Significant Difference In Neutrophil-to-lymphocyte Ratio Research Articles

Abstract 4135746: Assessing Coronary Artery Disease Severity: Leveraging Inflammatory Markers As a Prognostic Indicators

Introduction: Cardiovascular disease continues to be the leading cause of death and a significant cause of morbidity in the United States. In recent years, there has been increased interest in the role of inflammation in predicting and modifying the risk of coronary artery disease. Of the multitude of inflammatory markers studied subsequently, two of the most easily and widely obtained is the neutrophil to lymphocyte ratio (NLR) and the monocyte to lymphocyte ratio (MLR), which can be calculated from a complete blood count with differential. Multiple retrospective studies have demonstrated that the NLR and MLR have been used to diagnose ACS, predict mortality at a year after ACS, and risk stratify patients prior to percutaneous coronary intervention. Research Question: Are the NLR/MLR useful tools in predicting the severity of coronary artery disease (CAD) in patients admitted to a tertiary medical center in Southern Nevada for ACS between 2021 and 2023? Methods: A sample of n=344 patients was used to examine the potential significance of NLR/MLR to diagnose ACS and for predicting CAD severity. Traditional diagnostic test evaluation was used for determining CAD with a ratio of NLR=3.5 + MLR=0.35 (data medians) as the cut-off value. Patient risk group status (1:low risk to 4:high risk) was used as a binary outcome to test NLR/MLR between low and high risk groups using a nonparametric MWW test of medians. Additionally, ROC analysis was used to estimate an optimized cut-off for NLR/MLR as determined by AUC. Results: Results demonstrate for predicting ACS using the median NLR, sensitivity=88.07; specificity=14.88; PPV=52.01; NPV=54.35), LR(+)=1.03 and LR(-)= 0.80, using the median MLR results showed sensitivity=87.28; specificity=14.11; PPV=50.84; NPV=52.17, LR(+)=1.01 and LR(-)= 0.90. Subpopulation analysis demonstrated a statistically significant difference in NLR between “high risk ACS” vs “Low Risk ACS” (p<0.001). Examination of the ROC curve for predicting the high-risk group suggested an optimized cutoff of NLR=3.7; however, AUC was only 0.617, and sensitivity and specificity were not improved compared to using the median NLR. Conclusion: Our findings suggest that an NLR greater than 3.7 may indicate multivessel involvement or proximal/left main disease in CAD patients. However, due to its low specificity and AUC, NLR alone cannot reliably distinguish between single-vessel and multivessel CAD.

Prognostic value of neutrophil to lymphocyte ratio in patients with advanced pancreatic ductal adenocarcinoma treated with systemic chemotherapy

Objectives Although systemic chemotherapy for pancreatic ductal adenocarcinoma (PDAC) has made progress, ensuring long-term survival remains difficult. There are several reports on the usefulness of neutrophil-to-lymphocyte ratio (NLR) in predicting the prognosis of PDAC, but few reports in systemic chemotherapy. We hereby investigated the usefulness of NLR in systemic chemotherapy for PDAC. Materials and methods A retrospective study was conducted on patients with advanced PDAC treated with first-line systemic chemotherapy. Cox regression hazards models were performed to analyze the association between baseline patient characteristics and the initial treatment response, and overall survival (OS). Results A total of 60 patients with PDAC were enrolled. At baseline, there were significant differences in NLR and carbohydrate antigen 19-9 (CA19-9), as well as the selection rate of combination chemotherapy, between patients with partial response or stable disease and those with progressive disease. Univariate and multivariate analysis showed that NLR < 3.10, combination chemotherapy, and CA19-9 < 1011 U/mL were significant and independent predictive factors of the initial treatment response. Meanwhile, NLR < 3.10 and combination chemotherapy were independently associated with longer OS. Moreover, OS was significantly prolonged in patients with NLR < 3.10, regardless of whether combination chemotherapy or monotherapy. Patients with NLR < 3.10 at baseline had a significantly higher conversion rate to third-line chemotherapy and a longer duration of total chemotherapy. Conclusions This study suggests that NLR may be a useful marker for predicting the initial treatment response to first-line chemotherapy and the prognosis for patients with advanced PDAC.

