Neutrophil-to-lymphocyte Ratio Research Articles

The neutrophil-to-lymphocyte ratio for acute allograft rejection and delayed graft function prediction in kidney transplant recipients: a meta-analysis.

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been the focus of several observational studies investigating their roles in acute allograft rejection (AR) and delayed graft function (DGF) among kidney transplant (KT) recipients. This meta-analysis evaluated the impact of the NLR and PLR on the incidence of AR and DGF in KT recipients. We searched PubMed, MEDLINE and Science Direct from their inception through October 2023. Random effects models were used. To investigate potential sources of heterogeneity, we performed subgroup and meta-regression analyses. The Comprehensive Meta-Analysis ver. 3 software package was used. Seven studies (247 KT recipients with AR or DGF and 475 controls) were analyzed. Our pooled analysis showed a significantly higher NLR in KT recipients with AR (weighted mean difference [WMD], 2.292; 95% confidence interval [CI], 1.449-3.135; P<0.001) than in controls. The preoperative NLR was insignificantly higher in patients with DGF (WMD, 0.871; 95% CI, -0.103 to 1.846; P=0.08). The PLR was insignificantly higher in KT recipients with AR than in controls (WMD, 32.125; 95% CI, -19.978 to 84.228; P=0.227). The PLR was not significantly different between KT recipients with DGF and controls. Region, publication year, sample size, donor type, biopsy type, AR type and Newcastle-Ottawa Scale score did not affect the outcomes of the meta-analysis. Meta-regression showed that publication year and donor type might be sources of heterogeneity. This study revealed a significantly higher NLR in patients with AR. This suggests that NLR may be utilized as a noninvasive marker for AR in KT recipients.

The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients: a retrospective study

The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients: a retrospective study

Mortality Risk Prediction in Patients With Antimelanoma Differentiation-Associated, Gene 5 Antibody-Positive, Dermatomyositis-Associated Interstitial Lung Disease: Algorithm Development and Validation.

Patients with antimelanoma differentiation-associated gene 5 antibody-positive dermatomyositis-associated interstitial lung disease (anti-MDA5+DM-ILD) are susceptible to rapidly progressive interstitial lung disease (RP-ILD) and have a high risk of mortality. There is an urgent need for a reliable prediction model, accessible via an easy-to-use web-based tool, to evaluate the risk of death. This study aimed to develop and validate a risk prediction model of 3-month mortality using machine learning (ML) in a large multicenter cohort of patients with anti-MDA5+DM-ILD in China. In total, 609 consecutive patients with anti-MDA5+DM-ILD were retrospectively enrolled from 6 hospitals across China. Patient demographics and laboratory and clinical parameters were collected on admission. The primary endpoint was 3-month mortality due to all causes. Six ML algorithms (Extreme Gradient Boosting [XGBoost], logistic regression (LR), Light Gradient Boosting Machine [LightGBM], random forest [RF], support vector machine [SVM], and k-nearest neighbor [KNN]) were applied to construct and evaluate the model. After applying inclusion and exclusion criteria, 509 (83.6%) of the 609 patients were included in our study, divided into a training cohort (n=203, 39.9%), an internal validation cohort (n=51, 10%), and 2 external validation cohorts (n=92, 18.1%, and n=163, 32%). ML identified 8 important variables as critical for model construction: RP-ILD, erythrocyte sedimentation rate (ESR), serum albumin (ALB) level, age, C-reactive protein (CRP) level, aspartate aminotransferase (AST) level, lactate dehydrogenase (LDH) level, and the neutrophil-to-lymphocyte ratio (NLR). LR was chosen as the best algorithm for model construction, and the model demonstrated excellent performance, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.866, a sensitivity of 84.8%, and a specificity of 84.4% on the validation data set and an AUC of 0.90, a sensitivity of 85.0%, and a specificity of 83.9% on the training data set. Calibration curves and decision curve analysis (DCA) confirmed the model's accuracy and clinical applicability. Moreover, the model showed strong predictive performance in the external validation cohorts (cohort 1: AUC=0.836, 95% CI 0.754-0.916; cohort 2: AUC=0.915, 95% CI 0.871-0.959), indicating good generalizability. This model was integrated into a web-based tool to predict the 3-month mortality for patients with anti-MDA5+DM-ILD. We successfully developed a robust clinical prediction model and an accompanying web tool to estimate the 3-month mortality risk for patients with anti-MDA5+DM-ILD.

