Platelet-to-lymphocyte Ratio Research Articles

Predictive strength of inflammatory scores for in-hospital mortality in infective endocarditis.

Inflammatory markers have been proposed as prognostic tools for predicting in-hospital mortality in infective endocarditis (IE). Nonetheless, it is unclear whether these markers provide additional prognostic value over established indicators. This study compared nine different inflammation scores to assess their effectiveness in enhancing the prediction of in-hospital mortality. Patients with IE diagnosed between 2017 and 2023 at two cardiology centers in Istanbul were included in this study. Pre-treatment inflammatory markers were obtained from the hospital electronic database system. In-hospital mortality prognostication was assessed using Cox proportional hazards models. Atotal of 122 patients who were diagnosed with IE were included in the analysis. Overall, 38patients died during the hospital stay. The patients were categorized into two groups based on their mortality status. The prognostic nutritional index (PNI), platelet-to-lymphocyte ratio (PLR), and modified Glasgow prognostic score (mGPS) were identified as statistically significant predictors of in-hospital mortality. Based on the results of Cox regression analysis, the PNI (hazard ratio [HR]: 0.921, 95%confidence interval [CI]: 0.853-0.994, p = 0.035) emerged as the only independent predictor of in-hospital mortality of IE patients. Nine inflammatory scores were evaluated in this study. The PNI, PLR, and mGPS were statistically significant predictors of in-hospital mortality in patients with IE. The PNI was identified as the optimal score.

Association between platelet-to-lymphocyte ratio and immune checkpoint inhibitor-induced thyroid dysfunction.

To investigate the relationship between platelet-to-lymphocyte ratio (PLR) or neutrophil-to-lymphocyte ratio (NLR) and Immune checkpoint inhibitor (ICI)-induced thyroid dysfunction. This was a single-center retrospective observational study of patients with solid tumors receiving ICI therapy. Clinical characteristics of patients were assessed at baseline and during ICI therapy. Logistic regression was implemented to assess the association of PLR and NLR with thyroid dysfunction. Kaplan-Meier method was used to analyze the difference in time between the onset of hypothyroidism and thyrotoxicosis. A total of 355 patients with solid tumors were included in our study. Sixty-nine (19.44%) patients developed ICI-induced thyroid dysfunction after receiving ICI therapy, with a median (IQR) time to onset of 91(34-203.5) days. Patients with high PLR (H-PLR) had an increased risk of ICI-induced thyroid dysfunction (OR = 1.87, 95% CI 1.07-3.28, P = 0.028) compared to those with low PLR (L-PLR). Specifically, H-PLR was associated with ICI-induced thyrotoxicosis but not hypothyroidism (OR = 2.40, 95% CI 1.09-5.29, P = 0.030). Meanwhile, NLR was not correlated with ICI-induced thyroid dysfunction as a continuous (P = 0.699) or categorical variable (P = 0.914). The sensitivity analysis showed that H-PLR remains positively correlated with ICI-induced thyroid dysfunction. PLR rather than NLR was associated with the occurrence of ICI-induced thyroid dysfunction. Furthermore, PLR may serve as a predictive biomarker for ICI-induced thyroid dysfunction.

Association between inflammatory indices and preoperative deep vein thrombosis in patients undergoing total joint arthroplasty: a retrospective study

BackgroundTo investigate the association between inflammatory indices-systemic immune-inflammation index (SII), monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and preoperative deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA).MethodsWe created the receiver operator characteristic (ROC) curve using the ratios of SII, MLR, NLR, PLR to DVT before TJA, divided the enrolled patients into groups based on the cut-off value, and then analyzed risk factors for DVT before TJA in the multivariate binary logistic regression analysis.ResultsA total of 2125 patients were enrolled and preoperative DVT occurred in 110 cases (5.18%). Based on the ROC curve, we determined that the cut-off values for SII, MLR, NLR, and PLR were 470*109 /L, 0.306, 2.08, and 127; and the areas under the curve (AUC) were 0.623, 0.601, 0.611, and 0.62. Multivariate binary regression analysis revealed that the risk of preoperative DVT in TJA patients with SII ≥ 470*109/L, MLR ≥ 0.306, PLR ≥ 127, and NLR ≥ 2.08 increased by 2.26 (P < 0.001, 95% confidence interval (CI) [1.52–3.37]), 1.92 (P = 0.002, 95% CI [1.28–2.9]), 2.1 (P < 0.001, 95% CI [1.4–3.16]), and 1.94 (P = 0.002, 95% CI [1.29–2.92]) times, respectively. Age, P < 0.001, odds ratio (OR) = 1.08, 95%CI [1.05–1.10]; corticosteroid use, P = 0.002, OR 3.8, 95% CI [1.94–9.22]).ConclusionWe found that higher SII, MLR, NLR, and PLR levels, age, and corticosteroid use were independent risk factors for preoperative DVT in patients undergoing TJA.Clinical trial registrationChiCTR2100054844; Registration Date: 2021.12.28.