Inflammatory Markers in Thyroid Eye Disease: A Meta-Analysis

ABSTRACT Thyroid Eye Disease (TED) is an inflammatory autoimmune condition affecting the eyes, often associated with Graves’ disease. Inflammation is important in TED, involving immune cells and orbital tissues. While inflammatory markers have been studied in other diseases, their role in TED is unclear. We included 734 participants from 5 eligible studies investigated associations between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) and TED. Initial analysis found no significant differences in these markers between TED and control groups. However, sensitivity analysis excluding an outlier study revealed significant differences in NLR, PLR, and MLR between groups, suggesting the potential association between these inflammatory markers and TED. More research is needed, but these findings indicate complex TED pathogenesis and that inflammation may offer insights for TED diagnosis and management.

Evaluation of systemic immune inflammation index and neutrophil-to-lymphocyte ratio in schizophrenia, bipolar disorder and depression.

Numerous studies consistently report on the frequent presence of low-grade systemic inflammation in individuals with schizophrenia, bipolar disorder (BD), and depression. Neutrophil-to-lymphocyte ratio (NLR) and arecently established marker, systemic immune inflammation index (SII), are markers used to assess systemic inflammation and immune response. In this study, NLR and SII index values were examined and compared across patients diagnosed with major psychiatric disorders and healthy controls. The study included, totaling 129 patients, encompassed individuals who were diagnosed with schizophrenia in remission or BD in the euthymic period, and those undergoing treatment for major depressive disorder (MDD). The control group consisted of 62 healthy individuals. White blood cell (WBC), neutrophil, lymphocyte, platelet, and monocyte counts obtained retrospectively from complete blood profiles served as the basis for calculating NLR and SII values. In this study, higher WBC, neutrophil counts, NLR, and SII values were observed in schizophrenia and BD patients compared to the control group. In patients with MDD, no significant difference was found in terms of inflammatory blood cell markers compared to healthy controls. Higher NLR and Sİİ values were found in patients with schizophrenia and BD compared to patients with MDD. The results of the study indicate that the significant difference in NLR and SII values persists after treatment in patients with schizophrenia and BD, and that the abnormal inflammatory response continues during the treatment process (Tab. 2, Ref. 41).

Coronary microvascular dysfunction and inflammation: Insights from the Coronary Microvascular Disease Registry

BackgroundCoronary microvascular dysfunction (CMD) is associated with various inflammatory conditions that worsen endothelial dysfunction. This study aimed to investigate the relationship between CMD and inflammation using common inflammatory markers derived from complete blood count (CBC) analysis. MethodsInformation was gathered from the Coronary Microvascular Disease Registry to examine the neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-monocyte ratio (EMR), and monocyte-to-high-density lipoprotein ratio (MHR) in a cohort of patients with angina who showed non-obstructive coronary arteries and underwent invasive physiological assessments for CMD. ResultsOf the 171 patients studied, 126 were CMD-negative and 45 were CMD-positive, constituting two groups of interest. The average age of all patients was 61.7 ± 11.1 years, and 63.7 % were female. No significant differences were observed between the two groups in terms of baseline characteristics, cardiovascular risk factors, or potential anti-inflammatory medications. Furthermore, there were no statistically significant differences in NLR (2.54 ± 3.71 vs. 2.52 ± 2.28, p = 0.97), EMR (0.3 ± 0.21 vs. 0.34 ± 0.29, p = 0.31), or MHR (0.02 ± 0.01 vs. 0.01 ± 0.01, p = 0.54) between CMD-positive and CMD-negative patients. ConclusionOur findings did not show a noteworthy connection between CMD and inflammation, as suggested by various simple CBC-based biomarkers.

