Preoperative Neutrophil Count Research Articles

Development and validation of a machine learning predictive model for perioperative myocardial injury in cardiac surgery with cardiopulmonary bypass

BackgroundPerioperative myocardial injury (PMI) with different cut-off values has showed to be associated with different prognostic effect after cardiac surgery. Machine learning (ML) method has been widely used in perioperative risk predictions during cardiac surgery. However, the utilization of ML in PMI has not been studied yet. Therefore, we sought to develop and validate the performances of ML for PMI with different cut-off values in cardiac surgery with cardiopulmonary bypass (CPB).MethodsThis was a second analysis of a multicenter clinical trial (OPTIMAL) and requirement for written informed consent was waived due to the retrospective design. Patients aged 18–70 undergoing elective cardiac surgery with CPB from December 2018 to April 2021 were enrolled in China. The models were developed using the data from Fuwai Hospital and externally validated by the other three cardiac centres. Traditional logistic regression (LR) and eleven ML models were constructed. The primary outcome was PMI, defined as the postoperative maximum cardiac Troponin I beyond different times of upper reference limit (40x, 70x, 100x, 130x) We measured the model performance by examining the area under the receiver operating characteristic curve (AUROC), precision-recall curve (AUPRC), and calibration brier score.ResultsA total of 2983 eligible patients eventually participated in both the model development (n = 2420) and external validation (n = 563). The CatboostClassifier and RandomForestClassifier emerged as potential alternatives to the LR model for predicting PMI. The AUROC demonstrated an increase with each of the four cutoffs, peaking at 100x URL in the testing dataset and at 70x URL in the external validation dataset. However, it’s worth noting that the AUPRC decreased with each cutoff increment. Additionally, the Brier loss score decreased as the cutoffs increased, reaching its lowest point at 0.16 with a 130x URL cutoff. Moreover, extended CPB time, aortic duration, elevated preoperative N-terminal brain sodium peptide, reduced preoperative neutrophil count, higher body mass index, and increased high-sensitivity C-reactive protein levels were identified as risk factors for PMI across all four cutoff values.ConclusionsThe CatboostClassifier and RandomForestClassifer algorithms could be an alternative for LR in prediction of PMI. Furthermore, preoperative higher N-terminal brain sodium peptide and lower high-sensitivity C-reactive protein were strong risk factor for PMI, the underlying mechanism require further investigation.

Treatment outcomes in patients with acute thromboembolic occlusion of the superior mesenteric artery

ObjectivesThe goals of this study were to investigate the treatment outcomes of acute thromboembolic occlusion of the superior mesenteric artery (ATOS) and identify prognostic factors after treatment.MethodsThe clinical data of 62 patients with ATOS between 2013 and 2021 were retrospectively reviewed. Patients were stratified by the treatment strategy, complications and mortality were compared in different group.ResultsSixty-two consecutive patients were identified with ATOS. The median patient age was 69 years (interquartile range 58–79 years). Endovascular therapy was initiated in 21 patients, and 4 patients received conservative treatment. Open surgery was performed first in the remaining 37 patients. The technical success rates of the endovascular first group and open surgery group were 90.5% and 97.3%, respectively. One patient in the conservative treatment group had progression of ischemia to extensive bowel necrosis. There was no difference in 30-day mortality between these groups. Predictors of 30-day mortality included initial neutrophil count > 12* 103/dL, age over 60 years old and history of chronic renal insufficiency.ConclusionsEndovascular treatment or conservative treatment may be adopted in selected patients who do not exhibit signs and symptoms of bowel necrosis, and close monitoring for bowel necrosis is important. The increase in preoperative neutrophil count, age over 60 years old and history of chronic renal insufficiency were poor prognostic factors.

Total laryngectomy and readmission: causes, rates and predictors

BackgroundTotal laryngectomy (TL) is a complex procedure, and patients undergoing TL are at high risk for readmission, which exposes them to hospital-acquired complications. Readmission rate is a metric for quality of care. We aimed to identify the rate, causes, and predictors of hospital readmission within 60 days after discharge following TL.MethodsThis is a 12-year retrospective study where we included all patients undergoing TL in a single tertiary care center between 2008 and 2022. Patient charts were reviewed for demographics, comorbidities, and causes for readmission.ResultsOf 83 patients who underwent TL, 12 (14.50%) were readmitted within 60 days. Common causes were surgical site infection (33.33%) and mucocutaneous fistula (25%). Significant predictors for readmission were tobacco use (P = 0.003), African ethnicity (P = 0.004), being unmarried (P < 0.001), lower preoperative serum albumin (P < 0.001), higher preoperative TSH (P = 0.03), higher preoperative neutrophil count (P = 0.035), higher American Society of Anesthesiology (ASA) score (P = 0.028), and higher Cumulative Illness Rating Scale (CIRS) score (P = 0.029).ConclusionOne in every seven patients were readmitted following TL. Frequent causes include wound infection and fistulas. Predictors include preoperative hypoalbuminemia, hypothyroidism, African ethnicity, being unmarried, tobacco use, and a higher baseline burden of comorbidities. Such factors can be targeted to reduce hospital readmission rates.

