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Che J, Song J, Long Y, Wang C, Zheng C, Zhou R, Liu Z. Association Between the Neutrophil-Lymphocyte Ratio and Prognosis of Patients Admitted to the Intensive Care Unit With Chronic Heart Failure: A Retrospective Cohort Study. Angiology 2024; 75:786-795. [PMID: 37586709 DOI: 10.1177/00033197231196174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The present study aimed to explore the association between the neutrophil-to-lymphocyte ratio (NLR) and prognosis of critically ill chronic heart failure patients. The records of 5298 patients who met the inclusion criteria were extracted from the Medical Information Mart for Intensive Care IV database. The primary outcome was 30-days all-cause mortality and the secondary outcome was 90-days all-cause mortality. Multivariable logistic regression analysis was performed to examine the relationship between NLR and 30-days mortality. Subgroup analysis was carried out to identify whether the association between NLR and 30-days mortality differed across various subgroups. For 30-days mortality, after adjusting for multiple confounders, the odds ratio (OR) (95% confidence interval [CI]) for the second (NLR 4.0-8.4) and the third (NLR ≥8.4) tertiles were 1.52 (1.13-2.03) and 2.53 (1.92-3.34), respectively, compared with the first tertile (NLR <4.0). As for 90-days mortality, the OR for the second (NLR 4.0-8.4) was 1.34 (1.07-1.67) and 2.23 (1.81-2.76) for the third (NLR ≥8.4) tertiles compared with the reference (NLR<4.0). The interactions between the sepsis subgroup and 30-days mortality were significant. Our study concluded that the NLR was an independent predictor of 30- and 90-days mortality for critically ill patients with chronic heart failure.
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Affiliation(s)
- Jinhang Che
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaqi Song
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxiang Long
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunping Wang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Caiyin Zheng
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruoyu Zhou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zengzhang Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Meng X, Sun H, Tu X, Li W. The Predictive Role of Hematological Parameters in Hypertension. Angiology 2024; 75:705-716. [PMID: 37459606 DOI: 10.1177/00033197231190423] [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] [Indexed: 07/26/2023]
Abstract
Hypertension (HT) is a common chronic disease that often causes target-organ damage and severe complications, contributing to cardiovascular morbidity and mortality worldwide. Accumulating evidence suggests that inflammation plays a prominent role in the initiation and progression of HT. Multiple inflammatory biomarkers have been proposed to predict HT. Several new hematological parameters can reflect the inflammatory response and platelet activation. The major advantage of hematological parameters over conventional inflammatory markers is that they are relatively inexpensive and easily obtained from routine blood tests. Numerous studies have investigated several hematological parameters for their utility as predictive biomarkers for the diagnosis and prognosis of HT. Among them, the neutrophil to lymphocyte ratio (NLR), monocyte to high density lipoprotein cholesterol ratio (MHR), red cell distribution width (RDW), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and systemic immune-inflammation index (SII) have recently received attention. We searched PubMed and Embase databases (up to September 18, 2022) to assess the relationships between hematological parameters and HT. This review discusses the diagnostic and prognostic value of these hematological parameters in HT, providing an important basis for early screening, risk stratification, and optimal management of hypertensive patients.
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Affiliation(s)
- Xiangzhu Meng
- Department of Cardiology, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, China
| | - Hong Sun
- Department of Intensive Care Unit, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiaowen Tu
- Department of Cardiology, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, China
| | - Wei Li
- Department of Intensive Care Unit, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Pellegrino R, Paganelli R, Di Iorio A, Bandinelli S, Moretti A, Iolascon G, Sparvieri E, Tarantino D, Tanaka T, Ferrucci L. Neutrophil, lymphocyte count, and neutrophil to lymphocyte ratio predict multimorbidity and mortality-results from the Baltimore Longitudinal Study on Aging follow-up study. GeroScience 2024; 46:3047-3059. [PMID: 38183599 PMCID: PMC11009209 DOI: 10.1007/s11357-023-01034-7] [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: 09/08/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024] Open
Abstract
Immunosenescence is the age-related changes in the immune system, namely, progressively higher levels of circulating inflammatory markers, characteristics changes of circulating immune subset cells and altered immune function. The neutrophil to lymphocyte ratio (NL ratio) has been identified as a prognostic indicator for neoplastic disease progression, in predicting chronic degenerative diseases, and as a potential indirect marker of healthy aging. This study aims to examine the longitudinal association of neutrophil, lymphocyte absolute count, and their ratio with longitudinal risk for multimorbidity and mortality. The Baltimore Longitudinal Study of Aging (BLSA) is an open observational cohort study of community-dwelling volunteers that are followed every 1-4 years depending on their age. The sample considered in the study consists of 1769 participants (5090 follow-ups) with completed data for physical examination, health history assessment, and donated a blood sample. The NL ratio increased with age and was associated with a higher risk of mortality, while a lower NL ratio was inversely correlated with multimorbidity. Neutrophils increased with aging and an increase in their absolute number predicted mortality risk. However, the absolute number of lymphocytes was associated with age only in a cross-sectional analysis. In conclusion, this study supports the importance of the NL ratio and absolute neutrophil count as markers of aging health status, and as significant predictors of all-cause mortality and multimorbidity in aging individuals. It remains to be demonstrated whether interventions contrasting these trends in circulating cells may result in improved health outcomes.
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Affiliation(s)
- Raffaello Pellegrino
- Department of Scientific Research, Off-Campus Semmelweis University, Campus Ludes, 6912, Lugano-Pazzallo, Switzerland
- Santa Chiara Institute, 73100, Lecce, Italy
| | - Roberto Paganelli
- Saint Camillus International, University of Health and Medical Sciences, Rome, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine & Dentistry, University "G. d'Annunzio", 66100, Chieti-Pescara, Italy.
| | | | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | | | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Toshiko Tanaka
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute On Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute On Aging, National Institutes of Health, Baltimore, MD, 21224, USA
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Guzik TJ, Nosalski R, Maffia P, Drummond GR. Immune and inflammatory mechanisms in hypertension. Nat Rev Cardiol 2024; 21:396-416. [PMID: 38172242 DOI: 10.1038/s41569-023-00964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
Hypertension is a global health problem, with >1.3 billion individuals with high blood pressure worldwide. In this Review, we present an inflammatory paradigm for hypertension, emphasizing the crucial roles of immune cells, cytokines and chemokines in disease initiation and progression. T cells, monocytes, macrophages, dendritic cells, B cells and natural killer cells are all implicated in hypertension. Neoantigens, the NLRP3 inflammasome and increased sympathetic outflow, as well as cytokines (including IL-6, IL-7, IL-15, IL-18 and IL-21) and a high-salt environment, can contribute to immune activation in hypertension. The activated immune cells migrate to target organs such as arteries (especially the perivascular fat and adventitia), kidneys, the heart and the brain, where they release effector cytokines that elevate blood pressure and cause vascular remodelling, renal damage, cardiac hypertrophy, cognitive impairment and dementia. IL-17 secreted by CD4+ T helper 17 cells and γδ T cells, and interferon-γ and tumour necrosis factor secreted by immunosenescent CD8+ T cells, exert crucial effector roles in hypertension, whereas IL-10 and regulatory T cells are protective. Effector mediators impair nitric oxide bioavailability, leading to endothelial dysfunction and increased vascular contractility. Inflammatory effector mediators also alter renal sodium and water balance and promote renal fibrosis. These mechanisms link hypertension with obesity, autoimmunity, periodontitis and COVID-19. A comprehensive understanding of the immune and inflammatory mechanisms of hypertension is crucial for safely and effectively translating the findings to clinical practice.
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Affiliation(s)
- Tomasz J Guzik
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK.
- Department of Medicine and Omicron Medical Genomics Laboratory, Jagiellonian University, Collegium Medicum, Kraków, Poland.
- Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Glasgow, UK.
| | - Ryszard Nosalski
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Pasquale Maffia
- Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Glasgow, UK
- School of Infection & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Grant R Drummond
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Melbourne, Victoria, Australia
- Centre for Cardiovascular Biology and Disease Research, La Trobe University, Melbourne, Victoria, Australia
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Krishnan J, Hennen EM, Ao M, Kirabo A, Ahmad T, de la Visitación N, Patrick DM. NETosis Drives Blood Pressure Elevation and Vascular Dysfunction in Hypertension. Circ Res 2024; 134:1483-1494. [PMID: 38666386 PMCID: PMC11116040 DOI: 10.1161/circresaha.123.323897] [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: 10/25/2023] [Revised: 03/18/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Neutrophil extracellular traps (NETs) are composed of DNA, enzymes, and citrullinated histones that are expelled by neutrophils in the process of NETosis. NETs accumulate in the aorta and kidneys in hypertension. PAD4 (protein-arginine deiminase-4) is a calcium-dependent enzyme that is essential for NETosis. TRPV4 (transient receptor potential cation channel subfamily V member 4) is a mechanosensitive calcium channel expressed in neutrophils. Thus, we hypothesize that NETosis contributes to hypertension via NET-mediated endothelial cell (EC) dysfunction. METHODS NETosis-deficient Padi4-/- mice were treated with Ang II (angiotensin II). Blood pressure was measured by radiotelemetry, and vascular reactivity was measured with wire myography. Neutrophils were cultured with or without ECs and exposed to normotensive or hypertensive uniaxial stretch. NETosis was measured by flow cytometry. ECs were treated with citrullinated histone H3, and gene expression was measured by quantitative reverse transcription PCR. Aortic rings were incubated with citrullinated histone H3, and wire myography was performed to evaluate EC function. Neutrophils were treated with the TRPV4 agonist GSK1016790A. Calcium influx was measured using Fluo-4 dye, and NETosis was measured by immunofluorescence. RESULTS Padi4-/- mice exhibited attenuated hypertension, reduced aortic inflammation, and improved EC-dependent vascular relaxation in response to Ang II. Coculture of neutrophils with ECs and exposure to hypertensive uniaxial stretch increased NETosis and accumulation of neutrophil citrullinated histone H3. Histone H3 and citrullinated histone H3 exposure attenuates EC-dependent vascular relaxation. Treatment of neutrophils with the TRPV4 agonist GSK1016790A increases intracellular calcium and NETosis. CONCLUSIONS These observations identify a role of NETosis in the pathogenesis of hypertension. Moreover, they define an important role of EC stretch and TRPV4 as initiators of NETosis. Finally, they define a role of citrullinated histones as drivers of EC dysfunction in hypertension.
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Affiliation(s)
- Jaya Krishnan
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
| | - Elizabeth M. Hennen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN (E.M.H.)
| | - Mingfang Ao
- Department of Anesthesiology (M.A.), Vanderbilt University Medical Center, Nashville, TN
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Immunobiology (A.K.)
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN (A.K.)
- Vanderbilt Institute for Global Health, Nashville, TN (A.K.)
| | - Taseer Ahmad
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Department of Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, Pakistan (T.A.)
| | - Néstor de la Visitación
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine (D.M.P.), Vanderbilt University Medical Center, Nashville, TN
| | - David M. Patrick
- Division of Clinical Pharmacology, Department of Medicine (J.K., A.K., T.A., N.d.l.V., D.M.P.), Vanderbilt University Medical Center, Nashville, TN
- Department of Veterans Affairs, Nashville, TN (D.M.P.)
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Aljuraiban GS, Gibson R, Oude Griep LM. Associations of Systematic Inflammatory Markers with Diet Quality, Blood Pressure, and Obesity in the AIRWAVE Health Monitoring Study. J Inflamm Res 2024; 17:3129-3141. [PMID: 38784102 PMCID: PMC11112129 DOI: 10.2147/jir.s459238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Chronic low-grade inflammation is a characteristic feature of obesity, and elevated levels of inflammation are associated with pathophysiologic consequences and a constellation of metabolic disturbances, such as hypertension. The relationships of inflammation with diet, obesity, and hypertension are complex, hence, this study aimed to assess cross-sectional relationships between inflammatory scores, diet quality, obesity, high blood pressure (BP), and hypertension in the Airwave Health Monitoring Study cohort, a large cohort of police officers and police staff in the United Kingdom. Methods Data from 5198 men and 3347 women who completed health screening measurements and dietary assessment between 2007 and 2012 were included (n=8545 adults). Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and the systemic immune-inflammation index (SII) were calculated. Diet quality was evaluated using the Nutrient-Rich Food 9.3 (NRF9.3) index score. Results Results show that a 1SD higher diet quality score, waist circumference, and systolic/diastolic BP were significantly associated with SII differences of -33.3 (95% confidence interval (CI): -49.0, -17.6), 8.2 (95% CI: 0.2, 16.6), 17.9 (95% CI: 10.1, 25.8), and 18.3 (95% CI: 10.8, 25.7) (Model 2; P<0.0001), respectively. A 1SD higher diet quality score, waist circumference, and BMI were also significantly associated with PLR (P<0.0001). The odds of elevated PLR were higher in those with higher systolic and diastolic BP (P<0.0001, P=0.0006, respectively). Conclusion In conclusion, the findings of this analysis add to the existing knowledge indicating a link between inflammation and conditions such as obesity, hypertension, and behavioral factors including diet quality. Of the various inflammatory scores evaluated, SII and PLR were consistently significantly associated with diet quality and these conditions.
