Platelet-to-lymphocyte Ratio Research Articles

Multivariate analysis of blood parameters for predicting mortality in patients with hip fractures.

The present retrospective cross-sectional study aimed to evaluate the predictive value of blood parameters and ratios for predicting mortality in patients with hip fractures. In total, 758 patients with hip fractures attending the Department of Orthopedics and Traumatology, Kütahya Health Sciences University Faculty of Medicine (Kütahya, Turkey) between January 2016 and January 2023 were included in the present study. Patients were then divided into two groups, namely the mortality (n=464; 61.2%) and survivor (n=294; 38.8%) groups. Patients in the mortality group were further sub-divided into the following three subgroups: i) Those who succumbed in <1 month (n=117; 25.2%); ii) those who succumbed between 1 and 12 months (n=185; 39.9%); and iii) those who succumbed >12 months later (n=162; 34.9%). In addition, the RDW coefficient of variation, mean platelet volume (MPV), MPV/platelet ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), mean platelet volume-to-lymphocyte ratio and monocyte-to-eosinophil ratio means were all found to be significantly higher in the mortality group (P<0.05). MPV (P<0.01), HGB (P<0.05), eosinophil, EOS (P<0.01), HRR (P<0.01), and PLR (P<0.05) were all revealed to exert significant effects on mortality. An age cut-off of 74.50 years had a sensitivity of 81.5% and specificity of 37.1%, whereas an MPV cut-off of 8.85 yielded a sensitivity of 73.5% and specificity of 36.1%. By contrast, an HGB cutoff of 11.05 had a sensitivity of 55.6% and specificity of 35.7%, an eosinophil cut-off of 0.065 had a sensitivity of 47.6% and specificity of 35.4%, whilst a HRR cut-off of 0.7587 had a sensitivity of 55.2% and specificity of 30.3%. Furthermore, a PLR cut-off of 152.620 had a sensitivity of 67.2% and specificity of 41.8% for hip fracture-associated mortality. An age cut-off of 79.50 years had a sensitivity of 70.9% and specificity of 41.5%, while an age cut-off of 83.50 years had a sensitivity of 46.2% and specificity of 64.0% for mortality occurring <1 month after hip fractures. To conclude, results from the present study suggested that HRR has potential predictive value for hip fracture-associated mortality and 30-day mortality, whereas the PLR could only predict hip fracture-associated mortality.

Novel predictor of thrombosis after left atrial appendage closure -Neutrophil to Lymphocyte Ratio (NLR), platelet to LymPhocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR)-

Abstract Background Cardiogenic embolism by left atrial thrombi is one of the most important atrial fibrillation (AF)-related clinical problems. In a previous survey, 91% of nonrheumatic AF-related left atrial thrombi was originated in the left atrial appendage (LAA). The WATCHMAN device was developed as a permanent implantable device to seal off the LAA to prevent cardiogenic embolism. It has been used in Japan since September 2019. The WATCHMAN family is the only left atrial appendage closure (LAAC) device in Japan. After percutaneous left atrial appendage closure (LAAC), DRT is an important issue in some cases. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) are known as cancer prognostic factors and indicators of immune status. There are few reports on the predictor for device related thrombosis (DRT), transient ischemic attack (TIA), and ischemic stroke. Finding novel biomarkers could help clinical decision in antithrombotic therapy post LAAC and follow-up intervals. Purpose To investigate the association of NLR, PLR, and LMR with device related thrombosis, transient ischemic attack, and ischemic stroke in patients with LAAC. Methods Our database of LAAC was respectively analyzed. All LAAC cases were performed between January 2020 and September 2023. Blood cell counts were sampled in three days before LAAC. Postoperative antithrombotic therapy was individualized based on the patient’s background. We examined their background and clinical events. Results A total of 116 consecutive patients underwent LAAC in our institution excepting for one case that could not be performed due to a huge LAA (follow-up period, 610±37 days; age, 75±1 years; male sex, 73%; left ventricular ejection fraction, 58±1%; CHAD2S2-VASc, 4.6±0.1; HAS-BLED, 3.4±0.1). The results are shown in the Figure. Receiver-operating characteristic curve analysis confirmed the best cut-off value of NLR, PLR, and LMR for composite of DRT, TIA, and ischemic stroke (AUC = 0.69; 0.70; 0.67). In the univariate analysis, NLR&amp;lt;1.88, PLR&amp;lt;144, and LMR&amp;gt;3.40 are the independent predictor for the combination of DRT, TIA, and ischemic stroke (p-value = 0.02; 0.04; 0.05, respectively). Conclusion Low NLR, low PLR, and high LMR are the independent predictor for the combination of DRT, TIA, and ischemic stroke. These parameters can be useful in routine use because they can be easily calculated without additional costs.