The Impact of Variant Histology in Patients with Urothelial Carcinoma Treated with Radical Cystectomy: Can We Predict the Presence of Variant Histology?

Considering the divergent biological behaviors of certain histological subtypes of urothelial carcinoma, it would be of great importance to examine the impact of variant histology and to predict its presence in patients with bladder cancer. A single-center cohort study included 459 patients who underwent radical cystectomy for urothelial carcinoma between 2017 and 2021. Patients were followed up with until July 2022. We compared clinical, laboratory, and histopathologic characteristics and the overall survival between patients with pure urothelial carcinoma and variant histologies. Our results showed that the patients with variant histology were older and preoperatively more frequently had hydronephrosis and higher values of leukocytes and neutrophils. Also, we found a significant association between variant histology and an advanced stage of tumor disease, the presence of lymphovascular invasion, positive surgical margins, and metastases in surgically resected lymph nodes. The number of neutrophils was identified as an independent preoperative predictor of the presence of variant histology after a radical cystectomy. The overall survival of the patients with variant histology was significantly lower compared to the patients with pure urothelial carcinoma. According to our results, the presence of variant histology represents a more aggressive form of the disease. Preoperative neutrophil counts may indicate the presence of variant histology of urothelial carcinoma in patients with bladder cancer.

Leukocyte cell population data in patients with cardiac surgery and cardiopulmonary bypass: A potential readily available tool to monitor immunity.

Cardiac surgery with cardiopulmonary bypass triggers sterile inflammation that is responsible for post-operative morbidity. Automated flow cytometry devices used for leucocyte count provide cell population data (CPD) regarding fluorescence intensity, size and granularity of leukocytes that have never been studied in the context of sterile inflammation. Our objective was to explore leukocyte cell population data in patients undergoing cardiac surgery with cardiopulmonary bypass in order to determine whether CPD could be used to monitor immune cell activation. This is an ancillary study of a cohort of patients undergoing cardiac surgery with cardiopulmonary bypass. Cell population data (CPD) extracted from a routine automated flow cytometer were analyzed (Fluorescence targeted to nucleic acids). The time points of interest were: pre-operative, postoperative and 5 days after surgery. The variations in those parameters were studied. Data were then compared between patients according to the occurrence of a composite criteria (supra-ventricular arrythmia, stroke, acute renal failure, and/or death). Data from 1453 patients were analyzed. The neutrophil count, fluorescence granularity (NE-SCC), intensity (NE-SFL) and size (NE-FSC) increased with surgery. Heterogeneity of neutrophils decreased in terms of fluorescence granularity (NE-WX) and size (NE-WZ) but increased in terms of intensity (NE-WY). The lymphocyte count decreased with surgery. While fluorescence granularity (LY-X) and size increased (LY-Z), Lymphocyte intensity decreased (LY-Y). Lymphocytes were less heterogeneous in terms of their granularity, size and intensity after surgery (LY-WX, LY-WY, LY-WZ). Patients who developed the composite complication criteria had a higher pre-operative neutrophil count (5.08 [3.89;6.95] vs 4.76 [3.60;6.13], p = 0.02; AUC = 0.56 [0.51;0.60]), and more heterogeneous neutrophils in terms of fluorescence granularity (NE-WX, AUC = 0.57 [0.52;0.62]) and intensity (NE-WY, AUC 0.61 [0.56;0.65]). Those patients also had lower pre-operative lymphocyte count (1.49 [1.10;1.14] vs 1.81 [1.39;2.39], p<0.01, AUC = 0.61 [0.57;0.66]) and fluorescence granularity (LY-X, AUC = 0.57 [0.53;0.62]). NE-WX, NE-WY and LY-X were associated with post-operative complications after adjustment on the EuroSCORE 2 (adjusted odd ratio of 1.01 [1.00;1.02]; 1.01 [1.00;1.01] and 1.08 [1.02;1.15] respectively). Cardiac surgery with cardiopulmonary bypass was associated with substantial alterations of CPD probably reflecting leukocytes activation in sterile inflammation. Pre-operative NE-WX, NE-WY and LY-X biomarkers levels were associated with post-operative complications, independently of the EuroSCORE 2. Such routine, unexploited and low cost parameters might represent useful tools likely to monitor immune function and predict outcomes for patients undergoing cardiac surgery. Our findings requires validation on a larger external cohort.