Association between systemic inflammatory response index and glaucoma incidence from 2005 to 2008

ObjectiveThis study aimed to investigate the association between the Systemic Inflammatory Response Index (SIRI) and glaucoma using data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES).MethodsWe performed a cross-sectional analysis using data from NHANES (2005–2008). Among participants who underwent non-mydriatic retinal imaging and Frequency Doubling Technology (FDT) visual field testing, 4,514 were included after excluding those with missing key variable data. SIRI and other inflammatory indices, including the systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), were calculated from blood samples. Logistic regression models were employed to assess the relationship between these indices and glaucoma, adjusting for demographic and health-related variables.ResultsA significant positive association was found between elevated log2SIRI levels and the prevalence of glaucoma (Model 3: OR 1.24, 95% CI 1.07–1.44, p &amp;lt; 0.005). We performed an in-depth analysis of the Log2SIRI quartiles and found a significant association between Log2SIRI Q4 and the occurrence of glaucoma (Model 3: OR1.62, 95%CI 1.12–2.34, p = 0.011). This correlation was further validated using the area under the receiver operator characteristic curve (AUC) in Model 3(AUC = 0.674).ConclusionElevated SIRI levels are significantly associated with the prevalence of glaucoma, highlighting the potential role of systemic inflammation in glaucoma pathogenesis. SIRI may serve as a useful biomarker for identifying individuals at risk of glaucoma, facilitating early detection and targeted intervention strategies. Further research is needed to validate these findings and explore their clinical applications.

The association of lipid accumulation product with inflammatory parameters and mortality: evidence from a large population-based study

BackgroundObesity is closely associated with lipid metabolism, and the accumulation of lipids leads to low-level inflammation in the body, which can trigger cardiovascular disease. This study aimed to explore the association between a novel marker of lipid accumulation, the abdominal volume index (AVI), inflammatory parameters, and mortality.MethodsThis study enrolled 2,109 older adult senior citizens (aged over 60 years) with hypertension from the National Health and Nutrition Examination Survey. The primary endpoints included all-cause mortality and cardiovascular mortality, which were assessed by linking the data to the National Death Index records. Cox regression model and subgroup analysis were constructed to investigate the associations between AVI and both all-cause and cardiovascular mortality. Restricted cubic splines were employed to further explore the relationships among AVI, inflammatory parameters, and mortality. By considering inflammatory factors as mediators, we investigate the mediating effects of AVI on mortality.ResultsAfter a median follow-up of 69 months, there were 1,260 deaths, with 337 attributed to cardiovascular causes within the older adult population studied. In the multivariable-adjusted model, AVI was positively associated with both all-cause and cardiovascular mortality [Hazard Ratio (HR) = 1.09, 95% CI = 1.06–1.11 for all-cause mortality; HR = 1.07, 95% CI = 1.03–1.12 for cardiovascular mortality]. Kaplan-Meier survival plots indicated an overall median survival time of 144 months. Mediation analysis revealed that Systemic Inflammatory Response Index (SIRI), Monocyte-to-HDL ratio (MHR), and Neutrophil-to-Lymphocyte ratio (NLR) mediated 27.15%, 35.15%, and 16.55%, respectively, of the association between AVI and all-cause mortality.ConclusionAVI is positively associated with all-cause mortality in older adults with hypertension, and this association appears to be partially mediated by inflammatory parameters.

Hypofractionated radiotherapy combined with a PD-1 inhibitor, granulocyte macrophage-colony stimulating factor, and thymosin-α1 in advanced metastatic solid tumors: a multicenter Phase II clinical trial.

This multicenter Phase II clinical study assessed the efficacy and safety of hypofractionated radiotherapy (HFRT) in combination with a PD-1 inhibitor, granulocyte macrophage-colony stimulating factor (GM-CSF), and thymosin-α1 in patients with heavily treated metastatic solid tumors. Patients were enrolled between September 2022 and May 2024. HFRT was administered to targeted tumors, and GM-CSF was administered for 14days from day 1 of radiotherapy. Thymosin-α1 was injected concurrently twice weekly until disease progression. Immunotherapy with camrelizumab was started following HFRT and repeated every 3weeks. GM-CSF was administered daily for 7days before each cycle of immunotherapy. By June 15, 2024, there were 37 study participants. The median follow-up duration was 5.97months (range 0.40-20.9). Median progression-free survival was 3.5months (95% confidence interval 2.73-4.23) in the intention-to-treat population. The objective response rate was 23.08%, and the disease control rate was 65.38%. Overall survival data are not yet mature. Abscopal effects were observed in 6 patients (23.08%); four of whom achieved a partial response. Patients who achieved a partial response were significantly more likely to have an abscopal effect( P = 0.025). The group with a lower baseline neutrophil-lymphocyte ratio had a significantly lower risks of distant metastasis and death( P = 0.024). Seventeen adverse reactions were reported, including six grade 3 or 4 adverse events. There were no grade 5 adverse events. In conclusion, the trends in efficacy observed in our study are promising; however, well-designed protocols are essential to validate these findings.

