Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a population-based prospective cohort study

Association between systemic immune inflammation Index and all-cause mortality in incident peritoneal dialysis-treated CKD patients: a multi-center retrospective cohort study

BACKGROUND

Chronic inflammatory disorders in peritoneal dialysis (PD) contribute to the adverse clinical outcome. Systemic immune inflammation index (SII) is the novel and convenient measurement that is positively associated with various diseases. However, scarce is known regarding the association between SII with all-cause mortality among PD patients.

METHODS

In this multi-center retrospective cohort study, 1,677 incident patients with PD were enrolled. Eligible patients were stratified into groups based on SII level: tertile 1(< 456.76), tertile 2(456.76 to 819.03), and tertile 3(> 819.03). The primary endpoint was the all-cause mortality. Both Cox regression analysis and competing risk models were used to examine the association between SII and all-cause mortality. Subgroup analysis was performed to assess the influence of the SII tertiles on all-cause mortality in different subgroups.

RESULTS

During the follow-up period of 30.5 ± 20.0 months, 26.0% (437/1,677) patients died, of whom the SII tertile 3 group accounted for 39.1% (171/437) of the deaths. Patients in the SII tertile 3 group had a higher all-cause mortality rate than patients in the SII tertile 1 and 2 groups (log-rank = 13.037, P < 0.001). The SII tertile 3 group was significantly associated with 80% greater risk (95% confidence interval:1.13 to 2.85; P = 0.013) compared with the SII tertile 1 group in multivariable Cox regression analysis. The competing risk model also indicated that the relationship between SII tertiles and all-cause mortality remains (subdistribution hazard ratio: 1.86; 95% confidence interval: 1.15 to 2.02, P = 0.011). Furthermore, the relationship between the log-transformed SII and all-cause mortality in patients with PD was nearly linear (P = 0.124).

CONCLUSION

A close relationship was observed between the SII and all-cause mortality in patients undergoing PD, suggesting that more attention should be paid to the SII, which is a convenient and effective measurement in clinical practice.

Comparison of Systemic Immune-Inflammation Index and Naples Prognostic Score for Prediction Coronary Artery Severity Patients Undergoing Coronary Computed Tomographic Angiography

This study compared the predictive power of the systemic immune-inflammation index (SII) and Naples prognostic score (NPS) in determining the severity of coronary artery disease (CAD). The study included 1138 patients who underwent coronary computed tomographic angiography (CCTA). The primary outcome was the evaluation of CAD severity, determined by the Coronary Artery Disease-Reporting and Data System (CAD-RADS) obtained from the CCTA scans. A basic statistical model including age, gender, chest pain, diabetes mellitus, hypertension, hyperlipidemia, and smoking was built, and categorical variables, NPS (Naples 3,4 vs 0,1,2) and SII, were added to the basic statistical model. The net benefits of the predictive parameters were determined by a decision curve analysis, and the association between CAD-RADS and NPS, SII was quantified by odds ratios (OR) and 95% confidence intervals (CI). The decision curve analysis showed that adding SII to the statistical model had a better full range of probability of clinical net benefit compared with the baseline model (OR: 5.77, 95% CI 4.15-8.02, P < .001). However, adding the NPS (P = .11) to the model did not outperform the basic statistical model. In conclusion, the SII may have a net predictive effect on top of traditional risk factors.

The Systemic Immune-Inflammation Index and Predicting Cardiac Implantable Electronic Device Infections

This study aimed to evaluate the utility of the systemic immune-inflammation index (SII) in predicting the development of Cardiac Implantable Electronic Device (CIED) infections. A retrospective analysis was performed using the medical records of 2185 patients who underwent CIED (including de novo, revision, or upgrade) implantation at our institution from January 2012 to December 2019. We recorded CIED infections and risk factors according to the patient, device, and procedural characteristics during the median 28.7 months (6.2-56.8) follow-up. CIED infections were identified in 52 patients. Diabetes, chronic renal disease, SII before implantation, new cardiac resynchronization therapy (CRT) implantation, CRT-battery replacement, revision or upgrade, and the number of previous procedures were independent predictors of CIED infections. The area under the curve (AUC) of SII to predict CIED infection was .733 (95% CI: .654-.811). A raised SII may be a useful predictor of CIED infection.

Profiling an integrated network of cellular senescence and immune resilience measures in natural aging: a prospective multi-cohort study

Background

Biological aging begins decades before the onset of age-related clinical conditions and is mediated by both cellular senescence and declining adaptive immune function. These processes are functionally related with the rate of senescent cell accumulation dependent upon a balance between induction and immune clearance. We previously showed that biomarkers in these domains can identify patients at-risk of surgery-related adverse events. Here, we describe evidence of clinical relevance in early aging and metabolic phenotypes in a general adult population.

Methods

We enrolled a total of 482 participants (ages 25-90) into two prospective, cross-sectional healthy aging cohorts. Expression of biomarkers of adaptive immune function and cellular senescence (SapereX) was measured in CD3+ T cells isolated from peripheral blood.

Findings

We established a network of biomarkers of adaptive immune function that correlate with cellular senescence and associate with early aging phenotypes. SapereX immune components associated with a decrease in CD4+ T cells, an increase in cytotoxic CD8+ T cells, and a loss of CD8+ naïve T cells (Pearson correlation 0.3-0.6). These components also associated with a metric of immune resilience, an ability to withstand antigen challenge and inflammation. In contrast, SapereX components were only weakly associated with GlycanAge (Pearson correlation 0.03-0.15) and commonly used DNA methylation clocks (Pearson correlation 0-0.25). Finally, SapereX biomarkers, in particular p16, were associated with chronic inflammation and metabolic dysregulation.

Interpretation

Measurement of SapereX biomarkers may capture essential elements of the relationship between cellular senescence and dysregulated adaptive immune function and may provide a benchmark for clinically relevant health decisions.

No association between blood-based markers of immune system and migraine status: a population-based cohort study

BACKGROUND

Although some evidence implicates the immune system in migraine attacks, its role during attack-free periods remains largely unexplored. Therefore, we assessed the association between the immune system and migraine status.

METHODS

From the population-based Rotterdam Study, we included 6593 participants who underwent blood sampling and migraine assessments. In the blood samples, we measured white blood-cell-based immune markers. As a marker for the innate immune system, granulocyte and platelet counts were determined, whereas lymphocyte counts were used as a marker for the adaptive immune system. Migraine was assessed using a validated questionnaire based on ICHD-2 criteria. We investigated associations between blood-cell counts and migraine using logistic regression models adjusting for age, sex and other variables.

RESULTS

Mean age of participants was 65.6 ± 11.2 years and 56.7% were female. The lifetime prevalence of migraine was 15.1% (995/6593). We found no statistically significant associations between granulocyte (odds ratio [OR] per standard deviation increase 1.01 95% Confidence Interval [CI]: 0.93-1.09), platelet (OR 1.01 CI: 0.94-1.09) or lymphocyte counts (OR 1.01 CI: 0.93-1.08) and migraine status.

CONCLUSIONS

Our results do not support an association between white blood-cell-based immunity markers and migraine status.

The inflammatory potential of diet is associated with the risk of age-related eye diseases

BACKGROUND & AIMS

Inflammation is involved in the pathogenesis of cataract, age-related macular degeneration (AMD), and possibly open-angle glaucoma (OAG). We assessed whether the inflammatory potential of diet (quantified using the dietary inflammatory index; DII) affects the incidence of these common blinding age-related eye diseases. Serum inflammation markers were investigated as possible mediators.

METHODS

Participants aged >45 years were selected from the prospective, population-based Rotterdam Study. From 1991 onwards, every 4-5 years, participants underwent extensive eye examinations. At baseline, blood samples and dietary data (using food frequency questionnaires) were collected. The DII was adapted based on the data available. Of the 7436 participants free of eye diseases at baseline, 4036 developed incident eye diseases during follow-up (cataract = 2895, early-intermediate AMD = 891, late AMD = 81, OAG = 169).

RESULTS

The adapted DII (aDII) ranged from -4.26 (i.e., anti-inflammatory) to 4.53 (i.e., pro-inflammatory). A higher aDII was significantly associated with increased inflammation. A higher neutrophil-lymphocyte ratio (NLR) was associated with an increased risk of cataract and AMD. Additionally, complement component 3c (C3c) and systemic immune-inflammation index (SII) were associated with increased risks of cataract and late AMD, respectively. Every point increase in the aDII was associated with a 9% increased risk of cataract (Odds ratio [95% confidence interval]: 1.09 [1.04-1.14]). The NLR and C3c partly mediated this association. We also identified associations of the aDII with risk of AMD (early-intermediate AMD, OR [95% CI]: 1.11 [1.03-1.19]; late AMD, OR [95% CI]: 1.24 [1.02-1.53]). The NLR partly mediated these associations. The aDII was not associated with OAG.

CONCLUSIONS

A pro-inflammatory diet was associated with increased risks of cataract and AMD. Particularly the NLR, a marker of subclinical inflammation, appears to be implicated. These findings are relevant for patients with AMD and substantiate the current recommendations to strive for a healthy lifestyle to prevent blindness.

Individual and combined associations of estimated pulse wave velocity and systemic inflammation response index with risk of stroke in middle-aged and older Chinese adults: a prospective cohort study

Background and aims

Estimated pulse wave velocity (ePWV) and systemic inflammatory response index (SIRI) have been recently investigated as a marker of arterial stiffness and a novel systemic inflammatory indicator. This study aims to examine the independent and combined association of ePWV and SIRI with incident stroke and its subtypes.

