, and PLT values were compared between all groups. Results: Comparison of the patient and control group’s complete blood count data revealed higher leukocyte and neutrophil counts, IGC and also NLR, PLR, and SII values in the patient group compared to the control group. However, lymphocyte counts were lower in the patient group. None of the parameters previously emerging as significant in the data of patients with healing and non-healing idiopathic sudden hearing loss were statistically significant, and IGC is of no prognostic value in ISSNHL. Conclusion: IGC may be a novel and inexpensive indicator of ISSNHL and one easily determined with complete blood count, but it is of no prognostic value in the disease.

Investigating the clinical predictive utility of inflammatory markers and nomogram development in colorectal cancer patients with malnutrition.

The aim of this study is to investigate the relationship and prognostic significance of serum neutrophil-lymphocyte ratio (NLR), systemic immune-inflammatory index (SII), platelet-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) in colorectal cancer (CRC) patients with malnutrition, as well as to construct a nomogram for predicting the onset of malnutrition. The clinical data of 391 inpatients who were hospitalized from December 1, 2021 to January 31, 2023 the diagnosis of CRC were selected and divided into a malnutrition group (121 cases) and a well-nourished group (270 cases) according to whether they were malnourished or not. Focusing on comparing the differences in serum NLR, PLR, SII index, PNI index and general information between the two groups, the Binary logistics regression analysis was used to analyze the factors affecting malnutrition, and receiver operating characteristic (ROC) curves were established to assess the predictive value of serum NLR, PLR, SII index, and PNI index individually and jointly for malnutrition, and to calculate the optimal predictive thresholds. Finally a highly accurate clinical predictive nomogram was constructed. Compared with the well-nourished group, the malnourished group had higher serum NLR, SII index, PLR and lower PNI index levels, with statistically significant differences (p < 0.001). The area under the curve of NLR, SII index, PLR, and PNI index alone and in combination predicted a poor prognosis of 0.705, 0.665, 0.636, 0.773, and 0.784, respectively. After conducting Logistic regression analysis, the nomogram, which included BMI, NRS-2002, long-term bed rest, and PNI, demonstrated strong predictive capabilities. Decision curves highlighted the clinical utility of the predictive nomograms. The receiver operating characteristic curve revealed strong discrimination (area under the curve [AUC] = 0.958, 95% CI: 0.937-0.979). Additionally, the ROC analysis indicated a sensitivity of 0.843 and specificity of 0.937. Calibration curves exhibited excellent concordance between nomogram predictions and observed outcomes. Decision curves highlighted the clinical utility of the predictive nomograms. Serum NLR, SII index, PLR, and PNI are significant predictive factors for the development of malnutrition in patients with CRC. These indices, whether considered individually or collectively, possess clinical relevance in forecasting malnutrition. Furthermore, the creation of an innovative nomogram prediction model offers considerable clinical utility.

Complete Blood Cell Count-Based Ratios Identify Total Joint Arthroplasty Patients Likely to Benefit from Perioperative Dexamethasone.

Complete blood cell count-based ratios (CBRs), including the neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), are inflammatory markers associated with postoperative morbidity. Given the link between the surgical stress response and complications after total joint arthroplasty (TJA), this study aimed to evaluate whether higher preoperative CBR values predict greater postoperative benefits associated with dexamethasone utilization. The Premier Healthcare Database was queried for adult patients who underwent primary, elective total hip or knee arthroplasty (THA or TKA). Multivariable logistic regression models using dexamethasone exposure and CBRs as independent variables assessed primary end points of 90-day postoperative complications and length of stay (LOS) of ≥3 days. The probability difference between the dexamethasone and non-dexamethasone groups for each primary end point was determined across all values of each CBR. Probability differences were compared across CBR quartiles. A total of 32,849 primary, elective TJAs (12,788 THAs [38.93%], 20,061 TKAs [61.07%]) performed between 2016 and 2021 were identified, and 22,282 (67.83%) of the patients received perioperative dexamethasone. Among patients with an NLR value of >1.00, those receiving dexamethasone had a lower probability of postoperative complications (all p < 0.05). Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients in the highest NLR quartile (≥4.67) compared with the lowest quartile (NLR <1.84) (p = 0.002). Among patients with an MLR value of ≥0.36, those receiving dexamethasone had significantly lower odds of postoperative complications. Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients with an MLR of ≥0.33 (the 2 highest quartiles) compared with an MLR of <0.24 (the lowest quartile) (p = 0.039). Higher NLR and MLR values were associated with greater marginal benefit from perioperative dexamethasone treatment, establishing a modifiable link between adverse outcomes and perioperative inflammation in TJA. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Predictive value of neutrophil-lymphocyte ratio in assessing the outcomes of diabetic foot ulcer.