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Affiliation(s)
- Ghadeer S Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Rachel Gibson
- Department of Nutritional Sciences, King’s College London, London, SE1 9NH, UK
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Jacobs T, Jacobson SR, Fortea J, Berger JS, Vedvyas A, Marsh K, He T, Gutierrez-Jimenez E, Fillmore NR, Gonzalez M, Figueredo L, Gaggi NL, Plaska CR, Pomara N, Blessing E, Betensky R, Rusinek H, Zetterberg H, Blennow K, Glodzik L, Wisniweski TM, de Leon MJ, Osorio RS, Ramos-Cejudo J. The neutrophil to lymphocyte ratio associates with markers of Alzheimer's disease pathology in cognitively unimpaired elderly people. Immun Ageing 2024; 21:32. [PMID: 38760856 PMCID: PMC11100119 DOI: 10.1186/s12979-024-00435-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/29/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND An elevated neutrophil-lymphocyte ratio (NLR) in blood has been associated with Alzheimer's disease (AD). However, an elevated NLR has also been implicated in many other conditions that are risk factors for AD, prompting investigation into whether the NLR is directly linked with AD pathology or a result of underlying comorbidities. Herein, we explored the relationship between the NLR and AD biomarkers in the cerebrospinal fluid (CSF) of cognitively unimpaired (CU) subjects. Adjusting for sociodemographics, APOE4, and common comorbidities, we investigated these associations in two cohorts: the Alzheimer's Disease Neuroimaging Initiative (ADNI) and the M.J. de Leon CSF repository at NYU. Specifically, we examined associations between the NLR and cross-sectional measures of amyloid-β42 (Aβ42), total tau (t-tau), and phosphorylated tau181 (p-tau), as well as the trajectories of these CSF measures obtained longitudinally. RESULTS A total of 111 ADNI and 190 NYU participants classified as CU with available NLR, CSF, and covariate data were included. Compared to NYU, ADNI participants were older (73.79 vs. 61.53, p < 0.001), had a higher proportion of males (49.5% vs. 36.8%, p = 0.042), higher BMIs (27.94 vs. 25.79, p < 0.001), higher prevalence of hypertensive history (47.7% vs. 16.3%, p < 0.001), and a greater percentage of Aβ-positivity (34.2% vs. 20.0%, p = 0.009). In the ADNI cohort, we found cross-sectional associations between the NLR and CSF Aβ42 (β = -12.193, p = 0.021), but not t-tau or p-tau. In the NYU cohort, we found cross-sectional associations between the NLR and CSF t-tau (β = 26.812, p = 0.019) and p-tau (β = 3.441, p = 0.015), but not Aβ42. In the NYU cohort alone, subjects classified as Aβ + (n = 38) displayed a stronger association between the NLR and t-tau (β = 100.476, p = 0.037) compared to Aβ- subjects or the non-stratified cohort. In both cohorts, the same associations observed in the cross-sectional analyses were observed after incorporating longitudinal CSF data. CONCLUSIONS We report associations between the NLR and Aβ42 in the older ADNI cohort, and between the NLR and t-tau and p-tau in the younger NYU cohort. Associations persisted after adjusting for comorbidities, suggesting a direct link between the NLR and AD. However, changes in associations between the NLR and specific AD biomarkers may occur as part of immunosenescence.
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Affiliation(s)
- Tovia Jacobs
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
| | - Sean R Jacobson
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, MA, USA
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de La Santa Creu y Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeffrey S Berger
- Divisions of Cardiology and Hematology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Alok Vedvyas
- Department of Neurology, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Karyn Marsh
- Department of Neurology, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Tianshe He
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
| | | | - Nathanael R Fillmore
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, MA, USA
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Moses Gonzalez
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
| | - Luisa Figueredo
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
| | - Naomi L Gaggi
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
| | - Chelsea Reichert Plaska
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
- Nathan Kline Institute, 140 Old Orangeburg Rd, Orangeburg, NY, 10962, USA
| | - Nunzio Pomara
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
- Nathan Kline Institute, 140 Old Orangeburg Rd, Orangeburg, NY, 10962, USA
- Department of Pathology, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Esther Blessing
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
| | - Rebecca Betensky
- Department of Neurology, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Henry Rusinek
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
- Department of Radiology, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kaj Blennow
- Inst. of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Lab, Sahlgrenska University Hospital, Mölndal, Sweden
- Paris Brain Institute, ICM, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, and Department of Neurology, Institute On Aging and Brain Disorders, University of Science and Technology of China and First Affiliated Hospital of USTC, Hefei, People's Republic of China
| | - Lidia Glodzik
- Department of Neurology, New York University (NYU) Grossman School of Medicine, New York, NY, USA
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Thomas M Wisniweski
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA
- Department of Neurology, New York University (NYU) Grossman School of Medicine, New York, NY, USA
- Department of Pathology, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Mony J de Leon
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
- Retired director of Center for Brain Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Ricardo S Osorio
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA.
- Nathan Kline Institute, 140 Old Orangeburg Rd, Orangeburg, NY, 10962, USA.
| | - Jaime Ramos-Cejudo
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, Division of Brain Aging, 145 East 32Nd Street, New York, NY, 10016, USA.
- VA Boston Cooperative Studies Program, MAVERIC, VA Boston Healthcare System, Boston, MA, USA.
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Zhang X, Wei R, Wang X, Zhang W, Li M, Ni T, Weng W, Li Q. The neutrophil-to-lymphocyte ratio is associated with all-cause and cardiovascular mortality among individuals with hypertension. Cardiovasc Diabetol 2024; 23:117. [PMID: 38566082 PMCID: PMC10985955 DOI: 10.1186/s12933-024-02191-5] [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: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Identifying reliable prognostic markers is crucial for the effective management of hypertension. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential inflammatory marker linked to cardiovascular outcomes. This study aims to investigate the association of NLR with all-cause and cardiovascular mortality among patients with hypertension. METHODS This study analyzed data from 3067 hypertensive adults in the National Health and Nutritional Examination Surveys (NHANES) from 2009 to 2014. Mortality details were obtained from the National Death Index (NDI). Restricted cubic spline (RCS) was deployed to visualize the association of the NLR with mortality risk. Weighted Cox proportional hazards models were employed to assess the independent association of NLR with mortality risk. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to access the predictive ability of NLR for survival. Mediation analysis was used to explore the indirect impact of NLR on mortality mediated through eGFR. RESULTS Over a median 92.0-months follow-up, 538 deaths occurred, including 114 cardiovascular deaths. RCS analysis revealed a positive association between NLR and both all-cause and cardiovascular mortality. Participants were stratified into higher (> 3.5) and lower (≤ 3.5) NLR groups. Weighted Cox proportional hazards models demonstrated that individuals with higher NLR had a significantly increased risk of all-cause (HR 1.96, 95% confidence interval (CI) 1.52-2.52, p < 0.0001) and cardiovascular mortality (HR 2.33, 95% CI 1.54-3.51, p < 0.0001). Stratified and interaction analysis confirmed the stability of the core results. Notably, eGFR partially mediated the association between NLR and both all-cause and cardiovascular mortality by a 5.4% and 4.7% proportion, respectively. Additionally, the areas under the curve (AUC) of the 3-, 5- and 10- year survival was 0.68, 0.65 and 0.64 for all-cause mortality and 0.68, 0.70 and 0.69 for cardiovascular mortality, respectively. CONCLUSION Elevated NLR independently confers an increased risk for both all-cause and cardiovascular mortality in individuals with hypertension.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Rui Wei
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Wantong Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mengxuan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Tian Ni
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiliang Weng
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, No. 1, Xiyuan Playground, Zhong Zhi Road, Hai Dian District, Beijing, 100091, China.
| | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
- Department of General Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, No. 1, Xiyuan Playground, Zhong Zhi Road, Hai Dian District, Beijing, 100091, China.
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9
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Hong S, He H, Fang P, Liu S, Chen C. Association of neutrophil-to-lymphocyte ratio and risk of cardiovascular and all-cause mortality in hypertension patients. Heliyon 2024; 10:e27517. [PMID: 38496832 PMCID: PMC10944217 DOI: 10.1016/j.heliyon.2024.e27517] [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: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objective Hypertension affects over a billion people worldwide and is often associated with poor prognoses. The neutrophil-to-lymphocyte ratio (NLR) has become a significant marker, showing a connection to adverse outcomes in cardiovascular diseases (CVDs). The objective of this study is to examine the relationship between the NLR and outcomes in patients with hypertension. Methods The study included hypertensive individuals who were surveyed in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018. Mortality status was determined using the data from National Death Index (NDI). To investigate the dose-response relationship, restricted cubic spline (RCS) models were used. This study employed adjusted cox proportional hazards regression models to compute hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) for all-cause and cardiovascular mortality. The predictive accuracy of the NLR for survival outcomes was assessed utilizing time-dependent receiver operating characteristic (ROC) curve analysis. Results A total of 13,724 participants were included in the final analysis, including 7073 males and 6651 females. The cohort was stratified into higher (>2.0) and lower (≤2.0) NLR groups according to the median value. Over a median follow-up of 64 months, there were 1619 all-cause deaths and 522 cardiovascular deaths among participants. The RCS analysis indicated a non-linear relationship between NLR and the risk of mortality. The adjusted model showed that the group with a higher NLR had a significantly higher risk of all-cause (HR 1.47, 95% CI 1.22-1.77) and cardiovascular mortality (HR 2.08, 95% CI 1.52-2.86). ROC analysis showed that the area under the curves (AUCs) of 0.692, 0.662, 0.644, and 0.625 for predicting all-cause mortality, and 0.712, 0.692, 0.687, and 0.660 for cardiovascular mortality at 1, 3, 5, and 10 years. Conclusion Elevated NLR is associated with increased risk of cardiovascular and all-cause mortality, and NLR may independently predict outcomes in individuals with hypertension.
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Affiliation(s)
- Shaoqing Hong
- Corresponding author. Department of Cardiovascular Medicine, Huangshi Fifth Hospital, No.98 XiaLu Dadao, Xialu District, Huangshi, Hubei, 435005, China.
| | | | - Peng Fang
- Department of Cardiovascular Medicine, Huangshi Fifth Hospital, No.33 XiaLu Dadao, Xialu District, Huangshi, Hubei, 435005, China
| | - Shuai Liu
- Department of Cardiovascular Medicine, Huangshi Fifth Hospital, No.33 XiaLu Dadao, Xialu District, Huangshi, Hubei, 435005, China
| | - Changyi Chen
- Department of Cardiovascular Medicine, Huangshi Fifth Hospital, No.33 XiaLu Dadao, Xialu District, Huangshi, Hubei, 435005, China
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10
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Jacobs T, Jacobson SR, Fortea J, Berger JS, Vedvyas A, Marsh K, He T, Gutierrez-Jimenez E, Fillmore NR, Bubu OM, Gonzalez M, Figueredo L, Gaggi NL, Plaska CR, Pomara N, Blessing E, Betensky R, Rusinek H, Zetterberg H, Blennow K, Glodzik L, Wisniewski TM, Leon MJ, Osorio RS, Ramos-Cejudo J. The neutrophil to lymphocyte ratio associates with markers of Alzheimer's disease pathology in cognitively unimpaired elderly people. RESEARCH SQUARE 2024:rs.3.rs-4076789. [PMID: 38559231 PMCID: PMC10980096 DOI: 10.21203/rs.3.rs-4076789/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background An elevated neutrophil-lymphocyte ratio (NLR) in blood has been associated with Alzheimer's disease (AD). However, an elevated NLR has also been implicated in many other conditions that are risk factors for AD, prompting investigation into whether the NLR is directly linked with AD pathology or a result of underlying comorbidities. Herein, we explored the relationship between the NLR and AD biomarkers in the cerebrospinal fluid (CSF) of cognitively unimpaired (CU) subjects. Adjusting for sociodemographics, APOE4, and common comorbidities, we investigated these associations in two cohorts: the Alzheimer's Disease Neuroimaging Initiative (ADNI) and the M.J. de Leon CSF repository at NYU. Specifically, we examined associations between the NLR and cross-sectional measures of amyloid-β42 (Aβ42), total tau (t-tau), and phosphorylated tau181 (p-tau), as well as the trajectories of these CSF measures obtained longitudinally. Results A total of 111 ADNI and 190 NYU participants classified as CU with available NLR, CSF, and covariate data were included. Compared to NYU, ADNI participants were older (73.79 vs. 61.53, p < 0.001), had a higher proportion of males (49.5% vs. 36.8%, p = 0.042), higher BMIs (27.94 vs. 25.79, p < 0.001), higher prevalence of hypertensive history (47.7% vs. 16.3%, p < 0.001), and a greater percentage of Aβ-positivity (34.2% vs. 20.0%, p = 0.009). In the ADNI cohort, we found cross-sectional associations between the NLR and CSF Aβ42 (β=-12.193, p = 0.021), but not t-tau or p-tau. In the NYU cohort, we found cross-sectional associations between the NLR and CSF t-tau (β = 26.812, p = 0.019) and p-tau (β = 3.441, p = 0.015), but not Aβ42. In the NYU cohort alone, subjects classified as Aβ+ (n = 38) displayed a stronger association between the NLR and t-tau (β = 100.476, p = 0.037) compared to Aβ- subjects or the non-stratified cohort. In both cohorts, the same associations observed in the cross-sectional analyses were observed after incorporating longitudinal CSF data. Conclusions We report associations between the NLR and Aβ42 in the older ADNI cohort, and between the NLR and t-tau and p-tau181 in the younger NYU cohort. Associations persisted after adjusting for comorbidities, suggesting a direct link between the NLR and AD. However, changes in associations between the NLR and specific AD biomarkers may occur as part of immunosenescence.