Nomogram for prognosis prediction in metastatic pancreatic cancer patients undergoing intra-arterial infusion chemotherapy: incorporating immune-inflammation scores and coagulation indicators

BackgroundPancreatic cancer is one of the most malignant tumors with an inferior prognosis. This study aims to determine the prognostic significance of immune-inflammatory scores and coagulation indices in patients with metastatic pancreatic cancer(MPC) and develop a predictive nomogram.MethodsThis study retrospectively analyzed the clinical data of 384 patients with MPC who underwent intra-arterial infusion chemotherapy (IAIC). Patients were randomly divided into training and validation cohorts. Firstly, the optimal cutoff values for continuous variables were obtained in the training cohort. Then, survival analysis was performed to evaluate the impact of immune-inflammatory scores neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and coagulation indicators prothrombin time (PT), fibrinogen (FIB), and D-dimer on the overall survival (OS) of patients. Next, univariate analysis was utilized to identify prognostic factors, and a stepwise regression method was employed for variable selection to construct a nomogram based on the Cox proportional hazards model. Additionally, the predictive performance of the nomogram was assessed by the concordance index (C-index), the area under the ROC curve (AUC), and calibration curves. Finally, patients were stratified into risk groups based on the total score of the nomogram.ResultsThe Kaplan–Meier survival curves indicated that immune-inflammatory scores NLR, PLR, SII, and coagulation indicators PT, FIB, and D-dimer were associated with OS. Through Cox regression analysis, a nomogram was ultimately constructed incorporating NLR, PLR, PT, alkaline phosphatase (ALP), carbohydrate antigen 125 (CA125), age, and ablation. The model demonstrated good discriminative ability, with a C-index of 0.722, and the AUC values at 6- and 12-month OS predictions were 0.828 and 0.851 in the training cohort, while in the validation cohort, the corresponding AUC values were 0.754 and 0.791, respectively. The calibration curves showed a good fit, confirming the stability of the model. A cutoff value of 353.3 was identified as optimal for risk stratification, with a statistically significant difference in OS between the high- and low-risk groups.ConclusionThe nomogram based on immune-inflammatory scores, coagulation indicators, and other clinicopathological factors can effectively predict the OS of patients with MPC.

Exploring and validating associations between six systemic inflammatory indices and ischemic stroke in a middle-aged and old Chinese population

BackgroundInflammation and maladaptive immune mechanisms have been substantiated as integral components in the critical pathological processes of the injury cascade in ischemic stroke (IS). This study aimed to explore the associations between six systemic inflammatory indices and IS in a Chinese population.MethodsThis was a case-control study based on the retrospective review of electronic medical records from two hospitals in Shandong Province, China. Systemic inflammatory indices, including the systemic inflammation response index (SIRI), systemic immune inflammation index (SII), pan-immune-inflammation value (PIV), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR), were calculated. Logistic regression models and classification analyses were employed to evaluate associations and discriminatory abilities.ResultsIn total, 9392 participants aged 40–83 years old were included in the discovery (3620 pairs of IS-present cases and healthy controls) and validation (1076 pairs of IS-present cases and IS-absent controls with IS mimics) datasets. After adjusting for potential confounding factors, IS was found to be associated with all six systemic indices in the discovery dataset, including SIRI (odd ratio [OR] 8.77, 95% confidence interval [CI] 7.48–10.33), SII (1.03, 1.01–1.04), PIV (1.01, 1.01–1.01), NLR (2.23, 2.08–2.39), PLR (1.01, 1.01–1.01), and LMR (0.77, 0.75–0.78). Notably, only LMR exhibited significant associations with IS in both discovery and validation datasets (0.88, 0.83–0.93), suggesting an independent protective role of this index. SIRI, SII, PIV, NLR, and LMR showed good discriminative ability between IS patients and healthy controls in the discovery dataset (AUCs > 0.70). However, they performed poorly in distinguishing IS patients from IS mimics in the validation dataset (AUCs < 0.60).ConclusionThis study provides valuable insights into the associations between systemic inflammatory indices and IS, offering potential implications for risk stratification. While these inflammatory indices are potential indicators for distinguishing IS from healthy conditions, additional biomarkers may be needed when differentiating IS from other chronic inflammatory conditions in clinical practice.

