Neutrophils To Lymphocyte Ratio Research Articles

Evaluation of Neutrophil to Lymphocyte Ratio with Neurological Severity and Short-Term Outcome in Acute Ischemic Stroke

Introduction: Stroke represents a significant global health care challenge, ranking as the second most common cause of mortality and disability worldwide. Inflammatory process plays an important role in pathophysiology of acute ischemic stroke. These inflammatory responses increase the brain damage and cause neurological deterioration. Neutrophils and lymphocytes serve as pivotal mediators of inflammatory response. Aims and Objectives: This study aims to evaluate the association between the Neutrophils to lymphocyte ratio (NLR) with the initial severity of stroke and the short-term functional outcome using the NIHSS and BARTHEL index respectively. Materials and Methods: We conducted an observational cross-sectional study on 80 patients admitted at Father Muller Medical College Hospital, which is a tertiary care centre in Mangalore between May 2023 to April 2024. Diagnosis of stroke was based on clinical evaluation and Radiological imaging. Peripheral blood samples were collected for complete blood count within 24 hours of stroke onset. The NLR was determined by dividing the absolute neutrophil count (ANC) to the absolute lymphocyte count (ALC). This was then correlated with the NIHSS and the BARTHEL index. Results: This study included 80 patients, with the mean age of 65.1 years. Majority of the patients were in the age group 51-70years (55%). The mean NLR was found to be 13.39. The mean NIHSS and BARTHEL index was 11.08 and 63.69 respectively. The NLR showed significant correlation with the initial stroke severity and the short-term functional outcomes. For the purpose of correlation NLR was divided into three groups i.e. >3, 3-5 and >5. Patients with higher NLR (>5) were more likely to have a severe stroke and greater dependency. Conversely, those with lower NLR (<3) had a minor stroke and slight dependency. 80% of the patients with severe stroke had a NLR above 5, while 82% of the patients with minor stroke had a NLR below 3 (p value <0.001). This study also found a strong correlation between NIHSS and the BARTHEL index - patients with lower NIHSS and NLR were found to have a better short term function outcome. Conclusion: NLR was found to be significantly associated with the initial severity of stroke and the shortterm functional outcome. Because of its high specificity, low cost, routine use NLR can be used for the prediction of severity of stroke and patients can be prioritised for specialised treatment thus reducing the mortality rates.

Infection versus disease activity in systemic lupus erythematosus patients with fever

Backgroundto detect the role of procalcitonin, erythrocyte sedimentation rate to c-reactive protein (ESR/CRP) ratio, neutrophils-to-lymphocyte ratio (NLR), and platelets-to-lymphocyte ratio (PLR) in the diagnosis of infection in systemic lupus erythematosus (SLE) patients with fever, their diagnostic value to differentiate between infection and disease activity, and their correlation with disease activity.MethodsForty SLE patients and forty healthy control cases were included in the study. Disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K), and quality of life was assessed by Lupus QoL. A bacterial infection was detected by clinical symptoms and positive culture results. Laboratory tests were done for all patients and controls: complete blood count (CBC), ESR, CRP, and procalcitonin (PCT). NLR, PLR, and ESR/CRP ratios were calculated.ResultsThere was a statistically significant difference between infected SLE patients and non-infected SLE patients regarding PCT (p < 0.001), ESR (p = 0.002), CRP (p = 0.005), ESR/CRP ratio (0.002), and NLR (p = 0.023). PCT, ESR, CRP, and NLR were positively correlated with the presence of infection in SLE patients, while the ESR/CRP ratio was negatively correlated. There was no significant correlation with the SLEDAI-2 K score. Logistic regression analysis revealed that PCT was the best significant predictor of infection (OR 224.37, 95% CI 8.94–5631.35). PCT was a good predictor of infection, with a cut-off value of 0.90 ng/ml, which gave the best combination of sensitivity (84.62%) and specificity (85.71%).ConclusionPCT, ESR/CRP ratio, and NLR provide good diagnostic markers for the diagnosis of infection and can distinguish between infection and disease flare in SLE patients with fever.

Peripheral Inflammatory and Immune Landscape in Multiple System Atrophy: A Cross-Sectional Study.

