Neutrophil-lymphocyte Ratio Values Research Articles

Early Diagnostic Value of KIM-1, NGAL, and NLR in Acute Kidney Injury Caused by Diquat Poisoning

Background. The kidney is the main excretory organ after diquat absorption. Acute kidney injury (AKI) is a common complication in diquat poisoning patients. Objectives. To identify the value of combined detection of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and neutrophil-lymphocyte ratio (NLR) in the early diagnosis of diquat-induced AKI. Materials and Methods. The retrospective cohort study included 42 diquat poisoning patients. Results. Forty-two patients with diquat poisoning were included, of which 20 had fulminant poisoning (47.6%). At admission (0 h), levels of KIM-1, NGAL, NLR, and acute physiology and chronic health evaluation (APACHE) II scores in the fulminant poisoning group were higher than that of the moderate to severe poisoning group ( P < 0.05), and they were all higher than in the control group ( P < 0.05), while blood urea nitrogen (BUN) and uric acid (UA) levels did not significantly differ across the three groups ( P > 0.05). At 12 h and 24 h, the levels of KIM-1, NGAL, NLR, UA, BUN, and APACHE II scores of patients in the fulminant poisoning group were higher than those in the moderate to severe poisoning group ( P < 0.05), 12 h were higher than 0 h, and 24 h were higher than 12 h ( P < 0.05). Among 42 patients with diquat poisoning, 28 had AKI (66.7%). At 0 h, the AKI group had higher levels of KIM-1, NGAL, NLR, and APACHE II scores than in the non-AKI (NAKI) group ( P < 0.05), while there was no significant difference in BUN and UA levels between the two groups ( P > 0.05). At 12 h and 24 h, the levels of KIM-1, NGAL, NLR, UA, BUN, and APACHE II scores in the AKI group were higher than those in the NAKI group ( P < 0.05), 12 h were higher than 0 h, and 24 h were higher than 12 h ( P < 0.05). KIM-1, NGAL, and NLR are independent risk markers for AKI in diquat poisoning patients. At admission (0 h), the combined application of KIM-1, NGAL, and NLR’s sensitivity, specificity, and area under the curve (AUC) for predicting AKI in diquat poisoning patients was 0.893, 0.859, and 0.903, respectively. Conclusions. KIM-1, NGAL, and NLR can be employed as early diagnostic indicators for the clinical prediction of AKI in diquat poisoning patients. Our findings may help clinicians reduce the occurrence of AKI.

Can Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios Predict the Risk of Developing New Ischemic Lesions After Carotid Stenting?

Aim: It has been reported that the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are associated with carotid artery stenosis rate, risk of restenosis after stenting, and clinical outcome after an ischemic stroke, and are also predictive markers. The objective of this study is to evaluate whether NLR and PLR values and the associated temporal changes are indicators of the risk for newly developing ischemic lesions. Material and Methods: Patients who underwent stenting in our clinic between November 2019 and January 2022 and who had a complete blood count and a diffusion magnetic resonance imaging scan before and after the procedure, were included in the study and evaluated in two groups; patients with and without newly developing ischemic lesions. Results: Newly developing ischemic lesions were detected in 27 of the 50 patients included in the study. There was no difference in baseline and 48th-hour NLR and PLR rates and the temporal variation of these rates between patients with and without newly developing ischemic lesions. Erythrocyte distribution width (RDW) and hemoglobin (HGB) values were higher in the without newly developing ischemic lesions group at 48 hours, but there was only a significant difference between the RDW temporal change between the two groups. In the correlation analysis, no significant correlation was found between NLR, PLR, and their temporal changes, ipsilateral and contralateral stenosis rates, age, and residual stenosis rates. Conclusion: There was no significant relationship between the development of newly developing ischemic lesions and NLR and PLR values and the associated temporal changes.

Predictive value of NLR and PLR for immune-related adverse events: a systematic review and meta-analysis.

