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Shen Q, Zhou S, Song M, Ouyang X, Tan Y, Peng Y, Zhou Z, Peng H. Prevalence and prognostic value of malnutrition in patients with IPF using three scoring systems. Respir Med 2024; 233:107774. [PMID: 39168392 DOI: 10.1016/j.rmed.2024.107774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND To describe the nutritional status of IPF patients, report clinical associations and evaluate the prognostic value of them in IPF. METHODS 264 IPF patients diagnosed with IPF at the Second Xiangya Hospital of Central South University between January 2011 and January 2021 were recruited. Three different scoring systems, including nutritional risk index (NRI), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI) were used to describe the nutritional status of IPF patients. RESULT This study investigated the prevalence of malnutrition in 264 IPF patients, of which the percentage with malnutrition varied from 37.5 % with the NRI, to 47.4 % with the CONUT score, and to 6.4 % with the PNI. The moderate to severe malnutrition ranged from 10.2 % to 31.1 % across these indices, with PNI identifying only 4.9 % in this category. Worsening malnutrition status was associated with significantly higher incidence of all-cause mortality and IPF death regard of the malnutrition index as NRI (p < 0.05). When the normal nutrition of NRI was used as a reference, patients in the moderate to severe risk remained at a higher risk of all-cause death (HR = 2.06(1.25-3.41)) and IPF death(HR = 2.36(1.35-4.15)). The adjusted multivariate analysis, identified age(HR = 1.13(1.08-1.20)), DLCO <60, % predicted (HR = 3.31(1,24-9.42)) and the use of anti-fibrotic drugs (HR = 0.25(0.10-0.60)) as independent predictors of mortality. CONCLUSIONS Malnutrition is common among patients with IPF and the baseline as diagnosis of IPF is strongly related to increased mortality.
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Affiliation(s)
- Qinxue Shen
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Shiting Zhou
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Min Song
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Xiaoli Ouyang
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Yuexin Tan
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Yating Peng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Zijing Zhou
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Hong Peng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China.
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Kaya T, Ulaş SB, Nalbant A, Yıldırım İ, İşsever K, Karacaer C, Bilgin C, Vatan A, Acar T, Acar BA, Aras YG, Köroğlu M. C-reactive protein/albumin ratio as a novel predictor for nutritional status of geriatric patients. Brain Behav 2024; 14:e70017. [PMID: 39262165 PMCID: PMC11391020 DOI: 10.1002/brb3.70017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 08/13/2024] [Accepted: 08/19/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND AND AIMS The C-reactive protein to albumin ratio (CAR) is a novel parameter that has been reported as a significant prognostic marker in some diseases. The purpose of the present research was to investigate the predictive value of this ratio with regard to nutritional status in geriatric patients. METHODS AND RESULTS A total of 154 geriatric patients (age ≥65 years) who consecutively presented to the internal medicine outpatient clinic were included in this cross-sectional study. The Mini Nutritional Assessment (MNA) was used as a reference to determine the nutritional status of the patients. Based on the MNA results, the patients were divided into two groups: normal nutrition and malnourished or at risk of malnutrition. The median CAR of malnourished patients or those at risk of malnutrition was significantly higher than that of patients with normal nutritional status (p = .012). A significant negative correlation was also observed between the MNA score and the CAR (r = -0.196, p = .015). The receiver operating characteristic curve analysis indicated that the CAR was a significant predictor of malnourishment or the risk of malnutrition (p = .012). CONCLUSION The CAR could predict which geriatric patients were malnourished or at risk of malnutrition. CAR may be used as a new tool in the nutritional screening of geriatric patients.
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Affiliation(s)
- Tezcan Kaya
- Department of Internal MedicineSakarya University Faculty of MedicineSakaryaTurkey
| | | | - Ahmet Nalbant
- Department of Internal MedicineSakarya University Faculty of MedicineSakaryaTurkey
| | - İlhan Yıldırım
- Department of Internal MedicineGörele Dr. Ergun Özdemir State HospitalGiresunTurkey
| | - Kubilay İşsever
- Department of Internal MedicineGiresun University Faculty of MedicineGiresunTurkey
| | - Cengiz Karacaer
- Department of Internal MedicineSakarya Training and Research HospitalSakaryaTurkey
| | - Cahit Bilgin
- Department of Chest DiseasesSakarya University Faculty of MedicineSakaryaTurkey
| | - Aslı Vatan
- Department of Infectious DiseaseSakarya University Faculty of MedicineSakaryaTurkey
| | - Türkan Acar
- Department of NeurologySakarya University Faculty of MedicineSakaryaTurkey
| | | | - Yeşim Güzey Aras
- Department of NeurologySakarya University Faculty of MedicineSakaryaTurkey
| | - Mehmet Köroğlu
- Department of MicrobiologySakarya University Faculty of MedicineSakaryaTurkey
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Borda MG, Salazar-Londoño S, Lafuente-Sanchis P, Patricio Baldera J, Venegas LC, Tarazona-Santabalbina FJ, Aarsland D, Martín-Marco A, Pérez-Zepeda MU. Neutrophil-to-lymphocyte ratio and lymphocyte count as an alternative to body mass index for screening malnutrition in older adults living in the community. Eur J Nutr 2024; 63:1889-1899. [PMID: 38613694 DOI: 10.1007/s00394-024-03392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Accurate height and weight measurement can be challenging in older adults and complicates nutritional status assessment. Other parameters like the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte count (LC) could be an option to these measurements. We aimed to test these variables as subrogates of body mass index (BMI) or calf-circumference (CC) for malnutrition screening in community-dwelling older adults. METHODS This is a secondary analysis from the Salud, Bienestar y Envejecimiento (SABE) survey from Ecuador (2009). Includes data on demographics, health-related factors, physical assessments, and complete blood count, allowing to calculate NLR and LC to be used as part of the Mini Nutritional Assessment (MNA), instead of the BMI. Consequently, 4 models were included: standard MNA, MNA-CC, MNA-NLR and MNA-LC. Finally, age, sex, and comorbidities were considered as confounding variables. RESULTS In our analysis of 1,663 subjects, 50.81% were women. Positive correlations with standard MNA were found for MNA-NLR (Estimate = 0.654, p < 0.001) MNA-CC (Estimate = 0.875, p value < 0.001) and MNA-LC (Estimate = 0.679, p < 0.001). Bland-Altman plots showed the smallest bias in MNA-CC. Linear association models revealed varying associations between MNA variants and different parameters, being MNA-NLR strongly associated with all of them (e.g. Estimate = 0.014, p = 0.001 for albumin), except BMI. CONCLUSION The newly proposed model classified a greater number of subjects at risk of malnutrition and fewer with normal nutrition compared to the standard MNA. Additionally, it demonstrated a strong correlation and concordance with the standard MNA. This suggests that hematological parameters may offer an accurate alternative and important insights into malnutrition.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, PB, 8100, N-4068, Norway.