Neuroinflammation might contribute to the pathogenesis of multiple systemic atrophy (MSA). However, specific alterations in the peripheral inflammatory and immune profiles of patients with MSA remain unclear. To determine the peripheral inflammatory and immune profiles of patients with MSA and their potential value as biomarkers for facilitating clinical diagnosis and monitoring disease severity. This cross-sectional study included 235, 240, and 235 patients with MSA, patients with Parkinson's disease (PD), and healthy controls (HCs), respectively. Inflammatory and immune parameters were measured in peripheral blood, differences between groups were assessed, and clusters were analyzed. Associations between the parameters and clinical characteristics of MSA were assessed using Spearman and partial correlation analyses. Significant differences were observed especially in monocytes, neutrophils-to-lymphocyte ratio (NLR) and neutrophils-to-lymphocyte ratio (MPV) between MSA patients and HCs (P < 0.01). Monocytes and uric acid (UA) levels were also significantly different between the MSA and PD patients (P < 0.05). The combination of NLR and MPV distinguished MSA-P patients from HCs (areas under the curve = 0.824). In addition, complement components C4 and C3 were significantly correlated with the Scale Outcomes in PD for Autonomic Symptoms and Wexner scale, whereas immunoglobulin G (IgG) was significantly correlated with scores of Unified Multiple System Atrophy Rating Scale (P < 0.05). In MSA patients, monocytes, NLR and MPV might serve as potential diagnostic biomarkers, whereas MLR, C3, C4, and IgG significantly correlate with disease severity. © 2023 International Parkinson and Movement Disorder Society.

Acute phase reactants in non-COVID-19 community-acquired pneumonia

BackgroundAcute phase reactants (APR) are markers of inflammation that could be applied for the assessment of community-acquired pneumonia (CAP) severity in association with various pneumonia severity scores. So, the aim of the study was to assess levels of APR such as total leucocytic count (TLC), platelets, neutrophils, neutrophils-to-lymphocyte ratio (NLR), CRP, D-dimer, ferritin, and ESR in patients with CAP and to correlate between their values and disease severity.MethodologyThe study included 51 patients diagnosed as non-COVID-19 (CAP). Patients were classified into two groups group A (pneumonia only) and group B (pneumonia complicated with empyema/complicated para-pneumonic effusion). All patients underwent clinical evaluation, CURB65, radiological assessment, and blood sampling to measure APR.ResultsThe mean age of patients was 47 ± 17 years. The main symptoms were productive cough (90.2%) and Fever (92.2%).TLC, platelets, neutrophils, CRP, D-dimer, ferritin, and ESR were elevated than normal values. Significant positive correlations were found between the duration of fever and CRP, D-dimer, and ferritin with p values = 0.024, 0.012, and 0.034 respectively. Significant positive correlations were found between CURB65 and both CRP and ferritin with p values = 0.007 and 0.020. A significant increase in platelet count and ESR values was found in group B than in group A.ConclusionAPR are important markers that can be used in the assessment of CAP in collaboration with clinical evaluation and severity scores. CRP, D-dimer, and ferritin were positively correlated with CURB65, while ESR and platelets could be considered predictors of the development of complications.Trial registrationRetrospectively registered, registration number NCT05926089, date of registration is 06/29/2023.

Study of mortality risk factors and outcomes in COVID-19 patients at a tertiary care hospital in West Bengal, India

Background: The risk of mortality is high in Coronavirus disease-19 (COVID-19)patients. The management of COVID-19 patients may be aided by the identification of variables associated with mortality. The aim of the study was to ascertain the outcomes and mortality risk factors in COVID-19 patients at a tertiary care facility in West Bengal, India. Method: A total of 94 patients with moderate to severe symptoms of COVID-19 were included in this observational descriptive study from April 2021 to June 2021. The patients with moderate to severe infection diagnosed by Indian Council of Medical Research (ICMR) guidelines admitted to the hospital, and those willing to participate in the study, were included. Those with mild symptoms and who refused to participate were excluded from the study. The severity of patient condition was determined by Ministry of Health &amp; Family Welfare (MoHFW) guidelines. Informed consent has been obtained from patients. Data was analyzed by Microsoft® Excel workbook 2007 into SPSS v 21.0 (IBM, USA). Results: Fifty-four percent of the patients had moderate, and 45.7% had severe infections. In-hospital mortality was 41.5% among moderate to severe infected COVID 19 positive patients. Non-survivors have significantly higher levels of neutrophils to lymphocyte ratio (NLR), blood urea, and sodium levels in comparison with survivors (P&lt;0.05). On multivariate logistic regression, only the severity of infection (determined by Ministry of Health &amp; Family Welfare guidelines) was an independent predictor of in-hospital mortality (adjusted OR, 3.73; 95% CI, 1.4717 to 9.4616; P=0.005). Conclusion: COVID-19 patients with severe infection on admission are more likely to die. Bangladesh Crit Care J September 2023; 11 (2): 103-108

Oxidative Stress and Inflammatory Biomarkers in Patients with Diabetic Foot.

