Elevated neutrophil-to-lymphocyte ratio in pseudoexfoliation syndrome

Predictive role of systemic immune-inflammation index and neutrophil/lymphocyte ratio values in infants with retinopathy of prematurity

PURPOSE

To search the relationship between serum neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) values with the development of retinopathy of prematurity (ROP) and the requirement for laser treatment.

METHODS

This retrospective cohort study was carried out with 195 preterm infants between 2012 and 2023. The NLR, PLR, LMR, and SII values were calculated on both the first day and at the end of the first month after birth. The association between development of ROP and other risk factors were analyzed using univariate analysis and multivariate logistic regression analysis.

RESULTS

Of patients, 92 infants were diagnosed with ROP. Laser treatment was administered to 36 infants. The postnatal first-day NLR and SII values were higher in infants with ROP than in infants without ROP (p < 0.001 for both). Postnatal first-month NLR, LMR, and SII values were higher in infants with ROP (p < 0.001, p = 0.007, and p < 0.001, respectively). In multivariate analyses, postnatal first-day NLR and first-month LMR values were regarded as independent risk factors for the development of ROP (OR:8.867 and 1.286, p = 0.002 and p = 0.009, respectively). In multivariate analyses performed for laser treatment requirement, postnatal first-month PLR and SII values were determined as independent risk factors (OR:0.951 and 1.011, respectively, p = 0.004 for both).

CONCLUSIONS

Postnatal first-day NLR and first-month LMR values were determined as independent risk factors for the development of ROP. For the requirement of laser treatment, the postnatal first-month PLR and SII values were determined as independent risk factors.

Inflammation and Neurodegeneration in Glaucoma: Isolated Eye Disease or a Part of a Systemic Disorder? - Serum Proteomic Analysis

Introduction

Glaucoma is the most common optic neuropathy and the leading cause of irreversible blindness worldwide, which affects 3.54% of the population aged 40-80 years. Despite numerous published studies, some aspects of glaucoma pathogenesis, serum biomarkers, and their potential link with other diseases remain unclear. Recent articles have proposed that autoimmune, oxidative stress and inflammation may be involved in the pathogenesis of glaucoma.

Methods

We investigated the serum expression of 92 inflammatory and neurotrophic factors in glaucoma patients. The study group consisted of 26 glaucoma patients and 192 healthy subjects based on digital fundography.

Results

Patients with glaucoma had significantly lower serum expression of IL-2Rβ, TWEAK, CX3CL1, CD6, CD5, LAP TGF-beta1, LIF-R, TRAIL, NT-3, and CCL23 and significantly higher expression of IL-22Rα1.

Conclusion

Our results indicate that patients with glaucoma tend to have lower levels of neuroprotective proteins and higher levels of neuroinflammatory proteins, similar to those observed in psychiatric, neurodegenerative and autoimmune diseases, indicating a potential link between these conditions and glaucoma pathogenesis.

Systemic immuno-inflammatory index in patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma

Background

In recent years, the role of some hematological parameters used as chronic inflammation markers in the pathogenesis of many ocular and systemic diseases has been investigated. For ocular diseases such as uveitis, keratoconus, and retinal vein occlusion, the neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII) have been reported to be useful inflammatory biomarkers. It has also been reported that low-grade chronic inflammation plays a role in the formation of pseudoexfoliation.

Objective

To evaluate the NLR, SII, and platelet-lymphocyte ratio (PLR) in patients with pseudoexfoliation syndrome (PEXS) and pseudoexfoliative glaucoma (PEXG).

Design

This was a retrospective case-control study.

Methods

This study evaluated the clinical and laboratory data of 34 patients with PEXS, 33 patients with PEXG, and 33 control patients. Detailed eye examination notes in patient files and blood count measurements were recorded.

Results

SII values were the highest in the PEXS group, followed by the PEXG and control groups (582.01 ± 339.9, 478.14 ± 211.7, and 413.98 ± 129.5, respectively) (p = 0.043). In paired comparisons, the SII values of the PEXS group were significantly higher than the control group (p = 0.011). The mean NLR rate was highest in the PEXS group, followed by the PEXG and the control groups (2.46 ± 1.6, 2.17 ± 0.8, and 1.69 ± 0.4, respectively) (p = 0.023). In paired comparisons, the mean NLR levels were higher in the PEXS and the PEXG groups than in the control group (p = 0.03 and p = 0.01, respectively). There was no significant difference between the groups in terms of PLR. According to receiver operating characteristic curve analysis, the optimal cut-off value for estimating PEXS was found as >449.4 for SII and 1.78 for NLR (p = 0.011 and p = 0.031, respectively).