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain.
| | - Salomón Salazar-Londoño
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Lafuente-Sanchis
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain
| | - Jonathan Patricio Baldera
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, PB, 8100, N-4068, Norway
- Escuela de Estadística de la Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana
| | - Luis Carlos Venegas
- Hospital Universitario Mayor-Méderi, Universidad del Rosario, Bogotá, Colombia
| | - Francisco José Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, 28029, Spain
- Medical School, Universidad Católica de Valencia San Vicente Mártir, Valencia, 46001, Spain
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, PB, 8100, N-4068, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Antonio Martín-Marco
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain
| | - Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría, Ciudad de México, México
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México, Huixquilucan Edo, México
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Borda MG, Lafuente Sanchis P, Patricio Baldera J, Tarazona-Santabalbina FJ, Chavarro-Carvajal DA, Salazar-Londoño S, Bocharova M, Aarsland D, Martín-Marco A. Assessing Neutrophil-to-Lymphocyte Ratio as a Nutritional Indicator in Community-Dwelling Older Adults. Arch Med Res 2024; 55:103003. [PMID: 38795422 DOI: 10.1016/j.arcmed.2024.103003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/06/2024] [Accepted: 04/23/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND In an aging population, there is an increasing need for easily accessible nutritional markers. AIMS To determine whether the neutrophil-to-lymphocyte ratio (NLR) can serve as an effective nutritional indicator compared to the Mini-Nutritional Assessment Short Form (MNA-SF) or other common markers such as albumin and body mass index (BMI). METHODS Data were obtained from the SABE study in Ecuador, which included participants aged 60 years or older. This cross-sectional study collected comprehensive data, including demographics, health-related factors, and physical assessments. Neutrophil and lymphocyte counts were measured by complete blood count. Nutritional status was assessed by MNA-SF, and BMI was calculated. Several physical tests were performed to evaluate the participants' functional status. Confounding variables such as age, sex, and comorbidities were considered. RESULTS The final sample consisted of 1790 subjects (48.9% male). The overall median age was 68 years (IQR 64,76). BMI and lymphocytes were higher in females, while NLR was higher in males. MNA-SF showed a negative association with NLR. Similarly, lymphocyte count shows a positive association with MNA-SF. Physical tests, such as the Romberg test and the Five Times Sit-to-Stand test, also showed correlations with NLR and lymphocyte count, respectively. CONCLUSION The study results suggest a significant relationship between NLR and lymphocytes, and nutritional status. The correlation with albumin is stronger with NLR than with BMI. The simplicity and affordability of NLR may make it suitable for routine use in several medical fields, improving our understanding of the complex relationship between nutrition, inflammation, and overall health.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Alzira, Spain.
| | - Pablo Lafuente Sanchis
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Alzira, Spain
| | - Jonathan Patricio Baldera
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Escuela de Estadística de la Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana
| | - Francisco José Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, Alzira, Spain; Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Madrid, Spain; Medical School, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Diego Andrés Chavarro-Carvajal
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Salomón Salazar-Londoño
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mariia Bocharova
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Antonio Martín-Marco
- Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Alzira, Spain
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Higashi T, Murase K, Watanabe D, Ishihara T, Yokoi R, Kuno M, Fukada M, Iwashita T, Yu Tajima J, Kiyama S, Tanaka Y, Okumura N, Shimizu M, Matsuhashi N. Pretherapeutic factors predicting conversion surgery in unresectable pancreatic ductal adenocarcinoma: A retrospective study. Oncol Lett 2024; 27:171. [PMID: 38455662 PMCID: PMC10918512 DOI: 10.3892/ol.2024.14304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Recently, conversion surgery (CS) has been reported to improve the prognosis in patients with unresectable pancreatic ductal adenocarcinoma (UR-PDAC) with a favorable response to intense chemotherapy or chemoradiotherapy. However, few pretherapeutic parameters predict the attainability of CS in patients with UR-PDAC. The present study aimed to explore the pretherapeutic predictors for the attainability of CS in patients with UR-PDAC. The present study retrospectively evaluated 130 patients with UR-PDAC treated at Gifu University Hospital (Gifu, Japan) from January 2015 to December 2021. Survival analysis was performed using the Simon and Makuch-modified Kaplan-Meier method. The hazard ratio (HR) was estimated using a time-varying Cox regression model. The association between each predictor and CS was evaluated using the univariate analysis and age-adjusted Fine-Gray sub-distribution hazard model. The bootstrap bias-corrected area under the receiver operating characteristic curve analysis for predicting CS was used to assess the cut-off values for each predictor. The cumulative incidence rate was calculated with CS as the outcome when divided into two groups based on the cut-off value of each pretherapeutic predictor. Among the 130 patients included in the analysis, only 14 (11%) underwent CS. The median survival time was significantly longer in patients who underwent CS compared with patients without CS (56.3 vs. 14.1 months; P<0.001). The age-adjusted Fine-Gray sub-distribution hazard regression showed that the total protein (TP) [HR 2.81, 95% confidence interval (CI) 1.19-6.65; P=0.018], neutrophil-to-lymphocyte ratio (NLR) (HR 0.53, 95% CI 0.31-0.90; P=0.020), and lymphocyte-to-monocyte ratio (LMR) (HR 1.28, 95% CI 1.07-1.53; P=0.006) were significantly associated with CS. Moreover, TP ≥6.8, NLR <2.84 and LMR ≥3.87 were associated with a higher cumulative incidence of CS. In conclusion, pretherapeutic TP, NLR and LMR are clinically feasible biomarkers for predicting the attainability of CS in patients with UR-PDAC.
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Affiliation(s)
- Toshiya Higashi
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
| | - Katsutoshi Murase
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
| | - Daichi Watanabe
- Department of Pharmacy, Gifu University Hospital, Gifu 501-1194 Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu 501-1194 Japan
| | - Ryoma Yokoi
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
| | - Masashi Kuno
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
| | - Masahiro Fukada
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194 Japan
| | - Jesse Yu Tajima
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
| | - Shigeru Kiyama
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
| | - Naoki Okumura
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194 Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery, Gifu University Hospital, Gifu 501-1194 Japan
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XIAO P, PAN H, MA Q, SONG L, ZHONG D. [Correlation Analysis between Neutrophil-to-lymphocyte Ratio
and the Risk of Malnutrition in Stage IV Primary Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2024; 27:193-198. [PMID: 38590194 PMCID: PMC11002189 DOI: 10.3779/j.issn.1009-3419.2024.106.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Malnutrition is commonly associated with poor prognosis in patients with malignant tumors. The neutrophil-to-lymphocyte ratio (NLR) is an indicator of inflammation in the body and predicts the risk of malnutrition in a variety of diseases; however, its association with malnutrition in lung cancer patients is unclear. The aim of this study is to clarify the association between NLR and nutritional status in stage IV primary lung cancer and to further determine the optimal NLR cut-off that best predicts the risk of malnutrition. METHODS A retrospective analysis of 209 patients admitted to the Department of Medical Oncology, Tianjin Medical University General Hospital with a primary diagnosis of stage IV lung cancer from May 2019 to February 2021 was performed, and the nutritional risk screening 2002 (NRS 2002) was used to examine their nutritional status. Patient demographic information, pathology, Karnofsky performance status (KPS) score, body mass index (BMI), comorbidities and clinical biochemical indicators were also included. The correlation between NLR and NRS 2002 was investigated. Receiver operating characteristic (ROC) curve was used to determine the best NLR cut-off predi cting malnutrition risk. Multivariable Logistic regression was used to assess the association between NLR and malnutrition risk. RESULTS The rate of patients with stage IV primary lung cancer at nutritional risk was 36.36% (76/209). A significant positive correlation was observed between NLR values and NRS 2002 risk score (r=0.765, P<0.001). The ROC curve analysis indicated that an NLR of 3.94 was the optimal cut-off for predicting malnutrition risk (area under the curve=0.747, 95%CI: 0.678-0.815, P<0.001), which showed a sensitivity of 55%, a specificity of 86%, a positive predictive value of 68%, and a negative predictive value of 77%. Patients in the NLR>3.94 group had a significantly higher risk of malnutrition compared to those in the NLR≤3.94 group (69.49% vs 23.33%, P<0.001). Furthermore, NLR was identified as a risk factor for malnutrition in stage IV primary lung cancer patients. CONCLUSIONS NLR is associated with the risk of malnutrition in stage IV primary lung cancer, and NLR can be used as one of the indicators for screening nutritional risk in patients with stage IV primary lung cancer.