Currently, there is a lack of affordable and accessible indicators that can accurately predict immune-related adverse events (irAEs) resulting from the use of immune checkpoint inhibitors (ICIs). In order to address this knowledge gap, our study explore the potential predictive value of two ratios, namely the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), for irAEs in cancer patients. A systematic search was performed inPubMed, Embase, and the Cochrane library.Studies involving NLR or PLR with irAEs were included.Quality and risk of bias of the selected studies were assessed. Forest plots were created based on Cox model analysis. Random effects meta-analyses were conducted to estimate odds ratio (OR) and its 95% confidence interval (CI). After screening 594 studies, a total of 7 eligible studies with 1068 cancer patients were included. Analysis based on Cox regression showed that low neutrophil-lymphocyte ratio (L-NLR) (OR = 3.02, 95% CI 1.51 to 6.05, P = 0.002) and low platelet-lymphocyte ratio (L-PLR) (OR = 1.83, 95% CI 1.21 to 2.76, P = 0.004) were associated with irAEs. In the subgroup analysis of cut-off value, when the NLR cut-off value was 3, irAEs was significantly correlated with NLR (OR = 2.63, 95% CI 1.63 to 4.26, P < 0.001). Both L-NLR and L-PLR have been found to be significantly associated with irAEs. Consequently, patients identified as being at a higher risk for irAEs should be subjected to more diligent monitoring and close observation.

Evaluating the Predictive Value of Diagnostic Testicular Biopsy for Sperm Retrieval Outcomes in Men with Non-Obstructive Azoospermia.

Non-obstructive azoospermia (NOA) presents a challenge in male infertility management. This study aimed to assess the efficacy of diagnostic testicular biopsy (DTB) in predicting sperm retrieval success via therapeutic testicular biopsy (TTB) and to understand the role of systemic inflammation in microdissection testicular sperm extraction (mTESE) outcomes. A retrospective analysis was conducted on 50 NOA males who underwent mTESE at the University of Ioannina's Department of Urology from January 2017 to December 2019. All participants underwent thorough medical evaluations, including semen analyses and endocrinological assessments. DTB did not detect spermatozoa in half of the patients who later showed positive sperm findings in TTB. Preoperative variables, such as age, plasma levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), prolactin (PRL), estradiol (E2), and inflammation biomarkers (neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-eosinophil ratio (MER)), were not consistently predictive of sperm retrieval success. Notably, TTB-negative patients had elevated NLR and PLR values, suggesting a possible link between systemic inflammation and reduced sperm retrieval during mTESE. The findings question the necessity of an initial DTB, which might provide misleading results. A negative DTB should not deter further TTB or intracytoplasmic sperm injection (ICSI) attempts. The study emphasizes the need for further research to refine diagnostic approaches and deepen the understanding of factors influencing sperm retrieval in NOA patients, ultimately enhancing their prospects of biological parenthood.

Mean platelet volume and neutrophil/lymphocyte ratio in adolescent idiopathic scoliosis: can they be predictive value in diagnosis?

In our study, we evaluated whether mean platelet volume (MPV) and neutrophil lymphocyte ratio (NLR) are predictive values in the diagnosis of Adolescent Idiopathic Scoliosis in patients diagnosed with scoliosis in our clinic. Approximately 15000 patients who applied to our spine outpatient clinic with the suspicion of scoliosis between 2011 and 2018 were reviewed retrospectively. 292 patients were included in the study. The patients were divided into 3 groups. Group 1; control group group 2; group with the possibility of developing scoliosis under follow-upand group 3; the patient group diagnosed with scoliosis. Spinal curvature degrees of the patients were measured using the Cobb method. The MPV and NLR values of the patients were compared with the degree of curvature measured by the cobb method. NLR was 2.17 ± 2.10 K/ul in Group 1, 2.42 ± 1.76 K/ul in Group 2, and 2.72 ± 3.91 K/ul in Group 3. Although the NLR of the 3rd group was higher than the other 2 groups, it was not statistically significant. (p &gt; 0.05). MPV was 7.90 ± 1.07 fL in Group 1, 7.95 ±1.39 fL in Group 2, 8.33 ± 1.37 fL in Group 3.MPV was higher in Group 3 and was found to be statistically significant (p=0.024). After adjusting for the effects of gender and age variables on the groups, the difference in MPV between groups became more significant (p=0.017) . While there was no statistically significant difference between the groups in terms of NLR, it was observed that MPV was statistically significantly higher in patients with AIS.Could this relationship be a promising inflammatory marker for AIS? We think that this question should be answered by studies involving larger patient and control groups.