Background and Objectives: Diabetic foot (DF) development is driven by complex interactions of hyperglycemia, inflammation, and oxidative stress (OS). We aimed to investigate OS and inflammatory biomarkers in patients with DF and their potential to improve early diagnosis and management of DF. Materials and Methods: The prooxidant−antioxidant balance (PAB), superoxide dismutase (SOD), total oxidative status (TOS), total sulfhydryl groups (SHG), routine biochemical parameters, and complete blood count were determined in 42 patients with type-2 DM, of which 23 patients had DF, while 19 patients were without DF complications. The neutrophils-to-lymphocyte ratio (NLR) was evaluated as a biomarker of inflammation. Results: Patients with DF had significantly higher (p < 0.05) PAB levels (170 ± 33.9 U/L) compared to those without DF complications (142 ± 31.3 U/L). In addition, patients with DF had significantly reduced SOD activities (p < 0.01). NLR values were significantly higher in the DF group (median: 2.8; interquartile range: 2.0−4.3) than in the group without DF (median: 1.4; interquartile range: 1.4−2.1; p < 0.01). A positive correlation was found between the PAB and NLR index (r = 0.449; p < 0.05). The diagnostic accuracy of both PAB (AUC = 0.741; p < 0.01) and NLR (AUC = 0.760; p < 0.01) was estimated as acceptable. Conclusions: In conclusion, the development of DF is associated with enhanced OS and inflammation processes. PAB and NLR could be useful non-invasive biomarkers of DF development.

Hematological Parameters in COVID-19 Patients: Association with Severity of the Disease.

The novel coronavirus (COVID-19) produced severe acute respiratory coronavirus syndrome (SARS-CoV-2; formerly known as 2019-nCoV) and has mild to fatal symptoms. This study aimed to investigate the different blood markers in confirmed positive COVID-19 individuals and see how they associated with the severity of the condition. A cross-sectional study was conducted from September 2020 to March 2021 on seventy-six (20 female and 56 male) Iraqi patients unvaccinated against COVID-19. The mean age of the study subjects was (47.00±13.31; 43.86±14.27) for males and females, respectively. 68.42% of the cases with mild illness, 14.47% with moderate illness, and 17.10% were severely ill. The severity of COVID-19 was assessed by several hematological parameters, including white blood cell (WBC) count, derived indicators such as neutrophils to lymphocyte ratio (NLR) and IL6, C-reactive protein (CRP), D-dimer, and S-ferritin. The results showed that lymphocyte count was lower in severely ill patients compared to patients with mild and moderate symptoms, with a significant difference between the three groups (2.274.83). Additionally, the NLR results showed a significant rise (11.56±1.23) in severe COVID-19. The results of the present study indicated that serum levels of IL6, CRP, and S-ferritin revealed significant differences (41.20±6.23 pg/ml), (50.66±12.55 mg/l), and (454.60±95.69 ng/ml) at (P≤0.05) in sever ill compared with mild and moderately ill patients respectively. The results indicated a highly significant positive correlation between IL6 and severity of COVID-19 infection at P<0.01. Furthermore, a positive connection is seen in Neutrophil, CRP, and NLR (0.229, 0.264, and 0.277) at (P≤0.05) respectively.

Biological Rationale for Peripheral Blood Cell-Derived Inflammatory Indices and Related Prognostic Scores in Patients with Advanced Non-Small-Cell Lung Cancer.

To describe the biological rationale of peripheral blood cells (PBC)-derived inflammatory indexes and assess the related prognostic scores for patients with advanced non-small cell lung cancer (aNSCLC) treated with immune-checkpoint inhibitors (ICI). Inflammatory indexes based on PBC may indicate a pro-inflammatory condition affecting the immune response to cancer. The lung immune prognostic index (LIPI), consisting of derived neutrophils-to-lymphocyte ratio (NLR) and lactate dehydrogenase, is a validated prognostic tool, especially for pretreated aNSCLC patients, where the combination of NLR and PD-L1 tumour expression might also be predictive of immunotherapy benefit. In untreated high-PD-L1 aNSCLC patients, the Lung-Immune-Prognostic score (LIPS), including NLR, ECOG PS and concomitant steroids, is prognostic, and its modified version might indicate patients with favourable outcomes despite an ECOG PS of 2. NLR times platelets (i.e., SII), included in the NHS-Lung score, might improve the prognostication for combined chemoimmunotherapy. PBC-derived inflammatory indexes and related scores represent accurate, reproducible and non-expensive prognostic tools with clinical and research utility.