The association between eight complete blood count-derived inflammatory markers and muscle health

BackgroundMost studies have evaluated sarcopenia and muscle health solely based on muscle mass. This study comprehensively examined the associations between eight inflammatory indicators and muscle mass and strength, with the aim of identifying an indicator capable of evaluating muscle health across multiple dimensions.MethodsThis study included 10,440 participants from the National Health and Nutrition Examination Survey (NHANES, 2011–2018) and 5,384 participants from NHANES (2011–2014). Multivariate logistic regression, smooth curve fitting, restricted cubic spline (RCS) analysis, subgroup analysis, and Spearman's correlation were used to comprehensively assess the associations between the eight inflammatory indicators and muscle mass and strength. Receiver operating characteristic (ROC) curves were used to compare the predictive abilities of the different indices for low muscle mass and muscle strength. Additionally, NHANES data were cross-validated with data from 554 patients at our hospital to evaluate the ability of the systemic immune inflammatory index (SII) to distinguish between low muscle mass and strength.ResultsAfter controlling for all potential confounding factors, multiple logistic regression analysis revealed that apart from the platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and derived NLR (dNLR), the neutrophil-to-monocyte-plus-lymphocyte ratio (NMLR), neutrophil-to-lymphocyte ratio (NLR), SII, systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV) were significantly negatively correlated with muscle mass and strength. However, NMLR and NLR were significantly associated with changes in muscle mass only in Q4 (P &amp;lt; 0.05). In the stratified analysis by body mass index (BMI), only the SII, NLR, and NMLR were unaffected by BMI. In the cross-validation, the predictive performance of the SII for low muscle mass [area under the curve (AUC) = 0.699, 0.677, and 0.685] and low muscle strength (AUC = 0.857, 0.849, and 0.840) demonstrated a good reference value. RCS and smooth curve fitting analyses indicated that most inflammatory markers were linearly correlated with muscle health (P &amp;lt; 0.05).ConclusionCompared with other inflammatory markers (e.g., PIV and dNLR), the SII demonstrated a more robust predictive ability, was less influence by covariates, and exhibited high generalization performance in internal and external validation. SII may be crucial in identifying “hidden sarcopenia” and the early stages of muscle functional decline.

Hospital malnutrition and stroke: a study of nutritional risk and patient outcomes.

Introduction: Hospital malnutrition is a prevalent issue among stroke patients, with significant impacts on immune function and clinical outcomes. Malnutrition is associated with poor outcomes such as increased complications, prolonged recovery, and higher mortality. This study aims to assess the prevalence of malnutrition using the Malnutrition Screening Tool (MST) and its association with clinical outcomes, including length of stay (LOS), inflammatory markers, and mortality. Methods: A retrospective cohort study was conducted, including 230 stroke patients who were admitted between January 2022 and January 2024. Nutritional status was assessed using the MST, with key outcomes including LOS, Total Lymphocyte Count (TLC), Neutrophil-to-Lymphocyte Ratio (NLR), serum albumin, Prognostic Nutritional Index (PNI), and mortality. Statistical analyses were performed using chi-square tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables, with a p-value of &lt;0.05 considered statistically significant. Result: The study found that 26.5% of patients had an MST score of 2 or higher, indicating a high risk of malnutrition. Patients with high MST scores had significantly lower TLC (p = 0.017), indicating a weakened immune response. No significant differences were observed in LOS (p = 0.63), mortality (p = 0.404), or other inflammatory markers such as NLR, albumin, and PNI between the high-risk and low-risk groups. Conclusion: Malnutrition is common among stroke patients and is associated with impaired immune function, as evidenced by lower TLC in malnourished patients. Although no significant differences were observed in LOS or mortality, the findings underscore the importance of routine nutritional screening and timely intervention to improve patient outcomes.

Hospital malnutrition in gastro-entero-hepatology (GEH) patients and its relationship to clinical outcomes: a retrospective cohort study.