To assess the correlation of neutrophil-lymphocyte ratio with clinical outcomes in diabetic foot ulcer cases. The retrospective, cross-sectional, single-centre study was conducted at Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan), and comprised data from January 2019 to January 2022 of diabetic foot inpatients of either gender aged at least 18 years. Hospital complications and outcomes were noted along with other data on a self-designed proforma. Diagnostic performance of neutrophil-lymphocyte ratio and its correlation with qualitative variables were assessed. Data was analysed using SPSS 26. Of the 130 patients with mean age 60.13+/-11.75 years, 98(75.4%) were males. Surgical intervention was needed in 118(90.8%) cases, with below-knee amputation being the most frequent procedure 38(32.3%). Neutrophil-lymphocyte ratio >4 was significantly associated with a higher grade of diabetic foot ulcer, major amputation, and postoperative complications (p<0.0001) as well as with in-hospital (p=0.008) and 1-year mortality (p=0.01). Neutrophil-lymphocyte ratio could be potentially used as a sensitive and economically feasible biomarker for evaluating the prognosis of patients presenting with diabetic foot ulcers.

The Role of Peripheral Blood Inflammation Indices in Patients with a Diagnosis of Endometrial Hyperplasia and Cancer

Purpose: Endometrial cancer (EC) is an important problem with its increasing incidence, especially in developed countries. There is no generally accepted screening program yet. The management of endometrial hyperplasia (EH), which is the most important risk factor, is complex because it is an invasive process. Methods: A retrospective study was conducted with a total of 72 patients. Patients between the ages of 35-65 with abnormal uterine bleeding, and increased endometrial thickness on transvaginal sonography were evaluated with pathology results. Sociodemographic characteristics of the patients and laboratory values at hospital admission were obtained from hospital records. White blood cells (WBC), neutrophils, lymphocytes, monocytes, eosinophils, basophils, and thrombocyte counts (x10⁹/L); plateletcrit (%), hemoglobin (Hb) (g/dL), and hematocrit (Htc) (%) values were recorded. Neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and thrombocyte lymphocyte ratio (TLR) were obtained. Systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and pan-immune-inflammation value (PIV) were obtained. Results: Thirty-seven patients diagnosed with EH and 35 patients diagnosed with endometrial malignancy were included. The mean age of the EH was 45.5 years and the mean age of the malignant group was 50.5 years (p=0.027). The sociodemographic characteristics of the patients were found to be similar. There was no significant difference in complete blood count parameters between two groups. Mean values of NLR were 2.33 and 2.52 in EH and EC groups, respectively, p = 0.448. Mean values of MLR were 0.20 and 0.21, respectively, p = 0.498. Mean values of TLR were 0.16 and 0.15, respectively, p = 0.811. Mean values of SII were 720.1 and 812.4 (x10⁹/L), respectively, p = 0.456. Mean values of SIRI were 943.1 and 1095.6 (x10⁹/L), respectively, p = 0.257. Mean values of PIV were 312753.6 and 352975.1 (x10⁹/L), respectively, p = 0.514. Conclusion: Peripheral blood inflammation indices have recently been used in cancer diagnosis and follow-up. We did not find any statistically significant differences in the investigated parametrers between the EH and EC patient groups. Close follow-up is necessary in the presence of additional risk factors in women with EH.