Neutrophil-to-lymphocyte ratio as a predictor for cardiovascular diseases: a cohort study in Tianjin, China.

Based on a cohort in Tianjin, China, we explore the relationship between neutrophils-to-lymphocyte ratio (NLR) and the risk of cardiovascular diseases (CVDs). From January 2010 to December 2019, 4667 eligible participants aged more than 40 years old, CVDs-free, and registered in two community health service centers were recruited and followed up. The values of NLR collected at baseline were included in Cox proportional hazards model to evaluate its association with the incidence risk of CVDs. Hazard ratio (HR) and 95% confidence interval (CI) were calculated before and after adjustment for potential confounding factors selected by LASSO regression. During a total of 13,691 person-years of follow-up among all participants (median, 2.0 years; interquartile range, 1.7-2.5), 150 (3.42%) newly diagnosed CVDs events occurred, with the incidence density of CVDs of 10.96/1000 person-year. The incidence density in subgroups categorized by tertiles of baseline NLR was 8.08/1000, 11.74/1000, and 13.24/1000, respectively (p trend = 0.019). COX models revealed that after adjustment for potential confounders, NLR (as a continuous variable) was significantly related to the risk of total CVDs (HR 1.10, 95% CI: 1.04, 1.17), myocardial infarction (HR 1.12, 95% CI: 1.05, 1.20), and ischemic stroke (HR 1.21, 95% CI: 1.10, 1.33). When NLR was categorized into tertiles, participants in the top tertile had a significantly higher risk of CVDs (HR 1.61, 95% CI: 1.06, 2.44) and myocardial infarction (HR 1.88, 95% CI: 1.09, 3.27) relative to those in the bottom tertile.

Correlation between NLR and Ferritin in COVID-19 Patients in ICU Dr. Kariadi Hospital

COVID-19 infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diabetes mellitus and heart disease comorbid have high morbidity and mortality. Increased neutrophils to lymphocyte ratio (NLR) and ferritin assist early screening of disease severity, especially in the Intensive Care Unit (ICU). Proving relationship between NLR and ferritin in COVID-19 patients in the ICU. The study was an analytical observational with a cross-sectional approach from July-October 2020 at the Laboratory of Clinical Pathology and Medical Records Dr. Kariadi Hospital Semarang. Pearson correlation method significance p&lt;0.05, r 0.3&lt;r&lt;0.5, because normal normality. NLR and Ferritin mean value was 13.91 and 1675 with positive relationship correlation analysis (p=0.012,r=0.437),there was a correlation between NLR and ferritin in COVID-19 patients in the ICU. Increased NLR of COVID-19 patients due to infiltration of the innate and adaptive immune system in infected tissue,causes decreased circulating lymphocytes and disturbed proliferation caused by increased ferritin as an acute phase reactant protein. The study by Pastora JG,et al,2020,that serum ferritin concentrations were higher in non-survivor. In accordance with this, this increases NLR and ferritin in COVID-19 in the ICU. There is a moderate positive correlation between NLR and ferritin in COVID-19 patients at the ICU, Dr. Kariadi Hospital.

The importance of blood count and oxidative stress in the drug-naïve first episode schizophrenia

IntroductionSchizophrenia (SZ) is associated with changes in haematological parameters related to low-grade inflammation state and could be amplified via oxidative stress (OS) related mechanisms. Although studies confirm this relationship, the results could be cofounded by patients’ treatment.ObjectivesThe study aimed to assess the connection between venous blood count and OS in drug-naïve first-episode SZ patients.MethodsThe study consisted of 24 SZ drug-naïve patients during first episode of psychosis (median age: 22 years), and 31 healthy individuals (HC) as a control group (median age: 28 years). The examination included clinical data, OS parameters (enzymatic and non-enzymatic antioxidants), peripheral blood counts.ResultsWe did not find differences between SZ and HC in blood count parameters (p&gt;0.05). In patients group, white blood cells (WBC), neutrophils and neutrophils-to-lymphocyte ratio (NLR) were positively related with the severity of positive symptoms (R=0.59, R=0.53, R=0.50; p&lt;0.05, respectively). WBC was related to superoxide dismutase (SOD-1) levels (HC: R=-0.36, SZ: R=0.70; p&lt;0.05). Neutrophils were positively related to catalase (CAT) (R=0.52; p&lt;0.05) and ferric reducing antioxidant power (FRAP) (R=0.61; p&lt;0.05), but only in the patients’ group. There was a positive relationship between NLR and CAT (R=0.45; p&lt;0.05) in the SZ group.ConclusionsThe results indicate potential connection and interplay between OS and blood count parameters in the onset of psychotic episode. Further studies on a larger group of patients are needed.DisclosureNo significant relationships.