The effect of SARS-CoV-2 Omicron BA. 5.2 infection on perioperative physiological indicators in orthopedic patients

ObjectiveThe aim of this study was to investigate the effect of SARS-CoV-2 Omicron BA. 5.2 (hereafter referred to as Omicron BA. 5.2) infection on perioperative physiological indices and to provide clinical considerations for the precautions needed for patients who tested negative for SARS-CoV-2 infection perioperatively.MethodsPatients who underwent time-limited surgery (surgery that must be performed within a certain time) at the Department of Orthopedics of our hospital from September 1, 2022, to March 31, 2023, were divided into an observation group (those with Omicron BA 5.2 and a negative nucleic acid test after December 7, 2022, n = 100) and a control group (those negative for SARS-CoV-2 infection before December 7, 2022, n = 100). Changes in the following factors were compared within and between the two groups: heart rate, mean arterial pressure, oxygenation index at the time of entry into the operating room, incision of the skin and exit from the operating room and the neutrophil‒lymphocyte ratio (NLR), platelet‒lymphocyte ratio (PLR), systemic immune inflammation index (SII), D-dimer level, and fibrinogen degradation product (FDP) level. Changes in interleukin-6 and calcitonin levels were assessed the day after surgery, and multivariate regression analysis of the meaningful results was conducted.ResultsHeart rate, mean arterial pressure, oxygenation index, NLR, PLR, SII, interleukin-6 and calcitonin were similar between the two groups (P > 0.05). The observation group had higher postoperative D-dimer and FDP levels (P < 0.05). Multivariate regression analysis revealed that Omicron BA 5.2 infection, older age and a history of cerebral infarction were associated with increased D-dimer and FDP levels, and their odds ratios (ORs) and confidence intervals are 3.339 [95% CI, 1.372–8.419], P = 0.008; OR, 1.080 [95% CI, 1.023–1.139]; P = 0.005; OR, 10.644 [95% CI, 1.352–83.320], P = 0.025, respectively.ConclusionOmicron BA. 5.2 Infection affects the perioperative coagulation function of orthopedic patients, thereby inducing a hypercoagulable state characterized by significant elevations in D-dimer and FDP levels and increasing the risk of venous thrombosis. This infection had no obvious effect on other physiological indices. Early surgery is feasible, but thrombotic events need to be considered.

Hematological parameters in pediatric pulmonary and extrapulmonary tuberculosis in Vietnam: a prospective observational study

BackgroundTuberculosis in children remains a significant public health issue in Vietnam. This study aims to describe the clinical and paraclinical characteristics of children with pulmonary and extrapulmonary tuberculosis and to evaluate the value of certain hematological parameters in differentiating between these two forms.MethodsThis prospective observational study was conducted on 36 children diagnosed and treated for tuberculosis at Hue Central Hospital. Clinical and paraclinical characteristics were compared between pulmonary and extrapulmonary tuberculosis. The ROC curve, sensitivity, and specificity were used to compare the diagnostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and Systemic Immune-Inflammation Index (SII) in differentiating pulmonary from extrapulmonary tuberculosis.ResultsOf the 36 children with tuberculosis in the study group, 58.3% had pulmonary tuberculosis and 41.7% had extrapulmonary tuberculosis. There were significant differences between pulmonary and extrapulmonary tuberculosis in terms of gender distribution (p = 0.037), family history (p = 0.008), fever (p = 0.001), malnutrition (p = 0.008), and night sweats (p = 0.027). Pulmonary tuberculosis had significantly higher levels of inflammatory markers such as white blood cells, neutrophils, ESR, and CRP compared to extrapulmonary tuberculosis. The NLR and SII indices showed good discriminatory value, while the PLR index showed acceptable discriminatory value when comparing pulmonary and extrapulmonary tuberculosis. The SII index had the best diagnostic value with an AUC of 0.832, sensitivity of 66.7%, and specificity of 86.7%.ConclusionsHematological indices calculated from the complete blood count (NLR, PLR, SII) have good value in differentiating between pulmonary and extrapulmonary tuberculosis in children, with the SII index having the best value.

Prediction of Prostate Cancer From Routine Laboratory Markers With Automated Machine Learning.