The admission inflammatory biomarkers profile of elderly hip fractures and its association with one-year walking independence and mortality: a prospective study.

Immune response plays an important role in the regulation of elderly hip fracture. This study aims to analyze the relationship between systemic inflammatory markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) and mortality and walking independence, providing valuable references for the postoperative management of geriatric hip fracture. A retrospective analysis of prospective data on elderly patients who have undergone hip surgery and have been followed for at least one year. The receiver operating characteristic (ROC) curves and the optimum cutoff value were calculated. Univariate analysis and multivariate logistic regression analysis were used to identify the associations between admission four systemic inflammatory markers and one-year mortality and locomotion recovery. During the study period, respiratory disease was the most common cause of death, followed by cardiovascular disease. Multivariate analysis identified NLR (OR, 1.13; 95%CI: 1.09-1.17), SIRI(OR, 1.18; 95%CI: 1.08-1.28) and advanced age (OR, 1.06; 95%CI: 1.01-1.11) as independent risk factors for one-year mortality. In addition, 89 (rate, 31.8%) survivors had poor walking independence within one year. NLR (OR, 1.37; 95%CI: 1.26-1.50), SII(OR, 1.00; 95%CI: 1.001-1.003), SIRI(OR, 1.36; 95%CI: 1.18-1.57) and advanced age (OR, 1.08; 95%CI: 1.02-1.13) were associated with postoperative locomotion recovery. In summary, admission NLR and SIRI are correlated with a high risk of one-year walking independence and mortality, providing a basis for the clinical management of geriatric hip fractures.

Actinomyces status and inflammatory biomarkers in post-tonsillectomy hemorrhage cases

Background The presence of Actinomyces can be associated with complications. Aims This study aimed to determine the frequency of post-tonsillectomy hemorrhage (PTH), the presence of Actinomyces in palatine tonsils and serum inflammatory biomarker levels in PTH. Material and methods The cases who underwent tonsillectomy at a single center were included in the study. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII) and systemic inflammation response index (SIRI) values were calculated from the complete blood count test. The presence of Actinomyces was recorded from histopathological tonsillectomy material. Results A total of 1137 patients were included in the study. Actinomyces was detected in 93 (8.18%) patients. Bleeding complications were encountered in 65 cases (5.72%). No relationship was detected between the presence of Actinomyces and PTH rates (p = 0.433). While a relationship was found between age, NLR, and SIRI values and Actinomyces status (respectively, p < 0.001, p = 0.017, p = 0.038), no statistically significant relationship was found between tonsil size, PLR, and SII (p > 0.05). Conclusion and significance According to the data in our study, NLR and SIRI values were elevated in subjects with Actinomyces. Our findings suggest that this entity has a systemic manifestation. Serum inflammatory biomarkers and the presence of Actinomyces were not found to be associated with PTH.

Role of Preoperative Inflammatory Blood Cell Indexes as a Postoperative Risk Predictor Among Patients Undergoing On-Pump Cardiac Surgery.

Estimating patient risk before heart surgery (HS) is crucial. Perioperative inflammation is associated with several complications and mortality. This study investigated blood cell count inflammatory indices (BCCII) to predict risks, including neutrophil-to-lymphocyte ratio (NLR), derivate NLR (DNLR), neutrophil-to-platelet-lymphocyte ratio (NLPR), lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio (PLR), Systemic Inflammatory Index (SII), Systemic Inflammatory Reaction Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI). Data from a cohort of patients undergoing on-pump HS at a single center in Brazil were retrospectively analyzed. Data were obtained from medical records and a laboratory analyzer, and SPSS version 20.0 was used for index calculations and statistical analyses. In total, 444 surgeries were performed, and 40 in-hospital deaths occurred. Except for PLR, all other indexes were independent predictors of death after multivariate adjustment (all p < 0.05). Discrimination performance was absent for PLR and AISI, and NLR, NLPR, and DNLR demonstrated the best area under the receiver operating characteristic curve (AUC > 0.7; all p < 0.0001). For survivors (n = 404), all indexes exhibited a correlation with the length of hospital stay (all p < 0.03), and NLR, NLPR, and DNLR were predictors (p < 0.026) of poor operative outcomes (acute myocardial infarction, cerebrovascular attack, cardiac arrest, low cardiac output, prolonged mechanical ventilation, renal failure, and sepsis). All BCCII scores were associated with length of hospital stay. Apart from PLR, all indexes were independent predictors of in-hospital mortality. Accuracy was highest for NLR, NLPR, and DNLR; for survivors, these three factors were good predictors of poor operative outcomes.

