Role Of Neutrophil-lymphocyte Ratio Research Articles

Role of neutrophil lymphocyte ratio and platelet lymphocyte ratio as a predictive factor for severity of acute appendicitis.

Role of neutrophil lymphocyte ratio and platelet lymphocyte ratio as a predictive factor for severity of acute appendicitis.

Role of Neutrophil Lymphocyte Ratio in Prediction of Disease Activity in Ulcerative Colitis Disease

Role of Neutrophil Lymphocyte Ratio in Prediction of Disease Activity in Ulcerative Colitis Disease

Relationship of neutrophil/lymphocyte ratio with cerebral small vessel disease and its common imaging markers.

High neutrophil/lymphocyte ratio (NLR) is associated with poor prognosis in ischemic stroke. However, the role of NLR in cerebral small vessel disease (CSVD) is controversial. Herein, we evaluated the value of NLR in identifying CSVD and its relationship with the common imaging markers of CSVD. A total of 667 patients were enrolled in this study, including 368 in the CSVD group and 299 in the non-CSVD group. Clinical, laboratory, and imaging data were collected. The relationship of NLR with CSVD and common imaging markers of CSVD were analyzed with univariate and multivariate logistic regression analysis. The predictive value of NLR was assessed with the receiver operating characteristic curve. NLR (odds ratio [OR] = 1.929, 95% confidence interval [CI] = 1.599-2.327, p < .001) was an independent risk factor for CSVD. NLR was also independently associated with moderate to severe white matter hyperintensity (WMH) (OR = 2.136, 95% CI = 1.768-2.580, p < .001), moderate to severe periventricular WMH (OR = 2.138, 95% CI = 1.771-2.579, p < .001), and moderate to severe deep WMH (OR = 1.654, 95% CI = 1.438-1.902, p < .001), moderately to severely enlarged perivascular spaces (EPVS) (OR = 1.248, 95% CI = 1.110-1.402, p < .001), moderately to severely EPVS in the basal ganglia (OR = 1.136, 95% CI = 1.012-1.275, p = .030), and moderately to severely EPVS in the centrum semiovale (OR = 1.140, 95% CI = 1.027-1.266, p = .014). However, NLR was not statistically significantly associated with lacune. The optimal cutoff point of NLR in predicting CSVD was 2.47, with sensitivity and specificity of 84.2% and 66.9%, respectively (p < .01). The diagnostic effect was maximized when NLR was combined with other risk factors. NLR is an independent risk factor for CSVD and is independently associated with common imaging markers of CSVD. NLR may serve as a valid and convenient biomarker for assessing CSVD.

Role of Neutrophil-Lymphocyte Ratio in Predicting Severity of COVID-19

Background: Higher neutrophil-lymphocyte ratio (NLR) is considered as cardinal findings with prognostic potentials in identification of severe COVID-19 cases. However, whether baseline NLR could be a predictor of disease severity and outcome remained to be investigated. Hence, this study was conducted with an aim to evaluate the relation of NLR (on admission) with disease severity. Objective: The objective of the study was to estimate the neutrophil-lymphocyte ratio among COVID-19 patients and its role in predicting disease severity. Method: This cross-sectional study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2020 to June 2021. Ninety-four COVID-19 admitted patients were enrolled following inclusion &amp; exclusion criteria. Informed consent was taken from the subjects. Ethical clearance was obtained from institutional review board (IRB) of BSMMU. Complete blood count for N-L ratio was done by standard procedure on admission by SYSMEX XN-2000 haematology analyser. Clinical and laboratory information were recorded with a semi-structured questionnaire. After collection of all the required data, analysis was done by SPSS 24.0. Results: Mean age of the patients was 56.59±12.25 years, wherein maximum patients were male (67%), non-smoker (80.9%), and retired/current service holder (51.1%). Maximum patients were hypertensive (61.7%) and diabetic (56.4%). Besides, maximum study patients (64.9%) were in severe category of COVID-19, followed by moderate (20.2%) and mild (14.9%) category according to National Guidelines on Clinical Management of COVID-19 criteria. Mean NLR was 5.40±4.35 (SD), wherein on admission NLR was significantly higher among severe COVID-19 patients compared to mild/moderate category (6.90±4.64 vs 2.61±1.53, p &lt;0.05). 28-days hospital mortality was found to be significantly associated with NLR (p&lt;0.05). Receiver operator curve analysis found highly significant cut-off value for NLR (3.42) with 75.4% sensitivity and 75.8% specificity in predicting severe COVID-19 patients (AUC= 0.841, p value &lt;0.001). Multivariate logistic regression analysis found NLR as an independent predictor for severe COVID-19 (OR=4.68, 95% CI: 1.29-16.81, P=0.019). Pearson correlation analysis showed that NLR had significant positive correlation with CRP and D-dimer as p value &lt;0.05. Conclusion: NLR can predict the disease severity and outcome of hospitalized COVID-19 patients. However, further larger study is recommended.