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Ma YC, Ju YM, Cao MY, Yang D, Zhang KX, Liang H, Leng JY. Exploring the relationship between malnutrition and the systemic immune-inflammation index in older inpatients: a study based on comprehensive geriatric assessment. BMC Geriatr 2024; 24:19. [PMID: 38178005 PMCID: PMC10768166 DOI: 10.1186/s12877-023-04604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Malnutrition is a prevalent and major challenge among senior citizens, possibly due to the continual low-grade inflammatory state of the body. A novel inflammatory parameter, the systemic immune-inflammation index (SII), is highly valuable in evaluating and predicting the prognosis of a wide range of diseases. This study aims to explore the significance of the SII in assessing malnutrition in older inpatients. METHODS This retrospective study included 500 senior hospitalized patients who met the inclusion and exclusion criteria from the Comprehensive Geriatric Assessment database of the First Hospital of Jilin University. The Mini-Nutritional Assessment (MNA) questionnaire was used to evaluate the nutritional status of patients. The SII was calculated using complete blood counts, and we performed natural logarithm transformation of the SII [ln(SII)]. Multivariable logistic regression analysis was used to identify the association between ln(SII) and malnutrition. To ensure the stability of the findings, a sensitivity analysis was conducted. RESULTS The 500 patients had a mean age of 77.29 ± 9.85 years, and 68.6% were male. In accordance with the MNA, 30.4% of the patients were malnourished or at risk of malnutrition, and patients in this group had considerably greater levels of ln(SII) than patients with adequate nutrition (P < 0.001). The optimum ln(SII) cutoff value for patients with malnutrition or at risk of malnutrition was 6.46 (SII = 635.87) with 46.7% sensitivity and 80.2% specificity [95% CI: 0.613-0.721, AUC: 0.667, P < 0.001]. Multivariable logistic regression demonstrated that ln(SII) was an independent risk factor for the risk of malnutrition or malnutrition in older individuals (OR 3.984, 95% CI: 2.426-6.543, P < 0.001). Other metrics from the geriatric comprehensive assessment, including body mass index, calf circumference, fat ratio, activities of daily living and instrumental activities of daily living, and geriatric depression scale scores, were also independently correlated with nutritional status. CONCLUSIONS According to our research, a high SII is an independent predictor of older inpatient malnutrition, and the SII aids in screening for malnutrition and may be a potential target for intervention. Comprehensive geriatric assessment parameters such as BMI, calf circumference, fat ratio, activities of daily living and depression were also linked to malnutrition.
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Affiliation(s)
- Yu-Cen Ma
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yan-Min Ju
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Meng-Yu Cao
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Di Yang
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Ke-Xin Zhang
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Hong Liang
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Ji-Yan Leng
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China.
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Zhang L, Xu C, Bai L, Li L, Guo J, Li Y. The Clinical Value of Comprehensive Nursing Intervention in Preventing Severe Lymphopenia and Improving the Survival Rate Among Patients with Sepsis. Open Access Emerg Med 2023; 15:393-403. [PMID: 37886229 PMCID: PMC10599247 DOI: 10.2147/oaem.s433980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Background Intensive care unit (ICU) patients with sepsis who experience severe lymphopenia are at a higher risk of mortality, and they serve as a more accurate indicator of bacteremia compared to traditional infection markers. Aim Our study aimed to examine the influence of severe lymphopenia on ICU mortality and outcomes in sepsis patients, while also evaluating the clinical significance of comprehensive nursing intervention in preventing severe lymphopenia. Methods Patients with sepsis in the ICU at our hospital between January 2015 and January 2021 were split into a control group and a test group.The control group received regular nursing care, while the test group was provided with comprehensive nursing care in addition to the control group. The results encompassed mortality rates of 28 days, mortality rates of 1 year, and lengths of stay in the ICU. Results Our attention was directed towards day 4 absolute lymphocyte counts, taking into account the receiver operating characteristic (ROC) outcome. Patients with severe lymphopenia were older, more patients with 2 above comorbidities, higher co-infection rates and SOFA score. In addition, patients with severe lymphopenia required longer days stay in ICU (P<0.001), and presented with higher 28-day mortality (P=0.038) and 1-year mortality (P=0.004). Patients in control group have a higher incidence of severe lymphopenia (P=0.006), 28-day mortality (P=0.015) and 1-year mortality (P=0.019) compared with the test group. Conclusion Comprehensive nursing intervention can prevent the occurrence of severe lymphopenia, improve patients satisfaction and reduce mortality.
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Affiliation(s)
- Lin Zhang
- Department of Intensive Care Unit, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, 150036, People’s Republic of China
| | - Chao Xu
- Department of Intensive Care Unit, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, 150036, People’s Republic of China
| | - Lin Bai
- Department of Intensive Care Unit, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, 150036, People’s Republic of China
| | - Lin Li
- Department of Intensive Care Unit, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, 150036, People’s Republic of China
| | - Jinyan Guo
- Department of Intensive Care Unit, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, 150036, People’s Republic of China
| | - Yanyi Li
- Department of Intensive Care Unit, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, 150036, People’s Republic of China
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9
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Muscaritoli M, Modena A, Valerio M, Marchetti P, Magarotto R, Quadrini S, Narducci F, Tonini G, Grassani T, Cavanna L, Di Nunzio C, Citterio C, Occelli M, Strippoli A, Chiurazzi B, Frassoldati A, Altavilla G, Lucenti A, Nicolis F, Gori S. The Impact of NUTRItional Status at First Medical Oncology Visit on Clinical Outcomes: The NUTRIONCO Study. Cancers (Basel) 2023; 15:3206. [PMID: 37370816 DOI: 10.3390/cancers15123206] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Malnutrition affects up to 75% of cancer patients and results from a combination of anorexia and metabolic dysregulation. Metabolic and nutritional abnormalities in cancer patients can lead to cachexia, a multifactorial syndrome characterized by involuntary loss of skeletal muscle mass, systemic inflammation and increased protein catabolism. Cancer cachexia negatively affects patients' outcomes, response to anticancer treatments, quality of life, and survival. However, risk of malnutrition, and cachexia are still under-recognized in cancer patients. The Prevalence of Malnutrition in Oncology (PreMiO) study revealed that 51% of patients already had nutritional deficiencies at their first medical oncology visit. Here, we report the results of the subsequent retrospective, observational NUTRItional status at first medical oncology visit ON Clinical Outcomes (NUTRIONCO) study, aimed at assessing the impact of baseline nutritional and non-nutritional variables collected in the PreMiO study on the clinical outcomes of the same patients followed up from August 2019 to October 2021. We have highlighted a statistically significant association between baseline variables and patient death, rehospitalization, treatment toxicity, and disease progression at follow-up. We found a higher overall survival probability in the well-nourished general study population vs. malnourished patients (p < 0.001). Of major interest is the fact that patient stratification revealed that malnutrition decreased survival probability in non-metastatic patients but not in metastatic patients (p < 0.001). Multivariate analysis confirmed that baseline malnutrition (p = 0.004) and VAS score for appetite loss (p = 0.0104), in addition to albumin < 35 g/L (p < 0.0001) and neutrophil/lymphocyte ratio > 3 (p = 0.0007), were independently associated with the death of non-metastatic patients at follow-up. These findings highlight the importance of proactive, early management of malnutrition and cachexia in cancer patients, and in particular, in non-metastatic patients, from the perspective of a substantial improvement of their clinical outcomes.