Investigation of Blood Count-Based Inflammatory Biomarkers as Predictors of Response to Dupilumab Treatment in Patients with Chronic Rhinosinusitis with Nasal Polyps

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease often resistant to standard treatments. Dupilumab, a monoclonal antibody targeting the IL-4α receptor, has shown efficacy in CRSwNP, but a significant subset of patients do not respond to this therapy. This study aims to investigate pretreatment complete blood count (CBC)-based inflammatory biomarkers as predictors of response to dupilumab in patients with CRSwNP. Methods: This mono-centric, retrospective, single-arm longitudinal cohort study included 80 patients with uncontrolled CRSwNP who received dupilumab treatment at the Medical University of Graz. Patients were classified into responder and non-responder groups based on a reduction of &gt;1 in nasal polyp score (NPS) and a sinonasal outcome test-22 (SNOT-22) score &lt;40 points at six months. Pretreatment CBC-derived biomarkers, including eosinophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation indices including the aggregate inflammation systemic index (AISI), systemic inflammation index (SII), and systemic inflammation response index (SIRI), were analyzed for their predictive value. Results: Of the 80 patients, 72.5% were classified as responders, while 27.5% were non-responders. A significant positive correlation was found between baseline eosinophil count and NPS reduction (p = 0.027), suggesting that higher eosinophil levels may predict higher NPS reduction in dupilumab treatment. However, no significant associations were observed between NLR, PLR, and systemic inflammation indices with treatment outcomes. Conclusions: Pretreatment eosinophil count may serve as a potential biomarker for predicting nasal polyp reduction in dupilumab treatment of CRSwNP. Other CBC-based inflammatory markers did not show significant predictive value. Further prospective studies are needed to validate these findings and explore additional, reliable biomarkers to optimize treatment outcomes for CRSwNP patients.

Prognostic Value of Systemic Inflammation, Nutritional Status and Sarcopenia in Patients With Amyotrophic Lateral Sclerosis.

Nutritional status, systemic inflammatory responses and muscle mass are associated with the prognosis of patients with amyotrophic lateral sclerosis (ALS). However, the optimal biomarker for predicting prognosis remains unclear. This study aimed to identify the optimal indicators of survival among the nutrition-based, inflammation-based and muscle mass-related markers for ALS patients. We enrolled ALS patients from January 2014 to December 2019. Experienced neurologists followed up with the participants until January 2022. This study included a total of 17 nutritional, systemic inflammatory or muscle mass-related indicators. Maximally selected rank statistics determined the cut-off points for these indicators. Kaplan-Meier estimation was used to assess survival. Uni- and multivariate Cox proportional hazards models were used to determine the effects of indicators on survival. Finally, time-dependent receiver operating characteristic (time-ROC) curves and the C-index were calculated to evaluate the predictive efficacy of different indicators. A total of 506 patients with ALS were enrolled in this study, including 288 males (56.9%) and 218 females (43.1%), with a mean age of 54.2 ± 10.5 years. Among these ALS patients, 334 cases (68.0%) either died or underwent tracheotomy. In univariate Cox proportional hazards regression, 11 indicators were significantly associated with ALS survival (p < 0.05). And systemic immune inflammation (SII), platelet-to-lymphocyte ratio (PLR), modified geriatric nutritional risk index (mGNRI), creatinine and sarcopenia index (SI, (creatinine/cystatin C) × 100) were determined as independent predictors (p < 0.05) in multivariate Cox proportional hazards regression. A higher SI predicted longer survival (hazard ratio, 0.59; 95% confidence interval [CI], 0.46-0.76; p < 0.001). The results of time-ROC and C-index analyses indicated that SI had the best predictive efficacy for ALS survival, with a C-index of 0.65 (95% CI, 0.54-0.75) for 1-year, 0.61 (95% CI, 0.57-0.65) for 3-year and 0.59 (95% CI, 0.55-0.62) for 5-year survival. Across different subgroups, SI had the highest C-index in men and women, limb onset and aged < 60 year ALS patients, compared with other indicators. However, cystatin C was the best indicator for predicting the survival of ALS patients with bulbar onset, whereas the prognostic nutritional index (PNI) was the best for those aged ≥60 years. The serum SI demonstrates superior prognostic ability compared to other inflammation-based, nutrition-based and muscle mass-related indicators for patients with ALS. Given its simplicity and availability, it is well suited for clinical use in evaluating the prognosis of ALS patients.