Conclusions

In PEXS patients, both SII and NLR were significantly higher, albeit in a small group of patients, and SII may be a helpful and supportive parameter for NLR in risk estimation in these patients. There was a statistically significant difference only in NLR in patients with PEXG when compared with the control group. However, these results need to be supported by future longitudinal and larger studies to identify any possible link between hematological inflammatory markers and pseudoexfoliation.

Impact of cardiovascular comorbidity on increased neutrophil-lymphocyte ratio in pseudoexfoliation syndrome

BACKGROUND

The purpose of this study was to compare neutrophil-to-lymphocyte ratios (NLRs) of patients with pseudoexfoliation syndrome (PEX) according to the presence of cardiovascular disease (CVD) with those without CVD as controls.

METHODS

A total of 197 participants (97 patients with PEX and 100 participants without PEX regarded as the control group) were included in this retrospective study. The PEX group was divided into 2 subgroups, PEX with CVD (group 1) and PEX without CVD (group 2). NLRs were then compared to those of the control group.

RESULTS

The incidence of CVD was significantly (P = .015) higher in the PEX group than in the control group. NLR was significantly higher in the group 1 and group 2 compared with that of the control group (P = .048 and P = .002, respectively). In the PEX group, group 1 showed higher NLR than group 2 (P = .023).

CONCLUSION

Although the PEX group showed a higher incidence of CVD, the NLR was higher in the PEX group regardless of cardiovascular comorbidity than that in the control group.

Neutrophils and neutrophil extracellular trap components: Emerging biomarkers and therapeutic targets for age-related eye diseases

Age-related eye diseases, including dry eye, glaucoma, age-related macular degeneration, and diabetic retinopathy, represent a major global health issue based on their increasing prevalence and disabling action. Unraveling the molecular mechanisms underlying these diseases will provide novel opportunities to reduce the burden of age-related eye diseases and improve eye health, contributing to sustainable development goals achievement. The impairment of neutrophil extracellular traps formation/degradation processes seems to be one of these mechanisms. These traps formed by a meshwork of DNA and neutrophil cytosolic granule proteins may exacerbate the inflammatory response promoting chronic inflammation, a pivotal cause of age-related diseases. In this review, we describe current findings that suggest the role of neutrophils and their traps in the pathogenesis of the above-mentioned age-related eye diseases. Furthermore, we discuss why these cells and their constituents could be biomarkers and therapeutic targets for dry eye, glaucoma, age-related macular degeneration, and diabetic retinopathy. We also examine the therapeutic potential of some neutrophil function modulators and provide several recommendations for future research in age-related eye diseases.

Increased Desmosine in the lens capsules is associated with augmented elastin turnover in Pseudoexfoliation syndrome

Pseudoexfoliation syndrome (PXF) is an idiopathic disease with a high prevalence rate. The elastosis disorder is contributed by genetic and non-genetic factors. Elastin dysregulation associated with the disease mechanism is incompletely understood. This study evaluated the molecules of the elastogenesis machinery in PXF. Lens capsule and aqueous humor (aqH) samples (age/sex-matched) were collected from the eyes with PXF alone and PXF with glaucoma (PXF-G) undergoing Extra Capsular Cataract Extraction (ECCE) surgery. The Elastin turnover was assessed by estimating Desmosine levels in the lens capsules by HPLC analysis. Expression of elastogenesis genes [EMILIN1, CLU, FBN1, FN1, FBLN5, FBLN4 and LOXL1] were evaluated in the lens capsule by qPCR while the proteins were assessed in aqH by western blot analysis. The Desmosine content in the lens capsules were 3-fold and 6-fold elevated in PXF (P = 0.02) and PXF-G (P = 0.01) respectively compared to the cataract-alone, indicating increased elastin degradation. A significant increase in the transcript levels of the CLU, FBLN4, EMILIN1, FBLN5, FN1, FBN1, LOXL1 along with significant changes in protein expression of CLU, FBLN5, FBN1 and LOXL1 signified up-regulation of the elastogenesis machinery. The study provides direct evidence of augmented elastin degradation and turnover in the lens capsule of PXF marked by increased Desmosine content and the expression of proteins involved in mature elastin formation.

Relationship of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio With Visual Acuity After Surgical Repair of Open Globe Injury

Purpose: To assess the relationship and prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with poor final best-corrected visual acuity (BCVA) after surgical repair of open globe injuries (OGI) in adults.