Background: Hospital malnutrition remains a significant global health burden, particularly among gastro-entero-hepatology patients. It adversely impacts clinical outcomes, prolongs hospital stays, and raises healthcare costs. Despite its relevance, recent data on malnutrition among Indonesia’s gastro-entero-hepatology (GEH) patients are limited. Objective: To determine the prevalence of malnutrition and its associated risk factors and clinical outcomes, inflammatory markers, and Prognostic Nutritional Index (PNI) in GEH patients at Wahidin Sudirohusodo General Hospital. Methods: A retrospective cohort study was conducted among 569 GEH inpatients aged 18–59 years with hospital stays exceeding 7 days. Nutritional risk was assessed using the Malnutrition Screening Tool (MST), while Neutrophil-Lymphocyte Ratio (NLR), Total Lymphocyte Count (TLC), and Prognostic Nutritional Index (PNI) were measured as inflammatory markers. Statistical analyses evaluated correlations between malnutrition risk, clinical outcomes, and laboratory values. Results: Of the 569 patients, 7.4% were at high risk of malnutrition, 38.7% at moderate risk, and 54% at low risk. High-risk patients showed significantly elevated NLR (p = 0.000) and lower TLC (p = 0.000), reflecting an impaired immune response. These patients also had a lower PNI (p = 0.000) and more extended hospital stays (p = 0.000). No significant difference in mortality was found between different malnutrition risk groups. Conclusion: Malnutrition is prevalent among GEH patients, particularly those with malignancies. Early nutritional screening and appropriate interventions are essential to improving clinical outcomes and reducing hospital stay durations. A multidisciplinary approach is necessary to optimize patient care.

Peripheral blood-derived immune cell counts as prognostic indicators and their relationship with DNA methylation subclasses in glioblastoma patients.

Glioblastomas are known for their immunosuppressive tumor microenvironment, which may explain the failure of most clinical trials in the past decade. Recent studies have emphasized the significance of stratifying glioblastoma patients to predict better therapeutic responses and survival outcomes. This study aims to investigate the prognostic relevance of peripheral immune cell counts sampled prior to surgery, with a special focus on methylation-based subclassification. Peripheral blood was sampled in patients with newly diagnosed (n = 176) and recurrent (n = 41) glioblastoma at the time of surgery and analyzed for neutrophils, monocytes, leukocytes, platelets, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and platelet-lymphocyte ratio. Peripheral immune cell counts were correlated with patients' survival after combined radiochemotherapy. In addition, 850 k genome-wide DNA methylation was assessed on tissue for defining tumor subclasses and performing cell-type deconvolution. In newly diagnosed glioblastoma, patients with higher peripheral neutrophil counts had an unfavorable overall survival (OS) (p = 0.01, median overall-survival (mOS) 17.0 vs. 10.0 months). At the time of first recurrence, a significant decrease of peripheral immune cell counts was observed, and elevated monocyte (p = 0.03), neutrophil (p = 0.04), and platelet (p = 0.01) counts were associated with poorer survival outcomes. DNA methylation subclass-stratified analysis revealed a significant survival influence of neutrophils (p = 0.007) and lymphocytes (p = 0.04) in the mesenchymal (MES) subclass. Integrating deconvolution of matched tumor tissue showed that platelets and monocytes were correlated with a more differentiated, tumor-progressive cell state, and peripheral immune cell counts were most accurately reflected in tissue of the MES subclass. This study illustrates a restricted prognostic significance of peripheral immune cell counts in newly diagnosed glioblastoma and a constrained representation in matched tumor tissue, but it demonstrates a more pertinent situation at the time of recurrence and after DNA methylation-based stratification.

Clinical analysis and risk factors associated with poor prognosis in nontuberculous mycobacterial infection

ABSTRACT Recently, the incidence and prevalence of NTM have been increasing nationwide in many countries. This study aimed to identify risk factors associated with the prognosis and mortality of non-HIV nontuberculous mycobacterial disease patients. This retrospective study was conducted at Peking Union Medical College Hospital. The electronic medical records in the hospital’s database from January 2013 to December 2022 were retrospectively reviewed. Relevant data, including clinical characteristics, laboratory findings, microbiological tests, treatments, and outcomes were collected and subjected to statistical analyses. The search identified 745 patients diagnosed with NTM infection, of whom 147 met the inclusion criteria. NTM pulmonary disease was the most commonly observed (n = 93; 63.3%), followed by disseminated infection (n = 43; 29.3%). The most frequent NTM species was Mycobacterium avium complex (55.8%), followed by Mycobacterium abscessus (21.2%). The incidence of Aspergillus and Pseudomonas aeruginosa infection was significantly higher in the NTM pulmonary disease group than in the disseminated NTM group. Cumulative mortality in the total patients was 24.49% at 5 years. High Charlson Comorbidity Index (CCI), high neutrophil-to-lymphocyte-ratio (NLR), haematological disease, and disseminated infection were identified as independent predictors of unfavourable outcomes. The area under the curve (AUC) values for NLR and neutrophil-to-monocyte-plus-lymphocyte-ratio (NMLR) were 0.751 and 0.763 with optimal cut-off values of 9.50 and 3.83, respectively, for prediction of mortality in patients with NTM disease.