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Affiliation(s)
| | - Alessandra Modena
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Matteo Valerio
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | | | - Roberto Magarotto
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Silvia Quadrini
- Medical Oncology Unit, S.S. Trinità Hospital, 03039 Sora, Italy
| | | | - Giuseppe Tonini
- Medical Oncology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Teresa Grassani
- Medical Oncology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Luigi Cavanna
- Department of Oncology-Hematology, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Camilla Di Nunzio
- Department of Oncology-Hematology, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Chiara Citterio
- Department of Oncology-Hematology, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Marcella Occelli
- Department of Oncology, Santa Croce e Carle General Hospital, 12100 Cuneo, Italy
| | - Antonia Strippoli
- Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Bruno Chiurazzi
- Oncology Unit, Antonio Cardarelli Hospital, 80131 Naples, Italy
| | - Antonio Frassoldati
- Clinical Oncology Unit, S. Anna University Hospital, 44124 Cona-Ferrara, Italy
| | - Giuseppe Altavilla
- Medical Oncology Unit, Department of Human Pathology of Adult and Evolutive Age "G. Barresi", University of Messina, 98125 Messina, Italy
| | - Antonio Lucenti
- Medical Oncology Unit, Maria Paternò-Arezzo Hospital, 97100 Ragusa, Italy
| | - Fabrizio Nicolis
- Medical Direction, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
- AIOM Foundation, 20133 Milano, Italy
| | - Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
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10
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Moh MC, Low S, Shao YM, Subramaniam T, Sum CF, Lim SC. Association between neutrophil/lymphocyte ratio and kidney impairment in type 2 diabetes mellitus: A role of extracellular water/total body water ratio. Diabetes Res Clin Pract 2023; 199:110634. [PMID: 36948421 DOI: 10.1016/j.diabres.2023.110634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/26/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
AIMS We explored the predictive utility of baseline neutrophil/lymphocyte ratio (NLR), which reflects a systemic inflammatory tone, in kidney impairment in type 2 diabetes mellitus (T2DM); and investigated the effect of extracellular water/total body water (ECW/TBW) ratio on the relationship. METHODS This longitudinal study included 1,224 T2DM adults recruited from a single centre. Cox regression analyses examined the association between NLR and progressive kidney function decline or albuminuria progression. Improvements in risk discrimination were assessed using Harrell's concordance-statistics. The mediatory role of ECW/TBW ratio estimated by bioelectrical impedance was evaluated. RESULTS Higher baseline NLR levels were observed in cases with kidney function decline or albuminuria progression over a median 2-year follow-up. NLR independently predicted progressive kidney function decline (hazard ratio:1.39, 95% CI:1.21-1.60, P < 0.001) or albuminuria progression (hazard ratio:1.34, 95% CI:1.08-1.68, P = 0.009). Addition of NLR to a base model comprising demographics, T2DM duration, metabolic and renal parameters, and medications significantly improved the risk discrimination of kidney function decline (P = 0.022) but not albuminuria progression. ECW/TBW ratio accounted for 19.7% of the total effect between NLR and kidney function loss. CONCLUSIONS Increased NLR reflecting systemic inflammation is associated with progressive kidney function decline in T2DM, partially explained by dysregulated body fluid balance.
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Affiliation(s)
- Mei Chung Moh
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Serena Low
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore; Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore
| | - Yi-Ming Shao
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Tavintharan Subramaniam
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore; Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore; Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore; Saw Swee Hock School of Public Health, National University Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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11
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Caldiroli A, La Tegola D, Affaticati LM, Manzo F, Cella F, Scalia A, Capuzzi E, Nicastro M, Colmegna F, Buoli M, Clerici M, Dakanalis A. Clinical and Peripheral Biomarkers in Female Patients Affected by Anorexia: Does the Neutrophil/Lymphocyte Ratio (NLR) Affect Severity? Nutrients 2023; 15:nu15051133. [PMID: 36904132 PMCID: PMC10005379 DOI: 10.3390/nu15051133] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Anorexia Nervosa (AN) is a disabling disorder characterized by extreme weight loss and frequent chronicization, especially in its most severe forms. This condition is associated with a pro-inflammatory state; however, the role of immunity in symptom severity remains unclear. Total cholesterol, white blood cells, neutrophils, lymphocytes, platelets, iron, folate, vitamin D and B12 were dosed in 84 female AN outpatients. Mildly severe (Body Mass Index-BMI ≥ 17) versus severe (BMI < 17) patients were compared using one-way ANOVAs or χ2 tests. A binary logistic regression model was run to investigate the potential association between demographic/clinical variables or biochemical markers and the severity of AN. Patients with severe anorexia (compared to mild forms) were older (F = 5.33; p = 0.02), engaged in more frequent substance misuse (χ2 = 3.75; OR = 3.86; p = 0.05) and had a lower NLR (F = 4.12; p = 0.05). Only a lower NLR was predictive of severe manifestations of AN (OR = 0.007; p = 0.031). Overall, our study suggests that immune alterations may be predictive of AN severity. In more severe forms of AN, the response of the adaptive immunity is preserved, while the activation of the innate immunity may be reduced. Further studies with larger samples and a wider panel of biochemical markers are needed to confirm the present results.
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Affiliation(s)
- Alice Caldiroli
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Davide La Tegola
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Letizia Maria Affaticati
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Francesca Manzo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Francesca Cella
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Alberto Scalia
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Enrico Capuzzi
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Monica Nicastro
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Fabrizia Colmegna
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Massimo Clerici
- Department of Mental Health and Addiction, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-3755-651904
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12
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Biomarkers and Predictive Factors for Treatment Response to Tumor Necrosis Factor-α Inhibitors in Patients with Psoriasis. J Clin Med 2023; 12:jcm12030974. [PMID: 36769622 PMCID: PMC9918195 DOI: 10.3390/jcm12030974] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
We performed a retrospective and observational study of patients with psoriasis. The aim of this study was to define the laboratory indicators reflecting the treatment response to tumor necrosis factor (TNF)-α inhibitors and the predictors for the treatment response. From January 2010 to June 2022, 28, 15 and 12 patients with psoriasis were treated with infliximab (IFX), adalimumab (ADA) and certolizumab pegol (CZP), respectively. The values of C-reactive protein (CRP), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio and monocyte to lymphocyte ratio decreased in parallel with psoriasis area and severity index (PASI) at weeks 12 and 52 of treatment. The percentage reduction of the CRP was correlated with that of the PASI at week 52 in all patients and subgroups treated with IFX. The percentage reduction of the PLR was correlated with that of the PASI at week 52 in all patients. Linear multivariate regression analyses revealed that the presence of scalp lesions was associated with a high percentage reduction of the PASI at week 52 in the ADA subgroup. The CRP and PLR might act as biomarkers reflecting the treatment response to TNF-α inhibitors in patients with psoriasis. The presence of scalp lesions might be a predictive factor for a high treatment response to ADA in patients with psoriasis.
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13
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A high neutrophil to lymphocyte ratio is associated with poor nutritional status in chronic kidney disease patients. Br J Nutr 2022; 128:1990-1996. [PMID: 35086576 DOI: 10.1017/s000711452100516x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We aimed to investigate the relationship between the neutrophil to lymphocyte ratio (NLR) and nutritional parameters in chronic kidney disease (CKD) patients. In this cross-sectional study, 187 non-dialysis CKD patients were enrolled. Daily dietary energy intake (DEI) and daily dietary protein intake (DPI) were assessed by 3-d dietary records. Protein-energy wasting (PEW) was defined as Subjective Global Assessment (SGA) class B and C. Spearman correlation analysis, logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed. The median NLR was 2·51 (1·83, 3·83). Patients with CKD stage 5 had the highest NLR level. A total of 19·3 % (n 36) of patients suffered from PEW. The NLR was positively correlated with SGA and serum P, and the NLR was negatively correlated with BMI, waist and hip circumference, triceps skinfold thickness, mid-arm muscle circumference, DPI and Hb. Multivariate logistic regression analysis adjusted for DPI, DEI, serum creatinine, blood urea nitrogen, uric acid and Hb showed that a high NLR was an independent risk factor for PEW (OR = 1·393, 95 % CI 1·078, 1·800, P = 0·011). ROC analysis showed that an NLR ≥ 2·62 had the ability to identify PEW among CKD patients, with a sensitivity of 77·8 %, a specificity of 62·3 % and an AUC of 0·71 (95 % CI 0·63, 0·81, P < 0·001). The NLR was closely associated with nutritional status. NLR may be an indicator of PEW in CKD patients.