Evaluation of the Predictive Role of Neutrophil Lymphocyte Ratio and Mean Platelet Volume in Preterm Deliveries: A Cross-sectional Study

Introduction: Preterm birth is associated with high perinatal morbidity and mortality. Identifying women at risk for preterm labour early in pregnancy may improve pregnancy outcomes. Neutrophil-Lymphocyte Ratio (NLR) and Mean Platelet Volume (MPV) can be helpful in predicting preterm labour, as infection is an important factor in early preterm deliveries, with immunity playing a key role in preterm labour. Aim: To evaluate the predictive role of the NLR and MPV in preterm deliveries. Materials and Methods: This cross-sectional study was conducted in a tertiary care and research hospital from August 2022 to October 2023. Haematological and clinical data were retrieved for preterm deliveries (n=79, group I) and term deliveries (n=151, group II). The two groups were compared in terms of demographic characteristics, obstetric and laboratory findings, including maternal age, gravida, parity, birth weight, NLR, MPV, and haemoglobin levels. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 29.0. One-way Analysis of Variance (ANOVA) was used to compare the mean values among different groups. Categorical values were evaluated with Pearson’s Chi-square test. Receiver Operating Characteristic (ROC) curve was used to assess the diagnostic properties of the tests. Results: The two groups showed no statistical difference in terms of demographic parameters such as the mother’s age (p-value=0.611), parity (p-value=0.798), and gravida (p-value=0.583). The NLR was higher in group I (5.8±5.01) compared to group II (4.3±1.75), and this difference was statistically significant with a p-value of &lt;0.001. MPV was observed to be lower in group II (8.7±0.96) compared to group I (8.9±1.07); however, this difference was not statistically significant (p-value=0.128). The mean baby weight and mean maternal haemoglobin in group I were significantly lower compared to group II. Conclusion: In this study, the NLR value was significantly higher in patients with preterm deliveries compared to term deliveries. This study highlights the role of NLR as an emerging predictor of preterm deliveries and emphasises that NLR, obtained from an inexpensive and routinely conducted haemogram, has the potential to be used as an early indicator of preterm deliveries.

Role of Neutrophil Lymphocyte Ratio and Platelet Indices as Inflammatory Indicators and Its Association with Preeclampsia

Role of Neutrophil Lymphocyte Ratio and Platelet Indices as Inflammatory Indicators and Its Association with Preeclampsia