Evaluation of Peripheral Inflammatory Activity in Different Types of Dementia

Aim: Alzheimer's disease (AD) is a chronic neurodegenerative disease characterized by pathophysiological processes involving neuroinflammation, neurodegeneration, and synaptic dysfunction. Vascular dementia (VaD) stands as the second most prevalent form among all dementia types, sharing common pathophysiological mechanisms with AD, such as vascular oxidative stress and chronic inflammation.The neutrophil-to-lymphocyte ratio (NLR) is considered a simple, noninvasive, and widely available clinical marker of inflammation. The aim of this study is to investigate the potential differences between these two different types of dementia in terms of NLR values. Materials and Methods:The data of patients diagnosed with AD or VaD and healthy controls who applied to a University Hospital Neurology outpatient clinic were retrospectively examined, and the groups were analyzed with statistical methods in terms of NLR levels. Results: A total of 39 AD, 32 VaD, and 30 healthy controls were enrolled in the study. Hemogram analyses revealed significantly elevated NLR values in both the AD and VaD groups compared to the healthy control group (p = .001, p = .001, respectively). AD and VaD groups demonstrated no significant difference in NLR (p = .787).Additionally, as a result of regression analyses, it was determined that age and NLR were independent variables associated with the presence of dementia. Conclusions:NLR values are at higher levels in AD and VaD patient groups compared to healthy controls. Our results support the role of peripheral inflammation in the pathogenesis of VaD, as in AD. Additional studies are needed on potential inflammatory biomarkers of VaD.

Diagnostic value of dual-source, dual-energy computed tomography combined with the neutrophil-lymphocyte ratio for discriminating gastric signet ring cell from mixed signet ring cell and non-signet ring cell carcinomas

PurposeTo explore the diagnostic value of dual-source computed tomography (DSCT) and neutrophil to lymphocyte ratio (NLR) for differentiating gastric signet ring cell carcinoma (SRC) from mixed SRC (mSRC) and non-SRC (nSRC).MethodsThis retrospective study included patients with gastric adenocarcinoma who underwent DSCT between August 2019 and June 2021 at our Hospital. The iodine concentration in the venous phase (ICvp), standardized iodine concentration (NICVP), and the slope of the energy spectrum curve (kVP) were extracted from DSCT data. NLR was determined from laboratory results. DSCT (including ICVP, NICVP, and kVP) and combination (including DSCT model and NLR) models were established based on the multinomial logistic regression analysis. The receiver operator characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the diagnostic value.ResultsA total of 155 patients (SRC [n = 45, aged 61.22 ± 11.4 years], mSRC [n = 60, aged 61.09 ± 12.7 years], and nSRC [n = 50, aged 67.66 ± 8.76 years]) were included. There were significant differences in NLR, ICVP, NICVP, and kVP among the SRC, mSRC, and nSRC groups (all P < 0.001). The AUC of the combination model for SRC vs. mSRC + nSRC was 0.964 (95% CI: 0.923-1.000), with a sensitivity of 98.3% and a specificity of 86.7%, higher than with DSCT (AUC: 0.959, 95% CI: 0.919–0.998, sensitivity: 90.0%, specificity: 89.9%) or NLR (AUC: 0.670, 95% CI: 0.577–0.768, sensitivity: 62.2%, specificity: 61.8%).ConclusionDSCT combined with NLR showed high diagnostic efficacy in differentiating SRC from mSRC and nSRC.

Correlation Between Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Risk Stratification Indicators and Thrombus Burden in Patients with Moderate-to-High Risk Acute Pulmonary Embolism, and Changes After Treatment.