Assessing the Predictive Value of the Neutrophil-to-Lymphocyte Ratio for Post-Thrombotic Syndrome following Iliofemoral Deep Venous Thrombosis

Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT) that occurs in 20-50% of patients and results in a decreased quality of life. Even with the progressive identification of PTS risk factors, clinically useful predictors of PTS continue to be limited, unobjective, and ill-defined. The neutrophil-to-lymphocyte ratio (NLR) is an emerging prognostic biomarker used in a variety of diseases that reflects acute systemic inflammation. This pilot study aimed to evaluate the utility of the NLR at the time of iliofemoral DVT diagnosis in predicting PTS incidence in patients. A retrospective chart review was performed on patients identified with iliofemoral DVT at the University of Maryland Medical Center between 2020 and 2022. Patients with at least one follow-up visit between 3 to 6 months after initial DVT diagnosis were included. Diagnosis of PTS was determined based on Villalta Score. The Youden index with receiver operating characteristic (ROC) curve analysis was used to determine the NLR cutoff value that was predictive of PTS. A multivariable logistic regression model was then performed to assess the utility of this NLR cutoff value and other common clinical markers in predicting the presence of PTS symptoms. 418 patients with positive iliofemoral DVT venous duplex ultrasounds were screened for eligibility. 118 patients were eligible with a mean age of 53.18 ± 15.45 years. A total of 43 patients (36.44%) were found to have PTS. A NLR cutoff of 7.71 was determined with an area under the ROC curve (AUC) of 0.63 (p=0.046). When the NLR was assessed jointly with other clinical markers at the time of DVT diagnosis, NLR was a statistically significant positive predictor, measured using odds ratio (OR, 1.83; 95% CI, 1.20-2.78; p=0.005). Our study found that when stratified by a determined cutoff value, the NLR at the time of DVT diagnosis was significantly associated with the development of PTS in patients with iliofemoral DVT. This result is consistent with one prior research finding yet is novel in its specificity for iliofemoral DVTs and its acute lab collection for NLR calculation. The NLR should be further investigated as a potential inexpensive prognostic tool to aid in the improvement of treatment and prophylactic strategies for PTS.

Neutrophil-to-Lymphocyte Ratio Predicts Dialysis Timing & Prognosis in Critically Ill Patients.

The neutrophil-to-lymphocyte ratio (NLR) is a cost-effective indicator of inflammation, which may impact decisions regarding therapy for patients undergoing continuous renal replacement therapy (CRRT), even with ongoing clinical arguments. This study aimed to examine the correlation between NLR and the prognosis of critically ill patients undergoing CRRT, specifically about mortality and morbidity. Additionally, the study sought to assess NLR's potential as a prognostic indicator for CRRT initiation. Data were retrospectively analyzed from 175 critically ill patients who received CRRT. Clinical factors and biochemical markers were compared between survivors and non-survivors at admission, before CRRT, and at 24 and 72 h post-CRRT initiation. Elevated NLR levels were significantly associated with increased in-hospital mortality. Neutrophil counts showed statistical significance across all measurement points, while NLR and lymphocyte counts were significant only on the third day of CRRT (p 0.001 and 0.011, respectively). Non-survivors had higher NLR values than survivors and experienced shorter hospital stays (median 22 vs. 44 days for survivors, p < 0.001). Patients with higher baseline NLR values also had more complications. The NLR shows potential as a prognostic predictor for mortality in CRRT patients. Its integration into clinical practice could enhance patient care and treatment timing, and further studies should validate its clinical utility.

Correlation of newer inflammatory markers in patients with type 2 diabetes mellitus: A cross-sectional study