Neutrophil Lymphocyte Ratio as an Inflammatory Marker in Rheumatoid Arthritis

Objective: To determine the role of Neutrophil Lymphocyte Ratio as an inflammatory marker in Rheumatoid Arthritis. Study Design: Cross-sectional analytical study. Place and Duration of Study: Rheumatology Department, National Hospital and Medical Center, Lahore Pakistan, from Mar to Sep 2021. Methodology: After approval from Institutional Ethical Review Board, 160 patients diagnosed with rheumatoid arthritis, aged 21-80 years, were enrolled. Demographic information and medical history were obtained and divided into two groups: Active disease (DAS-28 score&gt;3.2) and LDA/remission (DAS-28 score&lt;3.2). Clinical parameters of the DAS-28 score and CBC, including NLR, were assessed and recorded. Results: Out of 160 patients, there were 132(82.5%) females. The duration of disease was 8.4±6.8 years. Mean VAS score, tender joint count, swollen joint count, and DAS-28 score were 3.8±2.6, 4.2±4.1, 2.4±2.7 and 4.0±1.6 respectively. RA Factor was positive in 121(75.6%) and Anti-CCP antibody in 102(63.8%). Anaemia was found in 45(28.1%). Mean platelet and TLC were 357.1+99.3 ×109/L and 9.0+2.9 ×109/L respectively. On division into groups, the mean NLR in LDA/Remission-Group and Active Disease-Group were 2.5±1.4 and 3.9±2.1, respectively. High NLR was seen in 46 (57.5%) with Active Disease-Group compared with 13 (16.3%) in LDA/Remission-Group (p-value&lt;0.001). Conclusion: High NLR was more common in active RA than LDA/remission, and NLR is useful in indicating disease activity.

Association of neutrophil-lymphocyte ratio with survival in peripheral early-stage non–small-cell lung cancer after stereotactic body radiation therapy.

e20547 Background: Prior studies have demonstrated that neutrophil-lymphocyte ratio (NLR) can predict overall survival in patients undergoing stereotactic body radiation therapy (SBRT) for multiple types of cancer. The role of neutrophil-lymphocyte ratio (NLR) as a predictor for survival in single fraction SBRT-treated non-small cell lung cancer (NSCLC) patients remains unclear. Methods: A single-institution database of peripheral early-stage NSCLC patients treated with SBRT from February 2007 to May 2022 was queried. Consecutive patients with peripheral early-stage NSCLC (T1-2N0M0) and a complete blood count within six months of the start of SBRT treatment were included. Patients treated with SBRT regimens of more than 3 fractions were excluded as these regimens were reserved for patients with centrally located lesions with higher risk of toxicity which could affect survival. Optimal threshold of neutrophil-lymphocyte ratio (NLR) was defined based on maximally selected rank statistics. Cox multivariable analysis (MVA), Kaplan-Meier, and propensity score matching were performed to evaluate outcomes. Results: A total of 286 patients (164 female [57.3%]; median [IQR] age 76 [69-81] years) were included for analysis with median follow up of 19.7 months. The median NLR was 3.06 ([IQR] 2.21-4.33). There were 15 local failures, 27 nodal failures, and 50 distant failures. On Cox multivariate analysis, as a continuous variable, NLR was shown to be an independent predictor of OS (adjusted hazards ratio [aHR] 1.06, 95% CI 1.02-1.10, p = 0.005; Figure 1) and PFS (aHR 1.05, 95% CI 1.01-1.09, p = 0.013; Figure 1). In addition, NLR was associated with DF (aHR 1.11, 95% CI 1.05-1.18, p &lt; 0.001; Figure 1). Maximally selected rank statistics determined 3.28 as the cutoff point of high NLR versus low NLR. These findings were confirmed upon propensity matching. Conclusions: Pretreatment NLR is an independent predictor for survival outcomes of peripheral early-stage NSCLC patients after SBRT. High NLR is associated with worse overall survival, progression-free survival, and distant metastasis. Pretreatment NLR levels should be tracked on trials for early-stage NSCLC patients.

Role of neutrophil-lymphocyte ratio as a prognostic marker for type 2 diabetic nephropathy among Indians.