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Affiliation(s)
- Tovia Jacobs
- New York University (NYU) Grossman School of Medicine
| | | | - Juan Fortea
- Hospital de la Santa Creu y Sant Pau, Universitat Autònoma de Barcelona
| | | | - Alok Vedvyas
- New York University (NYU) Grossman School of Medicine
| | - Karyn Marsh
- New York University (NYU) Grossman School of Medicine
| | - Tianshe He
- New York University (NYU) Grossman School of Medicine
| | | | | | | | | | | | - Naomi L Gaggi
- New York University (NYU) Grossman School of Medicine
| | | | - Nunzio Pomara
- New York University (NYU) Grossman School of Medicine
| | | | | | - Henry Rusinek
- New York University (NYU) Grossman School of Medicine
| | | | | | | | | | - Mony J Leon
- New York University (NYU) Grossman School of Medicine
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11
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Pardhiya S, Gaharwar US, Parambil AM, Nirala JP, Rajamani P. Biocompatibility assessment of bovine serum albumin conjugated manganese dioxide nanoparticle and their therapeutic role against microwave radiation induced haematological toxicity in male Wistar rats. Free Radic Res 2024; 58:194-216. [PMID: 38563404 DOI: 10.1080/10715762.2024.2333880] [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: 08/25/2023] [Accepted: 01/24/2024] [Indexed: 04/04/2024]
Abstract
Microwave (MW) radiations are widely used in communications, radar and medical treatment and thus human exposure to MW radiations have increased tremendously, raising health concerns as MW has been implicated in induction of oxidative stress condition in our body. Few metallic nanoparticles (NPs) have been shown to mimic the activity of antioxidant enzymes and hence can be applied for the modulation of adverse effects caused by MW. Present study aimed to assess the biocompatibility of Bovine serum albumin (BSA) conjugated manganese dioxide nanoparticles (MNP*) and to counteract the impact of MW on the haematological system of male Wistar rats. Experiments were conducted in two sets. Set I involved biodistribution and antioxidant activity evaluation of MNP* at different doses. Results showed a dose-dependent increase in antioxidant potential and significant biodistribution in the liver, spleen, kidney, and testis, with no organ damage, indicating its biocompatibility. Experiment set II constituted the study of separate and combined effects of MW and MNP* on haematological parameters, oxidative status, and genotoxic study in the blood of rats. MW exposure significantly altered red blood cell count, hemoglobin, packed cell volume percentage, monocyte percentage, aspartate aminotransferase, Alanine aminotransferase and uric acid. MW also induced significant DNA damage in the blood. A significant increase in lipid peroxidation and a decrease in antioxidant enzyme superoxide dismutase was also observed in MW exposed group. However, these alterations were reduced significantly when MNP* was administered. Thus, MNP* showed biocompatibility and modulatory effects against MW-induced alterations in the haematological system of rats.
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Affiliation(s)
- Sonali Pardhiya
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Usha Singh Gaharwar
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India
| | | | - Jay Prakash Nirala
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Paulraj Rajamani
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India
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12
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Gan L, Ye D, Feng Y, Pan H, Lu X, Wan J, Ye J. Immune cells and hypertension. Immunol Res 2024; 72:1-13. [PMID: 38044398 DOI: 10.1007/s12026-023-09414-z] [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: 12/07/2022] [Accepted: 08/10/2023] [Indexed: 12/05/2023]
Abstract
Hypertension is one of the leading causes of death due to target organ injury from cardiovascular disease. Although there are many treatments, only one-sixth of hypertensive patients effectively control their blood pressure. Therefore, further understanding the pathogenesis of hypertension is essential for the treatment of hypertension. Much research shows that immune cells play an important role in the pathogenesis of hypertension. Here, we discuss the roles of different immune cells in hypertension. Many immune cells participate in innate and adaptive immune responses, such as monocytes/macrophages, neutrophils, dendritic cells, NK cells, and B and T lymphocytes. Immune cells infiltrate the blood vessels, kidneys, and hearts and cause damage. The mechanism is that immune cells secrete cytokines such as interleukin, interferon, and tumor necrosis factor, which affect the inflammatory reaction, oxidative stress, and kidney sodium water retention, and finally aggravate or reduce the dysfunction, remodeling, and fibrosis of the blood vessel, kidney, and heart to participate in blood pressure regulation. This article reviews the research progress on immune cells and hypertension.
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Affiliation(s)
- Liren Gan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Di Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yongqi Feng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Heng Pan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Xiyi Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jun Wan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, China.
- Hubei Key Laboratory of Cardiology, Wuhan, China.
| | - Jing Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, China.
- Hubei Key Laboratory of Cardiology, Wuhan, China.
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13
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Kommoss KS, Bieler T, Ringen J, Lehmann A, Mihalceanu S, Hobohm L, Keller K, Brand A, Fischer B, Kramer D, Wild J, Waisman A, Enk A, Schäkel K, Heikenwälder M, Karbach S. A simple tool for evaluation of inflammation in psoriasis: Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio as markers in psoriasis patients and related murine models of psoriasis-like skin disease. J Mol Med (Berl) 2024; 102:247-255. [PMID: 38127137 PMCID: PMC10857970 DOI: 10.1007/s00109-023-02406-4] [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: 12/04/2022] [Revised: 11/04/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
Objective parameters to quantify psoriatic inflammation are needed for interdisciplinary patient care, as well as preclinical experimental models. This study evaluates neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in psoriasis patients and five murine models of psoriasis-like skin disease based on topical imiquimod application and overexpression of IL-17A under different promotors. We performed a single-center prospective observational study in a German population, investigating psoriasis patients prior to, 4 weeks, and 16 weeks post begin of systemic anti-inflammatory therapy. Psoriasis area and severity index (PASI), blood count, and C-reactive protein (CRP) levels were attained at each timepoint. Additionally, five murine models of psoriasis-like skin disease involving five distinct experimental procedures differing in time of disease-onset and severity were investigated regarding PLR and NLR. Of 43 recruited psoriasis patients, 34 patients were followed up to 16 weeks. The cohort was 69.77% male, showing a median age of 32.0 years (range 19.0-67.0; IQR 26). The median PASI decreased from 16.35 (8.0-50.0; 10.20) to 1.6 (0-10.3; 2.56) after 16 weeks of systemic therapy. Spearman's correlation showed statistically significant positive correlation for NLR with PASI (rs = 0.27, p = 0.006), however not for PLR. NLR, but not PLR, was significantly associated with PASI in a multiple linear regression analysis including age, sex, psoriasis arthritis, and smoking. In the murine models of psoriasis-like skin disease, both NLR and PLR were significantly increased in the acute-severe models compared to controls (p < 0.001, p = 0.005, and p = 0.02, respectively), demonstrating gradually less increased values from severe-acute to mild-late-onset psoriatic phenotype. NLR was significantly associated with PASI in psoriatic patients as well as psoriatic phenotype in different murine psoriasis models. Our data warrants investigation of NLR in psoriasis patients and preclinical psoriasis models as an objective biomarker of psoriatic skin inflammation. KEY MESSAGES : NLR, but not PLR, showed a statistically significant positive correlation with Psoriasis Area and Severity Index (PASI) in our human psoriasis cohort. Both NLR and PLR were significantly increased in murine psoriasis models compared to matched controls, with gradually less increased values from severe-acute to mild-late-onset psoriatic phenotype. NLR may represent an easily available, cheap, and objective parameter to monitor psoriatic inflammation in both clinical patient routine, as well as preclinical experimental murine models.
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Affiliation(s)
- Katharina S Kommoss
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany.
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Tabea Bieler
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Heidelberg, Germany
| | - Julia Ringen
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Annika Lehmann
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Silvia Mihalceanu
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Center for Cardiology-Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Karsten Keller
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Center for Cardiology-Cardiology I, University Medical Center Mainz, Mainz, Germany
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Brand
- Institute of Molecular Medicine, University Medical Center Mainz, Mainz, Germany
| | - Berenice Fischer
- Department of Dermatology, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Daniela Kramer
- Department of Dermatology, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Johannes Wild
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Center for Cardiology-Cardiology I, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK)-Partner Site RheinMain (Mainz), Mainz, Germany
| | - Ari Waisman
- Institute of Molecular Medicine, University Medical Center Mainz, Mainz, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Knut Schäkel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mathias Heikenwälder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- The M3 Research Center, Institute for Interdisciplinary Research On Cancer Metabolism and Chronic Inflammation, Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Susanne Karbach
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Center for Cardiology-Cardiology I, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK)-Partner Site RheinMain (Mainz), Mainz, Germany
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14
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Shu C, Zheng C, Luo D, Song J, Jiang Z, Ge L. Acute ischemic stroke prediction and predictive factors analysis using hematological indicators in elderly hypertensives post-transient ischemic attack. Sci Rep 2024; 14:695. [PMID: 38184714 PMCID: PMC10771433 DOI: 10.1038/s41598-024-51402-2] [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: 06/20/2023] [Accepted: 01/04/2024] [Indexed: 01/08/2024] Open
Abstract
Elderly hypertensive patients diagnosed with transient ischemic attack (TIA) are at a heightened risk for developing acute ischemic stroke (AIS). This underscores the critical need for effective risk prediction and identification of predictive factors. In our study, we utilized patient data from peripheral blood tests and clinical profiles within hospital information systems. These patients were followed for a three-year period to document incident AIS. Our cohort of 11,056 individuals was randomly divided into training, validation, and testing sets in a 5:2:3 ratio. We developed an XGBoost model, developed using selected indicators, provides an effective and non-invasive method for predicting the risk of AIS in elderly hypertensive patients diagnosed with TIA. Impressively, this model achieved a balanced accuracy of 0.9022, a recall of 0.8688, and a PR-AUC of 0.9315. Notably, our model effectively encapsulates essential data variations involving mixed nonlinear interactions, providing competitive performance against more complex models that incorporate a wider range of variables. Further, we conducted an in-depth analysis of the importance and sensitivity of each selected indicator and their interactions. This research equips clinicians with the necessary tools for more precise identification of high-risk individuals, thereby paving the way for more effective stroke prevention and management strategies.
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Affiliation(s)
- Chang Shu
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, 300350, China.
| | - Chenguang Zheng
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Da Luo
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Jie Song
- Academy of Medical Engineering and Translational Medicine, Intelligent Medical Engineering, Tianjin University, Tianjin, China
| | - Zhengyi Jiang
- Academy of Medical Engineering and Translational Medicine, Intelligent Medical Engineering, Tianjin University, Tianjin, China
| | - Le Ge
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, 300350, China.
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15
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Çakır MO. The Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Long-Term Survival in Patients With Severe Left Ventricular Dysfunction and Implantable Cardioverter Defibrillator. Cureus 2023; 15:e47441. [PMID: 37899896 PMCID: PMC10602596 DOI: 10.7759/cureus.47441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/31/2023] Open
Abstract
İntroduction: Systemic inflammation resulting from comorbidities such as arterial hypertension, diabetes, and obesity is responsible for the pathogenesis of myocardial structural and functional changes in heart failure. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel biomarkers of inflammation. The aim of this study was to evaluate the relationship between blood NLR and PLR levels and one-year cardiac mortality in primary prevention patients with left ventricular ejection fraction (LVEF) ≤35%, using an intracardiac defibrillator. METHODS A total of 180 compensated heart failure patients with LVEF<35% (ischemic or nonischemic) and implantable cardioverter-defibrillator (ICD) therapy for primary prevention who applied to the cardiology outpatient clinic of Zonguldak Bülent Ecevit Üniversitesi Hospital, Zonguldak, Türkiye, between March 2018 and June 2019 were consecutively included. The patients were followed for one year after the application. RESULTS In the multivariate logistic regression analysis model, only NLR (OR: 1.328; 95%CI: 1.129-1.563; p <0.01) was found independently associated with the risk of one-year cardiovascular mortality. Based on the NLR, levels were 2.69 ng/ml, and the area under the curve was found to be 0.795 (95%CI: 0.729-0.862) in the evaluation made with the receiver operating characteristic curve. CONCLUSION High NLR ratio levels independently predicted one-year cardiac mortality in patients with LVEF<35% and ICD for secondary protection. Large-scale randomized studies are needed to fully demonstrate the relationship between NLR levels and cardiovascular mortality in patients with severe left ventricular dysfunction and ICD.