The Predictive Value of Perioperative Inflammatory Indexes in Major Arterial Surgical Revascularization from Leriche Syndrome

Objectives: The role of inflammation in the pathophysiology of atherosclerosis is extensive. Our study aims to assess the predictive role of inflammatory indexes regarding in-hospital mortality in major vascular surgery of Leriche syndrome as a convenient, low-cost, and noninvasive prognostic marker to optimize the patient’s perioperative course. Methods: Our retrospective single-center study enrolled consecutive patients diagnosed with aortoiliac occlusive disease, Leriche syndrome, who underwent elective major vascular surgery between 2017 and 2023 in a tertiary cardiovascular center. Preoperative, postoperative, and day-one after-surgery data, including systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio, and monocyte–lymphocyte ratio, were studied to the endpoint, in-hospital death. We also tested the delta values of the indexes to the endpoint. The indexes were compared to the Revised Cardiac Risk Index (RCRI) and Vascular Surgery Group Cardiac Risk Index (VSG-CRI) for outcome prediction. Results: The tested inflammatory indexes significantly increased from the preoperative to postoperative and, further, to the day-one settings. Preoperative AISI (p = 0.040) emerged as the only independent risk factor regarding in-hospital death occurrence in Leriche patients who underwent major revascularization surgery. While RCRI did not significantly predict the endpoint (AUC = 0.698, p = 0.057), VSG-CRI (AUC = 0.864, p = 0.001) presented the best result in ROC analysis. Postoperative NLR (AUC = 0.758, p = 0.006) was next, followed by NLR postoperative–preoperative (_Preop-_Postop) delta value (AUC = 0.725, p = 0.004), postoperative SIRI (AUC = 0.716, p = 0.016), SIRI_Preop-_Postop delta value (AUC = 0.712, p = 0.016), postoperative SII (AUC = 0.692, p = 0.032), and SII_Preop-_Postop delta value (AUC = 0.631, p = 0.030). Conclusions: Inflammatory indexes are valuable tools for assessing perioperative risk in major vascular surgery, enhancing the value of the already validated risk scores.

Systemic Inflammatory Indices as Predictors of Lung Maturation in Preterm Infants Born Before 32 Weeks of Gestation

AbstractIncreased inflammation in premature infants in the prenatal period reduces respiratory distress syndrome (RDS). Several systemic inflammatory indices have been used to evaluate inflammatory responses in different pathologies. Our study aimed to determine the systemic inflammatory indices as predictors of lung maturation in preterm infants born before 32 weeks of gestation. In this study, preterm infants born before 32 weeks of gestation were enrolled and categorized based on the diagnosis of RDS. At birth, infants were assessed for various systemic inflammatory indices, including the systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), systemic inflammation response index (SIRI), and the monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). The study included 365 infants, of whom 211 had RDS. The median gestational ages (GA) were 27 (range: 25–29) and 30 (range: 29–31) weeks, and the median birth weights were 850 (range: 660–1,360) and 1,375 (1,090–1,600) g in the RDS and control groups, respectively. Infants in the RDS group had significantly lower MLR, NLR, PIV, SII, and SIRI values (p = 0.001) compared to the control group. The cutoff values for predicting RDS in the whole group were 239 for SII, 0.44 for SIRI, and 78 for PIV. For the group of preterm infants born at ≤28 weeks of gestation, values of 171, 0.5, and 87 for SII, SIRI and PIV, respectively, provided the best ability to predict RDS. For the whole cohort, SII level ≥239 was associated with a reduced risk of RDS, as revealed by multivariate analyses (p = 0.001). To account for GA, we performed regression analyses for infants born at ≤28 weeks. SII ≥171 (odds ratio [OR]: 0.12; 95% confidence interval [CI]: 0.05–0.3), PIV ≥87 (OR: 0.08; 95% CI: 0.03–0.21), and SIRI ≥0.5 (OR: 0.08; 95% CI: 0.03–0.2) were associated with a reduced risk of RDS. Inflammation in the perinatal period may reduce the frequency of RDS in premature infants.

The Effect of Systemic Inflammatory Response on Mechanical Thrombectomy is Partly Mediated by Pre-thrombectomy Cerebral Edema in Acute Stroke Patients.