Diabetic nephropathy/diabetic kidney disease (DKD) is one of the leading causes of renal failure. Early identification of the development or progression of diabetic nephropathy using appropriate screening and diagnostic tools is very important in order to provide timely and proper management. Inflammation plays a crucial role in development and progression of diabetic nephropathy. The aim of this study was to evaluate the relationship of inflammatory markers (neutrophil-to-lymphocyte ratio-NLR) as an early indicator to prevent the progression of diabetic kidney disease. A total of 158 patients with type 2 diabetes mellitus were distributed into three groups according urinary albumin-to-creatinine ratio. Levels of inflammatory markers neutrophil-to-lymphocyte ratio was recorded and compared among the three groups. Significant differences were detected between the groups in terms of neutrophil-to-lymphocyte ratio (p = 0.000).Characteristic curve analysis of inflammatory markers and microalbuminuria prediction demonstrated an area under curve (AUC) of 0.869 for neutrophil-to-lymphocyte ratio (p = 0.000). A NLR cut-off point of 2.2 has 72.3 % sensitivity and 78.1 % specificity, which suggested sufficient accuracy. Increased neutrophil-to-lymphocyte ratio was significantly correlated with diabetic nephropathy progression and increased neutrophil-to-lymphocyte ratio can be considered as an early indicator and a prognostic risk marker of diabetic nephropathy.

The Role of Neutrophil-Lymphocyte Ratio and Mean Platelet Volume on the Prognosis of Cardiac Masses

The Role of Neutrophil-Lymphocyte Ratio and Mean Platelet Volume on the Prognosis of Cardiac Masses

Role of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Diabetic Ulcer Patients

Role of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Diabetic Ulcer Patients

Can neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, prognostic nutrition index, and albumin be used to predict cholecystectomy morbidity in super-elderly patients?

This study aimed to evaluate the usability of neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic nutritional index (PNI), and serum albumin level in predicting cholecystectomy morbidity in elderly patients (85 years and older) who underwent cholecystectomy for acute cholecystitis. This retrospective study included super-elderly patients who underwent cholecystectomy due to acute cholecystitis at a tertiary health centre between January 2010 and January 2021. The patients were divided into two groups according to the presence of postoperative complications (morbidity). The differences between the two groups were evaluated. In addition, the role of NLR, PLR, PNI, and serum albumin level in predicting cholecystectomy morbidity for acute cholecystitis in super-elderly patients was assessed via ROC analysis. Of 30 patients who met the study criteria, 22 (73.3%) were female, and the mean age of all patients was 87.43±2.66 years (range 85-94 years). 7 (23.3%) patients had at least one comorbid disease during the preoperative period. The mean value of NLR, PLR, albumin, and PNI were 8.31, 153.76, 3.45, and 48.37, respectively. The morbidity rate of the study was 23.3%. The area under the curve (AUC) for NLR was 0.466 ([95% confidence interval [CI]: 0.259-0.672]; P=0.787), and the AUC for PLR was 0.429 ([95% CI: 0.201-0.656]; P=0.573). These two factors were not suitable for predicting morbidity. The AUC for PNI was 0.780 ([95% CI: 0.568-0.991]; P=0.027), and the AUC for albumin was 0.894 ([95% CI: 0.770-1.000]; P=0.002). At the cut-off value of 3.05 g/dL, the sensitivity and specificity of albumin were 91.3% and 71.4%, respectively, while the sensitivity and specificity of PNI at the 41.70 cut-off value were 82.6% and 71.4%, respectively. This study found that PNI and albumin can be used as predictive factors with high sensitivity and specificity for predicting cholecystectomy morbidity for acute cholecystitis in super-elderly patients. However, NLR and PLR had no significance in predicting cholecystectomy morbidity.