RELATIONSHIP OF NEUTROPHIL LYMPHOCYTE RATIO WITH APPENDICITIS INCIDENCE Review of Appendicitis Patients at Ibnu Sina Hospital, Gresik Regency in 2022-2023

This study aims to analyze the relationship between the neutrophil lymphocyte ratio (NLR) and the incidence of acute appendicitis in patients at Ibnu Sina Hospital, Gresik Regency, in the 2022-2023 period. Acute appendicitis is a frequent emergency surgical condition, especially in adolescents and young adults, with the risk of complications such as perforation and peritonitis. NLR, as an indicator of inflammatory response, is considered more practical and economical than CT scans and ultrasounds, which have limited cost, accessibility, and risk of radiation exposure. This study used an observational analytical method with a cross-sectional approach on 51 appendicitis patients who underwent appendectomy. NLR data was obtained through routine blood results, with statistical analysis using SPSS to test the normality and difference in NLR values between uncomplicated appendicitis and appendicitis with complications. There was a significant difference in the mean NLR value between patients with complementary and non-complementary appendicitis, with a p &lt; value of 0.001. The results of the ROC Curve analysis show that NLR has a high prediction value in predicting complementary appendicitis of 97.5%. This study concludes that NLR can be an effective indicator in distinguishing cases of complementary and non-complementary appendicitis and the potential of NLR as an easy and efficient screening tool in the treatment of acute appendicitis, especially in health facilities with limited resources.

Prediction of the outcome of intracerebral hemorrhage by blood neutrophil to lymphocyte ratio: a prospective observational study.

Intracerebral haemorrhage (ICH) is defined as bleeding within the brain parenchyma. Neutrophil lymphocyte ratio (NLR) is a dynamic parameter that can be affected by an underlying condition like microangiopathy (e.g. hemorrhagic stroke). The NLR value at the time of stress (e.g. ICH) could be a predictor among various other factors on the outcome of the disease. The aim of this study is to see if NLR could be a predictor of the outcome of the ICH. This is a prospective observational study conducted in the Department of Neurosurgery and Department of Neurology, from March 2020 to February 2021. The ICH cases presented to the emergency department within 24h of symptoms were included. The baseline haematological and biochemical investigations were sent and the noncontrast computed tomography (NCCT) head was done for the diagnosis of ICH. The NLR was measured. The ICH volume was calculated by ABC/2. Follow-up of the patient to measure outcome was done with a modified Rankin scale (mRS) on 30 days. Student's t-test was used to correlate NLR-mRS. Fischer's exact test was used for a categorical association of NLR to mRS. A total of 89 patients with ICH were enrolled in this study. In this study, 62.92% of patients had good outcomes (NLR of 4.88±3.06), whereas 37.08% of patients had bad outcomes (NLR of 9.09± 4.92). Statistically, higher NLR was significantly predictive of poorer outcomes. ICH causes stress in the body, which alters the value of NLR. Components of NLR are altered after haemorrhage due to a change in homeostasis of brain parenchyma. The NLR value obtained at the time of emergency department visits may help to predict the 30 days outcome of ICH.

Utility of Neutrophil–lymphocyte Ratio and Platelet–lymphocyte Ratio in Predicting Malignancy in Patients with Small Renal Mass

