Increased neutrophil to lymphocyte ratio in persons suffering from hypertension with hyperhomocysteinemia

Peripheral immune profile in drug-naïve dementia with Lewy bodies

BACKGROUND

Accumulating evidence suggests that peripheral inflammation is associated with the pathogenesis of Parkinson's disease (PD). We examined peripheral immune profiles and their association with clinical characteristics in patients with DLB and compared these with values in patients with PD.

METHODS

We analyzed peripheral blood from 93 participants (drug-naïve DLB, 31; drug-naïve PD, 31; controls, 31). Absolute leukocyte counts, absolute counts of leukocyte subpopulations, and peripheral blood inflammatory indices such as neutrophil-to-lymphocyte ratio were examined. Associations with clinical characteristics, cardiac sympathetic denervation, and striatal 123I-2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) binding were also examined.

RESULTS

Patients with DLB had lower absolute lymphocyte and basophil counts than did age-matched controls (both; p < 0.005). Higher basophil counts were marginally associated with higher global cognition (p = 0.054) and were significantly associated with milder motor severity (p = 0.020) and higher striatal 123I-FP-CIT binding (p = 0.038). By contrast, higher basophil counts were associated with more advanced PD characterized by decreased global cognition and severe cardiac sympathetic denervation. Although lower lymphocyte counts had relevance to more advanced PD, they had little relevance to clinical characteristics in patients with DLB. Higher peripheral blood inflammatory indices were associated with lower body mass index in both DLB and PD.

CONCLUSIONS

As in patients with PD, the peripheral immune profile is altered in patients with DLB. Some peripheral immune cell counts and inflammatory indices reflect the degree of disease progression. These findings may deepen our knowledge on the role of peripheral inflammation in the pathogenesis of DLB.

Neutrophil-lymphocyte ratio and its relation to microvascular complication in geriatric patients with diabetes: a case-controlled study

Background

Diabetes mellitus is a complex chronic disease characterized by chronic hyperglycemia resulting from defective insulin secretion, defective insulin action, or both. Chronic hyperglycemia related to diabetes can lead to end-organ dysfunction or failure, and changes related to diabetes involving arterioles and capillaries are responsible for long-term microvascular complications in diabetic patients. The neutrophil-to-lymphocyte ratio (NLR) is a novel, simple, and inexpensive marker of subclinical inflammation.

Aim of work

To evaluate the possibility that neutrophil-lymphocyte ratio (NLR) could be used as a predictor of microvascular complications during follow-up of elderly patients with type 2 diabetes.

Patients and methods

Sixty elderly diabetes patients ≥ 65 years old, diagnosed 16 according to ADA criteria, were collected from the endocrine clinic in Kasr El-Ainy Hospital. For every patient, full history and examination were done (including 18 neurological and fundus examinations). Labs (CBC with a differential in blood and 19 albumin/creatinine ratio in urine) were done and the neutrophil/lymphocyte ratio.

Results

We found that NLR has a statistically significant difference in the detection of nephropathy and retinopathy. There is a significant correlation between nephropathy and NL ratio in all patients (r = 0.44, P < 0.001). Elderly diabetic patients (with or without hypertension) with microvascular complications had a higher NLR value than those without complications.

Conclusion

NLR value can be used as a non-invasive simple marker for predicting microvascular complications in elderly diabetics with/without hypertension.

Retraction

Li, J., Tong, D., Wang, Y., Liu, Y., Zhang, X., Liu, N., Wang, S., Xu, Y., Li, Y., Yin, X., Liu, W. and Shao, Y. (2021), Neutrophil extracellular traps enhance procoagulant activity in patients with essential hypertension. J Thromb Haemost. https://doi.org/10.1111/jth.15210 The above article, published online on 12 December 2020 on Wiley Online Library (wileyonlinelibrary.com), has been retracted by mutual agreement among the authors, the journal co- Editors-in-Chief, David Lillicrap, MD, FRCPC and James Morrissey, PhD, the International Society on Thrombosis and Haemostasis, and Wiley Periodicals LLC The retraction has been issued due to unattributed overlap between this article and the following article published in Thrombosis Research, "Neutrophil extracellular traps exacerbate coagulation and endothelial damage in patients with essential hypertension and hyperhomocysteinemia" by Li, J-H, Tong, D-X, Wang, Y, Gao, L, Liu, Y, Zhang, X-H, Chen, W-J, Chi, J-Y, Liu N, Yang, K, Wang, S-P, Xu, Y, Li, Y, Yin, X-H, Liu, W-X. Volume 197, 2021, pages 36-43. https://doi.org/10.1016/j.thromres.2020.10.028.