Role of Neutrophil-Lymphocyte Ratio and other Inflammatory Markers in Cardiovascular Diseases

Role of Neutrophil-Lymphocyte Ratio and other Inflammatory Markers in Cardiovascular Diseases

Role of neutrophil-lymphocyte ratio as a potential marker to differentiate between pulmonary tuberculosis and community-acquired pneumonia in children

Background: This is often creating challenge to differentiate pulmonary tuberculosis (TB) with community acquired pneumonia (CAP) particularly in children. The neutrophil-lymphocyte count ratio (NLR) as an indicator of inflammation has been used in various infectious diseases. The aim of this study was to investigate the role of NLR as a possible marker in differentiating pulmonary TB from CAP.Methods: In this retrospective record based analytic study, conducted from July 2020 to Dec 2021, patient aged 2 months to 18 years diagnosed as pulmonary TB or CAP were enrolled in this study i.e., 155 children after exclusion. The diagnostic ability of NLR in differentiating between pulmonary Tb and CAP were assessed.Results: Out of 155 children, 85 (54.8%) had CAP and 70 (45.1%) had pulmonary TB. Mean values of NLR were significantly lower in patients with TB than in pneumonia (3.16±1.9 vs 5.05±1.2, p&lt;0.000). Total WBC, neutrophil, Hb and CRP were also significantly lower in patients with pulmonary TB. On the other hand, lymphocyte count was significantly higher in children with pulmonary TB in compare to children with pneumonia (p=0.04).Conclusions: The NLR can be used as a useful simple laboratory marker in differentiating children with Pulmonary TB from CAP, especially in resource limited high TB disease burden countries.

118P Predictive role of neutrophil lymphocyte ratio (NLR) in metastatic solid tumour patients receiving immune checkpoint inhibitors (ICI)

In recent years, neutrophil lymphocyte ratio has been extensively studied as a prognostic marker in patients with solid tumors on the basis that it reflects the inflammatory response to cancer. This study was undertaken to evaluate whether there is any association between clinical benefit rate and progression of disease, using neutrophil lymphocyte ratio as a marker during immunotherapy in advanced solid cancer treatment.

Role of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio and platelets in prognosis of patients with prostate cancer.

The aim of the present analysis was to evaluate the platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelets (PLT) and neutrophil level for their prognostic values in patients with prostate cancer who had been treated with radiotherapy. A retrospective analysis of 152 patients who were treated in the Radiotherapy Department at Maria Sklodowska-Curie National Research Institute of Oncology (Gliwice, Poland) between January 2012 and December 2014 was performed. The prognostic value (overall survival; OS) of the pre-treatment PLR, NLR, LMR, PLT, neutrophil level and other laboratory factors such as: leukocyte, lymphocyte, monocyte, hemoglobin, RBC, prostate-specific antigen level (PSA), Gleason score, age, smoking and comorbid condition were assessed using univariate analysis. The cut-off point was determined for NLR as 'elevated' at >4.66, LMR >3.26 and the PLR was considered 'elevated' at >89.6. Median follow-up was 4.9 years. The 5 and 7-year OS rates were 81.5 and 72.2%, respectively. In univariate analysis higher NLR (P=0.007), higher level of PLT (P=0.004), higher level of neutrophils (P=0.013), elevated level of leukocyte (P=0.043) and lymphocyte (P=0.043) were factors significantly associated with decreased OS. No difference was found for PLR (P=0.308) and LMR (P=0.109). The other factor associated with decreased OS were: higher Gleason score (>7; P=0.005), higher PSA level (>20 ng/dl; P=0.0001), smoking (P=0.003) and older age (>70 years; P=0.018). In multivariate analysis, NLR, LMR, leukocyte and RBC were independently associated with prognosis in patients with prostate cancer. Elevated pre-treatment NLR [hazard ratio (HR)=10.83; P=0.001), LMR (HR=3.14; P=0.007) and higher leukocyte level (HR=3.14; P=0.007) were independently associated with increased mortality risk. Overall, pre-treatment NLR, PLR, leukocyte and RBC levels were revealed to be independent prognostic factors.