EGS P14 Can preoperative Neutrophil-lymphocyte ratio predict post-operative complications in appendicectomy?

Abstract Background Complications after appendicectomy remain common. Neutrophil-lymphocyte ratio (NLR) measures inflammation by incorporating the innate and adaptive components of the circulating immune system. We hypothesised that pre-operative NLR could predict post-operative complications after emergency appendicectomy. Methods A multicentre retrospective observational study was performed investigating all adults undergoing emergency appendicectomy across four hospital (2 teaching centres and 2 district general hospitals) between August 2018 and November 2020. Patients were identified through pathology records. Electronic records were studied for patient demographics, pre-operative routine laboratory tests, imaging, operative details, and post-operative complications. Neutrophil-lymphocyte ratio was calculated by dividing the pre-operative neutrophil count value by the lymphocyte value. A threshold of 8 was used based on previous literature. Results There were 1130 patients identified who underwent emergency appendicectomy, with 43.6% female. ASA level was I or II in 93.8% of patients, and 82.3% underwent a laparoscopic approach. Perforated appendicitis was observed in 21.7% of patients and two patients died. Mean NLR was 10.3 (SD 8.2), with 50.9% of patients with an NLR of &amp;gt;8. NLR &amp;gt;8 was associated with deep surgical site infections (SSI) (p &amp;lt; 0.001). NLR &amp;gt; 8 was predictive of deep SSI with an odds ratio of 3.455 (CI 1.840–6.488, p &amp;lt; 0.001). Conclusions The NLR is an easy to calculate parameter which, when higher than 8, predicts deep surgical site infection following emergency appendicectomy and may help guide perioperative decision making such as antibiotic duration.

Preoperative peripheral blood inflammatory markers especially the fibrinogen-to-lymphocyte ratio and novel FLR-N score predict the prognosis of patients with early-stage resectable extrahepatic cholangiocarcinoma.

Systemic inflammation is important in the development of extrahepatic cholangiocarcinoma (ECC). The aim of this study was to compare the prognostic power of preoperative peripheral blood inflammatory markers and the novel FLR-N score in patients with resectable ECC. A total of 140 patients with resectable ECC and 140 healthy controls (HCs) were recruited for the study. The Mann-Whitney U test was used to evaluate the differences in inflammatory markers between groups. Kaplan-Meier and Cox regression analyses were used to evaluate the prognostic power of preoperative fibrinogen, albumin, prealbumin, bilirubin, neutrophils, lymphocytes, monocytes, platelets, fibrinogen-to-lymphocyte ratio (FLR), fibrinogen-to-albumin ratio (FAR), fibrinogen-to-prealbumin ratio (FPR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), FLR-neutrophil (FLR-N) score, and CA19-9 in patients with resectable ECC. Nomogram was developed based on the results of multivariate Cox analyses. Patients with resectable ECC had significantly higher levels of neutrophils, monocytes, fibrinogen, FLR, FAR, FPR, NLR, PLR, and MLR and lower levels of lymphocytes, albumin, and prealbumin than HCs (all P < 0.01). Albumin, prealbumin, and FPR had a good ability to distinguish between ECC patients with total bilirubin < 34 µmol/L and HCs (AUCs of 0.820, 0.827, and 0.836, respectively). Kaplan-Meier analysis showed that high neutrophil, fibrinogen, FLR, FAR, PLR, MLR, and FLR-N score values were associated with poor survival in patients with resectable ECC. Multivariate analyses indicated that neutrophils (P = 0.022), FLR (P = 0.040), FLR-N score (P < 0.0001), and positive lymph node metastasis (P = 0.016) were independent factors for overall survival (OS). Nomogram were developed to predict OS for patients with ECC. The prognostic roles of inflammatory markers in patients with resectable ECC were different. The preoperative neutrophil count, FLR and FLR-N score could serve as noninvasive markers for predicting the prognosis of resectable ECC.

Development and Validation of a Prediction Model for Chronic Post-Surgical Pain After Thoracic Surgery in Elderly Patients: A Retrospective Cohort Study.