Design: Retrospective analysis of data from an ongoing prospective cohort of consecutive patients.

Methods: In a tertiary university hospital, 197 eyes of 197 patients were included between 2013 and 2017. NLR and PLR were obtained from pre-operative blood tests to analyze its relationship with poor final BCVA.

Results: Severe visual impairment (SVI) was defined as ≤20/200, and was observed in 96 (48.7%) patients after surgical repair of OGI. SVI patients had higher NLR (7.4 ± 6.6 vs. 4.0 ± 3.2, p < 0.001), and PLR (167 ± 92 vs. 139 ± 64; p = 0.021) than non-SVI. NLR ≥ 3.47 and PLR ≥ 112.2 were the best cut-off values for SVI, were univariate risk factors for SVI, and had sensitivity: 69.0, 71.4, and specificity: 63.6, 44.8, respectively. In multivariate analysis, only OTS, athalamia, and hyphema remained as risk factors. NLR had significant correlation with ocular trauma score (OTS) (r = −0.389, p < 0.001) and final BCVA (r = 0.345, p < 0.001).

Limitations: Simultaneous trauma in other parts of the body that could influence the laboratory findings.

Conclusion: Patients with SVI after a repaired OGI had increased pre-operative NLR and PLR levels. High NLR and PLR are risk factors for SVI in univariate analysis. It is confirmed that low OTS is a risk factor for SVI. High NLR and PLR could be used as a prognostic tool to identify patients at higher risk for SVI after repair of OGI.

Neutrophil lymphocyte ratio as a predictor of perioperative complications in patients with PEX Syndrome during cataract surgery

INTRODUCTION

Pseudoexfoliation syndrome (PES) is an age-related process associated with glaucoma and cataracts. It increases the risk of complications during cataract surgery. Blood neutrophil-to-lymphocyte ratio (NLR) is shown to be an effective biomarker of inflammation in PES. We aimed to investigate association of NLR and pseudoexfoliation (PEX) related cataract surgery complications.

METHODS

A total of 210 eyes who underwent cataract surgery between January 2016 and January 2020 in our department were analyzed retrospectively. Patients were grouped with respect to developing complications and the two groups were compared. Medical records were reached to obtain neutrophil and lymphocyte values to calculate NLR. Data obtained were analyzed using chi-square test. Receiver operating characteristics curve analysis was performed to determine cutoff, sensitivity and specificity values. p value of ≤ 0.05 was considered statistically significant.

RESULTS

The mean age was 68.1 ± 7.2 years and mean NLR was 2.11 ± 0.81. Complications were observed in 32 (15.2%) of the patients (group 1). Neutrophil counts (5.19 ± 0.64 vs. 4.43 ± 0.86, p < 0.001) and the NLR (2.68 ± 0.73 vs. 2.01 ± 0.81, p < 0.001) of group 1 were significantly higher than group 2. The ROC analysis revealed a cutoff value of 2.33 for NLR to predict cataract surgery complications with sensitivity of 87.5% and specificity of 78.1%.

CONCLUSION

There is an association between NLR and increased risk of complications during cataract surgery in PES patients. NLR can be used as an easy method to help ophthalmologists in predicting the risks associated with cataract surgery in PEX eyes.

Evaluation of inflammatory biomarkers in patients with keratoconus

OBJECTIVE

To investigate the monocyte-to-HDL-cholesterol ratio (MHR), neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), eosinophil-to-lymphocytes ratio (ELR), platelet distribution width (PDW), red blood cell distribution width (RDW), mean platelet volume (MPV), MPV to platelet count ratio (MPV/PC), and RDW to platelet ratio (RPR) that are accepted as inflammatory markers in patients with keratoconus.

METHODS

In this study, 43 patients with keratoconus and 43 healthy individuals as the control group were retrospectively evaluated. High density lipoprotein cholesterol (HDL-c), lymphocyte, neutrophil, eosinophil, monocyte, platelet, MPV, PDW, and RDW values were obtained with complete blood count performed on the peripheral blood samples.