The Severity of COVID-19 and its Correlation with Inflammation Biomarkers

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov2) or Covid-19 has been spread quickly and caused 5 million deaths until February 2022. Severe symptoms of the infection may lead to death that prompt appropriate clinical diagnosis and adequate treatment going to be necessary. Covid-19 shows a severe inflammatory response which causes an imbalance in the immune response. Therefore, circulating biomarkers that can represent inflammation and immune status are potential predictors for the prognosis of COVID-19 patients. This study aims to know the role of Neutrophil-Lymphocyte Ratio (NLR), Neutrophil Monocyte Ratio (NMR), and Lymphocyte-monocyte Ratio (LMR) as inflammatory biomarkers for the severity of Covid-19.&#x0D; Methodology: This study is a single-center retrospective cohort study. The sample of this study was taken by consecutive sampling with complete clinical data from 893 Covid-19 patients from Andalas University Teaching Hospital from April 2020 to September 2021. This study uses SPSS Version 25.0 for data management and analysis.&#x0D; Result: Most of the degrees of Covid-19 infection were mild degrees as many as 597 people with an NLR average value of 2.07 (0.27-34.50), and NMR average value of 7.86 (3-46), an LMR average value of 3.67 (0.25-25), an ANC value of 3.990 (945-45). 14,608). Most of the degrees of infection in patients with negative PCR results were moderate degrees as many as 70 people with a mean NLR value of 9.0694 (0.51-47.50), a mean NMR value of 18.6199 (1.15-47.50), and a mean LMR was 3.0324 (0.29-19.50), the ANC value was 9769.73 (1.088-37,219). There was a relationship between the degree of Covid-19 infection and the NLR value (p=0.144), as well as the LMR (p=0.000), NMR(p=0.000), and ANC (p=0.000). There was no relationship between the degree of infection in the negative PCR patient group and the NLR value (p=0.000), as well as the LMR (p=0.700), NMR(p=0.120), and ANC (p=0.90).&#x0D; Conclusion: The severity of Covid-19 symptoms could be predicted through inflammatory biomarkers such as NLR, LMR, and NMR.

Role of Neutrophil-Lymphocyte Ratio and Mean Platelet Volume in the Outcome of Atherosclerotic Peripheral Vascular Disease Interventions

Purpose: Classically, neutrophils have been neglected in the pathophysiology of atherosclerosis. However, recent studies have highlighted their role. Similarly, the role of platelets in peripheral artery disease (PAD) has become evident now. The significance of neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) has been independently studied and found that elevated values are associated with poor outcomes of atherosclerotic peripheral vascular disease interventions. However, the measure of association of NLR and MPV to the outcomes of intervention has not been studied. Hence, this study was undertaken to examine the measure of association of NLR and MPV to the outcomes of atherosclerotic peripheral vascular disease interventions. Methodology: This is a prospective study conducted between January 1, 2020, and September 30, 2021, with 6 months of follow-up. Patients aged 21 years or more, diagnosed to have atherosclerotic peripheral vascular disease, and undergoing interventions (endovascular and open procedure) are included in the study. Patients &lt;21 years, not willing for any intervention, and with acute presentations were excluded. The primary endpoint assessed is graft patency at 6 months, and the secondary endpoints assessed are clinical improvement (which is a combined measure of change in ankle–brachial index, Rutherford grade, and ulcer status) at 1 and 6 months, redo procedure, and amputations within the follow-up period. Results: From January 2020 to September 2021, a total of 156 patients with atherosclerotic peripheral vascular disease fulfilled the inclusion and exclusion criteria. We observed that in 109 (69.9%) patients who had completed 6-month follow-up, 91 (83.5%) patients had graft patency and 18 (16.5%) patients had occluded graft. Independent receiver operating characteristic curve analysis of MPV and NLR showed that lower mean NLR and MPV values (cutoff taken as 10.15 for MPV) are associated with increased graft patency at 6 months than higher mean NLR and MPV values (NLR, P &lt; 0.001; MPV, P = 0.024). Discriminant analysis model developed with MPV and NLR as the set of predictors showed that NLR and MPV together are good predictors of graft patency at 6 months (Wilk's lambda: χ2 = 45.54, P &lt; 0.001). However, logistic regression analysis has shown that, in comparison to NLR, MPV is not a strong predictor of graft patency. Lower mean NLR value was associated with lower amputation rate (P &lt; 0.001), lower mortality rate (P &lt; 0.001), and higher clinical improvement rate at 1st month (P &lt; 0.001) and at 6 months (P &lt; 0.001) than patients with higher mean NLR. However, there was no statistically significant difference between two groups in predicting chance of redo procedure (P = 0.424). There was no statistically significant difference between the mean MPV values among patients who underwent amputation (P = 0.864), died (P = 0.640), or had redo procedure (P = 0.883), except for clinical improvement outcome where lower mean MPV value was associated with higher rate of clinical improvement at 1st month (P &lt; 0.001) and 6 months (P &lt; 0.001) than higher mean MPV value. Conclusion: In patients with atherosclerotic peripheral vascular disease, NLR value is a better predictor of outcomes after intervention than MPV, and lower mean NLR values are associated with increased rate of graft patency, clinical improvement, fewer amputations, and deaths.