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Affiliation(s)
- Mustafa Ozan Çakır
- Cardiology, Zonguldak Bülent Ecevit Üniversitesi Faculty of Medicine, Zonguldak, TUR
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16
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Pellegrino R, Paganelli R, Di Iorio A, Bandinelli S, Moretti A, Iolascon G, Sparvieri E, Tarantino D, Ferrucci L. Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio: results from InCHIANTI follow-up study. Immun Ageing 2023; 20:46. [PMID: 37667259 PMCID: PMC10476368 DOI: 10.1186/s12979-023-00370-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Neutrophils and lymphocytes represent the larger percentage of all white blood cells, they vary with age, with a progressive increase of the ratio in the first years of life, and then tend to remain at similar levels in steady state condition during adult age. Neutrophils to lymphocytes-ratio (NL-ratio) was proposed as an effective and low-cost marker to monitor and predict the evolution of several clinical conditions. The main objective of the study is to analyze its temporal trend variation, over twenty years' follow-up, according to age, sex, and main clinical diagnosis, in a large representative Italian population. METHODS The InCHIANTI study enrolled representative samples from the registry list of two towns in Tuscany, Italy. Baseline data were collected in 1998, and last follow-up visits were made in 2015-18. 1343 out of the 1453 participants enrolled were included, and consented to donate a blood sample. All subjects were assessed and followed for life-style, clinical condition, physical performance, and underwent an instrumental diagnostic session. RESULTS The NL-ratio showed a statistically significant interaction between birth-cohort and time of the study (p-value = 0.005). A gender dimorphism was recognized in the neutrophils absolute count and in the NL-ratio. Moreover, in female participants only, those who reported CHF had lower neutrophil-count and NL-ratio; whereas an increase in creatinine clearance was directly associated with NL-ratio. In male subjects, an increase of BMI was inversely associated with both NL-ratio and neutrophils-count during the follow-up; a similar association but in the opposite direction was observed in female participants. CONCLUSION NL-ratio is a more reliable predictor of healthy aging than absolute lymphocytes and/or neutrophils counts. It is associated with the changes induced by disease, lifestyle, and environmental challenges in the immune system. NL-ratio confirms the gender dimorphism in the occurrence of inflammation-driven diseases, thus providing additional evidence for the necessity of tailored sex-specific measures to prevent and treat such diseases.
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Affiliation(s)
- Raffaello Pellegrino
- Department of Scientific Research, Off-Campus Semmelweis University, Campus Ludes, 6912, Lugano-Pazzallo, Switzerland
| | - Roberto Paganelli
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine & Dentistry, University "G. d'Annunzio", Viale Abruzzo 322, 66100, Chieti-Pescara, Italy.
| | | | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | | | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, 21224, Baltimore, MD, USA
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Pellegrino R, Paganelli R, Di Iorio A, Bandinelli S, Moretti A, Iolascon G, Sparvieri E, Tarantino D, Ferrucci L. Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio. Results from InCHIANTI follow-up study. RESEARCH SQUARE 2023:rs.3.rs-3111431. [PMID: 37461588 PMCID: PMC10350238 DOI: 10.21203/rs.3.rs-3111431/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Neutrophils and lymphocytes represent the larger percentage of all white bloodcells, they vary with age, with a progressive increase of the ratio in the first years of life, and then tend to remain at similar levels in steady state condition during adult age. Neutrophils to lymphocytes-ratio (NL-ratio) was proposed as an effective and low-cost marker to monitor and predict the evolution of severalclinical conditions. The main objective of the study is to analyze its temporal trend variation, over twenty years' follow-up, according to age, sex, and main clinical diagnosis, in a large representative Italian population. Methods The InCHIANTI study enrolled representative samples from the registry list of two towns in Tuscany, Italy. Baseline data were collected in 1998, and last follow-up visits were made in 2015-18. 1343 out of the 1453 participants enrolled were included, and consented to donate a blood sample. All subjects were assessed and followed for life-style, clinical condition, physical performance, and underwent an instrumental diagnostic session. Results The NL-ratio showed a statistically significant interaction between birth-cohort and time of the study (p-value=0.005). A gender dimorphism was recognized in the neutrophils absolute count and in the NL-ratio. Moreover, in female participants only, those who reported CHF had lower neutrophil-count and NL-ratio; whereas an increase in creatinine clearance was directly associated with NL-ratio. In male subjects, an increase of BMI was inversely associated with both NL-ratio and neutrophils-count during the follow-up; a similar association but in the opposite direction was observed in female participants. Conclusion NL-ratio is a more reliable predictor of healthy aging than absolute lymphocytes and/or neutrophils counts. It is associated with the changes induced by disease, lifestyle, and environmental challenges in the immune system. NL-ratio confirms the gender dimorphism in the occurrence of inflammation-driven diseases, thus providing additional evidence for the necessity of tailored sex-specific measures to prevent and treat such diseases.
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Affiliation(s)
- Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano-Pazzallo, Switzerland
| | - Roberto Paganelli
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine & Dentistry; University "G. d'Annunzio"; 66100 - ChietiPescara, Italy
| | | | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138 - Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138 - Naples, Italy
| | | | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, USA, Baltimore, MD 21224, USA
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18
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Pellegrino R, Paganelli R, Iorio AD, Bandinelli S, Moretti A, Iolascon G, Sparvieri E, Tarantino D, Ferrucci L. Temporal trends, sex differences, and age-related disease influence in Neutrophil, Lymphocyte count and Neutrophil to Lymphocyte-ratio. Results from InCHIANTI follow-up study. RESEARCH SQUARE 2023:rs.3.rs-3111431. [PMID: 37461588 PMCID: PMC10350238 DOI: 10.21203/rs.3.rs-3111431/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background Neutrophils and lymphocytes represent the larger percentage of all white bloodcells, they vary with age, with a progressive increase of the ratio in the first years of life, and then tend to remain at similar levels in steady state condition during adult age. Neutrophils to lymphocytes-ratio (NL-ratio) was proposed as an effective and low-cost marker to monitor and predict the evolution of severalclinical conditions. The main objective of the study is to analyze its temporal trend variation, over twenty years' follow-up, according to age, sex, and main clinical diagnosis, in a large representative Italian population. Methods The InCHIANTI study enrolled representative samples from the registry list of two towns in Tuscany, Italy. Baseline data were collected in 1998, and last follow-up visits were made in 2015-18. 1343 out of the 1453 participants enrolled were included, and consented to donate a blood sample. All subjects were assessed and followed for life-style, clinical condition, physical performance, and underwent an instrumental diagnostic session. Results The NL-ratio showed a statistically significant interaction between birth-cohort and time of the study (p-value=0.005). A gender dimorphism was recognized in the neutrophils absolute count and in the NL-ratio. Moreover, in female participants only, those who reported CHF had lower neutrophil-count and NL-ratio; whereas an increase in creatinine clearance was directly associated with NL-ratio. In male subjects, an increase of BMI was inversely associated with both NL-ratio and neutrophils-count during the follow-up; a similar association but in the opposite direction was observed in female participants. Conclusion NL-ratio is a more reliable predictor of healthy aging than absolute lymphocytes and/or neutrophils counts. It is associated with the changes induced by disease, lifestyle, and environmental challenges in the immune system. NL-ratio confirms the gender dimorphism in the occurrence of inflammation-driven diseases, thus providing additional evidence for the necessity of tailored sex-specific measures to prevent and treat such diseases.
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Ahmad R, Narwaria M, Singh A, Kumar S, Haque M. Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools. Diagnostics (Basel) 2023; 13:2441. [PMID: 37510185 PMCID: PMC10378387 DOI: 10.3390/diagnostics13142441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus and can lead to patient demise if not immediately treated. From the recent literature, the diabetic ketoacidosis mortality rate, depending on age, is 2-5%. Insulin discontinuation and infection remain the two most common triggers for diabetic ketoacidosis. About 50% of cases of ketoacidosis result from bacterial infections like urinary tract infections and pneumonia. It is also important to diagnose the presence of infection in diabetic ketoacidosis patients to prevent the excessive use of antibiotics, which may lead to antibiotic resistance. Although performing bacterial culture is confirmatory for the presence or absence of bacterial infection, the time required to obtain the result is long. At the same time, emergency treatment needs to be started as early as possible. METHODS This narrative review examines various septic markers to identify the appropriate tools for diagnosis and to distinguish between diabetic ketoacidosis with and without infection. Electronic databases were searched using the Google engine with the keywords "Diabetes Mellitus", "Diabetic Ketoacidosis", "Infection with Diabetic Ketoacidosis", "biomarkers for infection in Diabetic Ketoacidosis", "Procalcitonin", "Inflammatory cytokines in DKA", "Lactic acidosis in DKA", and "White blood cell in infection in DKA". RESULTS This narrative review article presents the options for diagnosis and also aims to create awareness regarding the gravity of diabetic ketoacidosis with infection and emphasizes the importance of early diagnosis for appropriate management. Diabetes mellitus is a clinical condition that may lead to several acute and chronic complications. Acute diabetic ketoacidosis is a life-threatening condition in which an excess production of ketone bodies results in acidosis and hypovolemia. Infection is one of the most common triggers of diabetic ketoacidosis. When bacterial infection is present along with diabetic ketoacidosis, the mortality rate is even higher than for patients with diabetic ketoacidosis without infection. The symptoms and biomarkers of diabetic ketoacidosis are similar to that of infection, like fever, C reactive protein, and white blood cell count, since both create an environment of systemic inflammation. It is also essential to distinguish between the presence and absence of bacterial infection to ensure the appropriate use of antibiotics and prevent antimicrobial resistance. A bacterial culture report is confirmatory for the existence of bacterial infection, but this may take up to 24 h. Diagnosis needs to be performed approximately in the emergency room upon admission since there is a need for immediate management. Therefore, researching the possible diagnostic tools for the presence of infection in diabetic ketoacidosis patients is of great importance. Several of such biomarkers have been discussed in this research work.
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Affiliation(s)
- Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka 1230, Bangladesh
| | - Mahendra Narwaria
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, S G Highways, Ahmedabad 380054, India
| | - Arya Singh
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, S G Highways, Ahmedabad 380054, India
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, India
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
- Department of Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, India
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20
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Rao KR, Bao RY, Ming H, Liu JW, Dong YF. The Correlation Between Aldosterone and Leukocyte-Related Inflammation: A Comparison Between Patients with Primary Aldosteronism and Essential Hypertension. J Inflamm Res 2023; 16:2401-2413. [PMID: 37304156 PMCID: PMC10257052 DOI: 10.2147/jir.s409146] [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: 02/18/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023] Open
Abstract
Background Hypertension patients with primary aldosteronism (PA) have a higher risk of cardiovascular complications than blood pressure-matched essential hypertension (EH) patients. The cause may be closely related to inflammation. We explored the correlations between leukocyte-related inflammation parameters and plasma aldosterone concentration (PAC) in PA patients and clinical characteristics-matched EH patients. Methods A total of 346 PA and 346 sex, age and 24-h blood pressure-matched EH patients at the 2nd Affiliated Hospital of Nanchang University from January 2020 to June 2021 were enrolled in this study. The differences and correlations of aldosterone and leukocyte parameters between the two groups were analyzed. Results Compared with EH patients, the lymphocyte count was significantly lower (P = 0.004), the neutrophil-lymphocyte ratio (NLR) (P = 0.023) and the monocyte-lymphocyte ratio (MLR) (P = 0.037) were significantly higher in PA patients. Linear regression analysis and multivariate regression analysis identified that lymphocyte count, NLR and MLR were significantly and independently correlated with PAC in PA patients, and the correlations were stronger with increasing levels of aldosterone. However, in EH patients, only NLR maintained an independent correlation with PAC. Conclusion Leukocyte-related inflammation parameters, including lymphocyte count, NLR, and MLR, were significantly and independently correlated with PAC in PA patients. The correlations were stronger with increasing levels of aldosterone. However, the above correlations were not always present in patients with EH matched for clinical characteristics.
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Affiliation(s)
- Kun-Rui Rao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Ru-Yi Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Hu Ming
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Jian-Wei Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Yi-Fei Dong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- Key Laboratory of Molecular Biology in Jiangxi Province, Nanchang, People’s Republic of China
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21
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Adane T, Melku M, Worku YB, Fasil A, Aynalem M, Kelem A, Getawa S. The Association between Neutrophil-to-Lymphocyte Ratio and Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Diabetes Res 2023; 2023:3117396. [PMID: 37305430 PMCID: PMC10257553 DOI: 10.1155/2023/3117396] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/18/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
Background Glycated hemoglobin (HbA1c) is a commonly used clinical marker to monitor the control of type 2 diabetes mellitus patients (T2DM). However, it is unable to identify the ongoing inflammatory changes in the body. These factors could be easily identified and monitored by the neutrophil-to-lymphocyte ratio (NLR). Therefore, this study is aimed at investigating the relationship between NLR and glycemic control in T2DM. Method A comprehensive search of eligible studies was performed in various databases published until July 2021. A random effect model was used to estimate the standardized mean difference (SMD). A metaregression, subgroup, and sensitivity analysis were conducted to search for potential sources of heterogeneity. Result A total of 13 studies were included in this study. Accordingly, the SMD of the NLR values between the poor and good glycemic control groups was 0.79 (95% CI, 0.46-1.12). Our study also showed that high NLR was significantly associated with poor glycemic control in T2DM patients (OR = 1.50, 95% CI: 1.30-1.93). Conclusion The results of this study suggest an association between high NLR values and an elevated HbA1C in T2DM patients. Therefore, NLR should be considered a marker of glycemic control in addition to HbA1c in T2DM patients.