13P High neutrophils-to-lymphocyte ratio (NLR) predicts poor survival of high-PD-L1-expressing metastatic non-small cell lung carcinoma patients undergoing first-line immunotherapy with pembrolizumab

Systemic inflammatory response has independent prognostic value, across tumour types and geographical locations, in patients with advanced cancer: an elevated ratio of peripheral neutrophils-to-lymphocytes (NLR) has been recognized as a poor prognostic indicator in various cancers. This study aimed to determine whether NLR and platelets-to-lymphocytes ratio (PLR) reflect poor treatment benefits in patients suffering from metastatic Non Small Cell Lung Cancer (mNSCLC) who underwent first-line pembrolizumab monotherapy.

Circulating activated immune cells as a potential blood biomarkers of non-small cell lung cancer occurrence and progression

BackgroundTreatment for non-small cell lung cancer (NSCLC) has greatly improved in recent years. However, noninvasive early screening for carcinogenesis and progression unclear. The aim of this study was to explore the predictive value of peripheral blood immune cells in untreated NSCLC patients.MethodsWe retrospectively enrolled 305 untreated NSCLC patients and 132 healthy participants from February 2016 to August 2019 in Peking Union Medical College Hospital. Immune cell levels were determined by flow cytometry and routine blood tests.ResultsNSCLC patients had lower levels of T lymphocytes, NK cells, CD8+ T cells, naïve CD4+/CD4+, naïve CD4+ T cells and higher levels of CD4+ T cells, memory CD4+/CD4+ T cells, memory CD4+ T cells, CD4+CD28+/CD4+ T cells, CD4+CD28+ T cells, CD8+CD28+/CD8+ T cells, CD8+HLA-DR+/CD8+ T cells, CD8+HLA-DR+ T cells T cells, CD8+CD38+/CD8+ T cells, CD8+CD38+ T cells and CD4+/CD8+ T cells than those in controls. The percentages of specific lymphocyte subtypes were significantly different in cancer patients versus healthy individuals. For instance, cancer patients had lower levels of B cells, CD4+ T cells, naïve CD4+/CD4+ T cells, naïve CD4+ T cells, CD4+CD28+ T cells, CD8+CD28+ T cells and higher levels of NK cells, white blood cells (WBC), monocytes, neutrophils, eosinophils, basophils, monocytes to lymphocyte ratio (MLR), neutrophils to lymphocyte ratio (NLR), eosinophil to lymphocyte ratio (ELR), basophil to lymphocyte ratio (BLR), and blood platelet to lymphocyte ratio (PLR).ConclusionsAbnormal T cell levels can be used as an independent predictive biomarker for noninvasive early screening in NSCLC occurrence and progression.

Involvement of Neutrophils in Metastatic Evolution of Pancreatic Neuroendocrine Tumors.

Simple SummaryThe neutrophil-to-lymphocytes (NLR) reflects the systemic inflammation. Based on a cohort of 144 patients treated for localized or metastatic well-differentiated pancreatic neuroendocrine tumors (pNET), we identified the NLR ≥ 4 to be associated with worse overall survival. Using MCP-Counter on a publicly available pNET RNA-sequencing dataset, we inferred the tumor microenvironment composition of 83 primary pNET and 30 liver metastasis. The neutrophils scores were statistically higher in liver metastasis relative to primary pancreatic tumors (p = 0.005). Gene set enrichment analysis further revealed activation of complement pathway signature in liver metastasis. Through combination of the neutrophil and complement pathway genes, we found that pNET can be classified into two clusters: Neu-Comp1 and Neu-Comp2. Notably, the Neu-Compt1 cluster was enriched in neutrophils and complement pathway signatures and was associated with liver metastasis. These data offer new insights into the role of inflammatory factors in the metastatic progression of the pNET.Well-differentiated pancreatic neuroendocrine tumors (pNET) have an unpredictable natural history. The identification of both blood and tumor immune features associated with patients’ outcomes remains limited. Herein, we evaluated the best prognostic value of the neutrophils-to-lymphocyte ratio (NLR) in a cohort of 144 pNETs. The NLR ≥ 4 was associated with worse overall survival in both univariate analysis (HR = 3.53, CI95% = 1.50–8.31, p = 0.004) and multivariate analysis (HR = 2.57, CI95% = 1.061–6.216, p = 0.036). The presence of synchronous liver metastasis was identified as a prognostic factor in multivariate analysis (HR = 3.35, CI95% = 1.411–7.973, p = 0.006). Interestingly, the absolute tumor-associated neutrophils count was higher in liver metastasis as compared to their paired primary tumor (p = 0.048). Deconvolution of immune cells from the transcriptome of 83 primary tumors and 30 liver metastases reveals enrichment for neutrophils in metastasis relative to primary tumors (p = 0.005), and this was associated with upregulation of the complement pathway (NES = 1.84, p < 0.0001). Combining neutrophils signature and complement pathway genes, unsupervised clustering identified two pNETs subgroups, namely Neu-Comp1 and Neu-Comp2. Characterized by neutrophils infiltration and activation of the complement pathway, Neu-Comp1 was highly enriched for metastatic liver samples as compared to Neu-Comp2 (p < 0.0001). These data suggest the possible link between liver metastasis, complement pathway activation, and neutrophils infiltration in well-differentiated pNET and open avenues for targeting complement pathways in these tumors.