Methods

Data of the Dongfeng-Tongji cohort study was analyzed for 9,154 middle-aged and older adults, who were free of cardiovascular disease and cancer and were followed up to document incident stroke. But their association with incident stroke events and its subtypes have not been well studied. Multivariable adjusted Cox regression models were used to determine the independent and combined association of ePWV and SIRI with incident stroke events.

Results

Over a 7.22-year follow-up, the cohort documented 491 stroke cases (387 ischemic stroke and 104 hemorrhagic stroke). The multivariate adjusted model showed that with each one-unit increase in the level of ePWV, the corresponding hazard ratios (HRs) (95% CI) for total stroke, ischemic stroke, and hemorrhagic stroke were 1.53 (95% CI, 1.23-1.90), 1.42 (95% CI, 1.11-1.83), and 1.92 (95% CI, 1.21-3.03), respectively. Similarly, with each one-unit increase in log-transformed levels of SIRI, the corresponding HRs (95% CI) for total stroke, ischemic stroke, and hemorrhagic stroke were 1.23 (95% CI,1.04-1.47), 1.16 (95% CI, 0.96-1.41), and 1.52 (95% CI, 1.05-2.20), respectively. There appeared to be a combined effect of ePWV and SIRI on stroke; Participants with high levels of both ePWV and SIRI had a higher risk of total stroke and hemorrhagic stroke, with multiple adjusted HR of 2.43 (95% CI, 1.09-5.42). Additionally, the incorporation of ePWV in addition to traditional cardiovascular risk factors significantly improved the predictive accuracy for total stroke with C statistic increased from 0.684 (95% CI, 0.661-0.707) to 0.687 (95% CI, 0.664-0.710; x2 = 6.65; p for difference = 0.010), and (suggestively) for ischemic stroke with C statistic increased from 0.684 (95% CI, 0.659-0.71) to 0.691(95% CI, 0.666-0.717; x2 = 3.13, p for difference = 0.077), respectively.

Conclusions

The presence of both high ePWV and SIRI individually, as well as together, was found to be associated with an increased incidence of stroke. The combined stroke risk assessment using these two indicators could potentially improve non-invasive assessment and treatment strategies for high-risk patients, as these indicators are easily accessible in clinical practice.

Systemic immune-inflammation index in patients with generalized stage III grade C periodontitis

OBJECTIVES

Systemic immune-inflammation index (SII) is a novel, inflammatory biomarker whose role in predicting several chronic systemic diseases has been recently identified. However, its association with generalized stage III grade C periodontitis in young adults remains unknown.

MATERIAL AND METHODS

The study is a multicentered, double-blind, hospital-based case-control clinical study. Periodontal examination comprised of recording plaque index, sites with bleeding on probing, pocket depth and clinical attachment loss for patients with generalized stage III grade C periodontitis and periodontally healthy group. Complete blood counts were obtained and used for calculating SII, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio. Collected data were then subjected to statistical analyses.

RESULTS

SII was significantly higher in patients with generalized stage III grade C periodontitis compared to periodontally healthy individuals (723.87 vs. 537.74 × 109 /L, p < 0.0001). SII is associated with severe periodontitis in young adults (odds ratio [OR]:11.86, 95% CI 9.61-20.76, p < 0.0001) after adjusting for factors found significant in univariate analysis. Receiver operative curve analysis demonstrated a fair predictive validity of SII in detecting generalized stage III grade C periodontitis in young adults (AUC: 0.766, 95%CI 0.731-0.799, p < 0.0001, sensitivity 81.27%, specificity 76.50% and diagnostic accuracy 78.89%). SII did not exhibit superior predictive validity when compared with NLR in the context of generalized stage III grade C periodontitis (AUC for SII: 0.766, 95%CI 0.731-0.799, AUC for NLR: 0.788, 95% CI 0.754-0.819; p = 0.28).

CONCLUSION

SII is associated with generalized stage III grade C periodontitis in young adults.

Aging and antioxidants: the impact of dietary carotenoid intakes on soluble klotho levels in aged adults

Objectives

The association between dietary carotenoid intake and Soluble Klotho (S-Klotho) levels among the elderly population requires further evaluation. The purpose of this study is to evaluate the relationship between the dietary carotenoid intake and the S-Klotho plasma levels in older adults.

Methods

Eligible participants aged 60 years or above were selected from the National Health and Nutrition Examination Surveys (NHANES) data, collected between 2007 and 2016. The consumption of carotenoids was determined through two 24-hour dietary recall assessments. Moreover, the S-Klotho levels in the serum were measured using an Enzyme-Linked Immuno-Sorbent Assay (ELISA).

Results

A total of 5,056 participants were included in the study having a median total carotenoid intake of 9775.25 μg (95% confidence interval (CI): 8971.30-10579.21) and a median S-Klotho concentration of 815.59 pg/mL (95% CI: 802.59-828.60). The multivariable regression analysis showed that a single standard deviation increase in total carotenoid intake was significantly associated with an 8.40 pg/mL increase in S-Klotho levels (95% CI: 0.48-16.31). When the carotenoids were divided into quartiles, participants in the third ((4963.5μg/day,11662.5μg/day]) and fourth quartiles ((11662.5μg/day,377178μg/day]) showed higher S-Klotho levels compared to those in the first quartile. Among carotenoid subtypes, increased intake of α-carotene, β-carotene, and lutein with zeaxanthin was associated with elevated S-Klotho levels. These observed associations between carotenoid subtypes and S-Klotho levels remained consistent across male participants, having a normal weight, and a moderate physical activity based on stratified analysis.

Conclusion

The total carotenoid intake was positively related to plasma levels of S-Klotho in the elderly population, particularly for α-carotene, β-carotene, and lutein with zeaxanthin. However, further research is needed to confirm these findings and explore the underlying mechanisms behind this relationship.

Association between systemic immune-inflammation index and metabolic syndrome and its components: results from the National Health and Nutrition Examination Survey 2011-2016

BACKGROUND

Metabolic syndrome (MetS), a worldwide public health problem, affects human health and quality of life in a dramatic manner. A growing evidence base suggests that MetS is strongly associated with levels of systemic immune inflammation. The present study aimed to investigate the possible relationship between the systemic immune-inflammation index (SII), a novel inflammatory marker, and MetS to provide data support for effective MetS prevention by reducing the systemic inflammatory response.

METHODS

We included adult participants with complete SII and MetS information from the 2011-2016 National Health and Nutrition Examination Survey (NHANES). MetS was defined as using the criteria developed by the Adult Treatment Program III of the National Cholesterol Education Program. The formula for SII was as follows: SII = platelet counts × neutrophil counts/ lymphocyte counts. Weighted linear regression was used to assess differences in variables across SII quartile groups after the SII score was divided into 4 quartiles. The independent interaction between SII and MetS was investigated using weighted multivariate logistic regression analysis and subgroup analysis, and the relationship between SII levels and 5 particular MetS items was further explored in depth.

RESULTS

A total of 12,402 participants, 3,489 of whom were diagnosed with MetS, were included in this study. After correcting for covariates, the results of a logistic regression of multistage weighted complex sampling data revealed that participants with higher SII scores had a higher chance of developing MetS (odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.14-1.55) and that SII levels could be used as an independent risk factor to predict that likelihood of MetS onset. In the Q1-Q4 SII quartile group, the risk of developing MetS was 1.33 times higher in the Q4 group, which had the highest level of systemic immune inflammation than in the Q1 group. After adjusting for all confounding factors, SII scores were found to have a negative correlation with high-density lipoprotein cholesterol (OR = 1.29; 95% CI, 0.99-1.67, P = 0.056) and a significant positive correlation with waist circumference (OR = 2.17; 95% CI, 1.65-2.87, P < 0.001) and blood pressure (BP) (OR = 1.65; 95% CI, 1.20-2.27, P = 0.003). Gender, age, and smoking status were shown to alter the positive association between SII and MetS in subgroup analyses and interaction tests (p for interaction < 0.05). Additionally, we demonstrated a nonlinear correlation between SII and MetS. The findings of the restricted cubic spline indicated that there was an inverted U-shaped association between SII and MetS.

CONCLUSIONS

Our findings imply that increased SII levels are related to MetS, and SII may be a simple and cost-effective method to identify individuals with MetS. Therefore, protective measures such as early investigation and anti-inflammatory interventions are necessary to reduce the overall incidence of MetS.

Feasibility of using red cell distribution width for prediction of postoperative mortality in severe burn patients: an association with acute kidney injury after surgery

BACKGROUND

Severe burns cause pathophysiological processes that result in mortality. A laboratory biomarker, red cell distribution width (RDW), is known as a predictor of mortality in critically-ill patients. We examined the association between RDW and postoperative mortality in severe burn patients.

METHODS

We retrospectively analyzed medical data of 731 severely burned patients who underwent surgery under general anesthesia. We evaluated whether preoperative RDW value can predict 3-month mortality after burn surgery using receiver operating characteristic (ROC) curve analysis, logistic regression, and Cox proportional-hazards regression analysis. Mortality was also analyzed according to preoperative RDW values and incidence of postoperative acute kidney injury (AKI).

RESULTS

The 3-month mortality rate after burn surgery was 27.1% (198/731). The area under the ROC curve of preoperative RDW to predict mortality after burn surgery was 0.701 (95% confidence interval [CI], 0.667-0.734; P < 0.001) with a cut-off point of 12.9. The adjusted hazard ratio in patients with RDW > 12.9 was 1.238 (95% CI, 1.138-1.347; P < 0.001). Subgroup analysis showed that the survival rate was 88.8% for the non-AKI group with RDW ≤ 12.9 and 17.6% for the AKI group with RDW > 12.9. Preoperative RDW was considered an independent risk factor for mortality (odds ratio, 1.679; 95% CI, 1.378- 2.046; P < 0.001).