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14
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Gysi S, Doulberis M, Légeret C, Köhler H. The Role of the Pediatric Yorkhill Malnutrition Score (PYMS), Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Malnutrition Prediction of Hospitalized Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091378. [PMID: 36138687 PMCID: PMC9497887 DOI: 10.3390/children9091378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022]
Abstract
Malnutrition in hospitalized children represents a significant burden with occasionally detrimental consequences. In this retrospective analysis of pediatric patients aged one to 16 years old, who were hospitalized in the children’s cantonal hospital of Aarau, Switzerland, we investigated the utilization of PYMS (Pediatric Yorkhill Malnutrition Score) as a routine screening tool for malnutrition in pediatric inpatients. Additionally, we explored the correlation between PYMS and NLR (neutrophil−lymphocyte ratio) and PLR (platelet−lymphocyte ratio), which are two novel biomarkers. Various parameters were analyzed from the medical records of the patients. Most of the sample (n = 211, 77.3%) was characterized by a low PYMS of 0−1 point. Greater NLR and PLR values were significantly associated with greater PYMS (p = 0.030 and p = 0.004, respectively). ROC (receiver operating characteristic curves) analysis revealed that PLR had a significant predictive ability for having PYMS > 1 (AUC = 0.59; 95% CI: 0.51−0.68; p = 0.024). The optimal cut-off was 151 with sensitivity of 51.6% (95% CI: 38.6−64.5%) and specificity of 67.3% (95% CI: 60.5−73.6%). Furthermore, 37% of the children (n = 101) yielded a PLR over 151. Our results support a promising value of PLR as a predictive marker for moderate to severe malnutrition in hospitalized children.
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Affiliation(s)
- Spyridoula Gysi
- Children’s Hospital of Aarau, 5001 Aarau, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
- Correspondence: ; Tel.: +41-76-226-2027
| | - Michael Doulberis
- Division of Gastroenterology and Hepatology, Medical University Department, Cantonal Hospital of Aarau, 5001 Aarau, Switzerland
- Department of Gastroenterology and Hepatology, University of Zurich, 8091 Zurich, Switzerland
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Macedonia, Greece
| | - Corinne Légeret
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
- University Children’s Hospital Basel, 4056 Basel, Switzerland
| | - Henrik Köhler
- Children’s Hospital of Aarau, 5001 Aarau, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
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15
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Sasagawa S, Kato H, Nagaoka K, Sun C, Imano M, Sato T, Johnson TA, Fujita M, Maejima K, Okawa Y, Kakimi K, Yasuda T, Nakagawa H. Immuno-genomic profiling of biopsy specimens predicts neoadjuvant chemotherapy response in esophageal squamous cell carcinoma. Cell Rep Med 2022; 3:100705. [PMID: 35944530 PMCID: PMC9418738 DOI: 10.1016/j.xcrm.2022.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/15/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive cancers and is primarily treated with platinum-based neoadjuvant chemotherapy (NAC). Some ESCCs respond well to NAC. However, biomarkers to predict NAC sensitivity and their response mechanism in ESCC remain unclear. We perform whole-genome sequencing and RNA sequencing analysis of 141 ESCC biopsy specimens before NAC treatment to generate a machine-learning-based diagnostic model to predict NAC reactivity in ESCC and analyzed the association between immunogenomic features and NAC response. Neutrophil infiltration may play an important role in ESCC response to NAC. We also demonstrate that specific copy-number alterations and copy-number signatures in the ESCC genome are significantly associated with NAC response. The interactions between the tumor genome and immune features of ESCC are likely to be a good indicator of therapeutic capability and a therapeutic target for ESCC, and machine learning prediction for NAC response is useful.
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Affiliation(s)
- Shota Sasagawa
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Hiroaki Kato
- Department of Surgery, Graduate School of Medicine, Kindai University, Osaka 577-8502, Japan
| | - Koji Nagaoka
- Department of Immuno-therapeutics, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Changbo Sun
- Department of Immuno-therapeutics, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Motohiro Imano
- Department of Surgery, Graduate School of Medicine, Kindai University, Osaka 577-8502, Japan
| | - Takao Sato
- Department of Pathology, Kindai University Faculty of Medicine, Osaka 577-8502, Japan
| | - Todd A Johnson
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Masashi Fujita
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Kazuhiro Maejima
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Yuki Okawa
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Kazuhiro Kakimi
- Department of Immuno-therapeutics, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Takushi Yasuda
- Department of Surgery, Graduate School of Medicine, Kindai University, Osaka 577-8502, Japan
| | - Hidewaki Nakagawa
- Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan.
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16
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Yoshida Y, Iwasa H, Kim H, Suzuki T. Association between Neutrophil-to-Lymphocyte Ratio and Physical Function in Older Adults: A Community-Based Cross-Sectional Study in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158996. [PMID: 35897367 PMCID: PMC9332416 DOI: 10.3390/ijerph19158996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022]
Abstract
Inflammatory responses contribute to physical decline in older adults. Clinical studies have shown that the neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, is associated with physical decline. However, its association with physical function in community-dwelling older people is still unclear. Hence, we used cross-sectional data to investigate the relationship between NLR and physical function in community-dwelling older adults. Specifically, we analyzed data corresponding to 818 individuals (336 men and 482 women) aged ≥ 75 years, all of whom participated in comprehensive health examinations, including face-to-face interviews, biochemical analyses, and physical function tests. Using these data, we performed multivariable logistic regression analysis to assess the relationship between NLR and physical function, adjusting for sex, age, education, alcohol consumption, smoking, instrumental activity of daily living, body mass index, chronic disease, physical activity, serum albumin level, and depressive mood. The results showed that a higher NLR was associated with a lower grip strength, lower knee extension strength, and slower walking speed. Importantly, the relationship between NLR and physical function was maintained after adjusting for the confounding factors. Thus, we showed a significant association between NLR and physical function, supporting the use of NLR as a marker of physical function in community-dwelling older adults.
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Affiliation(s)
- Yuko Yoshida
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (H.I.); (H.K.); (T.S.)
- Correspondence: ; Tel.: +81-3-3964-3241
| | - Hajime Iwasa
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (H.I.); (H.K.); (T.S.)
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hunkyung Kim
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (H.I.); (H.K.); (T.S.)
| | - Takao Suzuki
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (H.I.); (H.K.); (T.S.)
- Institute of Gerontology, J. F. Oberlin University, Tokyo 194-0294, Japan
- National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
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17
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Asik Z, Özen M. Evaluation of frailty and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios relationship in elderly people. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:101-110. [PMID: 35392007 PMCID: PMC8971038 DOI: 10.18999/nagjms.84.1.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022]
Abstract
It was aimed to evaluate the relationship between frailty and inflammation in people receiving home health care. It was a cross-sectional study. Edmonton Frail Scale was used to determine the level of frailty and, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were used to determine inflammation. Of 332 people included in the study, 54.82% were females and 45.18% were males. Participants' ages were between 65 and 106. When we examined the frailty of the participants according to the Edmonton Frail Scale, the mean score was 9.403 ± 2.032. The mean neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of the participants were 4,397±5,038 and 169,363±101,461 respectively. Accordingly, neutrophil-to-lymphocyte ratio was high in men, frail elderly, 75-84 age range, hypertension patients, malnutrition patients; and neutrophil-to-lymphocyte ratio was low in diabetes mellitus, dementia, cerebrovascular accident and hemiplegia. Platelet-to-lymphocyte ratio, another inflammatory marker, was high in men, non-frail elderly, 75-84 age range, hypertension patients and cerebrovascular accident patients; it was low in hemiplegia, malnutrition, dementia, diabetes mellitus. In the study, no statistically significant difference was found between Edmonton Frail Scale and inflammatory markers. More studies are needed on this subject. In addition, we think that examining NLR and PLR values will be useful for monitoring inflammation in frail elderly.