Evaluation of hematological parameters as an indicator of disease severity in Covid-19 patients: Pakistan's experience.

BackgroundThe severity of COVID‐19 could be evaluated by examining several blood parameters mainly white blood cell (WBC) count, granulocytes, platelet, and novel hemocytometric markers neutrophils to lymphocyte ratio (NLR), platelet‐to‐lymphocyte (PLR), and lymphocyte to monocyte ratio (LMR). The current study was conducted to investigate alteration in blood parameters and their association with the severity and mortality of COVID‐19 patients.MethodologyAn observational cross‐sectional study was conducted retrospectively, a total of 101 COVID‐19 positive patients were examined: 52 were mild, 24 were moderate, 09 were severe, and 16 were critically diseased patients. We also recorded 16 deaths associated with the critical group. The overall mean age observed in our study was 48.94 years, where the mean age for critical individuals was 62.12 ± 14.35 years.ResultsA significant association between the disease severity and elevation in blood parameters were observed. The WBC's and granulocyte count were significantly increased (p value <0.001) while the mean platelet count (165.0 × 109/L) and red blood cell volume distribution width (RDW) were decreased in the critical group (57.86%) compared to mild group's patients (177.3%) (p = 0.83). The lymphocytes count was decreased in critical patients (1.40 × 109/L) compared to mild patients (1.92 × 109/L) (p = 0.28). A significant association was observed in platelet‐lymphocyte ratio (p < 0.001), Neutrophil‐Lymphocyte ratio (p = <0.001), and Lymphocyte‐Monocyte ratio (0.011).ConclusionThese blood parameters could be used as a suitable biomarker for the prognosis and severity of COVID‐19. Evaluating novel hemograms NLR, PLR, and LMR can aid clinicians to identify potentially severe cases at early stages, initiate effective management in time, and conduct early triage which may reduce the overall mortality of COVID‐19 patients.