PurposeChronic post-surgical pain (CPSP) is one of the adverse outcomes after surgery, especially in thoracotomy. However, the prevalence of CPSP in elderly adults (≥65 years), is still limited. Therefore, the present study was undertaken to establish and validate the prediction model of CPSP in those patients after thoracic surgery, including thoracotomy and video-assisted thoracoscopic surgery.Patients and MethodsThis retrospective, observational single-center cohort study was conducted in Nanfang Hospital, Southern Medical University, which randomly and consecutively collected 577 elderly patients who underwent thoracic surgery between January 1, 2017, and December 31, 2020. According to the Akaike information criterion, the prediction model was built based on all the data and was validated by calibration with 500 bootstrap samples.ResultsThe mean age of participants was 69.09±3.80 years old, and 63.1% were male. The prevalence of CPSP was 26.9%. Age more than 75 years, BMI, blood loss, longer length of hospital stays, and higher pre-operative neutrophil count were associated with CPSP. Except for these factors, we incorporated history of drinking to build up the prediction model. The areas under the curve (AUCs) of the prediction models were 0.66 (95% CI, 0.61–0.71) and 0.64 (95% CI, 0.59–0.69) in the observational and validation cohorts, respectively. And the calibration curve of the predictive model showed a good fit between the predicted risk of CPSP and observed outcomes in elderly patients.ConclusionThe present developed model may help clinicians to find high-risk elderly patients with CPSP after thoracic surgery and take corresponding measures in advance to reduce the incidence of CPSP and improve their life quality.

Abdomen anatomic characteristics on CT scans as predictive markers for short-term complications following radical resection of colorectal cancer.

BackgroundPrediction and management of short-term postoperative complications in patients with colorectal cancer are essential in postoperative rehabilitation. Through CT scan images, we can easily measure some parameters of abdomen anatomic characteristics. This study aimed to assess whether there is a relationship between the abdomen anatomic characteristics and short-term postoperative complications.Materials and methodsWe conducted a retrospective study. Eighty patients in each complication group and non-complication group were recruited with propensity score match. Demographics, perioperative laboratory results and surgical information were collected and compared between groups with univariate analysis. Significant elements were brought into subsequent logistic regression analysis and ROC analysis for further identification.ResultsUnivariate analysis showed that preoperative white blood cells, preoperative neutrophil counts, rectus abdominis thickness (RAT), subcutaneous fat thickness (SFT), and abdomen depth (AD) were significantly different between the complication group and non-complication group. Logistic regression analysis demonstrated that higher RAT (p = 0.002), SFT (p < 0.001) and AD (p < 0.001) independently predicted the incidence of short-term postoperative complications.ConclusionsIn this study on patients undergoing radical resection of colorectal cancer, abdomen anatomic characteristics including higher RAT, SFT and AD are associated with an increased risk of short-term postoperative complications.

Increased MPO in Colorectal Cancer Is Associated With High Peripheral Neutrophil Counts and a Poor Prognosis: A TCGA With Propensity Score-Matched Analysis.

BackgroundMyeloperoxidase (MPO) has been demonstrated to be a local mediator of inflammation in tissue damage in various inflammatory diseases. Given its controversial effect on colorectal cancer (CRC), there has been growing interest in investigating the role of this enzyme in CRC. The mechanism underlying MPO activity and CRC progression requires further clarification.MethodsThe expression and function of MPO in CRC were evaluated using TCGA analysis. TCGA, TIMER, and Human Cell Landscape analyses were used to analyze the correlation between MPO expression and neutrophil infiltration in CRC. Spearman’s bivariate correlation analysis was used to verify the correlation between MPO levels in CRC and the peripheral neutrophil count. In the clinical analysis, 8,121 patients who underwent elective surgery for CRC were enrolled in this retrospective cohort study from January 2008 to December 2014. Propensity score matching was used to address the differences in baseline characteristics. The Kaplan–Meier method and Cox regression analysis were used to identify independent prognostic factors in patients with CRC.ResultsMPO was upregulated in CRC tissues, which is related to malignant progression and worse survival in CRC patients from TCGA analysis. MPO was significantly correlated with the infiltration level of neutrophils in CRC in TCGA, TIMER, and Human Cell Landscape analyses. MPO was positively correlated with the peripheral neutrophil count. Data of the 8,121 patients who underwent CRC surgery were available for analysis. After propensity score matching, 3,358 patients were included in each group. Kaplan–Meier survival curves showed that high preoperative neutrophil levels were associated with decreased overall survival (OS; P < 0.001) and disease-free survival (DFS; P = 0.015). The preoperative neutrophil count was an independent risk factor for OS (hazard ratio [HR], 1.157; 95% confidence interval [CI], 1.055–1.268; P = 0.002) and DFS (HR, 1.118; 95% CI, 1.009–1.238; P = 0.033).ConclusionsOur research indicates that increased MPO levels in CRC are significantly correlated with high preoperative neutrophil counts, and both serve as prognostic indicators for worse survival in CRC patients. Our study suggests that neutrophils may be key players in the mechanism linking MPO levels with poor CRC outcomes.