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Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yilkal Belete Worku
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Fasil
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amanuel Kelem
- Department of Medical Laboratory Sciences, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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22
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Life is really simple, but we insist on making it complicated. (Confucius). Hypertens Res 2023; 46:1051-1053. [PMID: 36759664 DOI: 10.1038/s41440-023-01212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
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23
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Li Y, An D, Xie X, Dong Y. The relationship between neutrophil-to-lymphocyte ratio and cerebral collateral circulation in patients with symptomatic severe intracranial artery stenosis or occlusion. J Clin Neurosci 2023; 108:13-18. [PMID: 36565522 DOI: 10.1016/j.jocn.2022.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The neutrophil/lymphocyte ratio (NLR) has been considered a prognostic indicator for determining the systemic inflammatory response and atherosclerosis. We aimed to determine the relationship between NLR and the development of cerebral collateral circulation in patients with symptomatic severe stenosis or occlusion of intracranial arteries. METHODS All patients underwent digital subtraction angiography (DSA) within 14 days of admission and were divided into a group with good collateral circulation (77 patients) and a group with poor collateral circulation (86 patients) according to the DSA collateral compensation grading method. Apo B, total cholesterol, LDL, and Neutrophil count in the poor side branch group were significantly higher than in the good side branch group. Multifactorial analysis showed that high NLR levels were a valid predictor of poor collateral circulation in patients with symptomatic severe intracranial artery stenosis or occlusion. Spearman correlation analysis showed that the size of the collateral branch score was negatively correlated with NLR (r = -0.509, P < 0.001) and cholesterol content (r = -0.249, P = 0.002). NLR predicted poor collateral circulation with an AUC of 0.620 (sensitivity 66.7 %, specificity 61.3 %, 95 % CI = 0.517-0.723,P < 0.05). CONCLUSION We demonstrate a correlation between NLR levels and the development of collateral circulation in the brain in patients with symptomatic severe stenosis or occlusion of the intracranial arteries.
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Affiliation(s)
- Yao Li
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China; Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, China
| | - Dongxia An
- Department of Neurointervention, Beijing Fengtai Youanmen Hospital, Beijing, China; Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, China
| | - Xiaohua Xie
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China; Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, China
| | - Yanhong Dong
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China; Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, China.
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24
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Xu JP, Zeng RX, Zhang YZ, Lin SS, Tan JW, Zhu HY, Mai XY, Guo LH, Zhang MZ. Systemic inflammation markers and the prevalence of hypertension: A NHANES cross-sectional study. Hypertens Res 2023; 46:1009-1019. [PMID: 36707716 DOI: 10.1038/s41440-023-01195-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023]
Abstract
Systemic inflammation markers have been highlighted recently as related to cardiac and non-cardiac disorders. However, few studies have estimated pre-diagnostic associations between these markers and hypertension. In the National Health and Nutritional Examination Survey from 1999 to 2010, 22,290 adult participants were included for analysis. We assessed associations between four systemic inflammation markers based on blood cell counts: systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and hypertension prevalence in multivariate logistic regression analysis with odds ratio (OR) and 95% confidence interval (CI). To further explore their associations, subgroup and sensitivity analyses were performed. In continuous analyses, the ORs for hypertension prevalence per ln-transformed increment in SII and NLR were estimated at 1.115 and 1.087 (95% CI: 1.045-1.188; 1.008-1.173; respectively). Compared to those in the lowest tertiles, the hypertension risks for subjects in the highest SII and NLR tertiles were 1.20 and 1.11 times, respectively. Conversely, we found that PLR and LMR were negatively associated with hypertension prevalence in continuous analyses (1.060, 0.972-1.157; 0.926, 0.845-1.014; respectively), and the highest PLR and LMR tertiles (1.041, 0.959-1.129; 0.943, 0.866-1.028; respectively). Also, subgroup and sensitivity analyses indicated that SII had a greater correlation to hypertension. In conclusion, we find positive associations between SII and NLR and the prevalence of hypertension in this cross-sectional study. Our findings highlight that SII may be a superior systemic inflammation warning marker for hypertension.
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Affiliation(s)
- Jun-Peng Xu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Rui-Xiang Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Yu-Zhuo Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Shan-Shan Lin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Jia-Wei Tan
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Hai-Yue Zhu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Xiao-Yi Mai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Li-Heng Guo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Min-Zhou Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China. .,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
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25
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Scutca AC, Nicoară DM, Mărăzan M, Brad GF, Mărginean O. Neutrophil-to-Lymphocyte Ratio Adds Valuable Information Regarding the Presence of DKA in Children with New-Onset T1DM. J Clin Med 2022; 12:jcm12010221. [PMID: 36615022 PMCID: PMC9821096 DOI: 10.3390/jcm12010221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is an acute life-threatening complication occurring mainly at the onset of type 1 diabetes mellitus. The neutrophil-to-lymphocyte ratio (NLR), a marker for systemic inflammation, has recently generated increasing interest in many chronic diseases. The aim of this cross-sectional study was to determine the value of the neutrophil-to-lymphocyte ratio (NLR) in association with DKA severity across these cases. A total of 155 children with new-onset type 1 DM from one large center were included in the study. Total and differential leukocyte counts were measured upon admission and calculation of the NLR was performed. Patients were classified into four groups: without DKA, mild, moderate, and severe DKA at disease onset. Total WBCs, neutrophils, and monocytes increased with DKA severity (p-value < 0.005), while eosinophiles displayed an inverse relationship (p-value < 0.001). Median NLR scores increased from those without ketoacidosis (1.11) to mild (1.58), moderate (3.71), and severe (5.77) ketoacidosis groups. The statistical threshold value of the NLR in predicting DKA was 1.84, with a sensitivity of 80.2% and a specificity of 80%. Study findings indicate that a higher NLR score adds valuable information regarding the presence of DKA in children with new-onset T1DM.
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Affiliation(s)
- Alexandra-Cristina Scutca
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Delia-Maria Nicoară
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Correspondence:
| | - Monica Mărăzan
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Giorgiana-Flavia Brad
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Otilia Mărginean
- Department of Pediatrics, University of Medicine and Pharmacy “Victor Babes”, 300040 Timisoara, Romania
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
- Department XI Pediatrics, Discipline I Pediatrics, Disturbances of Growth and Development in Children–BELIVE, 300011 Timisoara, Romania
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26
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Tamaki S, Nagai Y, Shutta R, Masuda D, Yamashita S, Seo M, Yamada T, Nakagawa A, Yasumura Y, Nakagawa Y, Yano M, Hayashi T, Hikoso S, Nakatani D, Sotomi Y, Sakata Y. Combination of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as a Novel Predictor of Cardiac Death in Patients With Acute Decompensated Heart Failure With Preserved Left Ventricular Ejection Fraction: A Multicenter Study. J Am Heart Assoc 2022; 12:e026326. [PMID: 36565197 PMCID: PMC9973595 DOI: 10.1161/jaha.122.026326] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammation markers. Their combined usefulness for estimating the prognosis of patients with heart failure with preserved ejection fraction (HFpEF) admitted for acute decompensated heart failure remains elusive. Methods and Results We investigated 1026 patients registered in the Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction. Both NLR and PLR values were measured at the time of admission. Comorbidity burden was defined as the number of occurrences of 8 common comorbidities of HFpEF. The primary end point was cardiac death. The patients were stratified into 3 groups based on the optimal cut-off values of NLR and PLR on the receiver operating characteristic curve analysis for predicting cardiac death (low NLR and PLR, either high NLR or PLR, and both high NLR and PLR). After a median follow-up of 429 days, 195 patients died, with 85 of these deaths attributed to cardiac causes. An increased comorbidity burden was significantly associated with a higher proportion of patients with high NLR (>4.5) or PLR (>193), or both. High NLR and PLR values were independently associated with cardiac death, and a combination of both values was the strongest predictor (hazard ratio, 2.66 [95% CI, 1.51%-4.70%], P=0.0008). A significant difference was found in the rate of cardiac death among the 3 groups stratified by NLR and PLR values. Conclusions The combination of NLR and PLR is useful for the prediction of postdischarge cardiac death in patients with acute HFpEF. Registration URL: ClinicalTrials.gov; Unique identifier: UMIN000021831.
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Affiliation(s)
- Shunsuke Tamaki
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | - Yoshiyuki Nagai
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | - Ryu Shutta
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | - Daisaku Masuda
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | | | - Masahiro Seo
- Division of CardiologyOsaka General Medical CenterOsakaJapan
| | - Takahisa Yamada
- Division of CardiologyOsaka General Medical CenterOsakaJapan
| | - Akito Nakagawa
- Division of CardiologyAmagasaki Chuo HospitalAmagasakiJapan,Department of Medical InformaticsOsaka University Graduate School of MedicineOsakaJapan
| | | | | | | | | | - Shungo Hikoso
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Daisaku Nakatani
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yohei Sotomi
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yasushi Sakata
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
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27
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Chang C, Zhou J, Chou OHI, Chan J, Leung K, Lee TTL, Wong WT, Wai A, Liu T, Zhang Q, Lee S, Tse G. Predictive value of neutrophil-to-lymphocyte ratio for atrial fibrillation and stroke in type 2 diabetes mellitus: The Hong Kong Diabetes Study. Endocrinol Diabetes Metab 2022; 6:e397. [PMID: 36464326 PMCID: PMC9836252 DOI: 10.1002/edm2.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Neutrophil-to-lymphocyte ratio (NLR) is a routinely available biomarker that reflects systemic inflammation. The study evaluated the predictive value of NLR for ischemic stroke and atrial fibrillation (AF) in patients with type 2 diabetes mellitus. METHODS This was a population-based cohort study of patients with type 2 diabetes mellitus and complete blood count tests at baseline between 1 January 1st, 2009, and 31 December, 2009, at government-funded hospitals/clinics in Hong Kong. Follow-up was until 31 December, 2019, or death. RESULTS A total of 85,351 patients (age = 67.6 ± 13.2 years old, male = 48.8%, follow-up = 3101 ± 1441 days) were included. Univariable Cox regression found that increased NLR at quartiles 2, 3 and 4 was significantly associated with higher risks of new-onset ischemic stroke (hazard ratio [HR]: 1.28 [1.20-1.37], p < .001, HR: 1.41 [1.32-1.51], p < .001 and HR: 1.38 [1.29-1.47], p < .001) and AF (HR: 1.09 [1.02-1.17], p < .015; HR: 1.28 [1.20-1.37], p < .001; HR: 1.39 [1.31-1.49], p < .001) compared to quartile 1. On multivariable analysis, NLR remained a significant predictor of ischemic stroke risk for quartiles 2 and 3 (quartile 2: HR: 1.14 [1.05, 1.22], p = .001; quartile 3: HR: 1.14 [1.06, 1.23], p < .001) but not quartile 4 (HR: 1.08 [0.994, 1.17], p = .070). NLR was not predictive of AF after adjusting for confounders (quartile 2: HR: 0.966 [0.874, 1.07], p = .499; quartile 3: HR: 0.978 [0.884, 1.08], p = .661; quartile 4: HR: 1.05 [0.935, 1.16], p = .462). CONCLUSION NLR is a significant predictor of new-onset ischaemic stroke after adjusting for significant confounders in Chinese type 2 diabetes patients.
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Affiliation(s)
- Carlin Chang
- Department of MedicineQueen Mary HospitalPokfulamHong KongChina
| | - Jiandong Zhou
- School of Data ScienceCity University of Hong KongKowloonHong KongChina
| | | | - Justin Chan
- Diabetes Research Unit, Cardiovascular Analytics GroupUK CollaborationHong KongChina
| | - Keith Sai Kit Leung
- Diabetes Research Unit, Cardiovascular Analytics GroupUK CollaborationHong KongChina,Aston Medical SchoolAston UniversityBirminghamUK
| | - Teddy Tai Loy Lee
- Emergency Medicine Unit, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Wing Tak Wong
- School of Life SciencesThe Chinese University of Hong KongHong KongChina
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of CardiologyTianjin Institute of Cardiology, Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Qingpeng Zhang
- School of Data ScienceCity University of Hong KongKowloonHong KongChina
| | - Sharen Lee
- Diabetes Research Unit, Cardiovascular Analytics GroupUK CollaborationHong KongChina
| | - Gary Tse
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of CardiologyTianjin Institute of Cardiology, Second Hospital of Tianjin Medical UniversityTianjinChina,Kent and Medway Medical SchoolKentUK,School of Nursing and Health StudiesHong Kong Metropolitan UniversityHong KongChina
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Zhu Y, Li G, Laukkanen JA, Song X, Zhang J, Wei L, Chen X, Li Y, Liu C. Higher neutrophil to lymphocyte ratio is associated with renal dysfunction and cardiac adverse remodeling in elderly with metabolic syndrome. Front Cardiovasc Med 2022; 9:921204. [PMID: 36158844 PMCID: PMC9492939 DOI: 10.3389/fcvm.2022.921204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Previous studies have shown that metabolic syndrome (MetS) is associated with increased systemic inflammation and cardiac mortality in elderly subjects. However, information on the association of inflammation markers with cardiac adverse remodeling is limited in the elderly with MetS. Therefore, we investigated whether the inflammatory marker neutrophil/lymphocyte ratio (NLR) is associated with the cardiac adverse remodeling in Chinese elderly with MetS. Methods A total of 1,087 hospitalized Chinese elderly (aged ≥ 65 years) with MetS were collected retrospectively. The cross-sectional data of echocardiography and clinical parameters were compared among quartile NLR groups. Results In the elderly with MetS, higher quartile NLR (≥3.83) was found to be associated with male gender, older age, lower estimated glomerular filtration rate (eGFR), and cardiac left ventricular (LV) dilatation (all p <0.05). Conclusion Higher NLR is associated with male gender, older age, renal dysfunction, and cardiac adverse remodeling in Chinese elderly with MetS.