Leukocytes and Albumin in Canine Leishmaniasis

Background: Canine Leishmaniasis (CanL) is a multisystemic and chronic inflammatory disease characterized by nonspecific clinical manifestations. In CanL, inflammatory cells and chemical mediators released in response to the parasite play a role in disease development and progression. Alterations on hematological parameters have been documented in CanL. These changes can also be assessed in relation to systemic inflammation caused by this disease. The circulating leukocyte counting, such as neutrophils, as well as the albumin level, are considered direct indicators of an inflammatory host environment. Several studies point to the use of biomarkers on the assistance in diagnosis and prognosis of several canine pathologies. The present study investigated the Neutrophils to Lymphocyte Ratio (NLR), Albumin to Globulin Ratio (AGR), and Neutrophils to Albumin Ratio (NAR) on systemic inflammatory response induced by Canine Leishmaniasis (CanL).Materials, Methods &amp; Results: For this purpose, adult dogs with confirmed diagnosis to CanL were divided into symptomatic (SD, n = 33) and asymptomatic (AD, n = 20) dogs for L. infantum and control dogs (CD, n = 20). Routine hematological and biochemical parameters were determined in blood samples using a veterinary automatic hematology and biochemical analyzers. Asymptomatic dogs (AD) had a higher number of white blood cells and neutrophils (16.48 ± 4.93; 13.41 ± 3.60, respectively) in relation to symptomatic dogs (SD) (13.54 ± 5.13; 10.42± 3.69, respectively) (P = 0.015 and P &lt; 0.0001, respectively). Neutrophils to Lymphocyte Ratio (NLR) was higher in dogs with leishmaniasis (9.45 ± 3.76) than in healthy dogs (3.39 ± 1.19) (P &lt; 0.0001). Serum total proteins (STP) and globulins increased in CanL, while albumin and AGR decreased in CanL, when compared to CD and references values to canine species. Neutrophils to Albumin Ratio (NAR) was higher in AD and SD (5.02 ± 1.14; 4.79 ± 1.07, respectively) when compared to CD (2.36 ± 0.55) (P &lt; 0.0001). Discussion: As reported in scientific researches, dogs with Leishmaniasis present alterations in circulating cell counts. Based on these data, we decided to expand this information using the NLR as a parameter in an attempt to better clarify the changes in these cells in CanL. We observed that NLR was increased on CanL in relation to healthy dogs, which could be a consequence of relative neutrophilia rather than lymphopenia. Neutrophils to Lymphocyte Ratio (NLR) is a biomarker that conveys information about inflammatory conditions. An elevated NLR can reflect an upregulated innate immune response, since neutrophils are effector cells of innate immunity and are involved in several acute and chronic inflammatory processes. Albumin is an acute phase protein that is considered an immune-inflammatory biomarker, which can be found reduced systemically in progressive inflammatory response. Serum total proteins (STP) and globulins were increased in CanL. These data are already well documented in CanL, which serum globulins are mainly associated with the increase of acute phase proteins, cytokines, and increase of specific antibodies to Leishmaniainfantum. Our results showed neutrophilia with hypoalbuminemia in CanL. So, in an attempt to assess the relationship of these two available markers, we used NAR calculation in order to evaluate the changes induced by CanL. In this study NAR was higher in CanL when compared to control dogs. Thus, our data indicate that NLR and NAR could be used as biomarkers in veterinary medical clinics in order to assess inflammatory profile in CanL, mainly in asymptomatic dogs. These parameters obtained from routine blood tests might be useful as cost-effective, easily accessible and helpful markers in order to distinguish the inflammatory response intensity in CanL.

Neutrophils-to-lymphocyte ratio in acute ischemic stroke patients

Objective The aim of this study was to evaluate the neutrophils-to-lymphocyte ratio (NLR) among patients with ischemic stroke and to determine the relationship between NLR and poststroke prognosis Background Inflammations play a role in the pathogenesis of cerebral infarction. Cytokines and adhesion molecules regulate the increased migration of leukocytes to the brain. Neutrophils are the first type of leukocytes to infiltrate ischemic brain (30 min of cerebral ischemia), peak earlier (days 1–3), and then decrease rapidly with time. Lymphocyte recruitment into the brain is involved in the later stages of ischemic brain injury. Patients and methods A retrospective study was done on 60 patients with ischemic stroke and 35 age-matched and sex-matched healthy controls. NLR was assessed from the patients' blood samples. Results The results were collected, tabulated, and statistically analyzed by IBM personal computer and statistical package SPSS, version 2, a P value of less than 0.05 was considered statistically significant. NLR among ischemic stroke patients was significantly higher than that of the control group. The optimal cutoff value of NLR for the prediction of primary unfavorable outcome was 2.05 with a sensitivity of 90% and a specificity of 96%. Conclusion NLR is a nonexpensive and easy marker for predicting stroke severity on admission, which is a primary unfavorable functional outcome.

The Importance of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting the Appearance of the Rectal Stenosis or Rectal Obstruction in Patients with Rectal Adenocarcinomas

The purpose of this study was to establish a correlation between markers of inflammation and the risk of rectal stenosis or obstruction, in patients with rectal adenocarcinomas. We performed a retrospective observational study on 188 patients diagnosed with rectal adenocarcinomas. We attempted to establish a correlation between the neutrophils to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR) levels and the presence of rectal stenosis or rectal obstruction. From 188 patients included in the study, 65 patients had stenotic tumors (34.57% of cases) and 10 patients had occlusive tumors (5.31% of cases). We obtained a statistically significant correlation between the blood levels of neutrophils, lymphocytes, platelets, and the existence of rectal stenosis. (p[0.05). The cutoff value of NLR that correlates with the presence of rectal stenosis was 2.5 (95% CI: 0.426-0.574, AUC: 0.500). As for PLR, the cutoff value correlated with the presence of rectal stenosis was 106,522 (95%CI: 0.428-0.575, AUC: 0.502). We established a statistically significant correlation between NLR, PLR and rectal obstruction (p[0.05). The cutoff value of the NLR that correlates with the presence of rectal obstruction was 4.633 (95%CI: 0.614-0.751, AUC: 0.685). As for PLR, the cutoff value correlated with the presence of rectal stenosis was 345.05 (95% CI: 0.673-0.803, AUC: 0.742). Our study shows that there is a statistically significant correlation between NLR and PLR and the risk of rectal obstruction in patients with adenocarcinomas. It is still necessary to conduct prospective studies on much larger lots of patients to determine the NLR and PLR values that can predict rectal stenosis as well as rectal obstruction.