To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and risk stratification indicators as well as thrombus burden in patients with moderate-to-high risk acute pulmonary embolism (APE), and to assess the changes in these parameters following interventional therapy. This study retrospectively included patients with moderate-to-high risk APE who were admitted to the Department of Interventional Vascular Surgery at Putian First Hospital from May 2020 to May 2024. All patients received anticoagulation therapy, pulmonary artery catheter-directed thrombolysis, and/or mechanical thrombectomy. Patients were further divided into subgroup A if they did not present with any of the following conditions at admission: a) acute inflammatory diseases (including lung infections); b) malignant tumors; c) history of trauma or surgery within the past 2 months. Patients with any of the aforementioned conditions were classified as subgroup B. Additionally, 50 healthy individuals were randomly selected as the healthy control group. The NLR and PLR in subgroup A were significantly lower than those in subgroup B (P < .01). Compared with the healthy control group, the NLR in the APE group and subgroup A was significantly higher (P < .001). There were no significant differences in NLR and PLR between the troponin I-negative and troponin I-positive groups (P > .05), or between the N-terminal pro-B-type natriuretic peptide (NT-proBNP)-negative and NT-proBNP-positive groups (P > .05). There were no significant correlations between NLR and PLR with risk stratification indicators and pulmonary artery embolism index (P > .05). Compared with before treatment, NLR, troponin I, NT-proBNP, right ventricular diameter/left ventricular diameter ratio, and pulmonary artery embolism index were significantly reduced after treatment (P < .05), while there was no significant difference in PLR before and after treatment (P > .05). Elevated NLR in patients with APE, which decreases after effective treatment, may be used for assessing disease status and treatment efficacy. However, there is no correlation between NLR and risk stratification indicators or thrombus burden. PLR does not demonstrate significant value in assessing APE.

Association between neutrophil-to-lymphocyte ratio and postoperative fatigue in elderly patients with hip fracture

Backgroundand purpose: Postoperative fatigue (POF) is a common and distressing post-operative symptom. This study aimed to explore the relationship between neutrophil-to-lymphocyte ratio (NLR) and POF in elderly patients with hip fracture. MethodElderly patients (age ≥65 years) with acute hip fracture admitted to the Department of Orthopedics of Anqing Municipal Hospital from June 2018 to June 2020 were included. Fatigue was assessed using the Fatigue Severity Scale at the 3-month follow-up postoperatively. Univariate and multivariate analyses were performed to explore the associations between NLR and POF. The diagnostic performance of NLR was analysed using Receiver Operating Characteristic (ROC) curve analysis and the Delong test. ResultA total of 321 elderly patients with hip fractures were included; 120 (37.4 %) of them were diagnosed with POF. Univariate analysis indicated significant differences in NLR, platelet-to-lymphocyte ratio (PLR), education, neutrophil count, lymphocyte count, Hamilton Depression Scale (HAMD) and Insomnia Severity Index (ISI) scores (P < 0.05). Multivariate analysis indicated neutrophil count (odds ratio [OR], 1.46; 95 % confidence interval [CI] 1.27–1.67), lymphocyte count (OR 0.32, 95 % CI 0.19–0.53), NLR (OR1.81, 95 % CI 1.50–2.17) and PLR (OR 1.005, 95 % CI 1.001–1.009) were significantly associated with POF. The areas under the ROC curves (AUCs) of neutrophil count, lymphocyte count, NLR and PLR were 0.712, 0.667, 0.775 and 0.605, respectively. The Delong test indicated that NLR had the best diagnostic performance (p < 0.05). ConclusionNLR independently predicts POF in elderly patients with acute hip fracture.

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) levels following erector spinae plane block (ESPB) in posterior lumbar decompression: a randomized, controlled trial

PurposeNeutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are the inflammatory biomarkers of the stress response. In this study, we aimed to evaluate the effects of erector spinae plane block (ESPB) on posterior lumbar decompression and stabilization by comparing NLR, PLR, postoperative pain, opioid consumption, and functional recovery between sham block and ESPB.MethodsThis was a prospective, double-blinded, randomized controlled trial in a tertiary referral hospital. Sixty patients were randomized into two equal groups, each receiving either a sham block or ESPB. The primary outcome was the NLR and PLR 12 h and 24 h after lumbar posterior decompression and stabilization. The secondary outcomes were total opioid consumption and pain score 24 h postoperatively. Also, functional recovery determined by getting out of bed, verticalization, and walking by the balcony were reviewed as secondary outcomes.ResultsSignificant differences existed between the sham block and ESPB group in NLR (29.08 ± 12.29 vs. 16.97 ± 10.38; p < 0.0001) and PLR (556.77 ± 110.32 vs. 346.43 ± 117.34; p < 0.0001) 12 h after surgery. Also, there was a significant difference in NLR (p = 0.0466) and PLR (p < 0.0001) 24 h after surgery. In addition, there was a substantial difference in pain score, total opioid consumption, and functional recovery.ConclusionESPB performance during spinal surgery lowers NRL and PLR ratios 12 h and 24 h after surgery. In addition, ESPB provides better analgesia and improves functional recovery compared to sham block following posterior lumbar decompression and stabilization.