DESCRIPTION OF NEUTROPHIL-LYMPHOCYTE RATIO IN PATIENTS WITH THYROID NODULES DESCRIPTION STUDY AT DR SOETOMO HOSPITAL PERIOD JANUARY 2018 – DECEMBER 2020

Background:Thyroid nodules are found in more than 50% of patients using ultrasonography. The incidence of thyroid nodules in the population is increasing, between 5% and 15% are malignant nodules. In today's era, to identify the exact nature of thyroid nodules is very necessary, because thyroid cancer is the most common endocrine malignancy that occurs in thyroid nodules. The inflammatory process plays a major role in many cancer events, including tumor development, growth, clinical presentation, and prognosis. The neutrophil/lymphocyte ratio (NLR) is a simple index of the systemic inflammatory response. This study aims to describe the ratio of neutrophils and lymphocytes in thyroid nodules in patients at RSUD dr. Soetomo Surabaya. Method: In 102 cases of thyroid nodules, both benign and malignant, were retrospectively analyzed. We evaluated the neutrophil lymphocyte ratio with postoperative pathological anatomic outcomes. Complete blood count with differential count taken before surgery. The NLR was calculated by dividing the preoperative neutrophil count by the lymphocyte count. Samples were categorized into low grade (NLR < 1.91) and high grade (NLR 1.92). Results: There was a statistically significant difference in the neutrophil-lymphocyte ratio between benign thyroid nodules and malignant thyroid nodules (p=0.001). Low NLR values <1.91 were found in 25% of patients with benign thyroid nodules and 9.82% of patients with malignant thyroid nodules. High NLR values 1.92 were found in 25% of patients with benign thyroid nodules and 40.18% of patients with malignant thyroid nodules. Conclusion: Patients with malignant thyroid nodules tend to have high NLR, whereas patients with benign thyroid nodules tend to have lower NLR.

INVESTIGATION OF THE RELATIONSHIP BETWEEN NEUTROPHIL/LYMPHOCYTE RATIO AND ANALGESIC CONSUMPTION IN BIMAXILLARY ORTHOGNATHIC SURGERY PATIENTS

Objectives Neutrophil to lymphocyte ratio; as an inexpensive, easily measurable, and repeatable laboratory parameter is an indicator of subclinical inflammation, and is also a parameter that gives an idea about the systemic inflammatory response and cellular immune response. In general, lymphopenia reflects the weakness of cellular immunity, while neutrophilia is indicative of the response to systemic inflammation. The ratio of these two values to each other seems to be a marker showing the adequacy of the cellular immune response against this situation, despite the magnitude of systemic inflammation. In this study, we aimed to investigate the relationship between preoperative neutrophil-lymphocyte ratio (NLR) and postoperative analgesic drug consumption. Materials and Method Within the scope of the study, the files of 50 patients who underwent bimaxillary orthognathic surgery were retrospectively analyzed. The preoperative NLR values of the patients and the need for the analgesic drugs in the first 24 hours and after 24 hours were recorded and correlated. Results 24% of the patients were girls and 76% were boys. The average age was 20.54, and the average weight was 65.28 kg. There was a positive, strong, and significant correlation between the preoperative neutrophil count and preoperative NLR value and variables of analgesic drug consumption in the first 24 hours (r = 0.6814, p &amp;lt;0.001, and r = 0.6148, p &amp;lt;0.001, respectively). There was a negative, strong and significant correlation between the preoperative lymphocyte count and the first 24-hour analgesic drug consumption variables (r = -0.6773, p &amp;lt;0.001). Conclusion It was concluded that patients with a preoperative NLR value of 2.11 and above may require 4 or more analgesics in the first 24 hours, therefore, NLR value can give preliminary information about the need for postoperative analgesia, and these values could be taken into account when developing a strategy for postoperative analgesia.