CONCLUSIONS

Preoperative RDW may predict 3-month postoperative mortality in patients with severe burns, while preoperative RDW > 12.9 and postoperative AKI may further increase mortality after burn surgery.

Serum Inflammatory Markers and Amputations in Hand Osteomyelitis: A Retrospective Review of 146 Cases

BACKGROUND

The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation.

METHODS

We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available.

RESULTS

Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (<29%). A rise in CRP between diagnosis and follow-up was associated with an increased risk of amputation compared with a fall in CRP. The finding that WCC and CRP were both normal at diagnosis had a high negative predictive value against amputation (96%).

CONCLUSION

C-reactive protein has a higher sensitivity than WCC, NLR, and PLR when used as a diagnostic adjunct in hand osteomyelitis. White cell count and CRP both within reference ranges at diagnosis was highly negatively predictive against amputation.

Prognostic value of neutrophil-lymphocyte ratio in out-of-hospital cardiac arrest patients receiving targeted temperature management: An observational cohort study

BACKGROUND

Out-hospital cardiac arrest (OHCA) is a major cause of mortality and morbidity worldwide. The magnitude of the post-resuscitation inflammatory response is closely related to the severity of the circulatory dysfunction. Currently, targeted temperature management (TTM) has become an essential part of the post-resuscitation care for unconscious OHCA survivors. Some novel prognostic inflammatory markers may help predict outcomes of OHCA patients after TTM.

METHODS

A retrospective observational cohort study of 65 OHCA patients treated with TTM was conducted in a tertiary hospital in Taiwan. The primary outcome measure was in-hospital mortality. Baseline and post-TTM neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte (PLR), and the systemic immune inflammation index (SII) were identified as potential predictors.

RESULTS

These patients had a mean age of 62.2 ± 17.0 years. Among the total sample, 53.8% had an initial shockable rhythm and 61.5% had a presumed cardiac etiology. The median resuscitation duration was 20 min (IQR 13.5-28.5) and 60% received subsequent percutaneous coronary intervention. The mean baseline NLR, PLR and SII were 7.5 ± 16.7, 118 ± 207, 1395 ± 3004, and the mean post-TTM NLR, PLR and SII were 15.0 ± 11.6, 206 ± 124, 2369 ± 2569, respectively. Using multiple logistic regression analysis, post-TTM NLR was one of the independent factors which predicted in-hospital mortality (adjusted odds ratio (aOR): 1.249, 95% confidence interval (CI): 1.040-1.501, p = 0.017).

CONCLUSION

Post-TTM NLR is a predictor of in-hospital mortality in OHCA patients who underwent TTM.

The Usefulness of Cellular Immune Inflammation Markers and Ultrasound Evaluation in the Assessment of Disease Activity in Patients with Spondyloarthritis

BACKGROUND

The systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII) have been introduced as inflammatory markers and predictors of poor prognosis in cancer and cardiovascular diseases. An appropriate evaluation of disease activity in spondyloarthritis (SpA) might be challenging. The purpose of this study was to evaluate the usefulness of cellular immune inflammation markers and ultrasound (US) evaluation of entheses and joints in the assessment of disease activity in SpA patients.

METHODS

This cross-sectional study involved patients with SpA (62 axial SpA, 38 peripheral SpA, pSpA). The clinical data of both tender, swollen joint counts, erythrocyte sedimentation rate, C-reactive protein, white blood cell counts, and disease activity using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Disease Activity Index for Psoriatic Arthritis (DAPSA), were recorded. The SIRI, SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated. US examination was performed (22 small joints, Achilles tendon, and plantar aponeurosis for enthesitis).

RESULTS

The SII, SIRI, NLR, and PLR were higher, and LMR was lower in patients with high disease activity (BASDAI > 4). Higher SII was observed in pSpA patients with moderate/high disease activity (DAPSA > 14). The SIRI was correlated with clinical and laboratory parameters of disease activity. The SII was correlated with US parameters in pSpA. Higher SII and NLR values were found in patients with signs of activity compared with no activity in the US of peripheral joints. There were no associations with US changes in entheses.

CONCLUSIONS

The results of this study point to the value of SIRI and SII as biomarkers of disease activity in patients with SpA. The SII was associated with synovitis in the US of the peripheral joints.

Update on Biomarkers Associated with Large-Artery Atherosclerosis Stroke

Intracranial and extracranial large-artery atherosclerosis (LAA) are a main cause of ischemic stroke. Biomarkers may aid in the diagnosis of LAA and help to stratify patients' risk of stroke. We performed a narrative review of the literature, mainly published in the last five years, with the aim of identifying biomarkers associated either with intracranial or extracranial LAA in humans. Several potential biomarkers of LAA, mainly related to lipidic pathways and inflammation, have been studied. Diagnostic biomarkers of LAA were evaluated by measuring biomarkers levels in patients with LAA stroke and other stroke etiologies. Some biomarkers were associated with the functional prognosis of LAA stroke patients. Increased levels of IL-6 and sLOX-1 were associated with a risk of progression of carotid atherosclerotic disease. Findings support the notion that the immune system plays a central role in the pathogenesis of LAA. Overall, in most studies, results were not externally validated. In the future, biomarkers could be useful for the selection of patients for clinical trials. To adopt these biomarkers in clinical practice, we will need robust multicentric studies proving their reproducibility and a clear practical applicability for their use.

The Value of White Cell Inflammatory Biomarkers as Potential Predictors for Diabetic Retinopathy in Type 2 Diabetes Mellitus (T2DM)

The pathogenesis of diabetic retinopathy is still challenging, with recent evidence proving the key role of inflammation in the damage of the retinal neurovascular unit. This study aims to investigate the predictive value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic inflammation index (SII) for diabetic retinopathy (DR) and its severity. We performed a retrospective study on 129 T2DM patients, divided into three groups: without retinopathy (NDR), non-proliferative DR (NPDR), and proliferative DR (PDR). NLR, MLR, and SII were significantly higher in the PDR group when compared to NDR and NPDR (3.2 ± 1.6 vs. 2.4 ± 0.9 and 2.4 ± 1.1; p = 0.005; 0.376 ± 0.216 vs. 0.269 ± 0.083 and 0.275 ± 0.111, p = 0.001; 754.4 ± 514.4 vs. 551.5 ± 215.1 and 560.3 ± 248.6, p = 0.013, respectively). PDR was correlated with serum creatinine (OR: 2.551), NLR (OR: 1.645), MPV (OR: 1.41), and duration of diabetes (OR: 1.301). Logistic regression analysis identified three predictive models with very good discrimination power for PDR (AUC ROC of 0.803, 0.809, and 0.830, respectively): combining duration of diabetes with NLR, MLR, and, respectively, PLR, MPV, and serum creatinine. NLR, MPV, SII, and LMR were associated with PDR and could be useful when integrated into comprehensive risk prediction models.

Protective Effect of BCG and Neutrophil-to-Lymphocyte Ratio on Latent Tuberculosis in End Stage Renal Disease

INTRODUCTION

Bacillus Calmette-Guérin (BCG) vaccination has been reported to be protective against latent tuberculosis infection (LTBI) in the general population. The aim of this study was to investigate the protective effect of BCG vaccination against LTBI in adult patients with end-stage renal disease (ESRD) and renal transplants.

METHODS

Patients aged ≥ 20 years with ESRD who received hemodialysis (HD), peritoneal dialysis (PD) or kidney transplant were enrolled from January 2012 to December 2019 at a medical center and a regional hemodialysis center. Patients with active tuberculosis (TB), previously treated TB, active immunosuppressant therapy or human immunodeficiency virus infection were excluded. LTBI status was determined by QuantiFERON-TB Gold In-tube (QFT-GIT).

RESULTS

After the exclusion of indeterminate results of QFT-GIT, 517 participants were enrolled and 97 (18.8%) were identified as having LTBI. Participants with LTBI were older (55.1 ± 11.4 vs. 48.5 ± 14.6 years, p < 0.001) and had a significantly higher proportion receiving HD than those without LTBI (70.1% vs. 56.7%, p = 0.001). The percentage with BCG scars was higher in the non-LTBI group than in the LTBI group (94.8% vs. 81.4%, p < 0.001), whereas the neutrophil-to-lymphocyte ratio (NLR) (≥ 2.68) was significantly higher in the LTBI group (62.8% vs. 45.5%, p = 0.02). By multivariate logistic regression analysis, presence of BCG scar and high NLR were independent protective factors against LTBI [adjusted OR: 0.19 (0.063-0.58, p = 0.001) and 0.50 (0.28-0.89, p = 0.02)].

CONCLUSION

The prevalence of LTBI was as high as 18.8% in patients with end-stage kidney disease or kidney transplant. BCG vaccination and high NLR might have protective effects against LTBI in patients with renal failure or transplant.

Assessment of immune cell profiles among post-menopausal women in the Women's Health Initiative using DNA methylation-based methods

BACKGROUND

Over the past decade, DNA methylation (DNAm)-based deconvolution methods that leverage cell-specific DNAm markers of immune cell types have been developed to provide accurate estimates of the proportions of leukocytes in peripheral blood. Immune cell phenotyping using DNAm markers, termed immunomethylomics or methylation cytometry, offers a solution for determining the body's immune cell landscape that does not require fresh blood and is scalable to large sample sizes. Despite significant advances in DNAm-based deconvolution, references at the population level are needed for clinical and research interpretation of these additional immune layers. Here we aim to provide some references for immune populations in a group of multi-ethnic post-menopausal American women.