Immunoglobulin A levels and its correlation with neutrophil-to-lymphocyte ratio as inflammatory biomarkers for dry eye disease in type 2 diabetes: a retrospective study.

The neutrophil-to-lymphocyte ratio (NLR) and immunoglobulin A (IgA) level are commonly used as biomarkers for inflammation. Patients with type 2 diabetes (T2D) may experience an imbalance of tear film and inflammation, which can result in dry eye disease (DED). This study aimed to assess the levels of IgA and explore its correlation with the NLR as potential inflammatory biomarkers for dry eye disease in patients with T2D. A retrospective study was conducted at the cornea clinic and diabetes centre of King Abdulaziz Medical City (Jeddah, Saudi Arabia). The study included patients with DED and the number of available T2D-DED patients determined the sample size. Neutrophil, lymphocyte, IgA and CRP (C-reactive protein) laboratory values were obtained from medical records and correlational analyses were performed. The study included 85 patients with an average age of 54 ± 14.4 years for the DED group (n=32) and 62 ± 13.9 years for the T2D-DED group (n=53). The age difference between the two groups was statistically significant (p 0.0001). The NLR values of the T2D-DED and DED groups were 3.203 ± 0.66 and 2.406 ± 0.46, respectively, with no significant difference (p<0.285). Similarly, there were no significant differences in neutrophil and lymphocyte values between the two groups. The IgA levels showed no significant variation between T2D-DED and DED groups (p<0.364). Spearman's correlation analysis in the DED group showed a significant negative correlation between IgA and lymphocyte (p=0.011; r= - 0.471) values and significant positive correlations between IgA and neutrophil (p=0.014; r=0.309) and NLR (p=0.052; r= - 0.283) values. In the T2D-DED group, a significant correlation was found between IgA and CRP values (p=0.032; r=0.33). Although diabetic patients may exhibit higher levels of NLR and IgA that correlate with disease severity, our study did not find significant differences in NLR and IgA values between the two groups. These findings may guide future research and enhance understanding of the disease's underlying mechanisms.

Exploring the Correlates of Hematological Parameters With Early Diabetic Nephropathy in Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (DM) with nephropathy is a common complication in poorly controlled diabetes. Uncontrolled DM leads to intraglomerular vascular changes that cause physical injury to capillary walls, causing a profibrotic response in kidneys. The present study aimed to determine the association of hematological markers with microalbuminuria in early diabetic nephropathy. A single-center, cross-sectional study was conducted over the period of two years at the Department ofMedicine ofPradyumna Bal Memorial Hospital, Kalinga Institute of Medical Sciences. A total of 90patients diagnosed with type 2 DMwere classified into two groups (group A and group B) according to microalbuminuria; there were 45 patients in each group.Levels of hematological markers, i.e., neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width (RDW), between the study groups were examined and compared. A significant difference in NLR was found between groups A and B (p = 0.001). A statistically significant difference in RDW was found between the groups(p = 0.015). Receiver operating characteristic curve analysis of inflammatory markers and microalbuminuria prediction showed an area under the curve of 0.814 for NLR and 0.656 for RDW. Hematological parameters like NLRand RDWare elevated in early diabetic nephropathy patients. NLR isfound to be a better marker than RDW in predicting early nephropathy.

Effect of thyroid hormone status on complete blood cell count-derived inflammatory biomarkers in patients with moderate-to-severe Graves' ophthalmopathy.