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Affiliation(s)
- Zeynep Asik
- The Clinic of Family Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Mehmet Özen
- The Clinic of Family Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
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de Rezende Ferreira Mendes AL, Sampaio HADC, Ferreira Carioca AA, Pinheiro LGP, Vasques PHD, Rocha DC, Cacau LT, Bezerra IN. Women with Abnormal Mammographic Findings and High Neutrophil-to-Lymphocyte Ratio have the Worst Dietary Carbohydrate Quality Index. Nutr Cancer 2021; 74:2436-2443. [PMID: 34854778 DOI: 10.1080/01635581.2021.2009885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 06/03/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There are gaps in knowledge in breast cancer prevention studies focusing on interactions among mammographic findings, inflammation, and diet, especially those related to carbohydrates. OBJECTIVE We aimed to verify the association among mammographic findings, inflammatory markers, and carbohydrate quality index (CQI) in women. METHODOLOGY This was a cross-sectional study of 532 women assisted in a healthcare service. The enrolled women were divided into two groups according to their mammographic findings: those without and those with abnormal mammographic findings. Two 24-hour dietary reminders were applied, and CQI was determined based on four components: fibers, glycemic index, ratio between whole and total grains, and ratio between solid and total carbohydrates. The neutrophil-to-lymphocyte ratio (NLR) was calculated as an inflammatory marker. RESULTS There were 178 (33.5%) women with abnormal mammographic findings, and 20 (3.8%) had NLR. There was no association between CQI and mammographic findings and NLR. Women with abnormal mammographic findings and high NLR had lower CQI (p = 0.039) and lower whole total ratio (p = 0.024). CONCLUSION Women with abnormal findings and high NLR had worse CQI and worse overall total grain ratio.
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Affiliation(s)
| | | | | | - Luiz Gonzaga Porto Pinheiro
- Education and Oncology Studies Group (Grupo de Educação e Estudos em Oncologia - GEEON), Federal University of Ceará, Fortaleza, Brazil
| | - Paulo Henrique Diógenes Vasques
- Education and Oncology Studies Group (Grupo de Educação e Estudos em Oncologia - GEEON), Federal University of Ceará, Fortaleza, Brazil
| | | | - Leandro Teixeira Cacau
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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19
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Chen YH, Chou CH, Su HH, Tsai YT, Chiang MH, Kuo YJ, Chen YP. Correlation between neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture: a meta-analysis. J Orthop Surg Res 2021; 16:681. [PMID: 34794459 PMCID: PMC8600895 DOI: 10.1186/s13018-021-02831-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/04/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction The neutrophil-to-lymphocyte ratio (NLR) is a crucial prognosis predictor following several major operations. However, the association between NLR and the outcome after hip fracture surgery is unclear. In this meta-analysis, we investigated the correlation between NLR and postoperative mortality in geriatric patients following hip surgery.
Method PubMed, Embase, Cochrane library, and Google Scholar were searched for studies up to June 2021 reporting the correlation between NLR and postoperative mortality in elderly patients undergoing surgery for hip fracture. Data from studies reporting the mean of NLR and its 95% confidence interval (CI) were pooled. Both long-term (≥ 1 year) and short-term (≤ 30 days) mortality rates were included for analysis. Result Eight retrospective studies comprising a total of 1563 patients were included. Both preoperative and postoperative NLRs (mean difference [MD]: 2.75, 95% CI: 0.23–5.27; P = 0.03 and MD: 2.36, 95% CI: 0.51–4.21; P = 0.01, respectively) were significantly higher in the long-term mortality group than in the long-term survival group. However, no significant differences in NLR were noted between the short-term mortality and survival groups (MD: − 1.02, 95% CI: − 3.98 to 1.93; P = 0.5). Conclusion Higher preoperative and postoperative NLRs were correlated with a higher risk of long-term mortality following surgery for hip fracture in the geriatric population, suggesting the prognostic value of NLR for long-term survival. Further studies with well-controlled confounders are warranted to clarify the predictive value of NLR in clinical practice in geriatric patients with hip fracture. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02831-6.
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Affiliation(s)
- Yu-Hang Chen
- Department of General Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ching-Hsin Chou
- Department of General Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsin-Hsien Su
- Department of General Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Ting Tsai
- Department of General Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ming-Hsiu Chiang
- Department of General Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan.,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan. .,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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20
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Colloca G, Venturino A. Peripheral Blood Cell Variables Related to Systemic Inflammation in Patients With Unresectable or Metastatic Pancreatic Cancer: A Systematic Review and Meta-Analysis. Pancreas 2021; 50:1131-1136. [PMID: 34714276 DOI: 10.1097/mpa.0000000000001878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT Systemic inflammatory response (SIR) plays a central role in the prognosis of unresectable or metastatic pancreatic ductal adenocarcinoma (mPDAC), and many SIR-related peripheral blood cell (PBC)-derived variables have been proposed as prognostic factors. The study aims to perform a systematic review and, for the more studied PBC-derived variables, a meta-analysis. A systematic review from 2000 to 2020 on 2 databases by predefined criteria was performed for PBC-derived variables in patients with mPDAC receiving chemotherapy in relation with overall survival. Eligible studies were selected by inclusion criteria, and only the PBC variables reported in at least 10 studies were evaluated by meta-analysis. Three hundred and eighty articles were found, and 28 studies were selected. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were reported in 28 and 10 articles, respectively. The subsequent meta-analyses supported the prognostic effect for both, NLR (hazard ratio, 2.10; 95% confidence interval, 1.87-2.37) and PLR (hazard ratio, 1.22; 95% confidence interval, 1.08-1.37). Heterogeneity was significant for NLR (I2 = 62%) and low for PLR (I2 = 24%). Among SIR-related PBC-derived variables, NLR is the most suitable prognostic factor for future clinical trials of patients with mPDAC.
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Affiliation(s)
- Giuseppe Colloca
- From the Department of Oncology, Ospedale Saint Charles, Bordighera, Italy
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21
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Homkham N, Muangwong P, Pisprasert V, Traisathit P, Jiratrachu R, Chottaweesak P, Chitapanarux I. Dynamic changes in practical inflammation and immunity markers in cancer patients receiving immune-enhancing nutritional supplementation during concurrent chemoradiotherapy. Cancer Biomark 2021; 32:281-291. [PMID: 34151843 PMCID: PMC8673492 DOI: 10.3233/cbm-210086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immune-enhancing nutrition (IMN) strengthens the systematic inflammatory response and the immune system. Neutrophil to lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) are affected during cancer therapies. OBJECTIVE We carried out an analysis of the dynamic changes in NLR and ALC over time in cancer patients with or without IMN supplementation. METHODS 88 cancer patients receiving concurrent chemoradiotherapy (CCRT) were randomized into regular diet group, and regular diet and IMN group.Generalized estimation equation models were used to assess associations between patient's characteristics, IMN, and dynamic changes in NLR and ALC over time. RESULTS NLR and ALC at preCCRT were significantly associated with dynamic changes in NLR (adjusted β= 1.08, 95% confidence interval [CI]: 0.64-1.52) and ALC (adjusted β= 0.41, 95% CI: 0.36-0.46). The magnitudes of the NLR and ALC changes through CCRT were lower in patients receiving IMN, although the differences were not statistically significant except ALC at the end of CCRT in head and neck cancer patients (P= 0.023). CONCLUSION Dynamic negative changes in both markers were demonstrated throughout CCRT. There were non-significant trend in promising changes in both NLR and ALC values in the whole group in IMN supplementation.