RESULTS

We applied DNAm-based deconvolution to a large sample of post-menopausal women enrolled in the Women's Health Initiative (baseline, N = 58) or the ancillary Long Life Study (WHI-LLS, N = 1237) to determine the reference ranges of 58 immune parameters, including proportions and absolute counts for 19 leukocyte subsets and 20 derived cell ratios. Participants were 50-94 years old at the time of blood draw, and N = 898 (69.3%) self-identified as White. Using linear regression models, we observed significant associations between age at blood draw and absolute counts and proportions of naïve B, memory CD4+, naïve CD4+, naïve CD8+, memory CD8+ memory, neutrophils, and natural killer cells. We also assessed the same immune profiles in a subset of paired longitudinal samples collected 14-18 years apart across N = 52 participants. Our results demonstrate high inter-individual variability in rates of change of leukocyte subsets over this time. And, when conducting paired t tests to test the difference in counts and proportions between the baseline visit and LLS visit, there were significant changes in naïve B, memory CD4+, naïve CD4+, naïve CD8+, memory CD8+ cells and neutrophils, similar to the results seen when analyzing the association with age in the entire cohort.

CONCLUSIONS

Here, we show that derived cell counts largely reflect the immune profile associated with proportions and that these novel methods replicate the known immune profiles associated with age. Further, we demonstrate the value this methylation cytometry approach can add as a potential application in epidemiological studies.

Link between Blood Cell-Associated Inflammatory Indices and Chemotherapy-Induced Hyperglycemia in Women Affected with Breast Cancer: Clinical Studies

Krishna PrasadBackground  Development of treatment-induced hyperglycemia/diabetes is a considerable problem in women undergoing chemotherapy for breast cancer. In this study, baseline levels of blood cell-associated inflammatory indices (BCAII) were analyzed to understand their role in the development of treatment-induced hyperglycemia and diabetogenesis. Materials and Methods  This was a retrospective study, and information on women who were normoglycemic and nondiabetic and of women who were diabetic at the beginning of the treatment were collected from files. Demographic, pathology-related details, and complete blood profile were noted. Neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII) which indicate BCAII were calculated. Demographic details were subjected to frequency and percentage, while blood parameters were subjected to one-way analysis of variance followed by post hoc Bonferroni's multiple comparison tests. A p -value of <0.05 was considered significant. Results  The results indicated that a significant difference in levels of total count ( p  < 0.035), neutrophil, lymphocyte, and platelets ( p  < 0.001) were observed. Regarding BCAII, when compared with women who were normoglycemic at the end of treatment, NLR, dNLR, PLR, and SII were significantly high for people who were known diabetics at the beginning of treatment ( p  < 0.001). The dNLR ( p  = 0.0008), PLR ( p  < 0.001), and SII ( p  < 0.001) were significant for people who developed secondary hyperglycemia/diabetes, while only dNLR was significant for people who progressed from normal to prediabetes stage ( p  = 0.049) Conclusion  To the best of the authors' knowledge, this is the first study that indicates difference in baseline BCAII and development of treatment-induced hyperglycemia/diabetes indicating that underlying low levels of inflammation may contribute to diabetogenesis in women affected with breast cancer.

Blood-Based Biomarkers as Prognostic Factors of Recurrent Disease after Radical Cystectomy: A Systematic Review and Meta-Analysis

Survival outcomes after radical cystectomy (RC) for bladder cancer (BCa) have not improved in recent decades; nevertheless, RC remains the standard treatment for patients with localized muscle-invasive BCa. Identification of the patients most likely to benefit from RC only versus a combination with systemic therapy versus systemic therapy first/only and bladder-sparing is needed. This systematic review and meta-analysis pools the data from published studies on blood-based biomarkers to help prognosticate disease recurrence after RC. A literature search on PubMed and Scopus was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Articles published before November 2022 were screened for eligibility. A meta-analysis was performed on studies investigating the association of the neutrophil-to-lymphocyte ratio (NLR), the only biomarker with sufficient data, with recurrence-free survival. The systematic review identified 33 studies, and 7 articles were included in the meta-analysis. Our results demonstrated a statistically significant correlation between elevated NLR and an increased risk of disease recurrence (HR 1.26; 95% CI 1.09, 1.45; p = 0.002) after RC. The systematic review identified various other inflammatory biomarkers, such as interleukin-6 or the albumin-to-globulin ratio, which have been reported to have a prognostic impact on recurrence after RC. Besides that, the nutritional status, factors of angiogenesis and circulating tumor cells, and DNA seem to be promising tools for the prognostication of recurrence after RC. Due to the high heterogeneity between the studies and the different cut-off values of biomarkers, prospective and validation trials with larger sample sizes and standardized cut-off values should be conducted to strengthen the approach in using biomarkers as a tool for risk stratification in clinical decision-making for patients with localized muscle-invasive BCa.

Effects of protein-carbohydrate vs. carbohydrate alone supplementation on immune inflammation markers in endurance athletes: a randomized controlled trial

PURPOSE

The impact of ingesting carbohydrates alone or combined with proteins to support exercise immune adaptation in endurance athletes is scarcely investigated. The present study compares the effect of ingesting a combined protein-carbohydrate supplement vs. a carbohydrate-only supplement post-workout on immune inflammation markers following a 10 week periodized endurance training program in well-trained athletes.

METHODS

Twenty-five men completed the study after being randomly assigned to one of the following intervention groups: combined protein-carbohydrate (PRO-CHO n = 12, 31 ± 9 years, [Formula: see text]O_2peak 61.0 ± 5.6 ml^.kg^-1.min^-1) or non-protein isoenergetic carbohydrate (CHO, n = 13, 33 ± 8 years, [Formula: see text]O_2peak 60.6 ± 6.9 ml^.kg^-1.min^-1). Treatment consisted of ingesting 24 g of assigned supplement, mixed with 250 ml of orange juice, once a day for 10 weeks immediately post-workout (or before breakfast on non-training days). Measurements were conducted pre- and post-intervention on total leukocytes, leukocyte subsets (i.e., neutrophils, eosinophils, basophils, monocytes, and lymphocytes), and platelets. The inflammatory status was assessed by the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the systemic-immune inflammation index (SII).

RESULTS

Post-intervention, significant increases were observed for CHO group only for the three inflammatory markers: NLR (p = 0.050, d = 0.58), PLR (p = 0.041, d = 0.60), and SII (p = 0.004, d = 0.81) but not for PRO-CHO (p > 0.05).

CONCLUSION

Ingesting a post-workout protein-carbohydrate combined beverage promoted a more favourable immune status than carbohydrate-only ingestion by attenuating cellular inflammation over a 10 week training period in endurance male athletes.

TRIAL REGISTRATION

The study was registered in ClinicalTrials.gov with the following ID: NCT02954367. The study was registered by 3 November 2016.

Monocyte-to-lymphocyte ratio predicts mortality and cardiovascular mortality in the general population

BACKGROUND

Systemic chronic inflammation (SCI) is closely involved in the pathogenesis of many diseases. This study aims to investigate the association between MLR with mortality and cardiovascular disease (CVD) mortality in US adults.

METHODS

35,813 adults were enrolled from the 1999-2014 National Health and Nutrition Examination Survey (NHANES) cycle. Individuals were categorized according to MLR tertiles and followed until 31 December 2019. Kaplan-Meier plots and log-rank tests were utilized to explore survival differences among the MLR tertiles. Adjusted multivariable Cox analysis was employed to investigate the relationship of MLR with mortality and CVD mortality. Restricted cubic spline and subgroup analysis were further used to discern non-linear relationship and the relationship in categories.

RESULTS

During a median follow-up of 134 months, 5865 (16.4%) all-cause deaths and 1602 (4.5%) cardiovascular deaths occurred. Kaplan-Meier plots revealed significant differences in all-cause and cardiovascular mortality among the MLR tertiles. In the fully-adjusted Cox regression model, individuals in the highest tertile of MLR had higher risk of mortality (HR = 1.26, 95% CI: 1.17-1.35) and CVD mortality (HR = 1.41, HR, 95% CI: 1.23-1.62) than those in the lowest tertile. The restricted cubic spline exhibited a J-shaped relationship between MLR with mortality and CVD mortality (P for non-linearity <0.001). The further subgroup analysis demonstrated a robust trend across categories.

CONCLUSION

Our study demonstrated that increased baseline MLR was positively associated with a higher risk of death in US adults. MLR was a strong independent predictor of mortality and CVD mortality in the general population.

Association of the Systemic Immune-Inflammation Index with Outcomes in Acute Coronary Syndrome Patients with Chronic Kidney Disease

Background

The systemic immune-inflammation index (SII; neutrophil × platelet/lymphocyte) is a novel marker for immune and inflammatory status and is associated with adverse prognosis in cardiovascular disease.

Methods

In total, 744 patients diagnosed with acute coronary syndrome (ACS) and chronic kidney disease (CKD) were included in our study, received standard therapies, and were followed up. Patients were divided into high and low SII groups according to the baseline SII. The primary endpoint was major cardiovascular events (MACEs), defined as cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.