Oxidative Stress, GTPCH1, and Endothelial Nitric Oxide Synthase Uncoupling in Hypertension

Significance: Hypertension has major health consequences, which is associated with endothelial dysfunction. Endothelial nitric oxide synthase (eNOS)-produced nitric oxide (NO) signaling in the vasculature plays an important role in maintaining vascular homeostasis. Considering the importance of NO system, this review aims to provide a brief overview of the biochemistry of members of NO signaling, including GTPCH1 [guanosine 5'-triphosphate (GTP) cyclohydrolase 1], tetrahydrobiopterin (BH4), and eNOS. Recent Advances: Being NO signaling activators and regulators of eNOS signaling, BH4 treatment is getting widespread attention either as potential therapeutic agents or as preventive agents. Recent clinical trials also support that BH4 treatment could be considered a promising therapeutic in hypertension. Critical Issues: Under conditions of BH4 depletion, eNOS-generated superoxides trigger pathological events. Abnormalities in NO availability and BH4 deficiency lead to disturbed redox regulation causing pathological events. This disturbed signaling influences the development of systemic hypertension as well as pulmonary hypertension. Future Directions: Considering the importance of BH4 and NO to improve the translational significance, it is essential to continue research on this field to manipulate BH4 to increase the efficacy for treating hypertension. Thus, this review also examines the current state of knowledge on the effects of eNOS activators on preclinical models and humans to utilize this information for potential therapy.

Neutrophil extracellular traps exacerbate coagulation and endothelial damage in patients with essential hypertension and hyperhomocysteinemia

Patients with essential hypertension (EH) and hyperhomocysteinemia (HHCY) suffer from more increased thrombotic events than those in EH alone. However, the underlying mechanisms for this effect are not well understood. This study hypothesized that neutrophil extracellular trap (NET) releasing may be triggered by HHCY in patients in EH, thereby predisposing them to a more hypercoagulable state. Using a modified-capture enzyme-linked immunosorbent assay (ELISA) method, we observed that cell-free DNA (CF-DNA) and myeloperoxidase DNA (MPO-DNA) in patients With EH and HHCY were significantly higher. The NET formation was also positively correlated with homocysteine levels, neutrophil-lymphocyte ratio (NLR), and hypercoagulable markers (thrombin-antithrombin complex, D-dimers). Furthermore, neutrophils from patients in EH with HHCY were found to be predisposed to amplified NET release when compared to patients in EH without HHCY or CTR. Coagulation function assays showed that NETs in patients With EH and HHCY resulted in a significantly increased ability to generate thrombin and fibrin than in those in EH without HHCY or CTR. These procoagulant effects of NETs in patients With EH and HHCY were markedly inhibited (approximately 70%) by the cleavage of NETs with DNase I. Isolated NETs from patients With EH and HHCY neutrophils also exerted a strong cytotoxic effect on endothelial cells (ECs), converted them to apoptosis. This study revealed a previously unrecognized association between the hypercoagulable state and neutrophils in patients With EH and HHCY. Therefore, blocking NETs may represent a new therapeutic objective for preventing thrombosis in these patients.

Differential leukocyte count is associated with clinical phenotype in Parkinson's disease

INTRODUCTION

Elevated proinflammatory cytokines are associated with disease progression in patients with Parkinson's disease (PD). The aim of study is to investigate whether components of peripheral blood leukocyte are associated with clinical symptoms in patients with de novo PD.

METHODS

We analyzed data from 123 newly diagnosed de novo patients who had no focal and systemic inflammatory diseases. Associations between clinical symptoms and differential leukocyte count (DLC) or DLC associated peripheral inflammatory biomarkers were examined.