Correlation of the Neutrophil Lymphocyte Ratio with Malignancy Status in Thyroid Nodule

Background: Thyroid nodules are very common, found in more than 50% of patients when using ultrasonography. While the prevalence of thyroid nodules in the population is increasing, only 5% to 10% harbor malignant disease. Still, there is a pressing need to correctly identify the nature of thyroid nodules, because thyroid cancer is the most common endocrine malignancy and often presents in thyroid nodules. Inflammation plays a critical role in many aspects of cancer, including tumor development, progression, clinical presentations, and prognosis. The neutrophil/ lymphocyte ratio (NLR) is a simple index of systemic inflammatory response1,2. The aim of this study is to determine whether there is a relationship between the neutrophil/lymphocyte ratio with malignancy status of thyroid nodules. Methods: One hundred two cases of benign and malignant thyroid nodule were analyzed retrospectively. We evaluated neutrophil lymphocyte ratio with result post-operative pathological anatomy. Complete blood counts with differential counts were taken before operation. NLR was calculated by dividing preoperative neutrophil count with lymphocyte count. Sample were categorized into low grade (NLR &lt; 1,91) and high grade (NLR ≥ 1,92). Results: There was statistically significant difference of neutrophil-lymphocyte ratio between benign thyroid nodule and malignant thyroid nodule (p=0,001). Conclusion: NLR is easily accessible tests that can be automatically calculated from complete blood count without additional cost in differentiation of malignant thyroid nodule from benign nodule in the preoperative period. Keywords: Thyroid nodule; neutrophil lymphocyte ratio; malignancy.

Clinical Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Liver Transplantation

Objective: Liver transplantation has been reported to be a predictor of patient survival in acute coronary syndrome and various malignancies, including hepatocellular carcinoma (HCC). In a previous study, it was demonstrated that high Platelet-to-Lymphocyte Ratio (PLR) values before treatment are an independent prognostic factor predicting poor survival in patients with large HCC. We aimed to investigate whether preoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and thrombocyte count are prognostic factors for posttransplantation mortality or graft function in patients who underwent liver transplantation in the clinic.&#x0D; Material and Methods: The data of 40 patients who underwent liver transplantation in the clinic during January 2018–December 2020 were retrospectively analyzed and included in the study.&#x0D; Results: The mean age of the 40 patients included in the study was 51.1 ± 11.7 years. Of these, 27 (67.5%) were male, and 13 (32.5%) were female. Living-donor liver transplantation was performed in 33 patients, whereas cadaveric liver transplantation was performed in seven patients. The mean ejection fraction (EF) was 56.7% ± 3.2%, and the mean model for end-stage liver disease score was 22.4 ± 5.4. After one year of follow-up, 10 out of 40 patients (25%) died after orthotopic liver transplantation. The mean preoperative neutrophil count was found to be 5.7 ± 2.4 × 109/l in non-surviving patients and 3.1 ± 2.05 × 109/l in surviving patients. It was found that mortality increased in patients with high preoperative neutrophil values (NLR &gt; 3.7, p &lt; 0.001) and preoperative platelet count (&lt;79.52 × 109/L, p &lt; 0.001).&#x0D; Conclusion: Preoperative neutrophilia, thrombocytopenia and high NLR values may predict poor prognosis in patients undergoing OLT.

Correlation of neutrophil-to-lymphocyte ratio with the prognosis of non-ST-segment elevation in patients with acute coronary syndrome undergoing selective percutaneous coronary intervention.

ObjectiveWe aimed to explore the relationship between neutrophil-to-lymphocyte ratio (NLR) at three timepoints and prognosis of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing elective percutaneous coronary intervention (PCI) within 1 year of PCI.MethodsThis retrospective study enrolled 231 patients with NSTE-ACS who received PCI and were followed for 1 year after PCI. The study population was divided into major adverse cardiovascular and cerebrovascular events (MACE) and non-MACE groups.ResultsIn total, 214 patients completed the 1-year follow-up; 32 patients (15.0%) had MACE and 182 (85.0%) had no MACE. The MACE and non-MACE groups differed significantly in age, preoperative neutrophil count, preoperative and postoperative NLR, proportion of three-vessel lesion disease, preoperative lymphocyte count, postoperative lymphocyte count within 24 hours, postoperative lymphocyte count over 24 hours, and left ventricular ejection fraction (LVEF). Multivariate logistic regression analysis showed that preoperative NLR, postoperative NLR within 24 hours, age, and LVEF values were independent risk factors for MACE in patients with NSTE-ACS after elective PCI.ConclusionCompared with preoperative NLR, postoperative NLR (within 24 hours) may have a stronger ability to predict the occurrence of MACE in NSTE-ACS patients within 1 year after elective PCI.