CRP/albumin ratio in predicting 1-year mortality in elderly patients undergoing hip fracture surgery.

In the literature, rates of up to 37.1% have been reported for 1-year mortality after hip fractures. In this study, we aimed to determine whether the C-reactive protein/albumin ratio (CAR) is an independent risk factor for 1-year mortality after hip fracture and whether CAR, neutrophil/lymphocyte ratio (NLR), CRP, albumin level, and other parameters have an effect on mortality and morbidity. Over a 3-year period, 480 patients aged 65 years and older who underwent hemiarthroplasty for hip fracture were analyzed. A univariate logistic regression analysis was performed to identify prognostic factors for 1-year mortality. Significant variables were re-evaluated using binary logistic regression analysis. The number of patients who died within 1 year postoperatively was 95 (27.7%), and the median age was 85 years. In the receiver operating characteristic analysis (ROC) for 1-year mortality after hip fracture, the optimal cut-off value of CAR was found to be 1.03. The area under the curve (AUC) for mortality was 0.843, the sensitivity was 65.3%, and the specificity was 92.7% [95% confidence interval (CI), 0.791-0.895; p < 0.001]. The optimal cut-off value for CRP was 2.85, the AUC was 0.838, the sensitivity was 70%, and the specificity was 89% (95% CI, 0.785-0.890; p < 0.001). The optimal cut-off value of NLR for postoperative intensive care unit (ICU) admission was determined to be 6.64. CAR was a predictive factor for 1-year postoperative mortality and postoperative ICU admission, whereas NLR was a predictive factor for postoperative ICU admission.

PO110: Prognostic Value of Neutrophil-Lymphocyte Ratio in Patients with Advanced Lung Cancer After Particle Implantation

PO110: Prognostic Value of Neutrophil-Lymphocyte Ratio in Patients with Advanced Lung Cancer After Particle Implantation

Evaluation of Neutrophil/Lymphocyte Ratio, Low-Density Lipoprotein/Albumin Ratio, and Red Cell Distribution Width/Albumin Ratio in the Estimation of Proteinuria in Uncontrolled Diabetic Patients.

Introduction Diabetic nephropathy associated with end-stage renal disease (ESRD) is a significant public health problem due to its high morbidity and mortality. We aimed to improve the estimation of proteinuria in diabetic patients and potentially enhance risk stratification and clinical management strategies with the assessment of the correlation of the neutrophil/lymphocyte ratio (NLR), low-density lipoprotein/albumin ratio (LAR), and red cell distribution width/albumin ratio (RAR) with the proteinuria in the uncontrolled diabetes patient population. Methods This was a retrospective study including 327 patients with uncontrolled diabetes (HbA1c > 10%) seen in an outpatient clinic. The study enrolled patients over 18 years old, excluding those with active infections, malignancies, immunodeficiency, hematological diseases, pregnancy, breastfeeding, or type I diabetes. Patients using specific drugs affecting proteinuria or lipid levels were also excluded. Data from patients were retrospectively obtained, including gender, age, blood parameters, glucose, creatinine, albumin, cholesterol, triglyceride, and HbA1c levels, as well as spot urine protein and creatinine levels. Proteinuria was assessed using a spot urine protein/creatinine ratio (>0.30 indicated proteinuria). Patients were divided into two groups: group 1 (non-proteinuric with uncontrolled diabetes) and group 2 (proteinuric with uncontrolled diabetes). Demographics, laboratory results, and LAR, NLR, and RAR values were compared between the groups with univariate and multivariate analyses. All statistical analyses were performed using IBM SPSS Statistics for Windows software. For the statistical significance level, p<0.05 was accepted as meaningful. Results Among 327 patients with uncontrolled diabetes, 33.03% were proteinuric. Patients with proteinuria were significantly older (median age 65 vs. 61 years) and had higher NLR and RAR values. There were no significant differences observed in terms of LAR values between groups. Serum albumin levels were lower and urea levels were higher in the proteinuric group. A multivariate analysis was done to identify variables for the prediction of proteinuria. NLR and RAR were found to be independent predictors of proteinuria even after adjusting for potential confounders in the multivariate analysis. The model achieved a 71.9% correct classification rate. An NLR cutoff of 1.93 increased the likelihood of proteinuria 1.93-fold, while a RAR cutoff of 3.30 increased the likelihood 1.63-fold. Conclusions We found that the LAR ratio cannot be used to predict proteinuria in patients with HbA1C levels above 10, but the NLR and RAR ratios can guide the clinician regarding proteinuria and potentially enhance risk stratification and clinical management strategies before a detailed workup.