In this study, we attempted to select the optimum cases for a prostate biopsy based on routine laboratory test results in addition to prostate-specific antigen (PSA) blood test using H2O automated machine learning (AutoML) software, which includes many common machine learning algorithms. The study included 737 patients (46-88 years old). Routine laboratory measurements were used to train machine learning models using H2O AutoML. We created a model that classifies prostate biopsy results as malignant or benign. The performance of the best model was evaluated using the area under the receiver operating characteristic curve (AUC), log-loss metric, F1 score, positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity. The model's performance was evaluated through the SHapley Additive exPlanations (SHAP) analysis feature-based interpretation method applied to comprehend the machine learning model. The gradient boosting machine model was the most successful. The best result was obtained in the model with 11 parameters, including PSA, free PSA, free PSA to PSA, hemoglobin, neutrophils, platelets, neutrophil-to-lymphocyte ratio (NLR), glucose, platelet-to-lymphocyte ratio (PLR), lymphocytes, and age. The AUC of this model was 0.72, the specificity was 0.84, the PPV was 0.65, the NPV was 0.69, and the accuracy was 0.68. Our results suggest that adding only routine laboratory parameters to the PSA test and developing machine learning algorithms can help reduce the number of unnecessary prostate biopsies without overlooking the diagnosis of PCa.

MiRNAs and Hematological Markers in Non-Alcoholic Fatty Liver Disease-A New Diagnostic Path?

Background: Asymptomatic liver steatosis constitutes an emerging issue worldwide. Therefore, we decided to explore relationships between selected types of microRNAs (miRNAs), serological markers of liver fibrosis and hematological parameters in the course of non-alcoholic fatty liver disease (NAFLD). Methods: Two hundred and seven persons were included in the survey: 97 with NAFLD and 110 healthy controls. Serological concentrations of miR-126-3p, miR-197-3p, and miR-1-3p were measured in all participants. Direct indices of liver fibrosis [procollagen I carboxyterminal propeptide (PICP), procollagen III aminoterminal propeptide (PIIINP), platelet-derived growth factor AB (PDGF-AB), transforming growth factor-α (TGF-α) and laminin] together with indirect markers (AAR, APRI, FIB-4 and GPR) were also evaluated. The assessment of hematological parameters concerned: mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), red blood cell distribution width (RDW), MPV to platelet (PLT) ratio (MPR), RDW to PLT ratio (RPR), neutrophil to lymphocyte (LYM) ratio (NLR), PLT to LYM ratio (PLR) and RDW to LYM ratio (RLR). Additionally, the NAFLD fibrosis score and BARD score were applied. Results: The concentration of miR-126-3p and miR-1-3p was higher, and miR-197-3p was lower in the NAFLD group (p < 0.0001). miR-197-3p correlated notably with hematological indices: negatively with PDW (p < 0.05) and positively with PLR (p < 0.05). Conclusions: Significant correlations between miRNA molecules and hematological markers in the course of NAFLD indicate inflammation as a potential background and create new possibilities for a diagnostic approach.

EXPLORING THE UTILITY OF CELLULAR INDICES IN THE DIAGNOSIS OF ULCERATIVE COLITIS.

To describe the usefulness of cellular indices in the diagnosis of ulcerative colitis (UC). Diagnostic study of patients under 15 years of age undergoing colonoscopy ± esophagogastroduodenoscopy for suspected inflammatory bowel disease between 2015-2022 in a pediatric hospital. Patients with normal biopsy and anatomopathological diagnosis of UC were included. Using the area under the ROC curve, the values of platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), calculated by dividing the number of platelets, neutrophils, and monocytes by the number of lymphocytes, respectively, were compared to establish the sensitivity, specificity, predictive values and Odds Ratio of each parameter in the diagnosis of UC. Twenty-six patients were included: 14 with normal biopsy and 12 with UC. PLR and MLR values were significantly higher in patients with UC (p <0.05). The sensitivity, specificity, and negative predictive value of PLR, NLR and MLR for diagnosing UC were 58%, 83% and 91%; 85%, 35% and 50%; 70%, 71% and 87%, respectively. The biomarker with the highest diagnostic performance was MLR with a cutoff point of 0.235, area under the curve of 0.735 and Odds Ratio of 11 (95%CI 1.1-109.6; p= 0.041). MLR has a high sensitivity, negative predictive value, and Odds Ratio in the pre-endoscopic diagnosis of ulcerative colitis. These findings, although exploratory, suggest that MLR could be useful in clinical practice in the initial diagnostic workup of UC, and perhaps in the future in the prioritization of endoscopic studies according to MLR values.

Early and Long-Term Outcomes of Patients Undergoing Surgery for Native and Prosthetic Valve Endocarditis: The Role of Preoperative Neutrophil-to-Lymphocyte Ratio, Neutrophil-to-Platelet Ratio, and Monocyte-to Lymphocyte Ratio.