Results

During a median follow-up of 2.5 years, a total of 185 (24.9%) MACEs were recorded. Analysis of the ROC curve revealed that the best cutoff value of SII was 1159.84×10⁹/L for predicting MACEs. The Kaplan-Meier analysis showed that those patients in the low SII group had higher survival rates than those in the high SII group (p < 0.001). Compared to those in the low SII group, patients in the high SII group were at significantly higher risk of MACEs (134 (38.8%) vs 51 (12.8%), p < 0.001). Univariate and multivariable Cox regression analyses revealed that a high SII level was independently associated with MACEs in ACS patients with CKD (adjusted hazard ratio [HR]: 1.865, 95% confidence interval [CI]: 1.197-2.907, p = 0.006).

Conclusion

The present study showed that an elevated SII is associated with adverse cardiovascular outcomes in ACS with CKD patients, suggesting that SII may be a valuable predictor of poor prognosis in ACS with CKD patients. Further studies are needed to confirm our findings.

Quitting smoking after a cancer diagnosis is associated with high-risk neutrophil-to-lymphocyte ratio among tobacco use-related cancer survivors

Quitting smoking could potentially minimize the risk of a high neutrophil-to-lymphocyte ratio (NLR) among tobacco use-related (TUR) cancer survivors. A total of 1263 TUR cancer survivors aged 20 to 85 years old were investigated using data from the National Health and Nutritional Examination Survey 1999-2018. The primary outcome was the NLR, which was defined as having two levels: high-risk (≥ 3) and low-risk (< 3). The association between smoking cessation time and a high-risk NLR level was analyzed using weighted logistic regression models. Overall, the current smoking rate of TUR cancer survivors was found to be 21.7%. Older age (75 years above), gender and respiratory-related cancers are covariables associated with high risk of NLR levels for individual who identified as Non-Hispanic White (NHW). Non-Hispanic Black (NHB) (n = 27) who quit smoking after a cancer diagnosis were associated with the highest risk of a high NLR (OR 4.83, 95% CI 1.40-16.61, p = 0.01) compared to NHB nonsmokers (n = 139). These findings suggest that the risk of a high NLR level is strongly associated with the time of smoking cessation in NHB TUR cancer survivors. As a result, NHB TUR cancer survivors should quit smoking as soon as possible because the benefits of quitting smoking were observed over the 5 year period following smoking cessation.

Comparison of pan-immune-inflammation value with other inflammation markers of long-term survival after ST-segment elevation myocardial infarction

BACKGROUND

Atherosclerosis is a process that causes coronary artery disease and is associated with the inflammatory response. In this study, we aimed to evaluate the association of Pan-Immune-Inflammation Value (PIV) with in-hospital and long-term mortality in STEMI patients.

METHODS

A total of 658 patients who were admitted to the emergency department of two tertiary centers with the diagnosis of STEMI and underwent percutaneous coronary intervention (PCI) between 2018 and 2022 were retrospectively enrolled. PIV and other inflammation parameters were compared for the study population. The primary outcome was one-year all-cause of mortality.

RESULTS

The mean age was 58.7 ± 17.1 years and 507 (76.9%) were male. The mean duration of the follow-up was 18.8 ± 8.5 months (median 18.9 months). PIV was superior to the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and systemic immune-inflammation index for the prediction of primary and secondary outcomes in STEMI.

CONCLUSION

Our study reveals that PIV is a better predictor of mortality in STEMI patients. Prospective studies are needed to validate this biomarker.

Could the Systemic Immune Inflammation Index Predict Diagnosis, Recovery Time, Hypothyroidism, and Recurrence Rates in Subacute Thyroiditis?

Purpose

Subacute thyroiditis (SAT) is a non-infectious inflammatory disease of the thyroid. The Systemic Immune-Inflammation Index (SII), also known as an easy economical marker, correlates with the severity of inflammatory responses. We aimed to evaluate the clinical significance of the SII and to compare it to other inflammatory markers in terms of diagnosis, recovery time, and recurrence of SAT.

Patients and Methods

The current non-interventional observational prospective study was performed at Outpatient Department of Endocrinology, Erzurum Training and Research Hospital. Sixty-nine patients with SAT and fifty-nine healthy individuals in total were enrolled in our study. The follow-up period was 6-12 months for all patients regarding treatment response, recurrence, and hypothyroidism.

Results

The SII level was found to be significantly higher at the time of diagnosis in the SAT group compared to the control group (p=0.000). There was a significant positive correlation between the SII and SAT recovery time (p=0.000), particularly in patients receiving methyl prednisolone treatment (p=0.002). SII was not found to be significantly associated with hypothyroidism and recurrence in patients with SAT (p=0.261, p=0.568). However, compared to the ones without recurrence, thyroid stimulating hormone (TSH) and erythrocyte sedimentation rate levels at the time of diagnosis were found to be higher in those patients with recurrence (p=0.035, p=0.046).

Conclusion

SII is a low-cost, widely available, universal indicator of inflammatory processes in SAT. It could provide many benefits in the follow-up process and the selection of aggressive anti-inflammatory treatment by estimating recovery time. SII, as a practical biomarker, may be a new diagnostic and prognostic tool for SAT.

Neutrophil-to-lymphocyte ratio-a new diagnostic and prognostic marker of acute kidney injury. Barriers to broad clinical application

Hospital-acquired acute kidney injury is a heterogeneous clinical syndrome that has multiple aetiologies, widely differing pathogeneses, variable clinical manifestations, and diverse outcomes. There is a persistent unmet need for novel biomarkers that offer timely diagnosis and accurate prediction of the short- and long-term sequelae of acute kidney injury (AKI). AKI is associated with systemic and intrarenal inflammation. The neutrophil-to-lymphocyte ratio (NLR), a readily available marker of inflammation and physiologic stress, has gained increasing attention as universal marker in AKI patients. Numerous retrospective cross-sectional studies assessed the clinical usefulness of this test in high-risk patients with a known time point of the renal injury (surgery, radiological procedures). Strong associations have been demonstrated between high NLR and early onset, progression or recovery of AKI, and the in-hospital and post-discharge mortality of these patients. However, the results were contradictory. The huge heterogeneity of reporting concerning the timing and numbers of blood samples, calculation of the optimal cut-off and the demographic and clinical features of the patient cohorts were confounders. Uncertainty in the optimal cut-off values defining high NLR, the lack of prospective validation of this test and limited understanding of the strengths of associations between NLR and clinical outcomes were further barriers for the clinical adoption of NLR as a valid diagnostic and prognostic test in AKI patients.

Association of Systemic Immune Inflammation Index with All-Cause, Cardiovascular Disease, and Cancer-Related Mortality in Patients with Cardiovascular Disease: A Cross-Sectional Study

Objective

Our research was designed to investigate the relationship between systemic immune inflammation (SII) index and all-cause, cardiovascular disease (CVD), and cancer-related mortality in patients with CVD.

Methods

We used the National Health and Nutrition Examination Survey data from 1999 to 2018 to conduct this study. The association between SII index and all-cause, CVD, and cancer-related mortality in patients with CVD was examined using restricted cubic splines (RCS), Cox proportional hazard models, and subgroup analysis, respectively. CVD was defined as a composite of five outcomes of CVD, including coronary heart disease (CHD), congestive heart failure (CHF), angina pectoris, myocardial infarction, and stroke. Additionally, the link between SII index and all-cause, CVD, and cancer-related mortality in patients with a composite of five outcomes of CVD was also explored.

Results

In total, 5329 participants were included. The RCS also showed a U-curve correlation between SII index and the all-cause, CVD, and cancer-related mortality in patients with CVD. As compared with the individuals with lowest quartile of SII index, hazard ratios with 95% confidence intervals for all-cause, CVD, and cancer-related mortality across the quartiles were (1.202 (0.981, 1.474), 1.184 (0.967, 1.450), and 1.365 (1.115, 1.672)), (1.116 (0.815, 1.527), 1.017 (0.740, 1.398), and 1.220 (0.891, 1.670)), and (1.202 (0.981, 1.474), 1.184 (0.967, 1.450), and 1.365 (1.115, 1.672)), respectively, in the full-adjusted model. The SII index also had a U-shaped relationship with all-cause, CVD, and cancer-related mortality in patients with CHD, angina, and myocardial infarction. Additionally, the U-shaped relationship between SII index and all-cause, and cancer-related mortality also exists in CHF, and stroke. However, there was a positive linear correlation between SII index and CVD mortality in patients with CHF, and stroke.

Conclusion

In the United States general population, the correlation between SII index and all-cause, CVD, and cancer-related mortality showed a U-shaped curve in patients with CVD.

Cellular Integrative Immune Markers in Elite Athletes

The integrative immune markers neutrophil-lymphocyte-ratio (NLR), platelet-lymphocyte-ratio (PLR) and systemic immune inflammation index (SII) are established markers in clinical patient care. Adoption of these markers in elite athletics might prove beneficial for monitoring training and health. Blood samples of 195 healthy national Olympic squad athletes were collected before a graded bicycle-ergometric exercise test until complete exhaustion. Measurements included white blood cells, lymphocytes and platelets, allowing for the calculation of the integrative immune markers. Correlations between athlete characteristics (sex, age, sporting discipline, training experience, training volume) and integrative immune marker-values were assessed. In a subgroup analysis a second blood sample was collected from 25 athletes at 1 minute after exercise test to assess its effect on the immune marker levels.An inverse correlation between peak power output and SII-level (Pearson correlation coefficient=-.270, p<.001) and NLR-level (Pearson correlation coefficient=-.249, p<.001) was found. Athletes with higher aerobic fitness had significantly lower values of SII and PLR compared to athletes with lower aerobic fitness. An elevated SII (p=.003) and a reduced PLR (p=.001) was documented as acute response to the exercise test. The integrative immune markers might be a promising tool for monitoring training and health in elite athletes.