675 Are Postoperative Outcomes in Flap Operations Affected by Obesity?

Abstract Aim To explore the outcomes of flap surgeries and how obesity affects them. To find if there is a correlation between CBC indices (also inflammatory markers) with flap survival. Method All flap surgeries on adults in the collaborating departments in an Indian tertiary care hospital from 2021-2022 excluding finger flaps were prospectively analyzed. Data of 90 patients including postoperative complications, preoperative Neutrophil-Lymphocyte Ratio (NLR) were recorded.BMI is calculated to classify patients based on Asia-Pacific guidelines where BMI&amp;gt;25 is obese, 23-24.9 is overweight, &amp;lt;18 is underweight.Chi square tests were used to assess association between obesity, NLR and early (within 7 days of surgery) &amp;late (beyond 7 days) postoperative complications -flap loss, wound dehiscence, surgical site infection. Multiple regression model and ANOVA test were also done with these variables. Results There is significant association between patients’ obese or overweight habitus and postoperative surgical site complications. 38% early (p = 0.001) and 36% late (p = 0.044) complications happened in obese patients alone. There is significant association between NLR and early postoperative complications (p = 0.002).60% with high NLR values had severe early postoperative complications, compared to 16.7% of patients with normal NLR and 21.1% with mildly raised NLR. Obesity and high NLR [NLR 10-18 or moderate stress, NLR&amp;gt;18 or severe stress] independently have significant correlation (0.038 for obesity, 0.015 for NLR) with early postoperative complications. Conclusions Obesity combined with high preoperative NLR is a quick, inexpensive predictor of poor early postoperative flap survival.

The relationship between the cycle threshold value of SARS CoV-2 with neutrophil lymphocyte ratio (NLR), absolute lymphocyte count (ALC), severity degrees, long of treatment, and outcomes COVID-19 patients

Link of Video Abstract: https://youtu.be/uGfZNQrEQqY Background: Coronavirus disease 2019 (COVID-19) has caused serious public health problems since the end of 2019. Viral load is known in COVID-19 infection, which indicates the number of causative agents and is indirectly assessed by the Cycle threshold value (Ct value). Ct value assessment has not been declared an essential parameter in COVID-19 infection. Due to the high number of COVID-19 cases, an additional strategy is needed to help identify patients at high risk of experiencing severe clinical conditions by knowing the relationship between the Ct value of SARS CoV-2 and neutrophil lymphocyte ratio (NLR), absolute lymphocyte count (ALC), severity, length of stay, and outcomes. Methods: This was an analytic observational study with cross-sectional approach in confirmed COVID-19 patients to investigate the relationship between the Ct value of SARS CoV-2 and NLR, ALC, severity, length of stay, and outcome of COVID-19 patients. There were 337 patients analyzed with chi square test. Results: The results of this study indicate that the majority of subjects were male (51%), aged &lt;60 years (27%), Ct value ≤29 (70%), had a critical severity (36.5%), length of stay &gt;10 days (64.1%) and survived (74.7%). Inflammatory markers examination shows NLR&lt;3,13 (57.9%) and ALC&lt;1500 (66.2%). The chi-square test shows a significant relationship between Ct value and ALC, degree of severity, and outcome in COVID-19 patients (p &lt;0.05). No association was found between Ct value, NLR, and length of stay (p&gt;0.05). Conclusion: There is a relationship between Ct value and ALC, degree of severity, and outcome in COVID-19 patients.