Background/Objectives: Previous studies evaluated the prognostic role of hematological parameters in predicting outcome in patients with infective endocarditis (IE). However, only a few studies evaluated the role of hematological parameters in patients undergoing surgery for IE. The aim of this study was to review our 20-year experience with the treatment of native (NVE) and prosthetic (PVE) valve endocarditis and to evaluate the role of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to monocyte ratio (NMR), and systemic inflammatory index (SII) on early and long-term outcomes of patients undergoing surgery for NVE and PVE. Methods: All adult patients undergoing surgery for NVE and PVE at our institution between January 2001 and December 2022 were included in the study. Preoperative NLR, NPR, PLR, MLR, NMR, and SII were calculated using hemograms with complete blood count. Results: During the study period, 503 patients, 371 (74%) males, median age 65 (52-73) years, underwent surgery for NVE (n = 337, 67%) or PVE (n = 166, 33%). Patients with PVE had significantly more aortic annulus abscess (95 (57%) vs. 51 (15%); p < 0.001), longer CPB (180 (131-235) vs. 105 (84-145) min; p < 0.001) and aortic cross-clamping times (129 (96-175) vs. 82 (64-114) min; p < 0.001), and received more aortic homografts (47 (28%) vs. 28 (9%); p < 0.001) and postoperative pacemaker implantation (25 (15%) vs. 20 (6%); p < 0.001 compared to patients with NVE. Preoperative NLR was 3.7 (2.4-6.1), NPR was 23 (16-37), PLR was 159 (106-210), NMR was 8.4 (6.6-12), MRL was 0.41 (0.29-0.62], and SII was 790 (485-1396). NLR, NPR, and MLR were significantly lower in patients with NVE compared to patients with PVE and in survivors compared to non-survivors. Overall mean survival time was 12.2 ± 0.5 years, with patients with NVE having better early and late survival compared to patients with PVE. Patients with preoperative NLR < 3.8, NPR < 30.9, and MLR < 0.4 had significantly better mean survival time compared to patients with preoperative NLR > 3.8, NPR > 30.9, and MLR > 0.4, respectively. Conclusions: In patients undergoing surgery for IE, preoperative higher NLR, NPR, and MLR are associated with increased early and long-term mortality.

Neurovascular coupling dysfunction associated with inflammatory factors in sudden sensorineural hearing loss.

The neuropathologic mechanisms of sudden sensorineural hearing loss (SSNHL) are unknown. The aim of this study was to investigate the alterations of neurovascular coupling (NVC) in patients with SSNHL and its association with hematologic inflammatory factors. The amplitude of low-frequency fluctuations (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), and degree centrality (DC) were calculated in 48 patients with SSNHL and 54 age-, gender-, and education-matched healthy control (HC), and also utilized the arterial spin labeling imaging (ASL) to calculate cerebral blood flow (CBF). Four indices of NVC (CBF-ALFF, CBF-fALFF, CBF-ReHo, and CBF-DC) in the whole brain gray matter as well as the NVC ratio were compared between two groups. In addition, correlation analyses were performed with inflammatory factors for the NVC indexes at the global level and regional level, respectively. The NVC at global level was lower in SSNHL group than in HC, except for CBF-ALFF. At the regional level, most of the brain regions with abnormal NVC in SSNHL patients involved auditory and sensorimotor language centers and limbic system compared to HC. In addition, both at the global and regional levels, NVC metrics were shown to correlate with partial inflammatory factors or hematologic parameters, including platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), systemic immunoinflammatory index (SII), blood platelet count (PLT), and lymphocyte count (Lym). From the view of the NVC metrics, these findings provide new perspectives on the neuropathologic mechanisms and clinical treatment of SSNHL.

Development of a predictive scoring model for non-response to intravenous immunoglobulin in Kawasaki disease

To explore the predictive factors for non-response to intravenous immunoglobulin (IVIG) in children with Kawasaki disease (KD) and to establish an IVIG non-response prediction scoring model for the Sichuan region. A retrospective study was conducted by collecting clinical data from children with KD admitted to four tertiary hospitals in Sichuan Province between 2019 and 2023. Among them, 940 children responded to IVIG, while 74 children did not respond. Multivariate logistic regression analysis was used to identify the predictive factors for non-response to IVIG and to establish a predictive scoring model. The model's effectiveness was assessed using the receiver operating characteristic curve (ROC) and validated with an independent dataset. Multivariate logistic regression analysis showed that the platelet-to-lymphocyte ratio (PLR), hemoglobin (Hb), serum creatinine, aspartate aminotransferase (AST), and platelet count (PLT) were closely related to non-response to IVIG in children with KD (P<0.05). Based on these indicators, a predictive scoring model was established: PLR > 199, 0.4 points; Hb ≤ 116 g/L, 4 points; AST > 58 U/L, 0.2 points; serum creatinine > 38 µmol/L, 3.9 points; PLT count ≤ 275 × 109/L, 0.3 points. Using this model, children with KD were scored, and a total score greater than 4.3 was considered high risk of non-response to IVIG. The sensitivity of the model in predicting non-response to IVIG was 77.0%, specificity was 65.7%, and the area under the ROC curve was 0.746 (95%CI: 0.688-0.805). The predictive scoring model based on PLR, Hb, serum creatinine, AST, and PLT demonstrates good predictive performance for non-response to IVIG in children with KD in the Sichuan region and can serve as a reference for clinical decision-making.