Pre-operative hematological markers as predictive factors for overall survival and progression free survival in glioblastomas

IntroductionSeveral hematological factors, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutrition index (PNI) and albumin-to-globulin ratio (AGR), have been highlighted as systemic worse prognostic parameters for the outcome in gliomas. The aim of this study is to identify some pre-operative routinely blood tests as predictive parameters for the Overall Survival (OS) and Progression Free Survival (PFS) in glioblastoma (GBM). Materials and methodsFrom January 2013 to April 2019, 124 patients operated for glioblastoma were analyzed. Data were collected regarding age, sex, Karnofsky performance status (KPS), IDH status, the extent of resection (EOR) and adjuvant therapy. The hematological parameters were collected at admission: neutrophils, lymphocytes and platelets, hemoglobin, lactate dehydrogenase, albumin, NLR, PLR, AGR and PNI. The OS and the PFS were considered as the end-point for the evaluation of the predictive factors. ResultsA pre-operative neutrophil count > 7 × 109/L was a worse prognostic factor for OS and PFS at univariate analysis (p = 0.004 and p = 0.025), as well as hypo-albuminemia. Thrombocytosis, lymphopenia and NLR > 4 were associated to a worse OS, at uni- and multivariate analysis, resulting as poor predictive parameters, independently to EOR, the IDH mutation and the adjuvant therapy. ConclusionsStill nowadays there are no sensitive or specific hematological markers which are routinely applied for detecting and monitoring the treatment-response and the prognosis of glioblastoma. In our study, a pre-operative low cost and widely used blood markers, such as NLR, lymphocytes and platelets could be predictable prognostic factors for the Overall Survival of patients affected by glioblastomas.

Preoperative blood neutrophil count predicts survival in hepatocellular carcinoma patients with living donor liver transplantation

BackgroundThe Milan criteria (MC) used to select patients for liver transplantation among patients with hepatocellular carcinoma (HCC) do not include tumor biology. Furthermore, systemic inflammatory markers have been identified to predict tumor biology. The present study investigated prognostic value of systemic inflammatory markers, including neutrophil count, in predicting the prognosis of patients with HCC undergoing living donor liver transplantation (LDLT).MethodsWe retrospectively analyzed data regarding peripheral blood inflammatory markers, as well as patient and tumor characteristics of patients with HCC who underwent LDLT. Univariate and multivariate analyses were performed to analyze variables associated with survival.ResultsA total of 103 patients with HCC who underwent LDLT were included. The 3- and 5-year recurrence-free survival (RFS) in patients with a high neutrophil count (>2,640/µL) were significantly lower than those in patients with a low neutrophil count (≤2,640/µL; 70.0% and 64.7% vs. 88.3% and 84.6%, respectively; P=0.02). Patients with a high neutrophil count also had lower 5-year overall survival (OS; 63.9% vs. 79.3%, P=0.03). In multivariate analysis, radiologic MC (hazard ratio [HR], 5.04; P=0.02) and neutrophil count (HR, 4.47; P=0.04) were independent factors predicting RFS. Among patients exceeding the MC, those with a high neutrophil count had significantly lower 5-year RFS than those with low neutrophil count (10% vs. 83%; P<0.01).ConclusionsWe demonstrated that high preoperative neutrophil count is associated with poor RFS and OS in patients with HCC undergoing LDLT.

Can biochemical biomarkers predict mortality in percutaneous dilatational tracheostomies?

Aim: The aim of this retrospective study was to explore the possibility of using biochemical parameters as biomarkers in predicting mortality in patients undergoing percutaneous dilatational tracheostomy (PDT) where the prognosis may be fatal. Material and Method: The patients’ demographic features, early complications, days in the intensive care unit and mortality rates were recorded. Additionally, data obtained from venous blood samples taken 1 day prior to and 1 day following the PDT procedure were noted, neutrophil-to-lymphocyte ratios (NLR) and platelet-to-lymphocyte ratios (PLR) were assessed. Patients were divided into 2 groups: the survivor group (those who underwent PDT and were discharged from the hospital after treatment, n=20) and the non-survivor (patients who underwent PDT but died at the hospital after treatment, n=67).Results: A significant difference was found between the groups in terms of a number of days in intensive care (p=0.006), preoperative neutrophil count (p=0.041) and postoperative NLR (p=0.041). Differences were seen in the pre- and postoperative blood parameters of the patients in the non-survivor group in terms of lymphocyte count (p&amp;lt;0.001), Mean Platelet Volume (MPV) (p=0.002) and PLR (p&amp;lt;0.001) values. The results of the correlation analysis revealed a positive correlation between the prognosis and the neutrophil count (p=0.040) and between the prognosis and post-PDT NLR (p=0.040), but a negative correlation between the prognosis and duration of the hospital stay (p=0.005). ROC curve analysis showed that only the post-PDT NLR value, indicating 68.7% sensitivity and 60.0% specificity over the 6.91 cut-off point, could be a specific and sensitive biomedical marker and predictor of a prognosis that would end in mortality.Conclusion: As a result of this pilot study, it can be argued that the NLR level measured post-PDT can be a prognostic biomarker in predicting the risk of mortality for patients undergoing PDT.