RESULTS

Altered DLC and DLC associated peripheral inflammatory biomarkers were associated with PD related symptoms even though there was no sign of clinical inflammation. After controlling for covariables, olfaction and body mass index (BMI) were inversely associated with percentage of neutrophil, neutrophil to lymphocyte ratio, derived neutrophil to lymphocyte ratio, and positively associated with percentage of lymphocyte, lymphocyte to monocyte ratio. Patients with tremor-dominant or mixed type had lower peripheral inflammatory indices than those with akinetic rigid type.

CONCLUSION

Components of peripheral blood leukocytes reflect some clinical symptoms of PD. Patients with normosmia, tremor-dominant or mixed type, and patients without low BMI have low peripheral inflammatory indices. Relative mild peripheral inflammation may play one of major roles in developing mild disease phenotype in these patients.

Evaluation of platelet distribution width in hypertension with hyperhomocysteinemia

An increased platelet distribution width (PDW) value has been found in various cardiovascular diseases. The objective of this study was to evaluate the association between the PDW and hypertension with hyperhomocysteinemia in an elderly cohort. We performed a cross-sectional analysis among 2,685 elderly individuals who underwent hematological testing and blood pressure assessment. Individuals were divided according to the PDW quartiles. An unconditional multiple logistic regression analysis was used to determine the association between PDW and hypertension with hyperhomocysteinemia, after adjustments for gender, age, drinking status, creatinine levels, glucose levels, uric acid levels, triglyceride levels, platelet counts and body mass index. Homocysteine was observed to steadily and remarkably increase in the PDW quartiles. The PDW values of the hypertension with hyperhomocysteinemia group were significantly greater than the PDW values in the hypertension without hyperhomocysteinemia group or the normotension group. The PDW levels were associated with hypertension and hyperhomocysteinemia independently of the previously mentioned risk factors, and the odds ratio of the hypertension with hyperhomocysteinemia group was steadily and remarkably increased, by as much as two-fold, in the fourth quartile vs. the first quartile. In this elderly population-based cohort, elevated PDW levels were independently associated with hypertension and hyperhomocysteinemia, which may indicate that hypertension and hyperhomocysteinemia can induce platelet activation.

The neutrophil-to-lymphocyte ratio on admission is a good predictor for all-cause mortality in hypertensive patients over 80 years of age

BACKGROUND

Immuno-inflammation plays a major role in the process of hypertension. We aimed to evaluate the association between inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW) and all-cause mortality in elderly patients with hypertension.

METHODS

A total of 341 hypertensive patients over 80 years of age were included to this study. The NLR and RDW were measured on admission and all the selected patients were followed up for up to 90 days. Kaplan-Meier curves were plotted to evaluate the association between the NLR and the all-cause mortality at follow-up. Using Cox regression models, we investigated the prognostic value of NLR and RDW for all-cause mortality.

RESULTS

Patients with higher quartile of NLR linked to high mortality in hypertensive patients at 90 day after admission (16.47%,13.25%,1.14%,1.17% respectively; χ² = 20.581,P = 0.000). Surviving patients had lower RDW (13.61 ± 1.37 VS 14.18 ± 1.38, p = 0.041) and NLR (4.97 ± 5.72 VS 7.95 ± 6.88,p = 0.011). The receiver operating curve (ROC) of the NLR for all-cause mortality had an area under the curve (AUC) =0.714 (95%CI: 0.629-0.798, P = 0.000), with acritical value of 2.97, with sensitivity of 92.6%, and a specificity of 52.5%. The ROC of the RDW to predict all-cause mortality, had an AUC =0.654 (95%CI:0.548-0.761, P = 0.008), with acritical value of 13.2%.The Kaplan-Meier curve showed a significant difference between different NLR levels (p = 0.002). Multivariate Cox proportional hazard analysis shown 3rd quartile of NLR(RR = 9.646, 95% CI 1.302-34.457, P = 0.041) and 4th quartiles(RR = 16.451, 95% CI 2.137-66.643, P = 0.007) were found to independently predict all-cause death in hypertensive patients over 80 years of age. Higher rank of NLR was link to higher incidence of all-cause death for such patients.