Predictive value of lymphocyte-associated inflammation index in post-stroke cognitive impairment: a systematic review and meta-analysis

BackgroundThe predictive role of the lymphocyte-associated inflammation index in post-stroke cognitive impairment (PSCI) remains controversial. Therefore, we performed an updated meta-analysis to update the evidence.MethodsThis meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were systematically searched from their inception to May 5, 2024. Two investigators independently conducted literature screening and data extraction for the included studies. Two investigators independently assessed the quality of the included studies using the Newcastle-Ottawa Scale (NOS). Combined effect sizes were calculated using weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence intervals (CIs). Heterogeneity was tested using the chi-square (χ2) test (Cochran’s Q) and index of inconsistency (I2), Publication bias was assessed using funnel plots and Egger’s regression test.ResultsThis systematic review included a total of 16 studies, encompassing 3,406 patients. Meta-analysis revealed that neutrophil-to-lymphocyte ratio (NLR) levels were significantly higher in the PSCI group compared to the non-PSCI group (WMD: 1.12; 95% CI: 0.85, 1.40; p &amp;lt; 0.00001). Similarly, the platelet-to-lymphocyte ratio (PLR) levels were significantly higher in the PSCI group compared to the non-PSCI group (WMD: 16.80; 95% CI: 4.30, 29.29; p = 0.008). However, there was no statistically significant difference between the two groups concerning hemoglobin, albumin, lymphocyte, and platelet (HALP) scores (WMD: -12.78; 95% CI: −25.95, 0.38; p = 0.06) and lymphocyte count (WMD: -0.13; 95% CI: −0.34, 0.07; p = 0.20).ConclusionIncreased levels of PLR and NLR are strongly associated with the PSCI, which may serve as an effective tool for predicting PSCI. However, there is insufficient evidence to support a direct relationship between HALP scores, lymphocyte count, and PSCI.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023462232.

Pre-operative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Predictors of Morbidity and Mortality in Diabetic Foot Infection Amputation Patients

Background: Diabetic foot infection is a complication of uncontrolled diabetes. Some cases require amputation to avoid the spread of infection; however, this can also lead to poor outcomes. Inflammatory markers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), have been explored as predictors of outcomes following amputation; however, only a few published studies are available. Objective: The study aimed to determine the diagnostic value of pre-operative neutrophil-lymphocyte and platelet-lymphocyte ratios in predicting in-hospital morbidity and mortality among diabetic foot infection patients who underwent amputation in a tertiary government hospital. Methodology: This retrospective cohort study included a total of 535 diabetic foot ulcer patients who underwent amputation at a tertiary government hospital. Data was collected via medical chart review. Complete blood count (CBC) parameters closest to the time of amputation were obtained to calculate the neutrophil-lymphocyte and platelet-lymphocyte ratios. Stata software was used for data processing and analysis. Results: Only 10.28% of patients experienced in-hospital morbidity and/or mortality. Based on Youden’s index, the optimal cutoff points of neutrophil-lymphocyte and platelet-lymphocyte ratios were 7.27 and 32.40, respectively. Both markers showed 98% sensitivity in predicting the outcome. Specificity was 99% for the neutrophil-lymphocyte ratio and 93% for the platelet-lymphocyte ratio. Accuracy parameters remained high when morbidity and mortality were analyzed separately, and subgroup analyses by major and minor amputations were performed. Conclusion: Neutrophil-lymphocyte and platelet-lymphocyte ratios accurately predict in-hospital morbidity and mortality among diabetic foot infection patients who underwent amputation. The low cost and wide availability of a CBC make NLR and PLR valuable options in low-resource settings. Future studies should explore these markers' utility in predicting long-term outcomes after amputation.