To evaluate the systemic inflammation in moderate-to-severe Graves' ophthalmopathy patients with abnormal thyroid function by using complete blood cell count-derived inflammatory biomarkers and compare to moderate-to-severe GO patients with regulated thyroid function and healthy controls. The second aim is to evaluate the relationship of complete blood cell count-derived inflammatory biomarkers with clinical findings in moderate-to-severe GO. In this retrospective study, 90 GO patients with abnormal thyroid function composed Group 1, 58 patients who had normal thyroid function for at least 3months composed Group 2, and 50 healthy individuals composed Group 3. Demographic data, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and systemic immune-inflammatory index (SII) were evaluated. There was no statistically significant difference between groups in terms of age, sex, and smoking habits (p > 0.05). There was a statistically significant difference in NLR (p = 0.011), MLR (p = 0.013), MPV (p < 0.001), and SII (p < 0.001) values among 3 groups. For NLR, MLR, and SII the highest values were detected in Group 1. MPV levels were higher in Group 3 than Groups 1 and 2 (p < 0.001). None of the hematological parameters were found to be a risk factor for any clinical severity findings of GO. The higher levels of NLR, MLR, and SII levels may show systemic inflammation in GO patients with abnormal thyroid function, and this may have an impact on the clinical course of ophthalmopathy. These findings may suggest that cautious control of thyroid hormone levels is important in the management of GO.

Relationship between Neutrophil to Lymphocyte Ratio (NLR) and Gensini Score in Patients with Coronary Artery Disease (CAD) at Mataram City General Hospital: A Cross Sectional Study

Highlights: It discusses the relationship between NLR and the severity of coronary atherosclerosis. There is significant difference from the previous NLR research Abstract: Background. Neutrophil to Lymphocyte Ratio (NLR) is a marker of systemic inflammation correlated with the incidence of Coronary Artery Disease (CAD). Neutrophils infiltrate the coronary artery plaque causing acceleration of atherosclerosis. T lymphocyte recruitment is required at the early stages of plaque formation. Previous studies have shown that heightened NLR was correlated with the percentage of stenosis at the site of the multivessel lesion. Aims. This study aimed to determine the relationship between NLR with Gensini score of coronary arteries in CAD patients at Mataram City General Hospital. Material and method. This was a cross sectional study conducted in Mataram City General Hospital. Fifty-nine patients diagnosed with CAD participated in the study. Blood collection and coronary angiography were performed to assess NLR and Gensini Score. The main variables were NLR and Gensini Score. Gensini score of 1-29 was considered as mild atherosclerosis and Gensini score of 30 or more was considered as severe atherosclerosis. NLR was considered high if the value of NLR were &gt; 2.385 based on previous studies. Spearman test was performed to assess correlation between variables. Results. Approximately 53% subjects were categorized as severe atherosclerosis and 48% as mild atherosclerosis. The median values of Gensini score in the low NLR group were 25.0 and in the high NLR group were 40.0 (p=0,19). The median values of NLR in the mild group of atherosclerosis were 1.78 and in the severe atherosclerotic group were 2.15 (p=0,59). There was no significant difference in NLR between severe atherosclerosis and mild atherosclerosis groups. NLR was not associated with Gensini score (p=0,32). Conclusions. There was no significant relationship between Neutrophil to Lymphocyte Ratio with Gensini score of coronary arteries in CAD patients at Mataram City General Hospital.

Hematological Parameters as an Early Marker of Deep Vein Thrombosis in Diabetes Mellitus: An Observational Study.

Background Although the association between the presence of diabetes mellitus and the development of deep vein thrombosis (DVT) is well known, the role of novel biomarkers in predicting the development of DVT in diabetic patients is not yet known to a large extent.Studies have shown that complete blood count (CBC) and CBC-derived parameters such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can be used as surrogate markers to detect DVT. This study was conducted to assess the utility of NLR and PLR as a marker of DVT in diabetic patients. Methodology This case-control study was conducted among a calculated sample size of 109 DVT patients in one arm and 109 non-DVT patients in another arm.Hematological tests including total leucocyte count, differential leucocyte count, total neutrophil count, total lymphocyte count, total platelet count, NLR, and PLR were performed. Results We found a significant difference in NLR and PLR between the DVT and the non-DVT groups. In addition, we found that NLR and PLRwere significantly higher in the diabetic group, indicating the presence of inflammation in association with diabetes mellitus. Analysis of the receiver operating characteristic curve showed that at a cut-off value of 2.83, NLR can detect DVT in diabetic patients with 67% sensitivity and 92% specificity. Similarly, PLR at a cut-off value of 131.46 can detect DVT in diabetic patients with 56% sensitivity and 90% specificity. Conclusions We conclude that NLR and PLR are novel inflammatory markers that can help in the early detection of DVT in diabetic patients.