RESULTS

Absolute monocyte (593 ± 182 vs 492 ± 177; p < 0.05) and neutrophil (4860 ± 1553 vs 3954 ± 1297; p < 0.01) counts were statistically significantly higher in the keratoconus groups compared to the control group. MHR (13.18 ± 5.02 vs 9.88 ± 4.45; p < 0.01) and NLR (2.30 ± 0.87 vs 1.77 ± 0.61; p < 0.01) were statistically significantly higher and LMR (4.07 ± 1.67 vs 5.18 ± 2.06; p < 0.01) was significantly lower in the keratoconus group. As a result of univariate logistic regression analysis, it was observed that MHR and NLR were statistically significant relationship with keratoconus (p = 0.02 and p = 0.021) (Odds ratio = 5.41 (95% CI: 1.169-6.669) and Odds ratio:5.28 (95% CI: 1.024-6.321); respectively). No statistically significant difference was found between the groups in terms of PLR, ELR, RDW, MPV, PDW, MPV/PC, and RPR. Adjusting for age and gender, multivariate regression analysis revealed that MHR was the most significant parameter to demonstrate relationship with keratoconus (p = 0.025) (Odds ratio = 4.99 (95% CI: 1.019-6.332)).

CONCLUSION

MHR and NLR values considered as inflammatory markers were statistically significantly higher and LMR value was significantly lower in the keratoconus group. Among these values, MHR was the most reliable parameter.

Neutrophil-to-lymphocyte ratio in ocular diseases: a systematic review

AIM

To summarize the results of studies investigating neutrophil-to-lymphocyte ratio (NLR) and to identify the role of NLR in ocular diseases.

METHODS

With the aim of identifying the studies related to NLR, a search was conducted on http://www.ncbi.nlm.nih.gov/pubmed by utilizing the key words "neutrophil lymphocyte ratio, ocular diseases, and eye diseases" up to February 2018. All of the original articles were assessed according to date of publications, countries, clinics and topics. Studies about ocular inflammatory diseases were evaluated according to their qualifications, review methods and results.

RESULTS

A total of 4473 publications, including original research articles and reviews were screened. The number of publications was shown a regular logarithmic increase over the years. The majority of studies were performed by clinics in Turkey and many of these publications were performed by oncology and cardiology clinics. A total of 75 publications were identified to be about ocular diseases.

CONCLUSION

Elevated NLR as a cheap, reproducible, and readily available marker could be used as a diagnostic and/or prognostic marker in ocular diseases.

May Monocyte/HDL Cholesterol Ratio (MHR) and Neutrophil/Lymphocyte Ratio (NLR) Be an Indicator of Inflammation and Oxidative Stress in Patients with Keratoconus?

OBJECTIVE

To evaluate monocyte/high-density lipoprotein cholesterol ratio (MHR) and neutrophil/lymphocyte ratio (NLR) in patients with keratoconus (KC).

METHODS

Thirty-one patients with KC (group 1) and 31 healthy control subjects (group 2) were included in the study. All participants' ocular examination findings, clinical and laboratory parameters were obtained from file records and laboratory archives.

RESULTS

When group 1 was compared with group 2, MHR (13.7 ± 5.0 vs. 9.1 ± 3.7; p < .001) and NLR (2.3 ± 0.8 vs. 1.7 ± 0.6; p < .001) were statistically significantly higher in group 1. Optimal MHR cutoff value for KC was calculated as 10.2 with 77.4% sensitivity and 64.5% specificity, and optimal NLR cut-off value for KC was found as 1.9 with 71.4% sensitivity and 55% specificity.

CONCLUSION

MHR and NLR values recognized as indicators of oxidative stress and systemic inflammation were significantly higher in patients with KC compared to the control group.

The correlation of routine hematological indices with pterygium

Purpose:

Increased systemic/local inflammation and oxidative stress play a key role in the pathophysiology of pterygium, but there is limited information regarding routine hematological indices’ levels in patients with pterygium. In this study, we aimed to evaluate the levels of complete blood count parameters in patients with pterygium.

Material and Method:

In all, 61 patients with pterygium (pterygium group; mean age = 51.4 ± 13.8 years) and 55 healthy individuals (control group; mean age = 50.2 ± 13.1 years) were included in the study. Participants were given routine ophthalmic examinations; complete blood count parameters were assayed.

Results:

Compared to the control group, red cell distribution width level was significantly higher in patients with pterygium (p = 0.009), but the difference between the groups in terms of the other complete blood count parameters was not statistically significant. However, high-density lipoprotein cholesterol level was significantly lower in the pterygium group than control group (p = 0.015). In the pterygium group, low-density lipoprotein cholesterol levels were lower, but this difference was not statistically significant (p = 0.079).

Conclusion:

Red cell distribution width levels were significantly increased in patients with pterygium. Our data support the idea that inflammation cytokines and oxidative stress may play an important role in the pathogenesis of this disorder.