Genetic predisposition to altered blood cell homeostasis is associated with glioma risk and survival

Glioma is a highly fatal and heterogeneous brain tumor with few known risk factors. Our study examines genetically predicted variability in blood cell indices in relation to glioma risk and survival in 3418 cases and 8156 controls. We find that increased platelet to lymphocyte ratio (PLR) confers an increased risk of glioma (odds ratio (OR) = 1.25, p = 0.005), especially tumors with isocitrate dehydrogenase (IDH) mutations (OR = 1.38, p = 0.007) and IDHmut 1p/19q intact (IDHmut-intact OR = 1.53, p = 0.004) tumors. Genetically inferred increased counts of lymphocytes (IDHmut-intact OR = 0.70, p = 0.004) and neutrophils (IDHmut OR = 0.69, p = 0.019; IDHmut-intact OR = 0.60, p = 0.009) show inverse associations with risk, which may reflect enhanced immune-surveillance. Considering survival, we observe higher mortality risk in patients with IDHmut 1p/19q with genetically predicted increased counts of lymphocytes (hazard ratio (HR) = 1.65, 95% CI: 1.24–2.20), neutrophils (HR = 1.49, 1.13–1.97), and eosinophils (HR = 1.59, 1.18–2.14). Polygenic scores for blood cell traits are also differentially associated with 17 tumor immune microenvironment features in a subtype-specific manner, including signatures related to interferon signaling, PD-1 expression, and T-cell/Cytotoxic responses. Our findings highlight immune-mediated susceptibility mechanisms with potential disease management implications.

The prognostic value of the platelet-to-lymphocyte ratio in multiple myeloma patients treated with a bortezomib-based regimen

Multiple myeloma (MM) is the second most common hematological malignancy. Previous studies have validated the prognostic significance of the platelet-to-lymphocyte ratio (PLR) in patients with certain solid tumors. However, the relationship between the PLR and prognosis in myeloma patients has not been clearly demonstrated. In our study, we included 122 newly diagnosed MM patients who were treated with bortezomib-based chemotherapy. These patients were divided into low-PLR and high-PLR groups based on their initial PLR values. We compared the clinical characteristics between the two groups and utilized restricted cubic splines (RCSs) in the regression model to estimate the nonlinear relationship between the initial PLR and overall survival (OS) in MM patients. The results showed that patients in the low-PLR group had significantly worse OS (P = 0.00031) and progression-free survival (PFS) (P < 0.0001) compared to those in the high-PLR group. Furthermore, within the higher-risk MM group, a low PLR was also associated with worse OS (P = 0.0037) and PFS (P = 0.0048). Therefore, a low PLR was identified as an independent predictor of poor OS in MM patients. The RCS curves further confirmed a significant nonlinear relationship between the PLR and OS in patients with MM. The PLR may serve as a significant independent prognostic indicator for MM patients undergoing bortezomib-based chemotherapy, and there exists a crucial nonlinear relationship between the PLR and OS in these patients.

Comprehensive Evaluation of Inflammatory Biomarkers in Cervical Cancer Treated with Chemoradiotherapy.

Objective: Inflammatory biomarkers have been shown to possess both prognostic and predictive significance in various cancers. Among the emerging biomarkers, the pan-immune-inflammation value (PIV) has recently been introduced as a novel indicator representing both the immune response and the systemic inflammatory state. This study aims to comprehensively evaluate the predictive value of inflammatory biomarkers on survival outcomes in cervical cancer patients undergoing chemoradiotherapy. Methods: A total of 90 patients who had undergone chemoradiotherapy for cervical cancer were included. Data on demographics, treatment protocols, pre-treatment blood parameters, and survival outcomes were collected. The association between inflammatory biomarkers and survival outcomes was investigated through univariate and multivariate analyses. Results: The univariate analysis identified the following as predictors of progression-free survival (PFS): neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), PIV, C-reactive protein (CRP), albumin, and tumor size. Multivariate analysis revealed that only the PIV significantly predicted PFS (HR 3.05, 95% CI 1.0 to 9.3, p = 0.04). In the univariate analysis, several variables were predictive of overall survival (OS), including NLR, PLR, MLR, SII, PIV, CRP, LDH, albumin, tumor size, and Eastern Cooperative Oncology Group Performance Status (ECOG PS). Multivariate analysis revealed CRP (HR 3.41, 95% CI 1.5 to 7.7, p = 0.003) and ECOG PS (HR 4.78, 95% CI 1.3 to 17.3, p = 0.01) predictive of OS, with PIV approaching statistical significance (HR 2.56, 95% CI 0.8 to 7.6, p = 0.09). Conclusions: This study provides the first comprehensive analysis of the association between cervical cancer and various inflammatory biomarkers. Many of these biomarkers have demonstrated predictive value for survival outcomes in patients with cervical cancer undergoing definitive chemoradiotherapy. Among the biomarkers evaluated, CRP and PIV were identified as the most predictive, warranting further exploration in future research.

Are IL-17 inhibitors superior to IL-23 inhibitors in reducing systemic inflammation in moderate-to-severe plaque psoriasis? A retrospective cohort study.