To explore the effect of baseline Systemic Inflammatory Response reflected by platelet-to-lymphocyte ratio (PLR) and pre-thrombectomy cerebral edema reflected by Net Water Uptake (NWU) on futile recanalization in patients with Acute Ischemic Stroke (AIS) after successful thrombectomy, and to investigate the potential mediating role of baseline cerebral edema. 134 Patients with anterior circulation ischemic stroke receiving successful thrombectomy were retrospectively studied. Their demographic and clinical characteristics were collected at admission, and the NWU was quantitatively calculated based on baseline computed tomography (CT). The predictive value of PLR for futile recanalization and the relationship between PLR, NWU, and futile recanalization using mediation analysis were explored. Patients were followed up for 90 days and were divided into a futile recanalization group and a favorable prognosis group [90-day modified Rankin Scale score of 0-2]. High baseline PLR, NWU, no first-pass reperfusion, and large baseline ischemic core volume were independent predictors of futile recanalization after successful thrombectomy in patients with AIS. Mediation analysis results indicate that PLR may partially mediate the occurrence of futile recanalization through NWU. Baseline PLR and NWU were independent predictors of futile recanalization, and higher PLR and NWU values were associated with a higher likelihood of futile recanalization. The findings suggest that early cerebral edema reflected by a high NWU value may be a mediator of PLR-affecting prognosis.

Divergent associations of inflammatory markers with bone turnover markers in elderly patients with osteoporotic fractures

The association between inflammatory markers (IMs) and bone turnover markers (BTMs) in osteoporotic fracture patients has not been comprehensively studied. Therefore, this study examined the correlation between the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), or Monocyte-to-lymphocyte ratio (MLR) and BTMs in osteoporosis (OP) fracture patients. This retrospective cross-sectional study analyzed 740 OP fracture patients admitted to the hospital from January 2017 to July 2022. MLR, NLR, and PLR were calculated based on each patient’s complete blood count. The relationship between IMs and BTMs was assessed using three models by adjusting variables. Furthermore, the potential curve relationship between IMs and BTMs was also determined via the threshold effect analysis and curve fittings. In addition, stratified analysis was performed on each adjusted variable to confirm the stability of the results. After adjusting the variables, the results showed that NLR was negatively correlated with procollagen type 1 N-terminal propeptide (P1NP) (β = -1.1788, 95% CI: -1.7230 to -0.6345, P-value < 0.0001) and β-C-terminal telopeptide of type I collagen (β-CTX) (β = -0.0104, 95% CI: -0.0145 to -0.0062, P-value < 0.0001), Furthermore, MLR was negatively correlated with P1NP (β = -17.4523, 95% CI: -27.7335 to -7.1710, P-value = 0.0009) and β-CTX (β = -0.1327, 95% CI: -0.2211 to -0.0443, P-value = 0.0034). However, PLR indicated a positive correlation with P1NP (β = 0.0326, 95% CI: 0.0007 to 0.0645, P-value = 0.0458) and β-CTX (β = 0.0003, 95% CI: 0.0001 to 0.0006, P-value = 0.0204). The threshold effect analysis and curve fittings revealed the presence of a turning point between NLR, MLR, and P1NP, β-CTX. In addition, the stratified analysis validated the result’s stability. In conclusion, this study indicates a negative correlation between NLR and MLR with P1NP, while PLR shows a positive correlation with P1NP. Additionally, NLR and MLR exhibit a negative correlation with β-CTX, whereas PLR demonstrates a positive correlation with β-CTX. Further research is required to assess the intricate mechanisms linking IM with bone metabolism.

The association between hematological markers of inflammation and chronic cannabis use: a systematic review and meta-analysis of observational studies

IntroductionCannabinoids, both natural and synthetic, are a subject of scientific interest. Cannabis is widely used, and its impact on health and the immune system is being studied. The endocannabinoid system influences inflammation, including the Neutrophil-to-Lymphocyte Ratio (NLR), a potential diagnostic tool. Our study investigates the connection between cannabis use and NLR.MethodsOur systematic review was registered in Prospero (#CRD42023463539). We searched six databases (PubMed, Scopus, Embase, PsycINFO, Web of Science, and CINAHL Complete) for records in English from inception to May 2024. We included observational studies that measured the Neutrophil-to-Lymphocyte Ratio (NLR) in cannabis users and control participants. We used the Newcastle–Ottawa Quality Assessment Scale to assess the quality of the included studies. We selected a random-effects model, and the statistical analysis was performed using Stata software version 17.ResultsOut of a total of 4,054 records, only five articles were selected for inclusion in the meta-analysis. All of these chosen studies utilized a retrospective design. Furthermore, it's worth noting that all of the studies included were of high quality. In five studies involving 3,359 cannabis users and 10,437 non-users, no significant difference in NLR was found (WMD: 0.12 [-0.16, 0.41], I2: 39.89%). Subgroup analysis on healthy and schizophrenia participants didn't show significant NLR differences (p=0.76). Secondary analysis revealed cannabis users had higher Platelet-to-Lymphocyte Ratio (PLR) (67.80 [44.54, 91.06]), neutrophil count (0.68 [0.25, 1.12]), white blood cell count (0.92 [0.43, 1.41]), monocyte count (0.11 [0.05, 0.16]), and Systemic Immune Inflammation Index (SII) (83.48 [5.92, 157.04]) compared to non-usersConclusionOur systematic review and meta-analysis reveal that cannabis use may affect NLR and hematologic parameters, suggesting a potential immune impact. Complex associations exist, requiring further research. Schizophrenia and pro-inflammatory factors are discussed, highlighting the need for ongoing investigation into cannabis-related immune changes and mental health.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023463539.