Background: Globally, diabetes mellitus (DM) is a major health concerns and has reached alarming levels. DM is a group of metabolic disorders characterized by hyperglycemia leading to micro- and macro-vascular complications. Chronic low-grade inflammation is associated with the pathophysiology of DM. Aims and Objectives: The present study aimed to assess the levels of neutrophil-to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and other inflammatory markers in T2DM patients and their correlation with blood sugar and HbA1c. Materials and Methods: This cross-sectional study was conducted in Department of Biochemistry in association with Department of General Medicine and Pathology, NRI Institute of Medical Sciences (NRIIMS), Visakhapatnam, Andhra Pradesh, India. In this study, 90 T2DM patients and 90 non-diabetic subjects were recruited. Fasting and post-prandial blood samples were collected and used for the estimation of blood sugar, urea, creatinine, and lipid profile parameters. Whole blood (EDTA) samples were used for analysis of complete blood count (CBC) and HbA1c. NLR, PLR, SII, SIRI, MHR, NHR, LHR, and PHR were calculated from CBC values. Demographic details were collected. Results: In this study, significant increase in blood pressure (systolic [120.4±8.1 mmHg], diastolic [80.2±4.8 mmHg]), fasting blood sugar (FBS) (162.5±53.7 mg/dL), post-prandial blood sugar (238.3±78.8 mg/dL), HbA1c (8.5±2.2%), urea (28.6±8.6 mg/dL), creatinine (1.1±0.2 mg/dL), total cholesterol (186.8±46.1 mg/dL), triglycerides (168.9±61.2 mg/dL), LDLC (115.0±36.3 mg/dL), VLDL (33.8±12.4 mg/dL), and neutrophil count (66.6±11.4%) was observed in T2DM cases. Inflammatory markers such as NLR (4.2±1.1), PLR (0.17±0.01), SII (12.6±3.6), SIRI (25.7±5.2), MHR (0.15±0.08), NHR (1.9±0.72), and PHR (0.07±0.02) were significantly increased in T2DM cases than non-diabetic subjects. FBS was positively correlated with SIRI (r=0.180), MHR (r=0.257), NHR (r=0.418), and PHR (r=0.212). Similarly, HbA1c positively correlated with NHR (r=0.353) and PHR (r=0.177) in T2DM subjects. In this study, HDLC level and lymphocyte count was significantly decreased in T2DM cases. Conclusion: The study may conclude that increased levels of NLR, PLR, SII, SIRI, MHR, NHR, and PHR in T2DM and their positive correlation with blood sugar and HbA1c may serve as alternate markers of inflammation and are useful to assess the impact of systemic inflammatory response in T2DM patients.

Sub-clinical systemic inflammation as a determinant of admission duration in psychosis.

The immune system may play an important role in the aetiology of psychotic disorders and there is increasing interest in the relationship between immune markers and clinical outcomes in psychosis. The present study investigated whether subclinical systemic inflammation was associated with length of stay in individuals with psychosis admitted to a psychiatric hospital. We tested the hypothesis that a higher level of subclinical systemic inflammation, as measured by the neutrophil-to-lymphocyte ratio (NLR) would be associated with a longer period in hospital. Retrospective cohort study based on electronic health records. We included patients with a psychosis spectrum disorder (ICD10: F20-F29) who had a routine blood test upon being admitted to a psychiatric hospital within the South London and Maudsley NHS Foundation Mental Health Trust, London, UK between 2013 and 2019. Multiple linear regression was used to determine the association between the NLR at the time of admission and the duration of the corresponding hospital stay, adjusting for covariables. Data from 1683 individuals with psychosis were analyzed. The median admission duration was 31days (interquartile range=48days). Higher neutrophil-to-lymphocyte ratio (NLR) was significantly associated with longer admission (B = 0.07, p<0.003) after adjusting for covariates. An association between a NLR and a longer admission, whilst controlling for relevant covariables, was observed highlighting the potential utility of inflammatory markers as prognostic marker in clinical settings.

Diagnostic and prognostic relevance of inflammatory markers in surgically treated thymic epithelial tumors: An international multicenter study.

Complementary prognostic markers are needed in thymic epithelial tumors (TETs) to aid patient stratification and determine the most appropriate follow-up strategies. This study aimed to assess the diagnostic and prognostic relevance of blood-based inflammatory markers in a large cohort of surgically treated TET patients. A total of 743 TET patients who underwent surgical resection between 1999-2021 were included in this multicenter study. Inflammatory markers were recorded from the most recent preoperative blood cell count prior to surgery. Measured variables were rescaled and harmonized to obtain comparable values across the participating centers. Preoperative CRP was significantly higher in TET patients with increased tumor size (vs. those with T1 tumors, p=0.035). Likewise, neutrophil-to-lymphocyte ratio (NLR) (p=0.002) and platelet-to-lymphocyte ratio (PLR) (p<0.001) were both significantly higher in thymic carcinomas than in thymomas. Notably, increased NLR and PLR were mainly attributed to significantly decreased lymphocyte levels in thymic carcinoma patients. Concerning survival outcomes, we found that elevated PLR and fibrinogen influenced overall survival (OS) (p=0.002 and p=0.018, respectively) and cause-specific survival (CSS) (p=0.002 and p=0.009, respectively) independently of other variables in our multivariate models, and they constituted negative prognosticators in TETs. Elevated CRP had an independent negative impact only on OS. Although elevated NLR was linked with impaired prognosis in our univariate model (p=0.008), its independent prognostic significance could not be validated. Using the so-far largest cohort of surgically treated TET patients, our study demonstrates that CRP, PLR, and NLR have diagnostic significance in TETs, while elevated PLR and fibrinogen constitute independent negative prognosticators for OS and CSS. Accordingly, the current multicenter study offers additional guidance in developing personalized surveillance protocols in thymoma and thymic carcinoma.