The relationship between perioperative markers of the systemic inflammatory response and postoperative complications in patients undergoing curative resection of colon cancer.

75 Background: Surgical resection remains the mainstay of treatment for patients with potentially curable colorectal cancer (CRC). However, it can be associated with the development of postoperative complications (POC), which are associated with an increased cancer recurrence risk. Neutrophils are important in innate immunity, especially in the immediate postoperative period as part of the systemic inflammatory response (SIR). We aimed to assess the use of perioperative SIR markers as predictors of POC. Methods: Patients undergoing elective curative CRC surgery at one institution between March 2008 and June 2015 were identified from a prospective database. Demographics and clinicopathological data were extracted from medical records. Logistic regression was used to assess the relationship between perioperative blood counts, clinicopathological variables and POCs. Results: Of 443 cases, most were aged 65 years or older (n = 314, 71%), male (n = 245, 55%), smokers (n = 229, 52%), overweight or obese (n = 263, 59%) and had ASA score of 2 or less (n = 267, 60%). The majority underwent open resection (n = 288, 65%). Preoperative factors associated with the development of POC were: ASA grade &gt; 2 (OR 1.48, 95% CI 0.99-2.18, p = 0.05), smoking history (OR 1.99, 95% CI 1.35 – 2.93, p &lt; 0.001), neutrophil count &gt; 7.5x109/L (OR 3.40, 95% CI 1.82-6.36, p &lt; 0.001) and CRP &gt; 10mg/L (OR 1.70, 95%CI 1.12-2.59, p = 0.013). Postoperative factors associated with the development of POC were open surgery (OR 0.47, 95%CI 0.31-0.72, p &lt; 0.001), neutrophil count &gt; 7.5x109/L (OR 2.67, 95%CI 1.75-4.07, p &lt; 0.001) and CRP &gt; 150mg/L (OR 3.97, 95%CI 2.61-6.02, p &lt; 0.001) on postoperative day 3 (POD3). On multivariate analysis, a preoperative neutrophil count &gt; 7.5x109/L (OR 3.65, 95%CI 1.68-7.90, p &lt; 0.001), a neutrophil count &gt; 7.5 x109/L on POD3 (OR 1.69, 95%CI 1.05-2.72, p = 0.029) and CRP &gt; 150mg/L on POD3 (OR 3.66, 95%CI 2.29-5.87, p &lt; 0.001) were related to POC, independent of smoking, ASA and operative approach. Conclusions: Neutrophil count complements the prognostic value of pre and post-operative CRP to predict POC. Further validation work is required.

High Neutrophil Count as a Negative Prognostic Factor for Relapse in Patients with Thymic Epithelial Tumor.

Preoperative neutrophil count is reportedly associated with poor prognosis in cancer patients. This study aimed to investigate the clinical significance of pre-treatment peripheral blood cell counts in patients with thymic epithelial tumors (TETs). A retrospective review of 71 patients with completely resected TETs [64 thymoma, 6 thymic carcinoma, and 1 thymic neuroendocrine tumor] between 2000 and 2018 was conducted. Associations between tumor recurrence and pre-treatment peripheral blood cell counts of leukocytes (WBC), neutrophils (Neut), lymphocytes (Lymph), monocytes (Mono), and platelets (Plt) were analyzed. Optimal cut-off points were selected using receiver operating characteristic curve analysis to predict tumor recurrence. High WBC (≥ 7000), Neut (≥ 4450), and Plt (≥ 226 × 103) counts had significantly poor relapse-free survival (RFS), but high Lymph (≥ 1950) and Mono (≥ 400) did not. High Neut had the strongest correlation with recurrence (area under curve, 0.800); we focused on the analysis between high-Neut and low-Neut groups. High Neut countsignificantly correlated with smoking history, pre-treatment C-reactive protein level, and advanced stage; high Neut countand aggressive histology tended to show correlations. RFS was significantly poorer in the high-Neut group than in the low-Neut group (p = 0.003), with 5-year RFS rates of 63.8% and 96.8%, respectively. High Neut countwas a significant adverse predictor for RFS and cumulative incidence of recurrence (p = 0.005 and p < 0.001, respectively). The risk scoring system comprising high Neutcount, advanced stage, and aggressive histology demonstrated better prognostic ability than any prognostic factors alone. High Neut count significantly correlated with TET recurrence, suggesting a negative prognostic effect of latent inflammation in TET patients.