Association of blood count–derived immunoinflammatory makers and risk of epilepsy: A prospective cohort of 497,291 participants

ObjectiveTo explore the longitudinal association between blood count-derived immunoinflammatory markers and the risk of epilepsy in a large population cohort. MethodsWe used data from the UK Biobank (UKB) to investigate the association between pre-diagnostic peripheral immunoinflammatory cells and their derived ratios, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and the risk of epilepsy. This was a longitudinal cohort study in which multivariate Cox proportional hazards models and a series of sensitivity and subgroup analyses were performed to explore the nature of these associations. ResultsWe examined these associations in a prospective UKB cohort of 497,291 participants. During a median follow-up of 12.43 years, 2,715 participants developed epilepsy. After adjusting for all covariates, the results showed that higher monocyte counts and some blood count-derived immunoinflammatory metrics (monocyte counts, hazard ratio [HR]=1.093, 95 % confidence interval [CI] 1.052–1.136, P<0.001; NLR, HR=1.062, 95 % CI 1.022–1.103, P=0.002; PLR, HR=1.096, 95 % CI 1.055–1.139, P<0.001; SII, HR=1.041, 95 % CI 1.003–1.082, P=0.036) were associated with an increased risk of epilepsy. Conversely, we found that higher lymphocyte counts and LMR were negatively associated with the risk of epilepsy (lymphocyte count, HR=0.889, 95 % CI 0.856–0.923, P < 0.001; LMR, HR=0.85, 95 % CI 0.82–0.881, P < 0.001). ConclusionsMonocyte count, NLR, PLR, and SII increased the risk of epilepsy, whereas lymphocyte count and LMR decreased it. Further studies will help translate these findings into clinical practice or targeted treatments.

Preoperative Delta Neutrophil Index, Platelet Lymphocyte Ratio and Immature Granulocyte Count for Differentiating Metastatic Colon Cancer from Non-Metastatic Colon Cancer: A Retrospective Study.

Immature granulocytes show bone marrow activation before neutrophil response and there are studies in the literature showing that the number of immature granulocytes is an auxiliary marker in the diagnosis and treatment of different diseases. The Delta Neutrophil Index (DNI), Immature Granulocyte Count (IGC) have previously been studied as markers in thyroid and breast cancers. The aim of this study was to determine whether immature granulocyte IGC and DNI values measured in preoperative blood parameters have a diagnostic benefit for the detection of advanced colon cancer. A study was conducted on patients who had undergone selective operation for colon cancer in our clinic from February 2015 to February 2020. The patients were divided into two groups: early stage (stage I-III) and advanced stage (stage IV) colon cancer. The IGC and DNI values as well as other hematological parameters, demographic parameters (sex, age) in these two groups were compared. A total of 43 patients with mean age 67.47 (35-96) years were included in the study. Eighteen of the patients were male and 25 were female. When the early stage and advanced stage colon cancer groups were compared, no statistically significant difference was found between age, sex, white blood cell count, lymphocyte-to-monocyte ratio, eosinophil count, basophil count, mean platelet volume and: systemic immune-inflammation index score. It was observed that platelet-to-lymphocyte ratio, IGC and DNI or Immature Granulocyte Percentage (IGP) values were statistically significantly higher in the metastatic colon cancer group compared to the non-metastatic group. When the specificity and sensitivity of laboratory markers in metastatic colon cancer were examined, it was observed that the specificity and sensitivity of DNI or IGP and IGC were statistically higher than other values. DNI, IGC and PLR values, which are the parameters measured in the preoperative period are easily measurable laboratory parameters and do not involve additional costs in differentiating metastatic from non-metastatic colon cancer in the preoperative period.