ABSTRACT Background: Abdominal imaging has become increasingly prevalent, resulting in the incidental detection of renal tumors. The majority of small renal masses (SRMs), which are surgically removed, prove to be malignant. However, some cases turn out to be benign, which can lead to unnecessary surgeries with associated significant morbidity. Recently, many inflammatory biomarkers have shown to be promising prognostic factors in RCC. We aimed to assess the importance of inflammatory biomarkers, which are simple and economical, in SRMs. Objective: We investigated whether preoperative neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) can predict malignancy in patients with SRMs. Material and Methods: A retrospective analysis was performed on 108 patients who underwent partial or radical nephrectomy for SRMs (tumors smaller than 4 cm) from January 2016 to December 2022. The patients were classified into two groups based on their histopathological diagnosis: benign group (n = 28) and malignant group (n = 80). NLR and PLR values were assessed for sensitivity using the ROC curve. Independent t-test, Mann–Whitney test, and Chi-square test were utilized. P &lt;0.05 indicated statistical significance. Results: The mean age of patients was 58.9 ± 12.3 years in the benign group and 53.3 ± 11.9 years in the malignant group (P = 0.03). The mean tumor size was 3.26 ± 0.52 cm in the benign group and 3.04 ± 0.90 cm in the malignant group (P = 0.60). NLR (P = 0.008) and PLR (P ≤ 0.001) values were significantly higher in the malignant group (median: 3.65 and 201) compared to the benign group (median: 2.82 and 125), respectively. The area under a ROC curve was 0.669 (P = 0.002) and 0.758 (P &lt; 0.001), with sensitivity values of 62.5% and 87.5%, specificity of 64.29% and 57.14%, and cutoff points of 3.45 and 130.21, for NLR and PLR, respectively. Conclusion: NLR and PLR can be considered biomarkers for predicting malignancy in SRMs. NLR and PLR should be included in a patient’s clinical evaluation along with imaging studies and overall health status.

Exploring high-risk factors for the prediction of severe mycoplasma pneumonia in children.

As one of the most common causes of community-acquired pneumonia in children, the prevalence of mycoplasma pneumonia (MPP) has long been underestimated. This study aimed to analyze children's severe MPP (SMPP) by examining laboratory characteristics and identifying high-risk factors. Clinical data from 447 hospitalized children with MPP were retrospectively analyzed. Patients were categorized into ordinary MPP and SMPP groups. Initial laboratory results on admission were compared between groups, and risk factors for SMPP were assessed using receiver operating characteristic (ROC) and logistic regression analyses. Children with SMPP exhibited significantly higher levels of neutrophils, neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and lactate dehydrogenase (LDH), along with lower lymphocyte, albumin (ALB), and prealbumin (PAB) levels compared to the ordinary MPP group (all P<0.05). SMPP children also had a higher incidence of multiple pathogens (P<0.05). ROC analysis identified cutoff values for ESR, LDH, IL-6, CRP, neutrophil percentage, and NLR, with corresponding areas under the curve (AUCs) indicating their predictive values for SMPP. A combined analysis of these factors yielded an AUC of 0.732 (P<0.05). Multivariate logistic regression confirmed ESR >35.50 mm/h, LDH >360.50 U/L, IL-6 >20.28 pg/mL, and CRP >9.74 mg/L as independent high-risk factors for SMPP (P<0.05). ESR, LDH, IL-6, CRP, neutrophil percentage, and NLR are valuable predictors for early identification of SMPP in children. These findings provide essential insights for clinical management aimed at assessing and intervening in prognosis.

Relationship between NLR (Neutrophil/Lymphocyte ratio) value and clinical outcome in patients with external ventricular drainage due to intraventricular hemorrhage.

Intraventricular hemorrhages (IVH) are common pathologies in neurosurgery practice and are associated with the worst clinical outcome among all intracranial hemorrhages. Blood in the ventricles is thought to worsen the clinical condition by triggering inflammatory processes. In recent years, NLR value is a frequently used inflammatory parameter, and there are many publications reporting that a high NLR value is an important marker in predicting the severity of inflammation. Our study aimed to evaluate the effect of NLR values at admission on the clinical outcome of patients undergoing EVD due to IVH in our clinic. In our study, age and gender data, admission Glasgow Coma Scale (GCS), NLR value at the time of admission and clinical status at discharge of 36 patients, who underwent EVD following IVH in our hospital neurosurgery clinic between 2019 and 2024, were examined. Of the 36 cases in our study, 16 were female and 20 were male. For all cases, the mean age was 61.88, and the mean GCS values at admission were calculated as 8.5. In the laboratory of our hospital, the normal NLR range was determined as 0.78-3.53, and the mean NLR values at admission were evaluated as 16.57. When the clinical outcomes of the cases were examined, it was seen that 30 cases ended with exitus after intensive care follow-up, and 6 cases were discharged with good clinical outcomes (GCS:15). The mean NLR value was calculated as 18.00 for the patients who ended with exitus and 8.12 for the patients discharged with good clinical outcomes. NLR, which has been used to determine the severity of inflammation in recent years, has been reported to be a marker that can predict clinical outcomes of many diseases. In our study, NLR was observed to be high at admission in all cases, but it was significantly higher in the cases ending with exitus than in the cases not ending with exitus. As a result, it is thought that NLR value is a parameter that can be used to predict the clinical course in IVH patients undergoing EVD.