Short-term prognostic predictive value of the neutrophil/lymphocyte ratio combined with prognostic nutritional index in hepatitis B virus-related acute-on-chronic liver failure

Objective: To explore the prognostic predictive value of neutrophil/lymphocyte ratio (NLR) combined with prognostic nutritional index (PNI) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: Clinical data from 149 HBV-ACLF patients admitted to the infectious diseases Department of the General Hospital of Ningxia Medical University were retrospectively analyzed. Demographic data of the enrolled patients and the initial clinical-related data after admission were collected. Patients were divided into survival (93 cases) and death groups (56 cases) according to their prognostic condition 90 days after discharge. Demographic and clinical differences were compared between the two groups data. Receiver operating characteristic (ROC) curves were plotted to determine the optimal cutoff values for NLR and PNI in predicting the 90-day mortality rate of HBV-ACLF patients. The COX regression model was used to conduct univariate and multivariate analyses to investigate the correlation between NLR and PNI and the prognosis of HBV-ACLF patients. Kaplan-Meier survival analysis was used to explore the effects of NLR and PNI on the survival of HBV-ACLF patients. Results: The death group NLR was higher than that of the survival group, while the PNI was lower than that of the survival group, with a statistically significant difference. The area under the receiver operating characteristic curve (0.842, 95% CI: 0.779-0.906) showed patients with adverse prognosis assessed by NLR combined with PNI had a superior prognosis than that of the Model for End-Stage Liver Disease (MELD) and its combined serum sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores. COX regression analysis showed that NLR≥3.03 and MELD score were independent risk factors affecting the prognosis of HBV-ACLF patients. PNI > 36.13 was a protective factor for evaluating the prognosis of HBV-ACLF patients. Conclusion: NLR combined with PNI can enhance the prognostic predictive value of HBV-ACLF.

Neutrophil to Lymphocyte Ratio As A Predictor of Endoscopic Damage in Caustic Injuries

Objective: To assess the ingestion of caustic substances is a medical emergency and esophagogastroduodenoscopy (EGD) is helpful in diagnosis, prognostication and management. Here, we investigated the NLR of patients, to assess the correlation of neutrophil lymphocyte ratio (NLR) with degree of caustic injury and to evaluate whether NLR can predict the degree of caustic endoscopic injury. Method: This cross sectional study was carried out on 180 patients in gastroenterology department of DHQ teaching hospital, Gujranwala from 1st Jan 2021 to 31 Dec 2021. The endoscopy was performed and CBC was sent for analysis of NLR. The esophageal and stomach mucosal injury was graded by Zargar's classification and divided into low grade and high grade. Independent sample t test was used for comparison between mean NLR versus low and high grade injury. Results: Patients with high grade damage has remarkably higher values of NLR as compared to low grade. For prediction of grade of damage, ROC analysis was used and AUC (area under curve) value was 0.838 (95% CI (0.783-0.894, p&lt;0.001) and if we take NLR cut-off value as 3.5, the sensitivity will be 96.0% and specificity 63.3%, if we take cut-off value as 4.5, the sensitivity will be 93.1% and specificity 48.1% and if we take cut-off value as 5.5, the sensitivity will be 75.2% and specificity 35.4%. Conclusion: Neutrophil to lymphocyte ratio can predict degree of gastroesophageal injury in patients with caustic ingestion.

A COMPARISON OF NEUTROPHIL LYMPHOCYTE RATIO (NLR) BEFORE AND AFTER ANTI TUBERCULOSIS TREATMENT BASED ON AGE AND SEX CHARACTERISTICS