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Affiliation(s)
- Yuqi Zhu
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Li
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Gang Li
| | - Jari A. Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Central Finland Health Care District, Jyväskylä, Finland
| | - Xing Song
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Zhang
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linping Wei
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinrui Chen
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yufeng Li
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cheng Liu
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Zhao Y, Zhang S, Yi Y, Qu T, Gao S, Lin Y, Zhu H. Neutrophil-to-lymphocyte ratio as a predictor for cardiovascular diseases: a cohort study in Tianjin, China. J Hum Hypertens 2022:10.1038/s41371-022-00724-7. [PMID: 35859165 DOI: 10.1038/s41371-022-00724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/23/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022]
Abstract
Based on a cohort in Tianjin, China, we explore the relationship between neutrophils-to-lymphocyte ratio (NLR) and the risk of cardiovascular diseases (CVDs). From January 2010 to December 2019, 4667 eligible participants aged more than 40 years old, CVDs-free, and registered in two community health service centers were recruited and followed up. The values of NLR collected at baseline were included in Cox proportional hazards model to evaluate its association with the incidence risk of CVDs. Hazard ratio (HR) and 95% confidence interval (CI) were calculated before and after adjustment for potential confounding factors selected by LASSO regression. During a total of 13,691 person-years of follow-up among all participants (median, 2.0 years; interquartile range, 1.7-2.5), 150 (3.42%) newly diagnosed CVDs events occurred, with the incidence density of CVDs of 10.96/1000 person-year. The incidence density in subgroups categorized by tertiles of baseline NLR was 8.08/1000, 11.74/1000, and 13.24/1000, respectively (p trend = 0.019). COX models revealed that after adjustment for potential confounders, NLR (as a continuous variable) was significantly related to the risk of total CVDs (HR 1.10, 95% CI: 1.04, 1.17), myocardial infarction (HR 1.12, 95% CI: 1.05, 1.20), and ischemic stroke (HR 1.21, 95% CI: 1.10, 1.33). When NLR was categorized into tertiles, participants in the top tertile had a significantly higher risk of CVDs (HR 1.61, 95% CI: 1.06, 2.44) and myocardial infarction (HR 1.88, 95% CI: 1.09, 3.27) relative to those in the bottom tertile.
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Affiliation(s)
- Yuxin Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Shuaixiang Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Yue Yi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Ting Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Si Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Yizhou Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Hong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China. .,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China.
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Herold Z, Herold M, Lohinszky J, Szasz AM, Dank M, Somogyi A. Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer. World J Clin Cases 2022; 10:6825-6844. [PMID: 36051133 PMCID: PMC9297428 DOI: 10.12998/wjcc.v10.i20.6825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/23/2021] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Platelet count or complete blood count (CBC)-based ratios including lymphocyte-to-monocyte (LMR), neutrophil-to-lymphocyte (NLR), hemoglobin-to-platelet (HPR), red blood cell count distribution width-to-platelet (RPR), and platelet-to-lymphocyte (PLR) ratio are good predictors of colorectal cancer (CRC) survival. Their change in time is not well documented, however.
AIM To investigate the effect of longitudinal CBC ratio changes on CRC survival and their possible associations with clinicopathological properties, comorbidities, and anamnestic data.
METHODS A retrospective longitudinal observational study was conducted with the inclusion of 835 CRC patients, who attended at Semmelweis University, Budapest. CBC ratios and two additional newly defined personalized platelet count metrics (pPLTD and pPLTS, the platelet counts relative to the measurement at the time of CRC diagnosis and to the one 4-6 wk after tumor removal surgery, respectively) were recorded.
RESULTS The 835 CRC patients had a total of 4608 measurements (5.52 visits/patient, in average). Longitudinal survival models revealed that the increases/decreases in LMR [hazard ratio (HR): 0.4989, P < 0.0001], NLR (HR: 1.0819, P < 0.0001), HPR (HR: 0.0533, P = 0.0038), pPLTD (HR: 4.9229, P < 0.0001), and pPLTS (HR: 4.7568, P < 0.0001) values were poor prognostic signs of disease-specific survival. The same was obtained for all-cause mortality. Most abnormal changes occurred within the first 3 years after the diagnosis of CRC. RPR and PLR had an only marginal effect on disease-specific (P = 0.0675) and all-cause mortality (Bayesian 95% credible interval: 0.90–186.05), respectively.
CONCLUSION LMR, NLR, and HPR are good metrics to follow the prognosis of the disease. pPLTD and pPLTS perform just as well as the former, while the use of RPR and PLR with the course of the disease is not recommended. Early detection of the abnormal changes in pPLTD, pPLTS, LMR, NLR, or HPR may alert the practicing oncologist for further therapy decisions in a timely manner.
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Affiliation(s)
- Zoltan Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest 1088, Hungary
| | - Magdolna Herold
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest 1088, Hungary
| | - Julia Lohinszky
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest 1088, Hungary
| | - Attila Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary
| | - Magdolna Dank
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary
| | - Aniko Somogyi
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest 1088, Hungary
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Yi Y, Qu T, Shi A, Pang Z, Zhao Y, Li P, Xie J, Zhi X, Zhu Y, Zhu H. Relationship between inflammatory cells level and longer duration of hypertension in Chinese community residents. Clin Exp Hypertens 2022; 44:619-626. [PMID: 35838365 DOI: 10.1080/10641963.2022.2100411] [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: 11/03/2022]
Abstract
BACKGROUND To explore the relationship between duration of hypertension and inflammatory cell levels and to assess whether long duration might aggravate these inflammatory cells among Chinese urban community residents. METHODS A cross-sectional study of 5199 hypertensive and 2675 no-hypertensive participants who registered in community health service centers for physical examination was performed in Tianjin, China. Data of blood pressure and inflammatory cells were collected. Binary logistic regression was performed to assess the effect of hypertensive duration on the level of inflammatory cells before and after adjustment for the potential confounding factors. RESULTS Individuals with hypertension had significantly higher level of leukocyte count, neutrophil proportion, neutrophil-to-lymphocyte ratio (NLR), and lower level of lymphocyte proportion than those without hypertension. Two-way ANOVA showed that hypertension duration, rather than blood pressure control or their interaction, had significant influence on the levels of neutrophil proportion, lymphocyte proportion, and NLR. With the prolongation of the duration of hypertension, the level of neutrophil proportion and NLR increased, and the level of lymphocyte proportion decreased. Long hypertension duration (>10 years) was significantly associated with high level of neutrophil proportion (OR = 1.48, 95% CI: 1.25, 1.75), high level of NLR (OR = 1.53, 95% CI: 1.29, 1.81), and low level of lymphocyte proportion (OR = 1.54, 95% CI: 1.30, 1.82) in comparison with short duration (<5 years) after adjustment for confounding factors. CONCLUSION Hypertensive patients had higher level of leukocyte count, neutrophil proportion, NLR, and lower level of lymphocyte proportion than normotensive ones. Long duration of hypertension was associated with aggravated inflammatory biomarkers.
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Affiliation(s)
- Yue Yi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Ting Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Aibin Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Zhixin Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Yuxin Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Pengcheng Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Juan Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Xinyue Zhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Yun Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
| | - Hong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition & Public Health, Tianjin, China
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Yeh JJ, Lai M, Lin CL, Lu KH, Kao CH. Effects of statins on the risks of ischemic stroke and heart disease in human immunodeficiency virus infection, influenza and severe acute respiratory syndrome-associated coronavirus: respiratory virus infection with steroid use. Postgrad Med 2022; 134:589-597. [PMID: 35590450 DOI: 10.1080/00325481.2022.2080359] [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: 10/18/2022]
Abstract
OBJECTIVES We sought to fill the research gap on the effects of statins on the risks of ischemic stroke and heart disease among individuals with human immunodeficiency virus infection, influenza, and severe acute respiratory syndrome associated-coronavirus (HIS) disorders. METHODS We enrolled a HIS cohort treated with statins (n = 4921) and a HIS cohort not treated with statins (n = 4921). The cumulative incidence of ischemic stroke and heart disease was analyzed using a time-dependent Cox proportional regression analysis. We analyzed the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of ischemic stroke and heart disease for statins users relative to nonusers based on sex, age, comorbidities and medications. RESULTS The aHR (95% CI) was 0.38 (0.22-0.65) for ischemic stroke. The aHR (95% CI) of heart disease was 0.50 (0.46-0.55). The aHRs (95% CI) of statin users with low, medium, and high adherence (statin use covering <33%, 33%-66%, and >66%, respectively, of the study period) for the risks of ischemic stroke were 0.50 (0.27-0.92), 0.31 (0.10-1.01), and 0.16 (0.04-0.68) and for heart disease were 0.56 (0.51-0.61), 0.40 (0.33-0.48), and 0.44 (0.38-0.51), respectively, compared with statin nonusers. CONCLUSION Statin use was associated with lower aHRs for ischemic stroke and heart disease in those with HIS disorders with comorbidities.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Family Medicine, Geriatric Medicine, and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Meichu Lai
- Department of Laboratory Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Hua Lu
- Department of Family Medicine, Geriatric Medicine, and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Hashemi Moghanjoughi P, Neshat S, Rezaei A, Heshmat-Ghahdarijani K. Is the Neutrophil-to-lymphocyte ratio an exceptional indicator for metabolic syndrome disease and outcomes? Endocr Pract 2021; 28:342-348. [PMID: 34838762 DOI: 10.1016/j.eprac.2021.11.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022]
Abstract
Metabolic syndrome is a syndrome compromised of elevated fasting blood glucose, increased blood pressure, central obesity, decreased high density lipoprotein, and increased triglyceride levels. Because of its growing incidence and prevalence, and the effect that it has on developing other non-communicable disease, the importance gets even more value. Prediction and control of this disease in early stages and in the cheapest way, is a crucial need these days. Due to role of chronic low-grade inflammation in metabolic syndrome, cytokines and inflammatory factors like interleukin-6 and Tumor necrosis factor-a have a critical effect on this phenomenon. Neutrophil to lymphocyte (NLR) ratio is an inflammatory marker that has an unchallenging availability, and has a reasonable price. NLR has a relation with obesity, type 2 diabetes, hypertension (HTN), blood cholesterol levels. This states that there should be a relation between NLR and metabolic syndrome. NLR as a low-grade inflammation marker indicates a positive relationship with central obesity. Also, studies indicate that diabetes' incidence, its severity, and its control contribute a relation with NLR. Hypertension, and hyperlipidemia, both can be noticed with higher NLRs. In this rapid review we are going to assess the association between metabolic syndrome and NLR.
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Affiliation(s)
| | - Sina Neshat
- M.D., School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Rezaei
- M.D., School of Medicine, Boushehr University of Medical Sciences, Boushehr, Iran
| | - Kiyan Heshmat-Ghahdarijani
- M.D., Assistant Professor, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
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Arterial stiffness in children with primary hypertension is related to subclinical inflammation. Cent Eur J Immunol 2021; 46:336-343. [PMID: 34764805 PMCID: PMC8574109 DOI: 10.5114/ceji.2021.109156] [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] [Received: 02/02/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction The immune system can trigger an inflammatory process leading to blood pressure elevation and arterial damage. The aim of the study was to assess the relation between subclinical inflammation and arterial damage in pediatric patients with primary hypertension (PH) and to establish the usefulness of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios, and mean platelet volume (MPV) as markers of arterial damage in these subjects. Material and methods In 119 children with PH (14.94 ±2.76 years) and 45 healthy children (14.91 ±2.69 years) we analyzed markers of subclinical inflammation (NLR, PLR, MPV), clinical and biochemical parameters, office blood pressure, ambulatory blood pressure monitoring (ABPM), central blood pressure, aortic pulse wave velocity (aPWV), augmentation index corrected for heart rates 75 (AIx75HR), carotid intima media thickness (cIMT), and common carotid artery stiffness (E-tracking). Results Children with PH were characterized by significantly higher neutrophil (3.9 ±1.7 vs. 3.0 ±1.0 [1000/µl], p < 0.001) and platelet counts (271.9 ±62.3 vs. 250.3 ±60.3 [1000/µl], p = 0.047), NLR (1.9 ±1.5 vs. 1.3 ±0.4, p = 0.010), PLR (131.4 ±41.9 vs. 114.7 ±37.6, p = 0.020), aPWV (5.36 ±0.88 vs. 4.88 ±0.92 m/s, p = 0.004), and cIMT (0.46 ±0.07 vs. 0.43 ±0.07 mm, p = 0.002) compared to healthy children. In PH children NLR correlated positively (p < 0.05) with: systolic, diastolic and mean blood pressure in ABPM (r = 0.243, r = 0.216, r = 0.251), aPWV [m/s] (r = 0.241), aPWV Z-score (r = 0.204), and common carotid artery PWVbeta [m/s] (r = 0.202). Conclusions There is a link between arterial stiffness and subclinical inflammation in pediatric patients with primary hypertension. Neutrophil-to-lymphocyte ratio may serve as a promising marker of arterial stiffness in pediatric patients affected by primary hypertension.