Ethnic variations in post ST elevation myocardial infarction inflammatory kinetics

Abstract Introduction Sterile inflammation post myocardial infarction (MI) is essential to activation reparative mechanisms. However, excessive inflammation contributes to detrimental recovery and adverse outcomes(1). Several studies have reported an association between elevated leucocyte subpopulations and neutrophil-lymphocyte ratio (NLR) with poor prognosis after MI(2). In healthy volunteers, it is known that black individuals have a lower diurnal neutrophil, basophil, and monocyte count and the term ‘benign ethnic neutropenia’ has been used(3). However, the effect of ethnicity on leucocyte counts after MI is not known. Purpose We aimed to assess the interaction between ethnicity and leucocyte subpopulations and NLR. Understanding post-MI inflammation and its interaction with ethnicity is essential in providing personalised patient management and prognostication. Methods We conducted a single centre retrospective observational study of consecutive patients presenting with ST-segment elevation MI (STEMI) between 2016 and 2022. Patients were divided into white and other ethnic groups combined (‘ethnic minorities’) based on self-reported ethnicity. Leucocyte subpopulations, neutrophil and monocyte lymphocyte ratios (NLR and MLR, respectively) at baseline and for 4 days post admission were compared. Baseline variables were analysed with Shapiro-Wilk testing and presented as median (IQR). Area under the curve (AUC) was used to analyse magnitude of change in longitudinal analysis with smoothed conditional means (LOESS) to display trends in the data. Univariate and multivariate linear regression analyses were used to investigate for an association between ethnicity and baseline clinical variables. Results We included 1933 STEMI patients, of whom 1477 (76%) were white and 456 (24%) were from ethnic minority groups. Baseline neutrophils (7.73 [5.9-10] vs 9.04 [6.7-11.9] x109/L), monocytes (0.52 [0.38-0.69] vs 0.6 [0.44-0.82] x109/L), basophils (0.03 [0.02-0.04] vs 0.04 [0.02-0.06] x109/L), NLR (4.47 [2.93-7.19] vs 5.61 [3.64-8.89]) and MLR (0.3 [0.21-0.43] vs 0.36 [0.26-0.53]) were significantly lower (all p&amp;lt;0.001) in ethnic minority vs white patients. There were no differences in peak troponin T or CRP. Longitudinal assessment of leucocyte subgroups and NLR showed that white patients had a significantly higher AUC and difference between minimum and maximum values (delta) for neutrophils, monocytes, basophils and NLR (Panel 1). After correction, we observed a negative association between being in the ethnic minority group and baseline NLR (p=0.005) and basophil count (p&amp;lt;0.001). Conclusions Despite baseline differences in leucocyte subgroups and NLR according to ethnicity, there is a distinct interaction among patients with STEMI suggesting an ethnicity-specific inflammatory profile. Blunting of the magnitude and duration of leucocyte response is novel, and future work will focus on the implications for prognosis and tailored therapy.

Association of baseline neutrophil-to-lymphocyte ratio and prognosis in melanoma patients treated with PD-1/PD-L1 blockade: a systematic review and meta-analysis.