Indonesia is ranked third in the world with the most Tuberculosis (TB) cases. TB is an infection caused by bacteria thus can cause an inflammatory response then affects Neutrophil Lymphocyte Ratio (NLR). Anti-tuberculosis treatment with bactericidal and sterilization principles is expected to kill TB germs and reduce NLR values. The aim of this study was to analyze the NLR values in tuberculosis patients before and after anti-tuberculosis treatment based on age and sex characteristics. This is an analytic observational study using retrospective cohort approach in patients diagnosed with TB at the Muhammadiyah Kendal Hospital during January - August 2022. 70 samples were obtained through a purposive sampling method. This research used secondary data laboratory results consist of identity and NLR values before and after anti-tuberculosis treatment then analyzed with SPSS. Research data distribution wasn't normal. Results showed there was a significant comparison which was lower NLR values after treatment (p &lt;0.001) and a significant conversion of NLR values from abnormal to normal (p &lt;0.001). There was no significant difference based on sex before (p = 0.758) and after (p = 0.115) treatment. No significant difference was found by age category before (p = 0.174) and after (p = 0.284) treatment. Comparison of NLR values before and after anti-tuberculosis treatment found that there was a decrease in NLR values and most of the conversions were from abnormal to normal, but there were no differences based on age or sex characteristics.

Correlation of Severity of Depression with a Novel Inflammatory Marker: Neutrophil to Lymphocyte Ratio

Introduction: Many new inflammatory markers are being extensively used recently for assessing the severity and prognosis of chronic conditions. Neutrophil-Lymphocyte ratio (NLR) because of its simplicity and affordability stands out. Its applicability to psychiatric disorders specifically Depression is an eye-opener. Hamilton Rating Scale for Depression (HAM-D), a clinician-based scoring system is better among other self-scoring systems where the study population is semi-illiterate. Materials and Method: Total of 80 patients over a period of 1 year presenting to psychiatric OPD with depressive symptoms were evaluated for the severity of Major Depressive Disorder (MDD) using HAM-D scale. A score of 7-17, 18-24 and &gt;25 was categorised under mild, moderate, and severe degrees respectively. NLR was calculated and was correlated with their severity. Statistical analysis was done using PSPP software and p value of &lt;0.05 was considered significant. Results: Out of the 80 patients 45 were females and 35 were males. The average age was 35.41 years ± 10.13 SD. 23 patients categorised under mild depression had mean NLR of 1.56 ± 0.46 SD, 40 patients with moderate depression and 17 patients with severe depression had mean NLR of 2.70 ± 1.08 SD and 4.62 ± 1.31 SD respectively. The mean value of NLR for patients of severe depression lied in the Mild-Moderate Inflammation zone (3-7). P-value was &lt;0.05 and was considered significant. Discussion: A novel and easy biomarker like NLR can be as useful as assessing Inflammatory Cytokines like IL-6, IL-1 and TNF-α for assessing the severity of MDD. Rise of cortisol in persistent stress favours an increase in neutrophils and a reduction in lymphocytes, and thus, increased NLR. Thus, a rise of NLR with increasing severity of Depression could become a robust tool in future for predicting mortality and severity in patients suffering from MDD.

The Effectiveness of Meloxicam Adjuvant Therapy against Negative Symptoms and Neutrophil Lymphocyte Ratio (NLR) in Schizophrenic Patients

Highlights:1. The NLR value can show the role of neuroinflammation in schizophrenic patients.2. Meloxicam as adjuvant therapy can improve negative symptoms and changes in the NLR in schizophrenic patients. AbstractIntroduction: Neutrophil-lymphocyte ratio is a simple and affordable marker of inflammation that has recently been widely used to assess systemic inflammation in psychiatric patients. This study aimed to determine and analyze the effectiveness of meloxicam as adjuvant therapy to improve negative symptoms and changes in the neutrophil-lymphocyte ratio (NLR) in schizophrenic patients. Methods: This was a quasi-experimental study using a single-blind, pretest–post-test design. Subjects were determined using a purposive sampling technique based on inclusion criteria. This study examined 34 samples and divided them into two groups. The treatment group consisted of 17 subjects who received adjuvant therapy with meloxicam 15 mg/day for 4 weeks and 17 subjects in the control group. Data collection was obtained from medical records, interviews, field notes, positive scale, negative scale, and general psychopathology scale (PANSS) assessment sheets, and blood NLR examinations. Data analysis used SPSS 25.0.Results: The negative subscale PANSS score in the treatment group decreased lower than in the control group, with p-value = 0.640. However, the decrease in NLR values was more significant in the treatment group than in the control group, with p-value = 0.094. There was a decrease in the negative subscale PANSS scores and clinical NLR scores, but it was not statistically significant.Conclusion: Adjuvant therapy with Meloxicam, given once a day for four weeks, had an effect on decreasing the negative subscale PANSS score and NLR scores for schizophrenic patients at Dr. Arif Zainudin Regional Mental Hospital (RSJD), Surakarta, clinically, but it was not statistically significant.