Predictive value of hemogram parameters in malignant transformation of the endometrium in patients with different risk factors.

To investigate whether the pretreatment hemogram parameters and their ratios can be used in predicting the endometrial transformation in patients with abnormal uterine bleeding. Records of all patients who underwent an endometrial histopathological evaluation between 2011 and 2021 were investigated. Hemogram, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were analyzed. Chi square and Mann Whitney U tests were used for analysis. P<0.05 was considered statistically significant. 427 patients were included, of whom 117 were presented with endometrial hyperplasia without atypia (27.4%; mean age, 42±9.7; Group II), 70 with atypia (16.3%; mean age, 53.4±9; Group III), 102 with early endometrial cancer (EC) (23.8%; mean age, 63±7.8; Group IV) and 38 with advanced disease (8.8%; mean age, 63.3±10.5; Group V). Patients without pathology constituted the control group (23.4%; mean age, 42.2±9.5; Group I). Risk factors for atypia and carcinoma were determined as age, postmenopausal state, obesity, diabetes, and increased estrogen exposure (each, p<0.05). There was no significant difference in NLR and PLR (p>0.05). However, hemoglobin and hematocrit levels were higher in Groups IV and V (13.9 vs 13.1 mg/dL, and 39.1 vs 38.8%, respectively; p<0.01). Platelet value was significantly higher in Groups III to V (282x109/L, 283x109/L and 295x109/L; p<0.05, p<0.05 and p<0.01, respectively). Our findings support the impact of inflammation on malign transformation from normal endometrial mucosa to atypia and carcinoma. NLR and PLR values showed no statistical difference. Instead, thrombocytosis may have a predictive role in EC.

The Influencing Factors of Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker for Sepsis: Analysis from a Large Database

Abstract The neutrophil-to-lymphocyte ratio (NLR) is an important predictive prognostic tool. However, its accuracy for predicting sepsis remains debatable. This study aimed to evaluate the factors influencing the ability of NLR to predict sepsis. Adult patients with sepsis or septic shock from the eICU database were enrolled in this study. Results showed that there was a significant difference in NLR between the survival and nonsurvival groups (median [lower quartile–upper quartile], 15.27 [7.92–26.28] vs. 17.97 [8.94–31.85], P = 0.008). Area under the curve (AUC) of NLR on the sixth day was the highest. AUC of NLR was significantly higher in the Simplified Acute Physiological Score (SAPS) 3 ≤52 group than that in the SAPS3 &gt; 52 group (0.78 ± 0.05 vs. 0.69 ± 0.03, P = 0.007). AUC of NLR in the nonshock group was significantly higher than that in the shock group (0.72 ± 0.04 vs. 0.65 ± 0.05, P &lt; 0.01). The ability of NLR as a prognosis predictor of sepsis was influenced by admission time, SAPS3, and shock.

A cross sectional study to assess prediction of microalbuminuria using neutrophilto- lymphocyte ratio and red blood cell distribution width in diabetic patients