Weight and Blood-Based Markers of Cachexia Predict Disability, Hospitalization and Worse Survival in Cancer Immunotherapy Patients.

Cancer-associated cachexia can inhibit immune checkpoint inhibitor (ICI) therapy efficacy. Cachexia's effect on ICI therapy has not been studied in large cohorts of cancer patients aside from lung cancer. We studied associations between real-world routinely collected clinical cachexia markers and disability-free, hospitalization-free and overall survival of cancer patients. A retrospective study was conducted of electronic health records (EHR) of patients with lung, renal cell, melanoma and other cancers treated with ICI therapy at Northwestern Medicine of Chicago, IL, United States, between March 2011 and January 2022. Weight, body mass index, absolute neutrophil and lymphocyte counts, albumin and C-reactive protein (CRP) measures were analysed to calculate the Fearon consensus criteria for cachexia, weight loss grading system (WLGS) score, neutrophil-lymphocyte ratio (NLR), Prognostic Nutritional Index (PNI) and modified Glasgow Prognostic Score (mGPS) at ICI therapy initiation. Kaplan-Meier and Cox proportional hazards analyses were used to determine associations between these metrics and disability-free, hospitalization-free and overall survival. EHR analysis uncovered 3285 cancer patients on ICI therapy (54% > 65 years of age, 50.7% male, 77.7% White). At ICI therapy initiation, 1282 (39.0%) patients had cachexia (consensus criteria), 1641 (50.0%) had a WLGS score ≥ 2, 1806 (55.0%) had an NLR > 3, 1087 (33.1%) had albumin < 3.5 g/dL and 1318 (40.1%) had a PNI < 44. Missing measurements included CRP missing for 98.2% and mGPS missing for 98.6% of patients. Disability-free (n = 1373), hospitalization-free (n = 2374) and overall survival (n = 1599) events were analysed with 1-year rates of 65% (64%-67%), 35% (34%-37%) and 65% (63%-66%), respectively. Multivariate Cox model analyses showed hazard ratios (HR) for cachexia at 1.58 (95% CI 1.38-1.80), 1.47 (95% CI 1.33-1.63) and 1.97 (95% CI 1.75-2.23) for disability, hospitalization and death, respectively. HRs for WLGS ≥ 2 were 1.45 (95% CI 1.28-1.66), 1.37 (95% CI 1.24-1.51) and 1.91 (95% CI 1.69-2.17). HRs for NLR > 3 were 1.57 (95% CI 1.35-1.83), 1.40 (95% CI 1.25-1.58) and 1.95 (95% CI 1.67-2.27). HRs for albumin < 3.5 g/dL were 1.33 (95% CI 1.15-1.54), 1.67 (95% CI 1.50-1.86) and 2.09 (95% CI 1.84-2.36). HRs for PNI < 44 were 1.60 (95% CI 1.39-1.84), 1.46 (95% CI 1.31-1.63) and 2.07 (95% CI 1.80-2.37). Fearon consensus criteria, WLGS, NLR, albumin and PNI were routinely collected at ICI initiation in regular clinical practice and predictive of worse disability-free, hospitalization-free and overall survival in cancer patients receiving ICI therapy. These routine clinical measures may aid prognostication and decision-making in cancer patients with cachexia.

Serum Irisin as a Predictor for Peripheral arterial disease: Insights from a Clinical Study

ObjectiveThe purpose of this study was to investigate the correlation between serum irisin concentration and peripheral arterial disease (PAD), and to establish clinical prediction nomograms for PAD occurrence by comparing and analyzing clinical data from patients with PAD patients and healthy controls. MethodsA total of 112 patients with PAD and 90 healthy individuals were recruited for the study. Clinical data from both groups were collected and serum irisin concentration was measured using enzyme-linked immunosorbent assay (ELISA). Correlation analysis was conducted. Risk factors for PAD were identified through univariate and multivariate logistic regression. The clinical prediction nomograms were established and validated. ResultsA total of 202 patients were enrolled in this study, with an average age of 63.98 ± 10.40 years. Of these, 123 were male (60.9%) and 79 were female (39.1%). Hypertension was present in 104 patients (51.5%), diabetes in 59 patients (29.2%), dyslipidemia in 94 patients (46.5%), and 105 patients (52.0%) were smokers. Among them, 90 patients were assigned to the PAD group, which included 78 males (69.6%) and 34 females (30.4%), with an average age of 67.54 ± 10.31 years. In this group, 62 patients (55.4%) had hypertension, 53 (47.3%) had diabetes, 62 (55.4%) had dyslipidemia, and 78 (69.6%) were smokers. The Rutherford classification of these patients showed that 64 (57.1%) were at stage I, 25 (22.3%) at stage II, 16 (14.3%) at stage III, and 7 (6.3%) at stage IV. Serum irisin concentration in patients with PAD showed a significant positive correlation with serum high-density lipoprotein (HDL) (r=0.255) and a significant negative correlation with Rutherford classification (r=-0.374) and smoking status (r=-0.263). Univariate and multivariate logistic regression analyses identified irisin, age, diabetes, dyslipidemia, smoking, creatinine(CR), and neutrophil/lymphocyte ratio (NLR) as independent risk factors for the development of PAD ( P < 0.05). Based on these findings, a clinical prediction nomogram was established. Internal validation of the nomogram demonstrated strong discriminatory ability, with an area under the curve (AUC) of 0.942, indicating the model's excellent performance. Calibration curves and decision curve analyses further confirmed the model’s robust calibration and clinical applicability. ConclusionThis study concluded that serum irisin concentrations were significantly lower in the PAD group compared to the healthy control group, and that serum irisin concentrations in the PAD group were significantly correlated with serum HDL, Rutherford classification, and smoking status. Additionally, Irisin level, age, diabetes, dyslipidemia, smoking, CR, and NLR were identified as independent risk factors for PAD development. The clinical prediction nomogram based on these factors may aid in accurately predicting the risk of PAD development.