Dynamics of tumor in situ fluid circulating tumor DNA in recurrent glioblastomas forecasts treatment efficacy of immune checkpoint blockade coupled with low-dose bevacizumab

PurposeImmune checkpoint blockade (ICB) therapies have shown efficacy in various tumors, but long-term responses in glioblastoma are less than 10%. Quantifying tumor in situ fluid circulating tumor DNA (TISF-ctDNA) and therapeutic dynamics may enable real-time GBM disease burden evaluation. This study explores the potential of tumor in situ fluid circulating tumor DNA (TISF-ctDNA) dynamics in predicting treatment efficacy.MethodsTISF and peripheral blood samples were collected from patients with recurrent glioblastoma (rGBM) undergoing tislelizumab (a programmed death 1 inhibitor) combined with low-dose bevacizumab (an anti-vascular endothelial growth factor antibody) treatment before and during each immunotherapy cycle. Biomarkers evaluated included TISF-ctDNA, measured using Next Generation Sequencing (NGS), and host inflammation markers such as the platelet-to-lymphocyte ratio (PLR).ResultsAll 32 patients received tislelizumab plus low-dose bevacizumab regularly. The median progression-free survival (PFS) was 4.0 months, and overall survival (OS) was 22.3 months. An analysis of 19 patients with continuous evaluable TISF showed baseline TISF-ctDNA abundance did not correlate with OS (p = 0.23) or PFS (p = 0.23). However, a change in TISF-ctDNA maximal Somatic Variant Allelic Frequency (MVAF) after six treatment cycles predicted both PFS (p = 0.02) and OS (p < 0.0001). Lower baseline PLR also correlated with better survival outcomes.ConclusionThe combination of tislelizumab and low-dose bevacizumab therapy appears to be effective in extending both OS and PFS in rGBM patients. Continuous TISF-ctDNA testing shows potential utility in complementing radiological monitoring. The temporal change pattern of TISF MVAF is more predictive of immunotherapy response than imaging. PLR before immunotherapy can screen patients likely to benefit from tislelizumab plus low-dose bevacizumab therapy.Trial registrationThe trial registration number: NCT05502991; Date of registration: 2022-08-14.

Effect of oral doxycycline, azithromycin and isotretinoin on haematological inflammatory markers and interleukin-17A levels in acne vulgaris: a single blinded randomised interventional study.

Amidst the existing literature on the effect of isotretinoin on serum interleukin-17 levels in acne patients, the effects of oral antibiotics azithromycin and doxycycline on serum interleukin-17 is scarce. We conducted an investigator blinded randomized interventional study to compare the effect of doxycycline, azithromycin and isotretinoin on inflammatory markers and Interleukin-17A (IL-17A) levels in acne. Patients were randomized and received the treatment according to treatment arm till 12 weeks. At baseline and 12 weeks/treatment completion, clinical improvement and Red-cell-distribution width (RDW),Neutrophil-lymphocyte ratio(NLR),Platelet-lymphocyte ratio(PLR), Mean-Platelet volume(MPV), Platelet-distribution width(PDW) and Interleukin-17A levels were analysed. P-value < 0.05 was considered statistically significant. Out of 120 patients, 110 patients completed the study. Baseline Global acne grading scale (GAGS) in doxycycline, azithromycin or isotretinoin group was 24.32 ± 3.119, 24.12 ± 2.804 and 25.10 ± 3.985 respectively and post-treatment was 5.216 ± 1.88, 7.265 ± 2.17 and 2.769 ± 1.08. All the drugs caused a statistically significant decrease in RDW and IL-17A levels. Baseline levels of IL-17A were significantly higher in patients with higher GAGS and post-acne scarring. One of the limitations of our study was that we excluded severe nodulocystic acne patients thereby these results have to be carefully extrapolated.

The role of interleukin-20 and vascular endothelial growth factor-A biomarkers in the detection of renal impairment in patients with multiple myeloma

ABSTRACT Background Multiple myeloma (MM) is a malignant incurable disease characterized by monoclonal plasma cell increase associated with renal impairment. Evaluation of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), hemoglobin/red cell distribution width (HB/RDW), interleukin-20 (IL-20), and vascular endothelial growth factor-A (VEGFA) in patients with MM (with or without renal impairment) as prognostic and severity indicators. Research design and methods A cross-sectional study was conducted on sixty MM patients with renal impairment, sixty MM patients without renal impairment, and sixty subjects (control group). Complete blood count, IL-20 immunoassay, and gene expression of IL-20, and VEGFA were evaluated. Results Higher levels of NLR, MLR, and IL-20, moreover lower levels of PLR, HB/RDW, as well as upregulation of IL-20, and VEGFA gene expression were detected in MM patients especially renal impairment. Receiver operating characteristic curves analysis of NLR, MLR, PLR, and IL-20 showed high sensitivity and specificity in the diagnosis of MM and disease stages. Conclusions NLR, MLR, PLR, HB/RDW, IL-20, and VEGFA may be implicated in the inflammatory process of MM and renal impairment pathogenesis. NLR, MLR, and IL-20 can be used as prognostic markers in MM stages.