The Role of the Multi-Inflammatory Index as a Novel Predictor of Hospital Mortality in Acute Ischemic Stroke.

Background and objective Ischemic strokes account for the majority of all strokes. The severity of an acute ischemic stroke (AIS) can be estimated with the help of a number of different scoring systems. However, there is a need for bedside tests that will support the clinical diagnosis and thus help predict the severity of stroke. The researchon the multi-inflammatory index (MII), which is calculated using hemogram parameters, has shown immense promise. In light of this, the aim of this study was to establish the association between MII and the severity of AIS. Methods The study included 452 ischemic stroke patients over the age of 18 years who presented to the hospital within 72 hours of the onset of symptoms.Demographic information such as patient age and gender, hemogram parameters, ratios, indices, hospitalization, and mortality status were all recorded. The demographic data, hemogram parameters, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein (CRP)/lymphocyte ratio (CLR), and MII 1, 2, and 3 were compared between surviving and deceased patients. Results The MII-1, MII-2, and MII-3 index values were determined to be significantly low in the patients with Glasgow Coma Scale (GCS) scores of 13-15 compared to those with GCS scores ≤8, and inpatients with National Institutes of Health Stroke Scale (NIHSS) score of 1-4 compared to those with scores of 5-14, 15-20, and ≥21. The NLR, CLR, PLR, MII-1, MII-2, and MII-3 index values were significantly higher in the non-survivors (PLR: p=0.004, all other values: p<0.001). The performances of multiple models developed for the mortality cut-off points were evaluated. Together with other factors, Model 1 included the MII-1, Model 2 the MII-2, and Model 3 the MII-3. Although there was no significant difference between the AUC values of the models, the highest sensitivity rate was reached with Model 2 (74.48%), and the highest specificity rate with Model 3 (90.62%). Conclusion Based on our findings, MII is a simple and practical biomarker that can be easily obtained from NLR, PLR, and CRP, and can help in the early detection of poor prognosis in AIS. NLR was found to be superior to PLR and CLR in distinguishing fatal AIS cases.

Mean platelet volume, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and early post-operative anesthesia complications

Abstract Objectives We aimed to establish the relationship between pre-operatively measured mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) values and early anesthetic complications like bronchospasm &amp; laryngospasm and hypotension in patients undergoing adenotonsillar surgery and non-adenotonsillar surgeries in both pediatric and adult population. Methods Patients from both sexes aged 1–63 years, and the American Society of Anesthesiology (ASA) physical status I–II were included in the study with elective adenotonsillectomy and non-adenotonsillar surgeries. Results In total, we included 330 patients in our study. The respiratory complications observed significantly more frequent in pediatric adenotonsillar surgery group (p=0.001). When the post-operative complications were compared with the MPV, NLR and PLR values, it was observed that the MPV values were significantly higher in patients who had hypotension (p=0.01) and PLR values were significantly higher in pediatric adenotonsillectomy group who developed bronchospasm and laryngospasm. There was no relationship between other complications and the laboratory values of the groups. Conclusions In the study, we found that PLR values were significantly high in the pediatric patients having hypoxia who underwent adenotonsillectomy. MPV values were significantly high in the patients who had hypotension in the early post-operative period. Based on these findings, it has been suggested that pre-operative PLR value can be a predicting guide for bronchospasm, laryngospasm. On the other hand, MPV values can be used as a guide in terms of predicting hypotension.