The Role of Neutrophil Lymphocyte Ratio in Predicting Acute Appendicitis in Adult

Introduction: Acute appendicitis is one of the most common causes of acute abdomen with lifetime occurrence of approximately 7% and with perforation of 17-20%. There are various scoring systems and investigations which are used to ruling in the conditions but none of these are 100% accurate. The aim of this study was to observe relationship between neutrophil lymphocyte ratio (NLR) and simple and complicated acute appendicitis. Methods: This is a prospective observational study conducted for a period of 12 months. Clinical, laboratory and USG parameters were used to diagnose acute. HPE findings were taken as final diagnosis and the objective of the study compared. Results: Total of 100 patients were evaluated in this study. The mean age of the patients with acute appendicitis in this study was 30 years .The mean Alvarado score in this study was 7 and the mean NLR was 6.6. In this study, 24% of case who had TLC of more than 10000 per cubic millimeter had complicated appendicitis (p=0.685). 16% of total cases had complicated acute appendicitis with neutrophil percentage between 81%-90%, 20% with NLR &gt;8 had complicated acute appendicitis and 20% with NLR &gt;8 had HPE proven complicated acute appendicitis (p=0.001) Conclusion: Both neutrophil percentage and NLR were statistically significant in differentiating complicated acute appendicitis from simple acute appendicitis than total leucocyte count alone as shown by study.

STUDY OF PROGNOSTIC VALUE OF RATIO OF NEUTROPHIL TO LYMPHOCYTE TO PREDICT PROGNOSTIC OUTCOMES IN PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION.

Introduction: Atherosclerosis is a inammatory disease of arterial wall which have multifactorial causes. So study was done to investigate the role of neutrophil lymphocyte ratio in prediction of in hospital adverse events in ST elevated myocardial infarction (STEMI) patients thrombolysed with streptokinase (SK). Material and methods: The study consisted observational retrospective longitudinal study. In this 70 patients [47 (67.1%) men, 23(32.8%) women, mean age 53.6 ± 11.16 years], diagnosed case of acute ST elevation MI. Patints were devided in two group according to NLR (High NLR and Low NLR) detected by CBC. Result: A Total of 42 cases developed complications; in high NLR groups had higher rate of complications like Arrhythmia 6(60%), cardiogenic shock 12(80%), heart failure 10(77%), Post MI Angina 2 (50%) in hospital than those in low NLR group. Conclusion: Our ndings reveal that N/L ratio, a simple marker which can be derived from a routine complete blood count test was signicantly and independently related to prognosis of Acute myocardial infarction.