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Bruno AS, Lopes PDD, de Oliveira KCM, de Oliveira AK, de Assis Cau SB. Vascular Inflammation in Hypertension: Targeting Lipid Mediators Unbalance and Nitrosative Stress. Curr Hypertens Rev 2021; 17:35-46. [PMID: 31858899 DOI: 10.2174/1573402116666191220122332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/24/2019] [Accepted: 11/28/2019] [Indexed: 11/22/2022]
Abstract
Arterial hypertension is a worldwide public health threat. High Blood Pressure (BP) is commonly associated with endothelial dysfunction, nitric oxide synthases (NOS) unbalance and high peripheral vascular resistance. In addition to those, inflammation has also been designated as one of the major components of BP increase and organ damage in hypertension. This minireview discusses vascular inflammatory triggers of high BP and aims to fill the existing gaps of antiinflammatory therapy of hypertension. Among the reasons discussed, enhanced prostaglandins rather than resolvins lipid mediators, immune cell infiltration and oxidative/nitrosative stress are pivotal players of BP increase within the inflammatory hypothesis. To address these inflammatory targets, this review also proposes new concepts in hypertension treatment with non-steroidal antiinflammatory drugs (NSAIDs), nitric oxide-releasing NSAIDs (NO-NSAIDs) and specialized proresolving mediators (SPM). In this context, the failure of NSAIDs in hypertension treatment seems to be associated with the reduction of endogenous NO bioavailability, which is not necessarily an effect of all drug members of this pharmacological class. For this reason, NO-releasing NSAIDs seem to be safer and more specific therapy to treat vascular inflammation in hypertension than regular NSAIDs.
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Affiliation(s)
- Alexandre S Bruno
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
| | - Patricia das Dores Lopes
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
| | - Karla C M de Oliveira
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
| | - Anizia K de Oliveira
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
| | - Stefany B de Assis Cau
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais, MG, Brazil
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The population characteristics of the main leukocyte subsets and their association with chronic diseases in a community-dwelling population: a cross-sectional study. Prim Health Care Res Dev 2021; 22:e18. [PMID: 33958026 PMCID: PMC8165331 DOI: 10.1017/s1463423621000153] [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: 12/16/2022] Open
Abstract
Aim: To analyse the characteristics of the main leukocyte subsets and elucidate their distributions amongst the natural population. We wanted to determine whether leukocyte subsets are potential biomarkers to evaluate the risk of common chronic diseases. Background: The peripheral blood leukocyte count is a routine exam performed to detect pathogen infections. Recently, subsets of white blood cells and their homeostasis have shown strong associations with some chronic diseases. Therefore, studies aiming to discover whether the distribution of leukocyte counts and its subsets are useful for predicting health conditions are worthwhile. Methods: This cross-sectional study analysed 10 564 residents from the basic public health service project of the Health Checkup Program performed by the BaiYun Community Health Service Center. Data on demographic information, physical measurements, medical history, and routine blood examination parameters were collected using questionnaires and health check-ups. Restricted cubic spline incorporated into logistic regression analysis was performed to evaluate the association between subsets of leukocytes and common chronic diseases. Findings: The counts of leukocytes and their subsets in males were higher than those in females amongst all age groups, yet the percentages of lymphocytes and neutrophils did not present sex-specific differences. A low lymphocyte count and percentage were associated with old age. The neutrophil-to-lymphocyte ratio (NLR) in patients with hypertension was higher than that in the non-hypertensive population. The risk of NLR in the top quartiles was 1.17-fold higher than that in people in the lowest quartiles. Conclusions: The distributions of the white blood cell count and percentage were associated with age, sex, and body mass index (BMI). In addition to the immune barrier for pathogens, the NLR or monocyte-to-lymphocyte ratio (MLR) may be potentially used to indicate the risk of some chronic non-communicable diseases. Homeostasis of subsets of leukocytes may be an important biomarker for body health conditions.
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Neutrophil counts and the risk of first stroke in general hypertensive adults. Hypertens Res 2021; 44:830-839. [PMID: 33564178 DOI: 10.1038/s41440-021-00625-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022]
Abstract
We aimed to investigate the association between neutrophil counts and first stroke and examine possible effect modifiers among treated hypertensive adults. This is a post hoc analysis of the China Stroke Primary Prevention Trial (CSPPT). A total of 11,878 hypertensive adults with data on neutrophil counts at baseline were included in the current study. The primary outcome was first stroke. During a median follow-up of 4.5 years, 414 (3.5%) participants experienced a first stroke, including 358 with ischemic stroke, 55 with hemorrhagic stroke and one with uncertain type of stroke. Compared with participants in quartile 1 (<2.9 × 109/L) of neutrophil counts, those in the upper quartiles (quartile 2-4 [≥2.9 × 109/L]) had a significantly higher risk of first stroke (HR, 1.35; 95% CI: 1.02, 1.78) or first ischemic stroke (HR, 1.38; 95% CI: 1.02, 1.86). Moreover, a strong positive association between neutrophil counts and first ischemic stroke was found in participants with total homocysteine (tHcy) levels <15 μmol/L (HR, 1.74; 95% CI: 1.17, 2.58; vs. ≥15 μmol/L; HR, 0.91; 95% CI: 0.57, 1.46, P interaction = 0.042) at baseline or time-averaged mean arterial pressure (MAP) ≥102 mmHg (median) (HR, 1.92; 95% CI: 1.27, 2.89; vs. <102 mmHg; HR, 0.89; 95% CI: 0.57, 1.41, P interaction = 0.015) during the treatment period. However, no such association between neutrophil counts and first hemorrhagic stroke was found. In summary, high baseline neutrophil counts were associated with an increased risk of first ischemic stroke among hypertensive patients, especially in those with low tHcy at baseline or high time-averaged MAP during the treatment period.
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Huang LY, Sun FR, Yin JJ, Ma YH, Li HQ, Zhong XL, Yu JT, Song JH, Tan L. Associations of the neutrophil to lymphocyte ratio with intracranial artery stenosis and ischemic stroke. BMC Neurol 2021; 21:56. [PMID: 33546646 PMCID: PMC7863476 DOI: 10.1186/s12883-021-02073-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR) has emerged as an inflammatory marker. However, the associations of NLR with intracranial artery stenosis (ICAS) and ischemic stroke remain unclear. This study aimed to examine the associations of NLR with ICAS and ischemic stroke among a large and high-risk population. Methods Participants with records of clinical characteristics were prospectively recruited from the Neurology Department and Health & Physical Examination Center of Qingdao Municipal Hospital. Logistic regression analysis was used to examine the associations of NLR with ICAS and ischemic stroke. Moreover, we also conducted parametric mediation analysis to estimate the effect of NLR on the risk of ischemic stroke mediated through ICAS. Results A total of 2989 participants were enrolled in this study. After adjusting for covariates, NLR (OR = 1.125, 95%CI 1.070–1.183) and ICAS (OR = 1.638, 95%CI 1.364–1.967) were significantly associated with ischemic stroke. Compared with the first quartile NLR, the second, third and fourth quartiles NLR were independent risk predictors for ischemic stroke (P for trend < 0.001); the third and fourth quartiles were independent predictors for ICAS (P for trend < 0.001). The mediation analysis showed that ICAS partially mediated the association between NLR and ischemic stroke, accounting for 14.4% of the total effect (P < 0.001). Conclusions NLR was significantly associated with ICAS and ischemic stroke. Besides, ICAS partially mediated the association between NLR and ischemic stroke.
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Affiliation(s)
- Liang-Yu Huang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Fu-Rong Sun
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Jian-Jun Yin
- Department of Neurology, Qingdao Hiser Hospital, Qingdao University, Qingdao, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Hong-Qi Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xiao-Ling Zhong
- Department of Neurology, Qingdao Central Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Jing-Hui Song
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China.
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Wild J, Wenzel P. Myeloid cells, tissue homeostasis, and anatomical barriers as innate immune effectors in arterial hypertension. J Mol Med (Berl) 2021; 99:315-326. [PMID: 33443617 PMCID: PMC7899956 DOI: 10.1007/s00109-020-02019-1] [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: 03/17/2020] [Accepted: 11/18/2020] [Indexed: 11/29/2022]
Abstract
Although essential hypertension affects a large proportion of the human population and is one of the key drivers of cardiovascular mortality worldwide, we still do not have a complete understanding of its pathophysiology. More than 50 years ago, the immune system has been identified as an important part of the pathogenesis of arterial hypertension. An exceeding variety of recent publications deals with the interplay between the numerous different components of the immune system and mechanisms of arterial hypertension and has substantially contributed to our understanding of the role of immunity and inflammation in the pathogenesis of the disease. In this review, we focus on myeloid cells and anatomical barriers as particular aspects of innate immunity in arterial hypertension. Since it represents a first line of defense protecting against pathogens and maintaining tissue homeostasis, innate immunity provides many mechanistic hinge points in the area of hypertension.
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Affiliation(s)
- Johannes Wild
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,Center for Cardiology - Cardiology I and CTH Professorship "Vascular Inflammation", University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Berlin, Germany
| | - Philip Wenzel
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany. .,Center for Cardiology - Cardiology I and CTH Professorship "Vascular Inflammation", University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Berlin, Germany.
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40
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Wang Z, Zhao L, He S. Relation between neutrophil-to-lymphocyte ratio and mortality in patients with hypertrophic cardiomyopathy. Biomark Med 2020; 14:1693-1701. [PMID: 33346698 DOI: 10.2217/bmm-2020-0463] [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] [Indexed: 02/05/2023] Open
Abstract
Aim: We assessed the prognostic value of neutrophil-to-lymphocyte ratio (NLR) for all-cause mortality in patients with hypertrophic cardiomyopathy (HCM). Methods & results: A total of 354 HCM patients were enrolled. There were 44 all-cause mortality in total. Patients in the third tertile of NLR had the highest all-cause mortality rate of 5.2 per 100 person-years. Patients in tertile 3 had a significantly higher risk of all-cause mortality with adjusted hazard ratio of 2.4 (95% CI: 1.0-5.4; p = 0.040) when compared with that of patients in tertile 1. No significant interactions between NLR and other variables were observed during subgroup analysis. Conclusion: NLR was an independent risk factor for all-cause mortality in HCM patients.
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Affiliation(s)
- Ziqiong Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Liming Zhao
- Department of Cardiovascular Medicine, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan 610041, China
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
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Libianto R, Hu J, Chee MR, Hoo J, Lim YY, Shen J, Li Q, Young MJ, Fuller PJ, Yang J. A Multicenter Study of Neutrophil-to-Lymphocyte Ratio in Primary Aldosteronism. J Endocr Soc 2020; 4:bvaa153. [PMID: 33225198 PMCID: PMC7667995 DOI: 10.1210/jendso/bvaa153] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 12/28/2022] Open
Abstract
Background Hypertensive patients with primary aldosteronism (PA) have a higher risk of cardiovascular complications than those with blood pressure-matched essential hypertension. The excess cardiovascular consequences of PA can be attributed to the proinflammatory effect of excessive aldosterone and mineralocorticoid receptor activation in a range of peripheral tissues and cell types. The neutrophil-to-lymphocyte ratio (NLR) is a widely available marker of inflammation which has been shown to predict cardiovascular outcome in the general population. This study aims to evaluate the use of NLR as a potential biomarker of PA and PA severity. Methods Patients with PA (n = 355) were identified from 2 large PA databases in Australia and China, while controls (n = 222) were patients with hypertension who were referred for assessment but did not meet the diagnostic criteria for PA. The NLR was retrospectively collected from routine full blood examination, prior to commencement of targeted treatment for PA. Results The NLR did not differ between PA patients and hypertensive controls (median 2.3 and 2.4, P = 0.563). However, among patients with PA, the NLR was positively correlated with baseline and post-saline aldosterone levels (r = 0.22 and P < 0.001 for both) and negatively correlated with serum potassium (r = -0.15, P = 0.006). Furthermore, in a logistic regression analysis of data from patients with PA, the NLR predicted the presence of comorbid chronic kidney disease (CKD) (defined as estimated glomerular filtration rate <60 mL/min/1.73m2) with an odds ratio of 1.5 (P = 0.003). Conclusion While the NLR did not distinguish PA from controls, it was a marker of PA severity, being associated with aldosterone concentration as well as the presence of CKD. A prospective study is needed to further clarify the role of NLR in predicting end-organ damage associated with PA.