IL-17 and IL-23 inhibitors have shown successful results in improving skin lesions in the treatment of moderate-to-severe plaque psoriasis. However, psoriasis is a chronic inflammatory disease characterized by systemic inflammation including joints in addition to skin lesions. Therefore, in this retrospective and observational cohort study, we aimed to evaluate the effect of IL-17 inhibitors (secukinumab and ixekizumab) and IL-23 inhibitors (risankizumab and guselkumab) on systemic inflammation in psoriasis. We included 214 treatment courses with IL-17 inhibitors (n = 116, 54.2%) and IL-23 inhibitors (n = 98, 45.8%) and compared the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (d-NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-monocyte ratio (PMR), systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) at baseline and Week 16 of treatment. In patients receiving IL-17 inhibitor, NLR, d-NLR, PLR, SII, SIRI, and AISI were significantly decreased at Week 16 (p = 0.003, p = 0.001, p = 0.024, p = 0.001, p = 0.008, and p = 0.002, respectively). There was no significant reduction in systemic inflammatory markers in the anti-IL-23 group. At week 16, the anti-IL-17 group showed a significantly higher mean decrease from the baseline values of NLR, d-NLR, SII, SIRI, and AISI than the anti-IL-23 group (p = 0.021, p = 0.009, p = 0.012, p = 0.028, and p = 0.021, respectively). The PASI75/90/100 scores didn't significantly differ between the IL-17 and IL-23 groups. Achieving PASI90 response at Week 16 in the IL-17 group was associated with the change in AISI (p = 0.037). The PASI75 response at Week 16 in the IL-23 group was associated with the change in NLR, d-NLR, and SII (p = 0.044, p = 0.037, and p = 0.031, respectively). NLR (rho = 0.173, p = 0.014), d-NLR (rho = 0.189, p = 0.007), SII (rho = 0.158, p = 0.024), SIRI (rho = 0.156, p = 0.026), and MLR (rho = 0.165, p = 0.019) showed positive correlations with the baseline PASI, but no correlation was found with the change in systemic inflammatory markers and the change in PASI score. In the treatment of moderate-to-severe psoriasis, IL-17 inhibitors appear to have a greater decreasing effect on systemic inflammatory markers than IL-23 inhibitors. However, more evidence-based data are needed to conclude that IL-17 inhibitors are superior to IL-23 inhibitors in suppressing systemic inflammation in psoriatic disease.

Combining systemic inflammation biomarkers with traditional prognostic factors to predict surgical site infections in elderly hip fracture patients: a risk factor analysis and dynamic nomogram development

BackgroundSystemic inflammation biomarkers have been widely shown to be associated with infection. This study aimed to construct a nomogram based on systemic inflammation biomarkers and traditional prognostic factors to assess the risk of surgical site infection (SSI) after hip fracture in the elderly.MethodsData were retrospectively collected from patients over 60 with acute hip fractures who underwent surgery and were followed for more than 12 months between June 2017 and June 2022 at a tertiary referral hospital. Biomarkers were calculated from peripheral venous blood collected on admission. The Centers for Disease Control and Prevention (CDC) definition of SSI was applied, with SSI identified through medical and pathogen culture records during hospitalization and routine postoperative telephone follow-ups. Multivariable logistic regression identified independent risk factors for SSI and developed predictive nomograms. Model stability was validated using an external set of patients treated from July 2022 to June 2023.ResultsA total of 1430 patients were included in model development, with 41 cases (2.87%) of superficial SSI and 6 cases (0.42%) of deep SSI. Multivariable analysis identified traditional prognostic factors older age (OR = 1.08, 95% CI 1.04–1.12), ASA class III-IV (OR = 2.46, 95% CI 1.32–4.56), surgical delay ≥ 6 days (OR = 3.59, 95% CI 1.36–9.47), surgical duration > 180 min (OR = 2.72, 95% CI 1.17–6.35), and systemic inflammation biomarkers Platelet-to-lymphocyte ratio (PAR) ≥ 6.6 (OR = 2.25, 95% CI 1.17–4.33) and Systemic Immune-Inflammation Index (SII) ≥ 541.1 (OR = 2.24, 95% CI 1.14–4.40) as independent predictors of SSI. Model’s stability was proved by internal validation, and external validation with 307 patients, and an online dynamic nomogram (https://brooklyn99.shinyapps.io/DynNomapp/) was generated.ConclusionsThis study combined systemic inflammatory biomarkers and developed an online dynamic nomogram to predict SSI in elderly hip fracture patients, which could be used to guide early screening of patients with high risk of SSI and provide a reference tool for perioperative management.