CONCLUSION

The findings of the present study demonstrate the potential utility of NLR in risk stratification of elderly patients with hypertension to provide information for clinical treatment strategies.

WBC count predicts the risk of new-onset peripheral arterial disease in a Chinese community-based population

This longitudinal cohort study investigated whether peripheral WBC counts could predict peripheral arterial disease (PAD) incidence after a 2.3-year follow-up in a Chinese community-based population without PAD at baseline. A total of 3555 Chinese subjects without fever and PAD at baseline from an atherosclerosis cohort were included in our analysis. The ankle brachial index (ABI) was measured, and PAD was defined as an ABI <0.9. Multivariate regression models were used to evaluate the association of WBC count and new-onset PAD. The mean (±s.d.) baseline WBC count was 6.11±1.54 × 10⁹ l^-1, the mean (±s.d.) ABI was 1.11±0.08 at baseline and the incidence of PAD was 2.7% over 2.3 years. WBC counts were significantly associated with PAD incidence (odds ratio (OR)=1.27, 95% confidence interval (CI): 1.14-1.41, P<0.0001) with every 1 × 10⁹ l^-1 increase in WBC count. This relationship remained significant (OR=1.21, 95% CI: 1.08-1.36, P=0.0014) even after adjusting for other variables. The highest WBC quartile group had increased risk when compared with the lowest quartile group (OR=2.14, 95% CI: 1.09-4.22, P=0.027) in a multivariate logistic model. Furthermore, we did not find significant heterogeneity among the analyzed subgroups based on sex (male or female), age (<60 or ⩾60 years old), body mass index (BMI, <25 or ⩾25 kg m^-2), current smoking, current drinking, hypertension, diabetes mellitus, dyslipidemia or cardiovascular disease. In conclusion, elevated WBC counts independently predict the risk of new-onset PAD in a Chinese community-based population, supporting the hypothesis that systemic inflammation plays an important role in PAD development.

Association between mean platelet volume and hypertension incidence

Mean platelet volume (MPV) is increased in various cardiovascular diseases. We sought to determine the prognostic value of MPV for hypertension. We performed a retrospective cohort study. Baseline characteristics were measured in 9168 individuals without hypertension, and the follow-up period was 9 years. Hypertension was confirmed in 2881 participants during the follow-up period. When the participants were grouped according to MPV quartiles, the hazard ratio of future hypertension gradually increased across the MPV quartiles. The hazard ratios of hypertension for the II, III and IV (high) vs. I (low) quartiles of MPV were 1.13 (95% confidence interval (CI) 1.01-1.25, P=0.027), 1.25 (95% CI 1.12-1.39, P<0.001) and 1.40 (95% CI 1.26-1.55, P<0.001), respectively. In multivariate Cox regression analysis, MPV predicted hypertension independently of age, sex, platelet count, waist circumference, drinking, systolic blood pressure and creatinine levels. The present study indicated that elevated MPV is associated with increased incidence of hypertension independent of other risk factors, which suggests that platelet activity may play a role in hypertension incidence.

High Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Mortality in Chronic Hemodialysis Patients

The neutrophil-to-lymphocyte ratio (NLR) is a novel simple biomarker of inflammation. It has emerged as a predictor of poor prognosis in cancer and cardiovascular disease in general population. But little was known of its prognostic value in chronic hemodialysis (HD) patients. Here we investigated the association between NLR and cardiovascular risk markers, including increased pulse pressure (PP), left ventricular mass index (LVMI) and intima-media thickness (IMT), and mortality in HD patients. Two hundred and sixty-eight HD patients were enrolled in this study and were followed for 36 months. The primary end point was all-cause mortality and cardiovascular mortality. Multivariable Cox regression was used to calculate the adjusted hazard ratios for NLR on all-cause and cardiovascular survival. We pinpointed that higher NLR in HD patients was a predictor of increased PP, LVMI, and IMT; HD patients with higher NLR had a lower survival at the end of the study; furthermore, high NLR was an independent predictor of all-cause and cardiovascular mortality when adjusted for other risk factors. In conclusion, higher NLR in HD patients was associated with cardiovascular risk factors and mortality.