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Affiliation(s)
- Nontiya Homkham
- Faculty of Public Health, Thammasat University, Prathumthani, Thailand
| | - Pooriwat Muangwong
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Veeradej Pisprasert
- Division of Clinical Nutrition, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Center of Excellence in Bioresources for Agriculture, Industry and Medicine, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Rungarun Jiratrachu
- Division of Radiation Oncology, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Pattawee Chottaweesak
- Radiotherapy Unit, Radiology Department, Maharat Nakhonratchasima Hospital, Nakhonratchasima, Thailand
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
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22
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A comparison of inflammation markers for predicting oncological outcomes after surgical resection of non-small-cell lung cancer: a validated analysis of 2,066 patients. Sci Rep 2020; 10:19523. [PMID: 33177603 PMCID: PMC7658207 DOI: 10.1038/s41598-020-76644-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
Clinical and pathological predictors have proved to be insufficient in identifying high-risk patients who develop cancer recurrence after tumour resection. We aimed to compare the prognostic ability of various inflammation markers in patients undergoing surgical resection of lung cancer. We consecutively included 2,066 patients with stage I-III non-small-cell lung cancer undergoing surgical resection at the center between 2005 and 2015. We evaluated prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio along with their perioperative changes. We conducted stepwise backward variable elimination and internal validation to compare the selected markers' predictive performance for postoperative recurrence-free survival and overall survival. Preoperative neutrophil-to-lymphocyte ratio independently predicts recurrence-free survival (HR: 1.267, 95% CI 1.064-1.509, p = 0.0079, on base-2 logarithmic scale) and overall survival (HR: 1.357, 95% CI 1.070-1.721, p = 0.0117, on base-2 logarithmic scale). The cut-off value is 2.3 for predicting both recurrence (sensitivity: 46.1% and specificity: 66.7%) and mortality (sensitivity: 84.2% and specificity: 40.4%). Advanced cancer stage, poor tumour differentiation, and presence of perineural infiltration were significantly correlated with higher preoperative neutrophil-to-lymphocyte ratio. We concluded that preoperative neutrophil-to-lymphocyte ratio is superior to prognostic nutritional index and platelet-to-lymphocyte ratio in predicting postoperative recurrence and mortality of patients undergoing surgical resection of non-small-cell lung cancer.
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Liu F, Zhou S, Tan L, Jiang H, Huang Y. A Retrospective Cohort Study on Pretreated Neutrophil-to-Lymphocyte Ratio and Prognosis of Small Cell Lung Cancer: Evidence of Effect Modification by Chemotherapy Regimen. Cancer Manag Res 2020; 12:10341-10352. [PMID: 33116889 PMCID: PMC7586078 DOI: 10.2147/cmar.s263863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose Neutrophil-to-lymphocyte ratio (NLR) has been suggested as an independent risk factor for progression-free survival (PFS) and overall survival (OS) in small cell lung cancer (SCLC). However, it is still unknown whether there is a linear relationship between the NLR and the risk of death in SCLC. The objective of this study is to provide further results. Patients and Methods A retrospective cohort study was performed among a total of 251 participants with SCLC. Smooth curve fitting and piecewise Cox regression model were used to determine the linear relationship between NLR and mortality risk. A multivariable Cox regression model was used to estimate the effects of NLR on OS. Interaction and stratified analyses were conducted according to covariates. Results The analysis indicated no significant nonlinear relationship or threshold effect between NLR and hazard of death. Multivariate analysis revealed that every unit increase in NLR was associated with a 10% increase in mortality risk. High NLR (>3.5) at baseline was associated with poor OS (hazard ratio [HR]=1.97, P=0.009). The difference in median OS duration between the high and low NLR groups was statistically significant (9.1 months vs 14.6 months, P=0.0067). Furthermore, interaction analysis identified the chemotherapy regimen to play an interactive role in the association between NLR and hazard of death. Conclusion NLR was identified as an independent risk factor for OS in SCLC and the linear correlation was observed between them. Administration of etoposide plus cisplatin (EP) regimen in patients with low NLR resulted in better long-term outcome than that of etoposide plus carboplatin (EC) regimen, while administration of the EC regimen conferred longer OS than that of the EP regimen in patients with high NLR.
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Affiliation(s)
- Feiwen Liu
- Oncology Medical College, Guangxi Medical University, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Shaozhang Zhou
- Oncology Medical College, Guangxi Medical University, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.,Department of Respiratory Oncology, Guangxi Medical University Affiliated Tumor Hospital, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Liping Tan
- Department of Respiratory Oncology, Guangxi Medical University Affiliated Tumor Hospital, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Huiqin Jiang
- Oncology Medical College, Guangxi Medical University, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yucong Huang
- Oncology Medical College, Guangxi Medical University, Nanning City 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
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Riewruja K, Amarase C, Osateerakun P, Weerasopone S, Limpaphayom N, Honsawek S. Neutrophil-to-lymphocyte ratio predicts the severity of motor impairment in cerebral palsy children living at home and the rehabilitation center: A comparative study. Biomed Rep 2020; 13:63. [PMID: 33149907 DOI: 10.3892/br.2020.1370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the neutrophil-to-lymphocyte ratio (NLR) level in children with cerebral palsy (CP) living at home or the rehabilitation center. The correlation of NLR with different severities of motor impairment was assessed. This was a single-center, cross-sectional, observational study. A total of 80 CP children who were either living at home (n=34) or at the rehabilitation center (n=46) were included. Demographic characteristics, anthropometric parameters and complete blood counts were recorded, and the NLR values were calculated. The severity of motor impairment was evaluated and categorized according to the Gross Motor Functional Classification System (GMFCS) level. The mean age of CP participants was 8.52±1.92 years. The percentage of children with CP who were malnourished (underweight, stunted and wasted) was higher amongst those at the rehabilitation center compared with those living at home. The mean NLR of children with CP in the rehabilitation center was significantly higher compared with the patients living at home (P=0.003). Participants from the rehabilitation center had severe motor impairment (GMFCS levels IV-V) and significantly higher NLR values than those with mild motor impairments (GMFCS levels II-III; P=0.006). However, there were no differences in NLR values in relation to severity of motor impairment in CP children living at home. CP children had some degree of neuroinflammation and systemic inflammation. NLR may be a potential simple inflammatory parameter that may be used to predict the severity of the motor impairment, particularly in CP children living at a rehabilitation center.
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Affiliation(s)
- Kanyakorn Riewruja
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.,Department of Biochemistry, Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Chavarin Amarase
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Phatcharapa Osateerakun
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Soarawit Weerasopone
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Noppachart Limpaphayom
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Sittisak Honsawek
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.,Department of Biochemistry, Osteoarthritis and Musculoskeleton Research Unit, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
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High neutrophil to lymphocyte ratio as a prognostic marker in COVID-19 patients. Clin Nutr ESPEN 2020; 40:101-102. [PMID: 33183520 PMCID: PMC7427597 DOI: 10.1016/j.clnesp.2020.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022]
Abstract
Systemic inflammation has been reported as a new predictor for COVID-19 outcomes. Thus, we highlight in this viewpoint the importance of the neutrophil to lymphocyte ratio in COVID-19 pandemic-infected patients.