Background: This study was devised to evaluate the predictive value of neutrophilto- lymphocyte ratio (NLR), mean platelet volume (MPV), and red blood cell distribution width (RDW) to detect microalbuminuria in type 2 diabetic patients. This can help in early detection of microalbuminuria and assessment of prognosis inn patients suffering from type 2 diabetes mellitus (DM). Aims and Objectives: The objectives of the study were to assess the diagnostic accuracy of microalbuminuria using neutrophil-to-lymphocyte ratio and red blood cell distribution width in diabetic patients. Materials and Methods: A total of 188 patients with type 2 DM were selected for this study. Subjects were classified into three groups based on hemoglobin A1c and microalbuminuria. Group A had 63 patients with controlled diabetes, Group B had 62 patients with uncontrolled diabetes, both without microalbuminuria, and Group C had 62 patients with uncontrolled diabetes with microalbuminuria. Levels of NLR, MPV, and RDW between the study groups were analyzed. Results: A significant difference in NLR was found between Group C and Groups A and B (P&lt;0.001 and P=0.005, respectively). RDW was significantly different between Groups B and C (P=0.014). Receiver operating characteristic curve analysis was done between NLR and RDW. The area under curve was found to be of 0.678 for NLR (confidence interval: 0.59–0.75, P&lt;0.001) and 0.616 for RDW (confidence interval: 0.49–0.73, P=0.013). The study shows that an NLR cutoff point of 2.54 has 39.7% sensitivity, 78.8% specificity, and 45% positive predictive value (PPV). An RDW cutoff point of 14.44 has 37.9% sensitivity, 76% specificity, and 41.5% PPV. Conclusion: NLR and RDW can be beneficial to detect microalbuminuria in diabetic patients.

Can the Combination of Magnetic Resonance Imaging, Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict the Mass Origin in Ovarian Masses?

Evaluate the effectiveness of magnetic resonance imaging (MRI), blood parameters, and tumor markers to determine the role of objective criteria in distinguishing malignant, borderline, and benign masses and to minimize unnecessary surgical interventions by reducing interpretation differences. The histopathological and clinical-laboratory results of the patients who underwent surgery for the initial diagnosis and whose ovarian masses were confirmed were retrospectively reviewed. Between groups, age, cancer antigen 125, mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), the presence of ascites, the ovarian-adnexal reporting and data system MRI scores, mass characteristics, and lymphocyte count were compared. The study comprised a total of 191 patients. These patients were categorized into three groups: Benign (n=113), borderline (n=26), and malignant (n=52). No noteworthy correlation was detected between the unilocular or multilocular nature of solid, cystic, or mixed masses and the rates of NLR, PLR, or MPV. However, a notable correlation was identified between NLR and the presence of acidity (p=0.003). In ovarian cancer patients, there was no significant difference in NLR and MPV between malignant epithelial and malignant sex cord-stromal types (p>0.05), whereas a significant difference emerged in the PLR ratio (p=0.013). In ovarian masses with malignant potential, laboratory parameters such as NLR and PLR can guide the diagnosis process. In the future, various studies such as the development of different tests, markers, and imaging methods, the use of blood tests such as NLR, PLR, and MPV in cancer diagnosis will be possible. The results of these studies may contribute to the development of new methods for the diagnosis of ovarian cancer and the improvement of treatment protocols.

Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Predicting Preeclampsia During Pregnancy

To investigate the changes of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in women with normal pregnancy women and pregnant women with preeclampsia (PE) and the value of using NLR and PLR in the first trimester to predict PE. We retrospectively collected the clinical data of 485 pregnant women (97 had PE and 388 were of normal pregnancy) who were admitted to West China Second University Hospital and had their babies delivered there between January 1 and December 31, 2016 and 30 healthy women who were not pregnant and who had physical examination at the hospital over the same period. The subjects' NLR and PLR were calculated and compared. Logistic regression analysis was done to study the risk factors of PE, and the receiver operating characteristic curves were used to assess the value of using NLR and PLR in the first trimester to predict PE. There was no significant difference in NLR or PLR between the PE group and the normal pregnancy group in the first, second and third trimesters. Compared with that of the normal non-pregnant group, the NLR of the PE group and the normal pregnancy group started to rise in the first trimester, reached the maximum in the second trimester, and decreased in the third trimester; PLR started to decrease in the second trimester and reached the lowest level in the third trimester, exhibiting significant differences ( P<0.05). In the three trimesters, NLR and PLR were not associated with the severity of PE, maternal age, or pre-pregnancy BMI. The predictive model combining factors including pre-pregnancy obesity, advanced maternal age, and nulliparity showed an area under the curve ( AUC) of 0.84 for predicting PE. When NLR in the first trimester or PLR in the first trimester were added to the combined model of pre-pregnancy obesity, advanced maternal age, and nulliparity, the AUC subsequently derived were both 0.85. NLR and PLR are not independent influencing factors of PE and cannot improve the predictive value for PE.