P2.16-24 Prognostic Value of RDW, NLR and CYFRA 21-1 in Overall Survival of Patients with Metastatic NSCLC

Lung cancer remains as the main cause of death in many regions around the world. Unfortunately, most cases are diagnosed as advanced disease that determinates dismal outcomes. There is a lack of biomarkers in clinical practice and also high mortality rates not related to cancer. CYFRA 21-1 is an important biomarker related to burden of disease; neutrophils-to-lymphocyte ratio (NLR) and red blood call distribution width (RDW) represent systemic inflammatory biomarkers indirectly related to immune response, and nutritional components, which are critical factors that can increase the risk of death not related to cancer. Our aim was to evaluate the prognosis value of CYFRA 21-1, NLR, RDW and components of nutritional status (albumin, creatinine, and hemoglobin) in overall survival (OS) of metastatic NSCLC patients treated at a private institution (Oncosalud - AUNA). We analyzed data of 87 patients with metastatic NSCLC treated at Oncosalud-AUNA 2011 - 2014 (Lima - Peru). The clinical-pathological data were collected from digital medical records. The laboratory data (hemoglobin, albumin, RDW-CV, creatinine, neutrophil, lymphocyte, and monocyte) and CYFRA 21.1 were collected from blood routine tests. Optimal cutoff value of NLR (<3.6 and >3.6), LMR (<4.7 and >4.7), RDW-CV (<15% and >15%) and CYFRA 21.2 (<3.3 and >3.3) were determinate using the maximally selected rank statistics. OS was determinate using Kaplan-Meier method and survival curves comparison were performed using log-rank or Breslow test. Cox model was used to estimate the effect of nutritional components and tumoral biomarkers on overall survival. The median age was 68 years (range: 40-84) and 50.6% of cases were women. The 26.4% presented with 2-4 ECOG scale, the most frequent site of metastasis were bone (36%) and brain (22%), and the most common histology was adenocarcinoma (84%). Hemoglobin was low in 16% and 28.7% had abnormal albumin, 44.8% elevated RDW-CV, 24.1% abnormal creatinine, 47.1% elevated NLR, and 72.4% high CYFRA 21-1 value. The 88.5% of patients received chemotherapy and 11.5% had TKI as first-line treatment. The median follow-up was 60 months (95%CI: 44.4-74.6), median survival was 13.2 months (95%CI: 9.8 - 16.7), two and 5-years survival rate were 30.8% and 17.1%, respectively. In univariate analysis, only ³2 ECOG scale (p = 0.062), RDW-CV >15 (p = 0.011), NLR >3.6 (p = 0.019) and CYFRA 21.1 >3.3 ng/mL (p = 0.003) were associated with poor survival. We did not found significant differences with age, sex, Hb, albumin, and LMR. In the Cox model, low values of Hb (HR: 2.1, 95%CI: 1.01-4.5), high values of RDW-CV (HR: 2.6, 95% CI: 1.3 - 5.2), NLR (HR: 1.8, 95% CI: 1.1 – 3.2) and CYFRA21.2 (HR: 2.3, 95% CI: 1.1 - 4.6) were associated with poor OS. Overall survival for our patients was similar to reports from other series. Patients with elevated RDW, NLR and CYFRA 21.2 have poor prognostic in our cohort.

The Importance of Neutrophil to Lymphocyte Ratio and Peripheral Blood Eosinophilia in Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation: Recent Studies

Chronic obstructive pulmonary disease (COPD) is a chronic, progressive respiratory disease and the third leading cause of respiratory disease mortality. The diagnosis of COPD is changed to acute exacerbation of COPD (AECOPD) when respiratory symptoms become worse, beyond normal day-to-day variations and severely enough that changes in medication are required. Both neutrophils to lymphocyte ratio (NLR) and peripheral blood eosinophilia (PBE) are rapid and relatively inexpensive tests that can be easily applied in the clinical practice for the diagnosis and treatment of AECOPD patients. Furthermore, current studies found that NLR and PBE had a higher accuracy rate than other traditional markers (Leukocyte count and C-reactive protein) for the diagnosis and management of AECOPD. Besides, recent studies determined that NLR and PBE can be used for prediction of future exacerbations in COPD patients. This review aims to explore the current knowledge about the significance of NLR and PBE in AECOPD patients.