Associations between neonicotinoids and inflammation in US adults using hematological indices: NHANES 2015-2016.

Toxicological studies suggest neonicotinoids increase oxidative stress and inflammation, but few epidemiological studies have explored these effects. National Health and Nutrition Examination Survey (NHANES) 2015-2016 data were used to estimate associations between neonicotinoid exposure and inflammatory markers, including the C-reactive protein-to-lymphocyte count ratio (CLR), monocyte-to-high-density lipoprotein ratio (MHR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) using linear and multinomial logistic regression models. Sex was evaluated as a potential modifier. Detection of any parent neonicotinoid (β = -0.62, 95% confidence interval [CI] = -0.98, -0.26) and imidacloprid (β = -0.48, 95% CI = -0.87, -0.10) was associated with decreased CLR. Clothianidin was linked to reduced MLR (β = -0.04, 95% CI = -0.07, -0.02), but increased lymphocyte-to-monocyte ratio (β = 0.52, 95% CI = 0.27, 0.77). Higher dNLR (β = 0.85; 95% CI = 0.26, 1.43) was noted with detection of any neonicotinoid metabolite. Moderately high PLR was observed with detection of any neonicotinoid metabolite (relative risk ratio [RRR] = 1.63, 95% CI = 1.27, 2.09) or 5-hydroxy-imidacloprid (RRR = 2.19, 95% CI = 1.40, 3.41). Sex-modified analyses showed positive associations in males and inverse associations in females for MHR (P int = 0.099, clothianidin), PLR (P int = 0.026, clothianidin), and SII (P int = 0.056, any parent neonicotinoid; P int = 0.002, clothianidin), while the opposite pattern was noted with CLR (P int = 0.073, any parent neonicotinoid) and NLR (P int = 0.084, clothianidin). Neonicotinoids may be associated with inflammatory changes, with potential sexual dimorphism. Further studies are required to explore these findings.

Evaluating systemic immune-inflammation indices as predictive markers for endometriosis diagnosis: A retrospective observational study.

Endometriosis is a chronic inflammatory disease for which there is currently no accurate screening test to identify or predict the probability of the disease in individuals. This can often lead to delays in diagnosis. Several systemic immune-inflammation indices are currently used as predictive or supportive markers for several inflammation-associated diseases. In this study, we investigated whether these immune-inflammation indices, such as systemic immune inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and pan-immune inflammation value (PIV) could serve as predictive or supplementary markers for diagnosing endometriosis. A total of 434 women with confirmed endometriosis and 517 controls were included in this study. Data on peripheral blood tests, including total counts of white cells, neutrophils, monocytes, lymphocytes, and platelets, were collected, and systemic immune-inflammation indices were calculated. SII, SIRI, NLR, and PIV values were significantly higher in women diagnosed with endometriosis compared to controls. Using the cut-off values of 538 for SII, 0.814 for SIRI, 2.03 for NLR, and 210 for PIV, we achieved 76 % sensitivity and 70 % specificity. When the four indices were combined, the area under the ROC curve (AUC) was 0.796 (95 % CI: 0.766, 0.827), with 76 % sensitivity and 70 % specificity. In conclusion, while ultrasonography or MRI remains the gold standard for visualizing the lesions in diagnosing endometriosis, followed by laparoscopy and histologic verification, routine peripheral blood tests in combination with clinical symptoms, could provide additional clinical diagnostic value for endometriosis as a non-invasive and cost-effective test.