The Difference in Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), and Lactate Levels Between Sepsis and Septic Shock Patients Who Died in The ICU

Introduction: Sepsis and septic shock are organ dysfunctions caused by the dysregulation of the body's response to infection and are the most common causes of death. Objective: This study aims to describe the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lactate levels in patients with sepsis and septic shock who died in the Intensive Care Unit (ICU). Materials and Methods: An observational retrospective study was conducted by examining the medical record data of sepsis and sepsis shock patients who were hospitalized in the ICU of Dr. Soetomo General Academic Hospital Surabaya from January to December 2019. Results: The study sample was 28 patients: 16 with sepsis and 12 with septic shock. Fifteen patients (53.6%) were women. The patients’ mean age was 53.18 ± 13.61 years, and most patients (8 patients, 28.6%) belonged to the late adult age group (36-45 years). The most common comorbidities were diabetes mellitus and hypertension (30.8%). The highest incidence of infection in both groups occurred in the lungs (42.9%). Most of the patients had high SOFA scores, in the moderate (7-9) to severe (≥ 10) category (39.3%). Almost all patients (82.1%) were treated for less than one week. The hematological examination within the first 24 hours showed a leukocyte value of 16,995 (Leukocytosis) and a platelet value of 279,500 (Normal). The NLR of septic shock patients (31.38±55.61) was higher than the NLR of sepsis patients (23.75±22.87). The PLR of septic shock patients (534.02±1000.67) was lower than the PLR of patients (802.93±1509.89). Lastly, the lactate levels in septic shock patients (3.84±1.99) were higher than in sepsis patients (1.97±1.06). Conclusion: There were no significant differences in the NLR and PLR values ​​between sepsis and septic shock patients, but there were significant differences in their initial lactate levels.

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio, are they markers of COVID-19 severity or old age and frailty? A comparison of two distinct cohorts.

The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are simple markers of systemic inflammatory responses. It has been previously suggested that they can predict COVID-19 severity. Age and frailty may also influence their values. This study aimed to evaluate the impact of COVID-19 severity versus age and frailty on NLR and PLR values. This was a retrospective, observational two cohorts' comparative study. The first cohort is comprised of patents positive for SARS-CoV-2, with mild or asymptomatic disease, admitted to designated COVID-19 departments in a large geriatric medical center (GMC). The second included patients with COVID-19 admitted to designated COVID-19 departments in a large general hospital for symptomatic disease from March 2020 to March 2021. We compared baseline characteristics including comorbidities and chronic medications, disease symptoms, laboratory tests and compared the NLR and PLR between the two groups. The 177 patients admitted to the COVID-designated department in the GMC were over three decades older than the 289 COVID-19 patients admitted to the general hospital care (HC). They had substantially more comorbidities and chronic medications. All common disease symptoms were significantly more common in the HC group. Almost two thirds of the GMC patients remained asymptomatic compared to 2.1% in the HC group. Inflammatory markers, such as CRP and LDH, were significantly higher in the HC group. The NLR and PLR were both significantly higher in the GMC cohort comprised of older frailer patients with milder disease. NLR and PLR seem to be affected more by age and frailty than COVID-19 severity.

Hematological Indices Are Useful in Predicting Complications of Liver Cirrhosis.

Liver cirrhosis is the final stage of chronic liver disease. We aimed to evaluate non-invasive scores as predictors of complications and outcome in cirrhotic patients. A total of 150 cirrhotic patients were included. Models for end-stage liver disease (MELD), albumin-bilirubin (ALBI) score, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MoLR), and neutrophil-lymphocyte-albumin ratio (NLA) scores were tested in relation to the development of complications and mortality using receiver operating characteristic (ROC) curves. The ROC curve analysis showed (area under the curve) AUC values of NLR, NLA, ALBI, and MELD of 0.711, 0.730, 0.627, and 0.684, respectively, for short-term mortality. MELD, ALBI, and NLA scores showed a statistically significant correlation with hepatic encephalopathy (p = 0.000 vs. 0.014 vs. 0.040, respectively), and the MELD cut-off value of 16 had a sensitivity of 70% and a specificity of 52% (AUC: 0.671, 95% CI (0.577-0.765)). For the assessment of the presence of ascites, the AUC values for NLA and MoLR were 0.583 and 0.658, respectively, with cut-offs of 11.38 and 0.44. MELD, ALBI, and NLA are reliable predictors of hepatic encephalopathy. NLA and MoLR showed a significant correlation with the presence of ascites, and MELD, ALBI, NLR, and NLA have prognostic value to predict 30-day mortality in cirrhotic patients.