A Novel, Simple, and Low-Cost Approach for Machine Learning Screening of Kidney Cancer: An Eight-Indicator Blood Test Panel with Predictive Value for Early Diagnosis

Clear cell renal cell carcinoma (ccRCC) accounts for more than 90% of all renal cancers. The five-year survival rate of early-stage (TNM 1) ccRCC reaches 96%, while the advanced-stage (TNM 4) is only 23%. Therefore, early screening of patients with renal cancer is essential for the treatment of renal cancer and the long-term survival of patients. In this study, blood samples of patients were collected and a pre-defined set of blood indicators were measured. A random forest (RF) model was established to predict based on each indicator in the blood, and was trained with all relevant indicators for comprehensive predictions. In our study, we found that there was a high statistical significance (p < 0.001) for all indicators of healthy individuals and early cancer patients, except for uric acid (UA). At the same time, ccRCC also presented great differences in most blood indicators between males and females. In addition, patients with ccRCC had a higher probability of developing a low ratio of albumin (ALB) to globulin (GLB) (AGR < 1.2). Eight key indicators were used to classify and predict renal cell carcinoma. The area under the receiver operating characteristic (ROC) curve (AUC) of the eight-indicator model was as high as 0.932, the sensitivity was 88.2%, and the specificity was 86.3%, which are acceptable in many applications, thus realising early screening for renal cancer by blood indicators in a simple blood-draw physical examination. Furthermore, the composite indicator prediction method described in our study can be applied to other clinical conditions or diseases, where multiple blood indicators may be key to enhancing the diagnostic potential of screening strategies.

The pan-immune-inflammation value and systemic immune-inflammation index in advanced melanoma patients under immunotherapy

PURPOSE

To evaluate the pan-immune-inflammation value (PIV) and systemic immune-inflammation index (SII) in patients with cutaneous melanoma (CM) under immune checkpoint inhibitor (ICI) therapy.

METHODS

PIV and SII were calculated before the start of ICI therapy and at time of progression/death in patients with metastatic CM (stage III/IV). Sex-age-matched CM patients in stage I/II and healthy subjects (HC) served as controls.

RESULTS

The median PIV of stage III/IV patients was significantly (P = 0.0011) higher than in stage I/II patients and HC. SII was significantly (P = 0.00044) lower in HC than in CM patients. At baseline, PIV and SII did significantly correlate with lactate dehydrogenase (P = 0.045/0.017). However, ROC curve statistics revealed that SII and PIV were not significantly associated with clinical parameters, including best response to ICI treatment (P = 0.87/0.64), progression-free survival (P = 0.73/0.91), and melanoma-specific survival (P = 0.13/0.17). Moreover, there were no significant changes of PIV and SII from baseline to progression/death (P = 0.38/0.52).

CONCLUSIONS

Even though both immune-inflammation biomarkers showed some power to differentiate between CM stages and HC, respectively, PIV and SII seem not to be significant predictors for clinical outcome measures of CM patients under ICI therapy.

Information Value of Calculated Hematological Indices in the Assessment of Cardiac Risk in Oncological Surgery

The objective: to study information value of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in the cardiac risk assessment in abdominal oncological surgery.

Subjects and Methods. 94 patients of 68 [62‒73] years old who underwent elective surgery were examined.

Results. Cardiovascular comortbidity was diagnosed in 69 (73.4%) patients. 11 (11.7%) perioperative cardiovascular complications were registered. Cardiac mortality was 4.3%. Hematological indices were not associated with cardiovascular diseases (NLR: OR = 0.59‒1.42; 95% CI 0.14‒2.60; p = 0.29‒0.74, PLR: OR = 0.99‒1.00; 95% CI 0.97‒1.01; p = 0.31‒0.99). NLR and PLR were not predictors of cardiovascular complications (OR = 0.67; 95% CI 0.19‒2.37; p = 0.46 and OR = 1.00; 95% CI 0.99‒1.01; p = 0.68) and cardiac death (OR = 0.21; 95% CI 0.01‒8.05; p = 0.23 and OR = 0.99; 95% CI 0.98‒1.01; p = 0.79).

Conclusion. NLR and PLR cannot be recommended for the cardiac risk assessment in abdominal oncological surgery.

Association of the systemic immune-inflammation index with all-cause mortality in patients with arteriosclerotic cardiovascular disease

Objective

Systemic immune-inflammation index (SII), derived from blood cell counts of circulating platelets, neutrophils, and lymphocytes, has been identified as a novel inflammatory and prognostic marker. However, the clinical value of SII in patients with arteriosclerotic cardiovascular disease (ASCVD) had not been further explored. Thus, this study is designed to explore the associations of SII with mortality in ASCVD individuals.

Methods

All individuals with ASCVD aged ≥20 years were included from the National Health and Nutritional Examination Surveys (NHANES) 2005–2014 and followed for survival until 31 December 2019. Multivariable Cox analysis investigated the associations between SII, evaluated as a continuous variable with splines, as categorical ones (quartiles), and the all-cause death. To demonstrate the association between SII and mortality, subgroup analysis, restricted cubic spline along with piecewise linear regression were also conducted.

Results

A total of 2,595 participants (57.8% men) were included. During a median of 7.7 years of follow-up, 1,122 deaths due to all-cause were recorded. After adjusting for multiple confounders, when compared with the patients in quartile 1 (SII ln transform), those in quartile 4 had a 46% increased risk for all-cause death [hazard ratio (HR) = 1.46, 95% confidence interval (CI) = 1.22–1.75]. As a continuous variable, each unit of raised ln-SII was associated with a 24% increased risk of all-cause death (HR = 1.24, 95% CI = 1.10–1.38). In the restricted cubic spline regression model, the relationship between ln-SII and all-cause death was non-linear. The cutoff value of ln-SII for mortality was 6.57 and those with a higher than the threshold point had a 1.25-fold risk of mortality. No significant difference was noted below the threshold points.

Conclusion

An association was detected between the baseline ln-SII and all-cause mortality in a United States ASCVD population. Increased SII is associated with poor survival in individuals with ASCVD.

Prognostic Potential of the Baseline Pan-Immune-Inflammation Value and Neutrophil/Lymphocyte Ratio in Stage I to III Melanoma Patients

Prognostic biomarkers derived from complete blood count (CBC) have received marked interest as an indirect measure of the inflammatory pressure in cancers such as metastatic melanoma. Here, we evaluated the novel pan-immune-inflammation value (PIV) and the frequently assessed neutrophil/lymphocyte ratio (NLR) in a large cohort of patients with cutaneous melanoma (CM) without distant metastases (stages I to III). PIV and NLR were calculated at CM diagnosis. Healthy controls were also included. We used the Kaplan-Meier method to estimate crude survival probabilities and used Cox proportional hazards regression for multiple adjustment of hazard ratios. We observed that higher PIV (HR: 1.72, 95% CI 1.14 to 2.58 and HR: 1.696, 95% CI 1.029 to 2.795, respectively) and NLR (HR: 1.70, 95% CI 1.10 to 2.62) values were associated with CM relapse and CM-specific death in the crude analysis. However, when adjusting for potential confounders, in particular age and tumor thickness, the total effect of PIV and NLR on CM-relapse-free (HR: 1.28, 95% CI 0.83 to 1.98 and HR: 1.26, 95% CI 0.80 to 1.98, respectively) and CM-specific survival (HR: 1.36, 95% CI 0.80 to 2.30 and HR: 1.37, 95% CI 0.80 to 2.33, respectively) was substantially reduced. However, both PIV and NLR were positively correlated with age and tumor thickness, which are important independent predictors for CM relapse and CM-specific death. In conclusion, in stage I to III CM patients PIV as well as NLR appear to be confounded by age and tumor thickness and probably have no potential to further improve the prediction of survival of stage I to III CM patients beyond standard prognostic factors.

Association of dietary inflammatory potential with risk of overall and cause-specific mortality

Inflammation is a central mechanism in metabolic disorders associated with morbidity and mortality and dietary factors can modulate inflammation. We aimed to prospectively investigate the association between an empirically developed, food-based dietary inflammatory pattern (EDIP) score and the risk of overall and cause-specific mortality, using data from the US National Health and Nutrition Examination Survey from 1999 to 2014. EDIP score was derived by entering thirty-nine predefined commonly consumed food groups into the reduced rank regression models followed by stepwise linear regression, which was most predictive of two plasma inflammation biomarkers including C-reactive protein and leucocyte count among 25 500 US adults. This score was further validated in a testing set of 9466 adults. Deaths from baseline until 31 December 2015 were identified through record linkage to the National Death Index. During a median follow-up of 7·8 years among 40 074 participants, we documented 4904 deaths. Compared with participants in the lowest quintile of EDIP score, those in the highest quintile had a higher risk of overall death (hazard ratio (HR) = 1·19, 95 % CI 1·08, 1·32, P_trend = 0·002), and deaths from cancer (HR = 1·41, 95 % CI 1·14, 1·74, P_trend = 0·017) and CVD (HR = 1·22, 95 % CI 0·98, 1·53, P_trend = 0·211). When stratified by age, the association of EDIP with overall mortality was stronger among individuals under 65 years of age (P_interaction = 0·001). Diets with a higher inflammatory potential were associated with increased risk of overall and cancer-specific mortality. Interventions to reduce the adverse effect of pro-inflammatory diets may potentially promote health and longevity.