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Development of predictive models for nutritional assessment in the elderly. Public Health Nutr 2020; 24:449-456. [PMID: 32753089 DOI: 10.1017/s1368980020002153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To propose malnutrition screening methods for the elderly population using predictive multivariate models. Due to the greater risk of nutrition deficiencies in ageing populations, nutritional assessment of the elderly is necessary in primary health care. DESIGN This was a cross-sectional study. Multivariate models were obtained by means of discriminant analysis and binary logistic regression. The diagnostic accuracy of each multivariate model was determined and compared with the Chang method based on receiver operating characteristic curves. The optimal cut-point, sensitivity, specificity and Youden index were estimated for each of the models. SETTING The province of Cordoba, Spain. PARTICIPANTS Two hundred fifty-five patients over the age of 65 years from three health centres and three nursing homes. RESULTS Fourteen models for predicting risk of malnutrition were obtained, six by discriminant multivariate analysis and eight by binary logistic regression. Sensitivity ranged from 55·6 to 93·1 % and specificity from 64·9 to 94 %. The maximum and minimum Youden indexes were 0·77 and 0·49, respectively. We finally selected a model which does not require a blood test. CONCLUSIONS The proposed models simplify nutritional assessment in the elderly and, except for number 2 of those calculated by binary logistic regression, have better diagnostic accuracy than the Spanish version of the Mini Nutritional Assessment screening tool. The selected model, whose validation is necessary for the future with other different samples, provides good diagnostic accuracy, and it can be performed by non-medical personnel, making it an accessible, easy and rapid tool in daily clinical practice.
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Ooi SL, Pak SC, Micalos PS, Schupfer E, Zielinski R, Jeffries T, Harris G, Golombick T, McKinnon D. Rice bran arabinoxylan compound and quality of life of cancer patients (RBAC-QoL): Study protocol for a randomized pilot feasibility trial. Contemp Clin Trials Commun 2020; 19:100580. [PMID: 32548333 PMCID: PMC7284132 DOI: 10.1016/j.conctc.2020.100580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Rice bran arabinoxylan compound (RBAC) is a nutraceutical for enhancing a depleted immune system during and after cancer treatment. This pilot feasibility trial aims to evaluate the effects of RBAC on cancer patients' quality of life during active treatment, compared to placebo, using a validated questionnaire. Other outcome measures include changes in inflammatory and nutritional status, cytokine profile, and gut microbiota. Methods/Design The study will recruit 50 participants from a regional cancer center in Australia. Patients aged 18–70, diagnosed with solid organ cancers stage II and above, and currently undergoing active systemic therapies, are eligible. Random allocation of participants into two groups is stratified based on metastatic status and treatment type. The dosage is either 3 g/day of RBAC or placebo in identical packaging. The participants, study coordinator, and treating oncologists are blinded to the interventions. Data collections are at baseline and at four follow-up sessions, which are six weeks apart (24 weeks). Statistical analysis will involve a protected p-value with multiple dependent values and analyzed by ANOVA with repeated measures on the occasion of testing and with both a full Bonferroni or Sidak corrections applied to protect against Type I errors. Any observed significance warrants further analysis with pairwise comparisons. Analysis of covariance will also be performed to assess any influence of the demographic data, cancer diagnosis, as well as changes in physical activity, dietary habits, and complementary medicine usage. Comparisons of gut microbiota will be based on the analysis of the fecal microbiome using 16S ribosomal ribonucleic acid amplicon sequencing. The proposed research timeline is from October 2018 to May 2022. Trial registration ANZCTR. Reg No: ACTRN12619000562178p.
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Affiliation(s)
- Soo Liang Ooi
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
- Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia
| | - Sok Cheon Pak
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
- Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia
- Corresponding author. School of Biomedical Sciences, Charles Sturt University, Panorama Avenue, Bathurst, NSW, 2795, Australia.
| | - Peter S. Micalos
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
| | - Emily Schupfer
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
| | - Rob Zielinski
- Central West Cancer Centre, Orange Health Service, Orange, NSW, 2800, Australia
- School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Thomas Jeffries
- School of Science, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Garth Harris
- BioMedica Nutraceuticals Pty Ltd, Alexandria, NSW, 2015, Australia
| | | | - David McKinnon
- Edith Cowan Institute for Education Research, Edith Cowan University, Joondalup, WA, 6027, Australia
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Ahn SS, Yoo J, Jung SM, Song JJ, Park YB, Lee SW. Comparison of the Clinical Implications among Five Different Nutritional Indices in Patients with Lupus Nephritis. Nutrients 2019; 11:nu11071456. [PMID: 31252552 PMCID: PMC6682980 DOI: 10.3390/nu11071456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is characterized with aberrant responses in the immune systems and lupus nephritis (LN) is one of the most serious complications of SLE. This study evaluated the clinical significance of different nutritional indices in 207 renal biopsy-proven LN patients. The clinical and laboratory data were reviewed, and five different nutritional indices were calculated: (i) Controlling nutritional status (CONUT) score; (ii) prognostic nutritional index (PNI); (iii) nutritional risk index; (iv) neutrophil-to-lymphocyte ratio; and (v) body mass index. The factors associated with end-stage renal failure (ESRF) were assessed using a Cox-proportional hazard analysis. The patients with ESRF had significantly lower median PNI (31.1 vs. 34.7, p = 0.012) than those without ESRF at baseline. The CONUT score and PNI had the highest correlation between the SLE disease activity index-2000 (r = 0.467 and p = −0.356, all p < 0.001) and was significantly associated with SLE activity-related measures. In the Cox-proportional hazard analysis, PNI (odds ratio 0.925, 95% confidence interval 0.865–0.989, p = 0.022) was independently associated with ESRF along with creatinine and chronicity index, and the renal survival rate was significantly lower in patients with PNI ≤35.41 than in those with PNI >35.41 (p = 0.003). Among nutritional indices, the CONUT score and PNI better correlated with disease activity and PNI was associated with ESRF.
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Affiliation(s)
- Sung Soo Ahn
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Juyoung Yoo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul 03722, Korea.
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Kaya T, Açıkgöz SB, Yıldırım M, Nalbant A, Altaş AE, Cinemre H. Association between neutrophil-to-lymphocyte ratio and nutritional status in geriatric patients. J Clin Lab Anal 2018; 33:e22636. [PMID: 30058169 DOI: 10.1002/jcla.22636] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) and presence of malnutrition have been found to be associated with mortality and morbidity in various clinical conditions. We investigated the association between NLR and nutritional status in geriatric patients. METHODS This cross-sectional study included 95 geriatric (age ≥ 65 years) patients from general internal medicine outpatient clinic of a university hospital. Nutritional status of the patients was evaluated using Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index, albumin, total cholesterol, body mass index, mid-arm circumference, and calf circumference. NLR was calculated from the complete blood count results. RESULTS A total of 59 patients were female, and the mean age was 73 ± 9.8 years. According to the MNA, 51.6% of patients had a normal nutritional status, and 48.4% were malnourished or at risk of malnutrition. The mean NLR of patients with malnourished or at risk of malnutrition was significantly higher than that of patients with normal nutritional status (P = 0.004). There was a negative correlation between NLRs and the MNA scores (r = -0.276, P = 0.007). Optimal NLR cutoff point for patients with malnourished or at risk of malnutrition was 1.81 with 71.7% sensitivity and 63.3% specificity [95% confidence interval (CI): 0.562-0.780, P = 0.004]. Logistic regression analysis revealed that elevated NLR was an independent factor in prediction of malnutrition or risk of malnutrition in geriatric patients. CONCLUSION These results demonstrated that NLR was associated with the nutritional status of geriatric patients. NLR may be a useful nutritional marker for evaluating the nutritional status of geriatric outpatients.
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Affiliation(s)
- Tezcan Kaya
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Seyyid Bilal Açıkgöz
- Department of Internal Medicine, Kargı Ahmet Hamdi Akpınar State Hospital, Çorum, Turkey
| | - Mehmet Yıldırım
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ahmet Nalbant
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ayfer Erdoğan Altaş
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Hakan Cinemre
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
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