Elevated levels of plasma tumor necrosis factor alpha in patients with pseudoexfoliation glaucoma

Background

Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine, which plays a role in glaucomatous neurodegeneration. Based on the plausible role of inflammation in the pathogenesis of pseudoexfoliation glaucoma (PEG), we investigated whether there is any relationship between the levels of plasma TNF-α and PEG or any of its clinical indices in comparison to normal controls.

Methods

The study was designed as a retrospective analysis. Plasma samples from 49 PEG patients and 88 non-glaucomatous controls were evaluated for TNF-α levels using an enzyme-linked immunosorbent assay (ELISA). The assay was performed in duplicates on a biochemical/ELISA analyzer.

Results

The two study groups were similar in age, sex and systemic disease distribution. The mean TNF-α concentration was significantly higher in the PEG patients (5.54±4.58 pg/mL) than in the control subjects (0.93±1.49 pg/mL; 95% confidence interval [CI] =3.50–5.72; p=0.000). The overall dose–response trend was significant (χ²=57.07, df=2; p=0.000). A moderate positive and significant correlation was seen between TNF-α level and cup/disc ratio, an important clinical index for PEG. Besides, binary logistic regression analysis showed that the risk of PEG was most significantly affected by TNF-α level as compared to no association with age and sex. In receiver operating characteristic analysis, the area under the curve was 0.777 (95% CI =0.682–0.872) and statistically significant (p=0.000).

Conclusion

Elevated systemic levels of inflammatory marker, TNF-α, are associated with PEG and may possibly serve as a biomarker for undiagnosed early glaucoma and/or as a marker for disease progression.

Increased red cell distribution width levels in children with seasonal allergic conjunctivitis

PURPOSE

Seasonal allergic conjunctivitis (SAC) is an inflammatory disease of the conjunctiva. Red cell distribution width (RDW) is a widely accepted inflammatory marker. We aimed to investigate whether RDW level is associated with the development of SAC in pediatric population.

METHODS

The present study consisted of 90 subjects (45 children with SAC and 45 age- and sex-matched healthy children). The demographic findings, complete blood count parameters including RDW and laboratory parameters, were evaluated.

RESULTS

The mean RDW levels were significantly higher in children with SAC compared to the control group (14.02 ± 0.82 vs. 13.26 ± 0.64%, respectively, p < 0.001). In receiver operating characteristic analysis, the area under the curve for RDW for predicting SAC was 0.786, and a RDW value of 13.45 or higher predicted SAC with a sensitivity of 75.6% and specificity of 65%.

CONCLUSION

Our study suggests that elevated RDW levels are significantly associated with SAC in pediatric population, which may imply a possible role of increased inflammatory status and oxidative stress in the pathogenesis of SAC.

The diagnostic value of white blood cell, neutrophil, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio in patients with primary angle closure glaucoma

Objective

Inflammatory mechanisms may have a role in the pathogenesis of primary angle closure glaucoma (PACG). The objective of this study was to investigate the diagnostic value of white blood cell (WBC), neutrophil, neutrophil to lymphocyte ratio (NLR), and lymphocyte to monocyte ratio (LMR) in patients with PACG and its association with glaucoma severity.

Method

The study was retrospectively assessed in 771 consecutive PACG patients and 770 control subjects, laboratory parameters and clinical parameters were obtained from a medical data platform. Patients were divided into three groups with different severity based on perimetry, i.e. mild (mean deviation (MD) ≤6.00 dB), moderate (12 dB≥ MD>6 dB) and severe (MD>12 dB). We developed a nomogram to specifically identify individual patient’s risk.

Results

The mean levels of neutrophil, NLR and WBC was higher in PACG than control group, and lowest in the mild PACG group, followed by moderate PACG and severe PACG (p<0.05). The AUROC value of NLR and LMR was found to be 0.719, 0.699, respectively. Multiple linear regressions showed that there was a significant correlation between WBC and MD (B=0.151, p<0.001), neutrophil and MD (B=0.143, p=0.003), NLR and MD (B=0.144, p=0.001), LMR and MD (B=-0.100, p=0.034). Logistic regression analyses revealed that WBC (OR=1.208, 95%CI=1.179-1.238), neutrophil (OR=1.598, 95%CI=1.541-1.656), NLR (OR=2.313, 95%CI=2.200-2.431), and LMR (OR=0.682, 95%CI=0.666-0.699) were associated with PACG.

Conclusion

Our study suggested that WBC, neutrophil, NLR, and LMR was related with PACG, and NLR and LMR may be useful as biomarkers.