Value of the Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting CPET Performance in Patients with Stable CAD and Recent Elective PCI

Background and Objectives: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). Materials and Methods: Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. Results: Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups—poor FC (≤70%, n = 35) and preserved FC (>70%, n = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, p = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. Conclusions: Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.

Preprocedural SII Combined with High-Sensitivity C-Reactive Protein Predicts the Risk of Contrast-Induced Acute Kidney Injury in STEMI Patients Undergoing Percutaneous Coronary Intervention

Objective

To investigate the relationship between the incidence of contrast-induced acute kidney injury (CI-AKI) and the levels of the systemic immune-inflammatory index (SII, platelet × neutrophil/lymphocyte ratio) and high-sensitivity C-reactive protein (hsCRP) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), to analyze further the predictive value of the combination of SII and hsCRP for CI-AKI.

Methods

Retrospectively analyze the clinical data of STEMI patients who underwent PCI in our cardiology department from November 2019 to March 2021. Restricted cubic splines were used to determine the correlation between SII and hsCRP and the risk of CI-AKI. Patients were divided into the CI-AKI group (n=71) and the non-CI-AKI group (n=344) according to postoperative creatinine changes. Logistic regression was used to analyze the factors influencing CI-AKI. ROC curves were used to evaluate the predictive value of SII, hsCRP, and their combined levels on CI-AKI.

Results

Restricted cubic spline analysis showed that when SII>653.73×10⁹/L and hsCRP>5.52mg/dl, there was a positive correlation with the incidence of CI-AKI. And the incidence of CI-AKI rose with the inflammation status. The receiver operating characteristic curve of SII combined with hsCRP was 0.831, which was higher than SII or hsCRP alone. The logistic regression analysis showed that high-risk factors of CI-AKI were diabetes mellitus, platelet count, and highly elevated SII and hsCRP.

Conclusion

Within a certain range, elevated inflammatory biomarkers SII and hsCRP were risk factors for CI-AKI after PCI in patients with STEMI. This study suggests that the combination of SII and hsCRP predicts the risk of CI-AKI more accurately than either biomarker alone.

Inflammatory indices obtained from routine blood tests show an inflammatory state associated with disease progression in engineered stone silicosis patients

Patients with silicosis caused by occupational exposure to engineered stone (ES) present a rapid progression from simple silicosis (SS) to progressive massive fibrosis (PMF). Patient classification follows international rules based on radiology and high-resolution computed tomography (HRCT), but limited studies, if any, have explored biomarkers from routine clinical tests that can be used as predictors of disease status. Our objective was thus to investigate circulating biomarker levels and systemic inflammatory indices in ES silicosis patients whose exposure to ES dust ended several years ago. Ninety-one adult men, ex-workers in the manufacturing of ES, 53 diagnosed with SS and 38 with PMF, and 22 healthy male volunteers (HC) as controls not exposed to ES dust, were recruited. The following circulating levels of biomarkers like lactate dehydrogenase (LDH), angiotensin-converting-enzyme (ACE), protein C reactive (PCR), rheumatoid factor, alkaline phosphatase and fibrinogen were obtained from clinical reports after being measured from blood samples. As biochemical markers, only LDH (HC = 262 ± 48.1; SS = 315.4 ± 65.4; PMF = 337.6 ± 79.3 U/L), ACE (HC = 43.1 ± 18.4; SS = 78.2 ± 27.2; PMF = 86.1 ± 23.7 U/L) and fibrinogen (HC = 182.3 ± 49.1; SS = 212.2 ± 43.5; PMF = 256 ± 77.3 U/L) levels showed a significant sequential increase, not been observed for the rest of biomarkers, in the HC → SS → PMF direction. Moreover, several systemic inflammation indices neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), aggregate index of systemic inflammation (AISI) derived from whole blood cell counts showed significant differences between the HC, SS and PMF groups. All these biomarkers were analyzed using receiver operating characteristic (ROC) curves, and the results provided moderately high sensitivity and specificity for discriminating between ES silicosis patient groups and healthy controls. Our study reveals that some inflammatory biomarkers, easily available from routine blood analysis, are present in ES silicosis patients even several years after cessation of exposure to ES silica dust and they could help to know the progression of the disease.

Are neutrophil–lymphocyte and platelet–lymphocyte ratios useful for determining active phase of Peyronie’s disease?

Background:

Management options for Peyronie’s disease (PD) are determined by the phase of the condition. Experts counsel against surgical intervention during the active phase of PD. Patients with chronic phase of PD are offered either collagenase injections or surgical intervention. Accurately characterising a patient’s phase of PD is crucial in determining the appropriate treatment option.

Objective:

To investigate neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) as possible predictors for the determination of acute or chronic phase of PD.

Methods:

This study retrospectively queried all patients who presented for initial diagnosis of PD from 2016 to 2020 and had complete blood count (CBC) laboratory values before initial therapy. PD phase was defined per the American Urological Association guidelines. The active phase of PD was defined as a changing penile curvature and/or growing palpable plaque. The chronic phase of PD was defined as a stabilised penile curvature. All statistical analyses were two-tailed, using a significance level of 0.05.

Results:

One hundred nine patients met inclusion: 27 (25%) active phase and 82 (75%) chronic phase patients. Demographic and erectile characteristics were not statistically different between the two groups. NLR and PLR values between active and chronic phase patients were comparable ( p > 0.05). A linear regression evaluated correlations between the duration of PD and either NLR or PLR. Neither NLR nor PLR was correlated with PD duration on Spearman, Pearson, or Kandall tests. In addition, NLR and PLR were not noted to be predictors of PD phase on multiple logistic regression. Finally, a receiver operator characteristic curve was generated. NLR and PLR yielded an area under curve of 58% and 57.8%, respectively.

Conclusions:

Two recent studies suggested NLR and PLR could be used to predict the phases of PD. However, after evaluating a cohort of 109 men from our institution, our data do not support the use of peripheral blood PLR or NLR to determine the phase of PD.

Association between Systemic Immune-Inflammation Index and Symptomatic Intracranial Hemorrhage in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment

BACKGROUND/OBJECTIVE

Systemic immune-inflammation index (SII) is a novel inflammatory factor, which may be involved in the destruction of the blood-brain barrier (BBB) after acute ischemic stroke (AIS); however, the association between SII and symptomatic intracranial hemorrhage (sICH) in AIS patients undergoing endovascular treatment (EVT) remains unclear.

METHODS

Patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) who underwent EVT were consecutively enrolled. Blood samples were collected in the emergency room and SII was calculated by neutrophils × platelets/lymphocytes. Participants were categorized into tertiles according to admission SII. The main outcome was defined as the occurrence of sICH, following the European Cooperative Acute Stroke Study III (ECASS-III) criteria.

RESULTS

A total of 379 AIS-LVO patients with EVT were enrolled (median age = 71 years, 52.5% males). The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 15 (IQR, 12-18). The median of SII was 820.9 × 109/L (IQR, 473.1-1345.2). Forty-three (11.3%) patients who developed sICH. SII was found to be independently associated with sICH after EVT (adjusted odd ratio (OR) = 1.005 (per 10 units increase); 95% confidence interval (CI): 1.002-1.008; p = 0.002). Compared to patients in the lowest SII tertile, patients in the highest tertile had a higher risk of sICH (adj-OR 3.379; 95% CI 1.302-8.768; p = 0.012). The risk of sICH increased with the increase of SII in a dose-dependent manner (p for trend = 0.004). There was no interaction between potential modifiers and SII on sICH.

CONCLUSIONS

Admission SII positively associated with sICH in AIS-LVO patients treated with EVT. These results need to be confirmed in future studies.

Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases

Over the last 10 years, the evaluation of the neutrophil-to-lymphocyte ratio (NLR) as an emerging marker of diseases has become a compelling field of bio-medical research. Although a precise and unique cut-off value has not been yet found, its role as a flag of immune system homeostasis is well established. NLR has a well-known prognostic value and independently correlates with mortality in the general population and in several specific subsets of disease (sepsis, pneumonia, COVID-19, cancer, etc.). Moreover, NLR was recently considered as part of the decision-making processes concerning the admission/recovery of patients with COVID-19 pneumonia. This review aims to provide an overview of the main use of this biomarker, focusing on the pathophysiology and the molecular basis underlying its central role as a reliable mirror of inflammatory status and adaptive immunity.

Profiling the Murine Acute Phase and Inflammatory Responses to African Snake Venom: An Approach to Inform Acute Snakebite Pathology

Snake envenoming causes rapid systemic and local effects that often result in fatal or long-term disability outcomes. It seems likely that acute phase and inflammatory responses contribute to these haemorrhagic, coagulopathic, neurotoxic, nephrotoxic and local tissue destructive pathologies. However, the contributory role of acute phase/inflammatory responses to envenoming is under-researched and poorly understood—particularly for envenoming by sub-Saharan African venomous snakes. To provide data to help guide future studies of human patients, and to explore the rationale for adjunct anti-inflammatory medication, here we used an in vivo murine model to systematically assess acute phase and inflammatory responses of mice to ten African snake venoms. In addition to investigating snake species-specific effects of venom on the cardiovascular system and other key organs and tissues, we examined the response to intravascular envenoming by acute phase reactants, including serum amyloid A, P-selectin and haptoglobin, and several cytokines. Venoms of the spitting (Naja nigricollis) and forest (N. melanoleuca) cobras resulted in higher acute phase and inflammatory responses than venoms from the other cobras, mambas and vipers tested. Naja nigricollis venom also stimulated a 100-fold increase in systemic interleukin 6. Thin blood films from venom-treated mice revealed species-specific changes in red blood cell morphology, indicative of membrane abnormalities and functional damage, lymphopenia and neutrophil leukocytosis. Our ex vivo assays with healthy human blood treated with these venoms identified that N. nigricollis venom induced marked levels of haemolysis and platelet aggregation. We conclude that African snake venoms stimulate very diverse responses in this mouse model of acute systemic envenoming, and that venoms of the African cobras N. nigricollis and N. melanoleuca, in particular, cause marked inflammatory and non-specific acute phase responses. We also report that several African snake venoms cause haemolytic changes. These findings emphasise the importance of understanding acute responses to envenoming, and that further research in this area may facilitate new diagnostic and treatment approaches, which in turn may lead to better clinical outcomes for snakebite patients.