Platelet-to-Lymphocyte Ratio as Coagulopathy Predictor in COVID-19 Patients at Margono Soekarjo Hospital

Coronavirus Disease 2019 (COVID-19) is a disease possibly attacking various organs and systems of the body including the coagulation system causing coagulopathy. Various laboratory biomarkers have been developed to detect coagulopathy. This research aimed to determine the correlation and ability of Platelet-to-Lymphocyte Ratio (PLR) in predicting coagulopathy when compared to D-dimer. A cross-sectional research was conducted on 1580 data of COVID-19 patients at Margono Soekarjo Hospital. The research data were then analyzed using Spearman’s correlation test to figure out the correlation between PLR and D-dimer. This research was also intended to find the PLR Cut-Off Value (COV), Odds Ratio (OR), Area Under Receiver Operating Characteristic (AUROC), and diagnostic value. Platelet-to-lymphocyte ratio value had a significant correlation with D-dimer levels (r=0.260, p=0.000). The COV of PLR was 176.61 with the OR of 2.7 (2.2-3.3 95%CI), AUROC of 0.638, sensitivity of 62%, and specificity of 62%. PLR can be used as a screening biomarker to predict the occurrence of coagulopathy in COVID-19 patients.

Association between Platelet-Lymphocyte Ratio and Proteinuria in T2DM Patient

Diabetes Mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia and glucose intolerance. Type 2 DM (T2DM) covers over 90% of DM cases. Diabetic nephropathy is a microvascular complication of DM. Proteinuria is as a marker of diabetic nephropathy in DM patients, which reflects disturbances of glomerular filtration and protein reabsorption. Platelet-to-Lymphocyte Ratio (PLR) is a new marker of inflammation and predictor of various medical conditions that is cheap and easy to access through a complete blood count. The pathophysiology of diabetic nephropathy has been reported to be related to chronic inflammation, hypercoagulation, and oxidative stress, which can affect the increase in the number of platelets and decrease in the number of lymphocytes. This study aimed to determine the correlation between PLR and proteinuria in T2DM patients. This cross-sectional study design used medical records data and involved patients presenting T2DM at dr. Soebandi Hospital, Jember from April 2021 to March 2023. The correlation between variables was analyzed using the Spearman correlation test (p &lt;0.05). Based on the result with a subject of 98 T2DM patients, statistical analysis showed a significant correlation between PLR and proteinuria (p=0.000) with moderate strength of correlation (r=0.468). The average PLR value in T2DM patients with proteinuria was higher (255.41) than in T2DM patients without proteinuria (139.85).

Prognostic values of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in the early prediction of aluminum phosphide-poisoned patients’ outcomes

Background In Egypt, aluminum phosphide (ALP) is one of the most serious health problems that threaten the health system, with a very high mortality rate that ranges from 30%–100% of cases, according to medical facilities. ALP records suicidal deaths related to the toxin ingestion in Egypt, which accounts for 70% of the deaths. Patients usually deteriorate early; death is expected in the first 48 h. The aim of this study is to investigate the early recorded neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in anticipation of the ALP-intoxicated patients’ outcome. Patients and methods Thirty-three subjects diagnosed with ALP poisoning were divided into two groups according to their need for mechanical ventilation and whether they could survive or not. A complete blood count (CBC) was done immediately after admission, and NLR and PLR were calculated. Patients’ conditions were evaluated by arterial blood gases (ABG), random blood sugar (RBS), sodium (Na+), potassium (K+), and an electrocardiogram (ECG). Results There were significant differences in the need for ICU and mechanical ventilation between the different NLR groups. There was also a highly significant difference in the patient’s fate. Increased NLR was associated with a high incidence of mechanical ventilation and death in ALP-poisoned patients. Conclusion The early assessment of NLR can be valuable in predicting death and the need for ICU admission. NLR ≥ 3.35 can predict death in ALP-poisoned patients. Early CBC and calculation of NLR are promising tools that are easy and more accurate than the presence of leukocytosis or leucopenia.