Immunotherapy treatments that target programmed cell death receptor-1 (PD-1) or its ligand (PD-L1) have revolutionized the treatment of metastatic melanoma and currently represent the standard first-line treatment for this type of cancer. However, it is still not entirely clear which biomarkers are cost-effective, simple, and highly reliable. This systematic review and meta-analysis aims to analyze the predictive value of the baseline neutrophil-lymphocyte ratio (NLR) regarding disease progression and overall survival of patients with metastatic melanoma undergoing treatment with PD-1/PD-L1 blockade. PubMed, Scopus, and Web of Science were searched for studies comparing high versus low NLR. We performed the meta-analysis using RStudio v4.4.2 software. A total of 20 studies and 2691 patients were included, all with diagnoses of melanoma. The majority of the individuals were male 2278 (84, 65%). The median overall survival (OS) and progression-free survival (PFS) ranged from 5.0 to 44.4 and from 1.8 to 15.0 months, respectively. Compared with the high NLR ratio, the low exposure group achieved better rates of OS [hazard ratio (HR), 2.07; 95% CI, 1.73-2.48; P < 0.00001; I² = 47%]. Regarding PFS, there was a statistically significant difference between groups with tendencies toward the low NLR exposure group (HR, 1.59; 95% CI, 1.39-1.81; P < 0.00001; I²=31%]. This systematic review and meta-analysis revealed significant lower OS in melanoma patients treated with PD-1/PD-L1 blockade who had elevated baseline NLR values. Furthermore, an increased PFS was observed in patients with a lower baseline NLR value. This study highlights NLR as an important prognostic biomarker for patients with metastatic melanoma who are candidates for treatment with PD-1 and PD-L1.

Aggregate Index of Systemic Inflammation: The Strongest Predictor of In-Hospital Venous Thromboembolism Events among Patients Hospitalized for Trauma or Surgery

BackgroundTo investigate the power of inflammation/immune indices in-hospital deep vein thrombosis (DVT) and any venous thromboembolism event (VTE: DVT + pulmonary emboli; PE) that may occur after trauma or surgery and to identify the strongest predictors. MethodsThis was a retrospective study conducted between January 2020 and December 2022. A total of 216 patients with suspicion of DVT or PE during their hospital stay for trauma or surgery were included in the study. Monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) were calculated. Participants were divided into the following 3 groups: Those without DVT or PE (Control group, n = 70), only DVT (DVT group, n = 71), and both DVT and PE (VTE group, n = 75). ResultsThe median D-dimer, NLR, PLR, MLR, SII, SIRI and AISI values of VTE group were significantly higher than both the control and DVT groups (p< 0.001 for all). The DVT group also had significantly higher values for these parameters compared to controls (p<0.001 for all). All of these indices had significantly high performance to detect DVT or PE (p<0.001 for all). Despite very high performance (some exceeding D-dimer measurement) detected for all examined parameters, AISI was the best predictor in both DVT and VTE (DVT + PE) prediction (AUC = 0.995 and 0.959, respectively) ConclusionThese indices, especially AISI, can play a role in the initial screening and risk stratification of patients at high risk of DVT or VTE after surgery or trauma.

Association between Preoperative Neutrophil-lymphocyte Ratio and All-cause Mortality in Patients Treated with Thoracic Endovascular Aortic Repair for Degenerative Thoracic Aortic Aneurysm

The neutrophil-lymphocyte ratio (NLR) has been increasingly recognized as a reliable surrogate marker for predicting mortality in clinical practice. This study determined the predictive ability of NLR for overall mortality after thoracic endovascular aortic repair (TEVAR) for degenerative thoracic aortic aneurysm (TAA). Data from patients treated with TEVAR for degenerative TAA at our university hospital from January 2013 to December 2021 were evaluated. The preoperative NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. One hundred-three patients were included in this study. During a 9-year follow-up, 32 patients (31.1%) died. Multivariable analyses showed that age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.00-1.12; P=0.021), ischemic heart disease (HR, 2.13; 95% CI, 1.05-4.36; P=0.038), and NLR (HR, 1.36; 95% CI, 1.08-1.72; P=0.009) predicted all-cause mortality after TEVAR. A receiver operating characteristic curve determined the optimal cutoff value of NLR to predict all-cause mortality was 3.48. An elevated preoperative NLR is indicative of a higher likelihood of all-cause mortality in patients treated with TEVAR for degenerative TAA, suggesting that NLR could serve as a possible biomarker for stratifying patients at risk of overall mortality after TEVAR.