The Significance of Systemic Immune-Inflammatory Index for Mortality Prediction in Diabetic Patients Treated with Off-Pump Coronary Artery Bypass Surgery

Diabetes mellitus (DM) represents a complex carbohydrate metabolism disorder characterized by inflammatory over-reactivity. The study aimed to investigate the potential influence of postoperative inflammatory activation on mortality risk after off-pump coronary artery bypass grafting in diabetic patients. There were 510 patients treated with off-pump coronary artery bypass grafting due to stable complex coronary artery disease, including 175 patients with type-2 DM (T2DM.) The mean follow-up time was 3.7 +/− 1.5 years with a 9% all-cause mortality rate in the diabetic group. In multivariable analysis, preoperative comorbidities (stroke, peripheral artery disease, postoperative systemic inflammatory index >952, and postoperative left ventricle ejection fraction (LVEF) < 45%) were revealed as prognostic factors. The receiver operator characteristics curve analysis for postoperative calculations of systemic immune-inflammatory index (SII) appeared significant (AUC = 0.698, p = 0.008), yielding sensitivity of 68.75% and specificity of 71.07%. Systemic immune-inflammatory index (SII) can be regarded as a predictive marker for long-term prognosis in diabetic patients after off-pump coronary artery bypass grafting. The role of perioperative inflammatory activation may play a crucial role in mortality prediction.

Retrospective Study of the Association Between Platelet-to-Lymphocyte Ratio in Patients with Acute Coronary Syndrome on Admission to a Rural Referral Center in East Java, Indonesia, and the Incidence of New Symptomatic Heart Failure at 6 Months

BACKGROUND This was a retrospective study conducted at a rural referral center in East Java, Indonesia, to evaluate the association between the platelet-to-lymphocyte ratio (PLR) on hospital admission and the incidence of new symptomatic heart failure (HF) within 6 months in patients with acute coronary syndrome (ACS). MATERIAL AND METHODS The study population consisted of all ACS patients who were hospitalized between 1 January and 31 December 2018 at a non-percutaneous coronary intervention-capable secondary referral hospital and came for a routine follow-up until 6 months afterwards. The diagnosis of new symptomatic HF was based on International Classification of Diseases 10th revision code I50.9. RESULTS From 126 hospitalized patients, 92 patients were included in the analysis. The incidence rate of new symptomatic HF at 6 months was 70.65%. High PLR upon initial admission was significantly associated with new symptomatic HF incidence (odds ratio=1.70, P<0.001). PLR was also able to discriminate new symptomatic HF incidence at 6 months with area under the curve of 0.83 (P=0.001). Multivariate Cox regression analysis showed that PLR was an independent predictor for new symptomatic HF incidence (hazard ratio=4.5, P=0.001). CONCLUSIONS In a rural center in Indonesia, the PLR was independently correlated with the onset of new symptomatic HF in patients with ACS 6 months after hospital admission. The PLR may be a supplementary biomarker for clinical outcomes in patients with ACS for use in resource-limited regions.

Value of the Systemic Immune-Inflammatory Index (SII) in Predicting the Prognosis of Patients With Peripartum Cardiomyopathy

Background

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening complication of pregnancy. The identification of early prognostic markers in patients diagnosed with PPCM is very important. The systemic immune-inflammation index (SII) is a new inflammatory biomarker, and the aim of this study was to evaluate the prognostic value of SII in patients with PPCM.

Methods

A total of 61 patients with PPCM who were admitted in our hospital from 2015 to 2020 were retrospectively analyzed in this study. The follow-up period of all patients was at least 6 months after diagnosis. Recovery of left ventricular (LV) systolic function was defined as the presence of left ventricular ejection fraction > 45%. The second endpoint was defined as composite adverse cardiac events, including cardiac death or hospitalization due to worsening heart failure. Univariate and multivariate logistic regression analysis were used to determine the independent predictors of non-recovery of LV systolic function. The receiver operating characteristic (ROC) curve analysis was used to establish a cut-off level of SII value to predict persistent LV systolic dysfunction.

Results

The follow-up duration was 40.5 ± 16.3 months. Among the 61 patients, 43 patients showed left ventricular recovery and 18 patients did not at the last follow-up visit. The baseline SII levels were significantly higher in the non-recovery group (P < 0.05). Multivariate logistic regression showed that the SII and left ventricular end-diastolic dimension (LVEDD) were independent predictors of persistent LV systolic dysfunction (OR: 1.177, 95% CI: 1.038–1.335, P = 0.011 and OR: 1.148, 95% CI: 1.011–1.304, P = 0.033, respectively). A SII value of 876 was the best cut-off value (the area under the curve was 0.791, 95% CI: 0.667–0.915, P < 0.05), and the sensitivity and specificity were 73 and 71%, respectively.

Conclusions

The SII and LVEDD are independent prognostic factors for persistent LV systolic dysfunction in patients with PPCM. The SII may be a useful tool for identifying high-risk PPCM patients.

The omega-3 index is inversely associated with the neutrophil-lymphocyte ratio in adults'

The neutrophil-lymphocyte ratio (NLR) is a biomarker of systemic inflammation and measures innate-adaptive immune system balance. The omega-3-index (O3I) measures the amount of EPA+DHA in blood. Both a low O3I and an elevated NLR are associated with increased risk for chronic disease and mortality, including cardiovascular diseases and cancer. Hypothesizing that low O3I may partly contribute to systemic chronic inflammation, we asked if a relationship existed between O3I and NLR in healthy adults (≥18 y, n = 28,871, 51% female) without inflammation [C-reactive protein (CRP) <3 mg/mL)] who underwent a routine clinical assessment. NLR was inversely associated with O3I before (p < 0.0001) and after adjusting for age, sex, BMI, and CRP (p < 0.0001). Pearson correlations of other variables with NLR were r = 0.06 (CRP), r = 0.14 (age), and r = 0.01(BMI). In this healthy population, an O3I < 6.6% was associated with increasing NLR whereas NLR remained relatively constant (low) when O3I > 6.6%, suggestive of a quiescent, balanced immune system.

Pan-immune-inflammation value independently predicts disease recurrence in patients with Merkel cell carcinoma

Purpose

We aimed to determine whether the pan-immune-inflammation value (PIV) of patients with Merkel cell carcinoma (MCC) at primary diagnosis differs from controls and whether it is associated with disease stage and outcome.

Methods

In this retrospective study, we recruited MCC patients with stage I–III. PIV was calculated from absolute complete blood cell counts obtained within one week at MCC diagnosis as follows: [neutrophils (10³/mm³) × platelets (10³/mm³) × monocytes (10³/mm³)]/lymphocytes (10³/mm³). As controls, we studied age–gender-matched cutaneous melanoma (CM, stage I–III) patients and healthy controls (HC). Univariate and multivariate statistics were used.

Results

The median PIV in MCC patients was significantly increased compared to both CM patients as well as healthy controls. PIV of MCC patients in stage II and III was significantly higher compared to stage I patients. ROC analysis revealed that MCC recurrence was significantly associated with a PIV greater than 372 [p < 0.0001, Youden index 0.58; hazard ratio: 4 (95% confidence interval: 1.7 to 9.2)]. In multivariate analysis, only a PIV greater than 372 and higher MCC stage were determined as independent predictors for disease recurrence.

Conclusion

We determined, for the first time, the prognostic ability of the promising blood-based biomarker PIV in MCC patients and observed that PIV is increased in MCC patients in dependence on disease stage and independently predicts MCC recurrence.

Systemic Immune-Inflammation Index: A Novel Predictor of Coronary Thrombus Burden in Patients with Non-ST Acute Coronary Syndrome

Background and Objectives: Excessive coronary thrombus burden is known to cause an increase in mortality and major adverse cardiac events (MACEs) in NSTE-ACS (non-ST acute coronary syndrome) patients. We investigated the association between the systemic immune-inflammation index (SII) and coronary thrombus burden in patients with non-ST segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography and percutaneous coronary intervention (PCI). Materials and Methods: A total of 389 patients with the diagnosis of NSTEMI participated in our study. Coronary thrombus burden was classified in the TIMI (thrombolysis in myocardial infarction) thrombus grade scale and patients were divided into two groups: a TIMI thrombus grade 0–1 group (n = 209, 157 males) and a TIMI thrombus grade 2–6 group (n = 180, 118 males). Demographics, angiographic lesion images, coronary thrombus burden, clinical risk factors, laboratory parameters, and SII score were compared between the two groups. Results: The high thrombus burden patient group had a higher neutrophil count, WBC count, platelet count, and systemic immune-inflammation index (SII) (p < 0.001). The receiver operating characteristic (ROC) curve analysis showed that at a cutoff of 1103, the value of SII manifested 74.4% sensitivity and 74.6% specificity for detecting a high coronary thrombus burden. Conclusions: Our study showed that the SII levels at hospital admission were independently associated with high coronary thrombus with NSTEMI.