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Affiliation(s)
- Renata Libianto
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min R Chee
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Jesse Hoo
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Yin Y Lim
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Jimmy Shen
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia.,Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Prahan, Victoria, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia
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Lankarani KB, Honarvar B, Keshani P, Raeisi Shahraki H. Determinant components of newly onset versus improved metabolic syndrome in a population of Iran. Sci Rep 2020; 10:19563. [PMID: 33177586 PMCID: PMC7659336 DOI: 10.1038/s41598-020-76531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 10/29/2020] [Indexed: 02/08/2023] Open
Abstract
This study aimed to determine the risk factors related to regression and progression of metabolic syndrome, in a 4-year cohort study. A total of 540 individuals (≥ 18 years old) participated in both phase of the study. Participants were categorized into 3 categories of regressed, progressed and unchanged metabolic syndrome (MetS). Demographic, anthropometric and biochemical parameters were assessed for each individual in both phase. Variables differences (delta: Δ) between the two phase of study were calculated. Unchanged group was considered as baseline category. Based on IDF, MetS had been regressed and progressed in 42 participants (7.7%) and 112 (20.7%) participants respectively, in the second phase. More than 47% of people, whose MetS regressed, experienced also NAFLD regression. Results of multiple variable analysis revealed that increased age, positive Δ-TG, and Δ-FBS, significantly increased the odds of MetS progression based on IDF and ATP III definitions, while negative Δ-HDL and Δ-neutrophil to lymph ration increased the odds of progression. On the other hand, negative Δ-TG and positive Δ-HDL significantly increased the odds of Mets regression based of both IDF and ATP III. Management of hypertriglyceridemia, hyperglycemia, and HDL is a critical, non-invasive and accessible approach to change the trend of MetS.
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Affiliation(s)
- Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Honarvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Parisa Keshani
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Raeisi Shahraki
- Department of Biostatistics and Epidemiology, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Pietropaoli D, Monaco A, D'Aiuto F, Muñoz Aguilera E, Ortu E, Giannoni M, Czesnikiewicz-Guzik M, Guzik TJ, Ferri C, Del Pinto R. Active gingival inflammation is linked to hypertension. J Hypertens 2020; 38:2018-2027. [PMID: 32890278 DOI: 10.1097/hjh.0000000000002514] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) including hypertension, are characterized by underlying systemic inflammation. Periodontitis, which can impact the systemic inflammatory burden has recently been linked to high blood pressure (BP). However, the relationship of gingival bleeding, as an easily accessible marker of periodontal disorder, with hypertension, remains unclear. METHODS Survey-based propensity score matching (PSM) incorporating major confounders shared between hypertension and periodontal diseases was applied to cross-sectional NHANES III data from 5396 adults at least 30 years old who underwent BP measurement and periodontal examination, identifying two matched groups with and without gingival bleeding. The association of bleeding gums with SBP (mmHg) and high/uncontrolled BP was then assessed with generalized additive models incorporating inflammatory markers. Stratification by periodontal status (healthy; gingivitis; stable periodontitis; unstable periodontitis) was performed. Variables importance was estimated using machine learning. RESULTS Gingival bleeding (gingivitis; unstable periodontitis) was independently associated with +2.6 mmHg (P < 0.001) SBP compared with no bleeding (healthy periodontium; stable periodontitis), and with greater odds (OR = 1.42; 95% CI = 1.19-1.68; P < 0.001) of high/uncontrolled BP. Participants with unstable periodontitis had higher SBP than those with stable periodontitis (+2.1 mmHg; P < 0.001) or gingivitis (+5.3 mmHg; P < 0.001). Unstable periodontitis and gingivitis were consistently associated with increased risk of high/uncontrolled BP (OR = 1.65, 95% CI = 2.14-1.82; OR = 1.49, 95% CI = 1.22-1.82, respectively). Inflammatory markers allowed a maximum of 12% gain in the models' predictive power. CONCLUSION Gingival bleeding contributes to shaping the relationship between periodontal diseases and BP, but the burden represented by periodontitis is also crucial. Periodontal evaluation might be of importance in difficult to control hypertension.
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Affiliation(s)
- Davide Pietropaoli
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Annalisa Monaco
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London
| | - Eva Muñoz Aguilera
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London
| | - Eleonora Ortu
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Mario Giannoni
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Marta Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow, UK
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Internal and Agricultural Medicine, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Rita Del Pinto
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
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Cronjé HT, Elliott HR, Nienaber-Rousseau C, Green FR, Schutte AE, Pieters M. Methylation vs. Protein Inflammatory Biomarkers and Their Associations With Cardiovascular Function. Front Immunol 2020; 11:1577. [PMID: 32849535 PMCID: PMC7411149 DOI: 10.3389/fimmu.2020.01577] [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: 02/25/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Abstract
DNA methylation data can be used to estimate proportions of leukocyte subsets retrospectively, when directly measured cell counts are unavailable. The methylation-derived neutrophil-to-lymphocyte and lymphocyte-to-monocyte ratios (mdNLRs and mdLMRs) have proven to be particularly useful as indicators of systemic inflammation. As with directly measured NLRs and LMRs, these methylation-derived ratios have been used as prognostic markers for cancer, although little is known about them in relation to other disorders with inflammatory components, such as cardiovascular disease (CVD). Recently, methylation of five genomic cytosine-phosphate-guanine sites (CpGs) was suggested as proxies for mdNLRs, potentially providing a cost-effective alternative when whole-genome methylation data are not available. This study compares seven methylation-derived inflammatory markers (mdNLR, mdLMR, and individual CpG sites) with five conventionally used protein-based inflammatory markers (C-reactive protein, interleukins 6 and 10, tumor-necrosis factor alpha, and interferon-gamma) and a protein-based inflammation score, in their associations with cardiovascular function (CVF) and risk. We found that markers of CVF were more strongly associated with methylation-derived than protein-based markers. In addition, the protein-based and methylation-derived inflammatory markers complemented rather than proxied one another in their contribution to the variance in CVF. There were no strong correlations between the methylation and protein markers either. Therefore, the methylation markers could offer unique information on the inflammatory process and are not just surrogate markers for inflammatory proteins. Although the five CpGs mirrored the mdNLR well in their capacity as proxies, they contributed to CVF above and beyond the mdNLR, suggesting possible added functional relevance. We conclude that methylation-derived indicators of inflammation enable individuals with increased CVD risk to be identified without measurement of protein-based inflammatory markers. In addition, the five CpGs investigated here could be useful surrogates for the NLR when the cost of array data cannot be met. Used in tandem, methylation-derived and protein-based inflammatory markers explain more variance than protein-based inflammatory markers alone.
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Affiliation(s)
- Héléne Toinét Cronjé
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Hannah R Elliott
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Fiona R Green
- Faculty of Health and Medical Sciences, Formerly School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - Aletta E Schutte
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,School of Public Health and Community Medicine, University of New South Wales, George Institute for Global Health, Sydney, NSW, Australia
| | - Marlien Pieters
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
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Li H, Wang CJ, Zhou YQ, Wang YY, Mou CH, Zhang SG, Wang JW. Neutrophil to lymphocyte rate and serum prealbumin maybe predictors for abnormal high blood pressure caused by adrenocorticotropic hormone therapy in children with epileptic spasms: two cases report. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:248. [PMID: 32309395 PMCID: PMC7154432 DOI: 10.21037/atm.2020.01.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epileptic spasms are a catastrophic form of epilepsy. When epileptic spasms occur under 2-year-old, they may be also called “infantile spasms”. Adrenocorticotropic hormone (ACTH) is recommended as first line intervention for the treatment of epileptic spasms without tuberous sclerosis complex. The chief risks of ACTH therapy are immunosuppression and hypertension. We reported rare cases of abnormal high blood pressure in two male epileptic spasms patients during ACTH therapy. Both patients’ blood pressure reached a high blood pressure stage 2 on the 9th day and 10th day of ACTH treatment, respectively. The blood pressure returned to normal range after the drug dosage was reduced or stopped. The lower level of neutrophil%, neutrophil count, and a higher level of lymphocyte%, lymphocyte count and prealbumin than normal range were observed in both patients before ACTH therapy. The neutrophil to lymphocyte rate might be a predictor for high blood pressure among patients treated with ACTH. The rates of both patients were under 0.50 (0.42 for Case 1 and 0.17 for Case 2). We reported the documented cases in two Chinese pediatric patients who suffered from epileptic spasms treated with ACTH resulted in abnormal high blood pressure, which could be predicted by using neutrophil to lymphocyte rate. We also mentioned serum prealbumin might be another predictor. More clinical data is required to elucidate the relationship between serum prealbumin level and blood pressure.
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Affiliation(s)
- Hao Li
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.,Clinical Research Center, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.,Department of Pharmacy, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Cui-Jin Wang
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yun-Qing Zhou
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ying-Yan Wang
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Chang-Hua Mou
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shun-Guo Zhang
- Department of Pharmacy, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ji-Wen Wang
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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46
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Chen C, Zhao HY, Zhang YH. Correlation between neutrophil-to-lymphocyte ratio and kidney dysfunction in undiagnosed hypertensive population from general health checkup. J Clin Hypertens (Greenwich) 2019; 22:47-56. [PMID: 31786831 DOI: 10.1111/jch.13749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 12/25/2022]
Abstract
Recently, neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are frequently used to evaluate disease progression and outcome. Here, we aim to analyze the associations between NLR or MLR and kidney function in undiagnosed hypertensive individuals from general population during routine health checkup. Liver function was analyzed for comparison. From 2011 to 2016, 53 939 examiners have registered for health checkup in Yanbian University Hospital, Yanbian, China. Among 15 219 participants who have complete datasets, 4997 individuals were hypertensive (HTN, SBP/DBP: ≥ 140/90 mm Hg). NLR, glucose, lipids (Chol, TG, LDL), kidney (CREA, BUN), and liver (AST, ALT, GGT, ALB, TBIL) functional parameters were significantly higher in HTN. Pearman correlation analysis showed that NLR was positively correlated with SBP and CREA only in HTN. MLR was associated with CREA in both HTN and non-HTN. NLR or MLR was associated with liver functions similarly in HTN and non-HTN. The authors then divided NLR or MLR into tertiles (NLR: 0-1.7276, 1.7276-3, >3; MLR: 0-0.1845, 0.1845-0.3, >0.3). NLR was positively associated with BUN at NLR >1.7276 and with CREA at all tertiles in HTN. MLR was correlated with CREA and BUN at high MLR in non-HTN. Further analysis showed that age or gender did not affect the associations of NLR and MLR with kidney function in HTN, but strong association was observed in male or aged (>65 years old) non-HTN group. These results showed that NLR could be used as a cost-effective predictor of kidney abnormality in HTN patients even in a general population.
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Affiliation(s)
- Chen Chen
- Yanbian University Hospital, Clinical Research Center, Yanji, China
| | - Hai Yan Zhao
- Yanbian University Hospital, Clinical Research Center, Yanji, China
| | - Yin Hua Zhang
- Yanbian University Hospital, Clinical Research Center, Yanji, China.,Department of Physiology & Biomedical Sciences, Ischemic/hypoxic Disease Institutes, Seoul National University, College of Medicine, Seoul, Korea.,Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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(-)-Epicatechin metabolites promote vascular health through epigenetic reprogramming of endothelial-immune cell signaling and reversing systemic low-grade inflammation. Biochem Pharmacol 2019; 173:113699. [PMID: 31756325 DOI: 10.1016/j.bcp.2019.113699] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/06/2019] [Indexed: 12/16/2022]
Abstract
Ingestion of (-)-epicatechin flavanols reverses endothelial dysfunction by increasing flow mediated dilation and by reducing vascular inflammation and oxidative stress, monocyte-endothelial cell adhesion and transendothelial monocyte migration in vitro and in vivo. This involves multiple changes in gene expression and epigenetic DNA methylation by poorly understood mechanisms. By in silico docking and molecular modeling we demonstrate favorable binding of different glucuronidated, sulfated or methylated (-)-epicatechin metabolites to different DNA methyltransferases (DNMT1/DNMT3A). In favor of this model, genome-wide DNA methylation profiling of endothelial cells treated with TNF and different (-)-epicatechin metabolites revealed specific DNA methylation changes in gene networks controlling cell adhesion-extravasation endothelial hyperpermeability as well as gamma-aminobutyric acid, renin-angiotensin and nitric oxide hypertension pathways. Remarkably, blood epigenetic profiles of an 8 weeks intervention with monomeric and oligomeric flavanols (MOF) including (-)-epicatechin in male smokers revealed individual epigenetic gene changes targeting similar pathways as the in vitro exposure experiments in endothelial cells. Furthermore, epigenetic changes following MOF diet intervention oppose atherosclerosis associated epigenetic changes. In line with biological data, the individual epigenetic response to a MOF diet is associated with different vascular health parameters (glutathione peroxidase 1 and endothelin-1 expression, acetylcholine-mediated microvascular response), in part involving systemic shifts in blood immune cell types which reduce the neutrophil-lymphocyte ratio (NLR). Altogether, our study suggests that different (-)-epicatechin metabolites promote vascular health in part via epigenetic reprogramming of endothelial-immune cell signaling and reversing systemic low-grade inflammation.
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