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Yin R, Zhao M, Xu D, Wang Q, Li M, Zhang W, Zhang F, Zeng X, Huo Y, Hou Y. Relapsing polychondritis: focus on cardiac involvement. Front Immunol 2023; 14:1218475. [PMID: 37771578 PMCID: PMC10523381 DOI: 10.3389/fimmu.2023.1218475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/24/2023] [Indexed: 09/30/2023] Open
Abstract
Background Relapsing polychondritis (RP) with cardiac involvement may present with acute cardiovascular events, and may be associated with a negative prognosis. Herein, we analyzed the clinical characteristics of RP patients with cardiac involvement. Method RP patients, hospitalized from December 2005 to December 2021 at Peking Union Medical College Hospital (PUMCH), were screened. Univariate and multivariate logistic regression analyses were used to statistically analyze the clinical characteristics of these patients. Results The incidence of cardiac involvement in inpatients with RP was 24.1%. Univariate logistic regression analysis revealed age, central nervous system (CNS) involvement, neutrophil-to-lymphocyte ratio (NLR) > 6.41, and disease duration > 4 years as risk factors for cardiac involvement in RP. Conversely, the incidence of tracheobronchial and chest wall involvement was significantly lower in the group with cardiac involvement. Multivariate logistic regression confirmed that age, CNS involvement, NLR > 6.41, and disease duration > 4 years were independent factors for cardiac involvement. Subsequently, we identified five well-defined clinical patterns of RP, based on the involvement of different organs in our patients, and found that the heart-brain model was significantly mutually exclusive with the airway model. Conclusion Occurrence of cardiac involvement in RP is associated with age, CNS involvement, NLR, and disease duration. It is mutually exclusive with airway-related involvement. Regular echocardiography and electrocardiography are necessary for patients with RP.
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Affiliation(s)
- Ruxue Yin
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Mengzhu Zhao
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Dong Xu
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Qian Wang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Mengtao Li
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Wen Zhang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Fengchun Zhang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Xiaofeng Zeng
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Yuping Huo
- Department of Rheumatology, Jin Cheng People’s Hospital, Jincheng, Shanxi, China
| | - Yong Hou
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
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2
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Totaro A, Testa G, Calafiore AM, Ienco V, Sacra V, Busti A, Pierro A, Sperlongano S, Golino P, Sacra C. Neutrophil to lymphocyte ratio predicts permanent pacemaker implantation in TAVR patients. J Card Surg 2022; 37:5095-5102. [PMID: 36378937 DOI: 10.1111/jocs.17212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In this prospective multicenter analysis, we aimed to investigate the predictive role of neutrophil/lymphocyte ratio (NLR) in permanent pacemaker implantation (PPI) in patients undergoing transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS One hundred and seventy-nine consecutive patients without previous PPI underwent TAVR from February 2017 to September 2021. Patients were further divided based on presence (n = 48) and absence of conduction abnormalities (CAs) at hospital admission (n = 131). RESULTS In patients with previous CAs, NLR values did not differ significantly between patients requiring PPI (n = 16, 33%) and those not requiring it. In contrast, in patients with no CAs at hospital admission, NLR values measured at admission and on TAVR day were significantly higher in patients requiring PPI (n = 17, 13%) (4.07 ± 3.22 vs. 3.01 ± 1.47, p = .025, and 10.81 ± 7.81 vs. 5.84 ± 3.78, p = .000, respectively). Multivariable analysis showed that NLR at TAVR day was an independent predictor of PPI in patients without CAs (OR 1.294; 95% CI 1.028-1.630; p = .028), but not in those with previous CAs. ROC curve analysis showed that the cut point was a NLR value of >7.25. Time to PPI was delayed till 21 days in patients without CAs. CONCLUSIONS In this prospective study, higher NLR values on the day of TAVR day were associated with an increased PPI rate in patients undergoing TAVR with no previous CAs. It is advisable, being inflammation part of the process, to prolong the time of observation for all patients without CAs till at least 21 days not to miss any new CA necessitating PPI.
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Affiliation(s)
- Antonio Totaro
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Gianluca Testa
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy.,Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Antonio M Calafiore
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy
| | - Vincenzo Ienco
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy
| | - Vincenzo Sacra
- Department of Traslational Medical Sciences, Division of Cardiology, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Busti
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Antonio Pierro
- Department of Radiology, Gemelli Molise Hospital, Campobasso, Italy
| | - Simona Sperlongano
- Department of Traslational Medical Sciences, Division of Cardiology, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Golino
- Department of Traslational Medical Sciences, Division of Cardiology, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cosimo Sacra
- Department of Cardiovascular Sciences, Gemelli Molise Hospital, Campobasso, Italy
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3
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Guo S, Zhang E, Zhang B, Liu Q, Meng Z, Li Z, Wang C, Gong Z, Wu Y. Identification of Key Non-coding RNAs and Transcription Factors in Calcific Aortic Valve Disease. Front Cardiovasc Med 2022; 9:826744. [PMID: 35845040 PMCID: PMC9276990 DOI: 10.3389/fcvm.2022.826744] [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: 12/01/2021] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Calcific aortic valve disease (CAVD) is one of the most frequently occurring valvular heart diseases among the aging population. Currently, there is no known pharmacological treatment available to delay or reverse CAVD progression. The regulation of gene expression could contribute to the initiation, progression, and treatment of CAVD. Non-coding RNAs (ncRNAs) and transcription factors play essential regulatory roles in gene expression in CAVD; thus, further research is urgently needed. Materials and Methods The gene-expression profiles of GSE51472 and GSE12644 were obtained from the Gene Expression Omnibus database, and differentially expressed genes (DEGs) were identified in each dataset. A protein-protein-interaction (PPI) network of DEGs was then constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins database, and functional modules were analyzed with ClusterOne plugin in Cytoscape. Furthermore, Gene Ontology-functional annotation and Kyoto Encyclopedia of Genes and Genomes-pathway analysis were conducted for each functional module. Most crucially, ncRNAs and transcription factors acting on each functional module were separately identified using the RNAInter and TRRUST databases. The expression of predicted transcription factors and key genes was validated using GSE51472 and GSE12644. Furthermore, quantitative real-time PCR (qRT-PCR) experiments were performed to validate the differential expression of most promising candidates in human CAVD and control samples. Results Among 552 DEGs, 383 were upregulated and 169 were downregulated. In the PPI network, 15 functional modules involving 182 genes and proteins were identified. After hypergeometric testing, 45 ncRNAs and 33 transcription factors were obtained. Among the predicted transcription factors, CIITA, HIF1A, JUN, POU2F2, and STAT6 were differentially expressed in both the training and validation sets. In addition, we found that key genes, namely, CD2, CD86, CXCL8, FCGR3B, GZMB, ITGB2, LY86, MMP9, PPBP, and TYROBP were also differentially expressed in both the training and validation sets. Among the most promising candidates, differential expressions of ETS1, JUN, NFKB1, RELA, SP1, STAT1, ANCR, and LOC101927497 were identified via qRT-PCR experiments. Conclusion In this study, we identified functional modules with ncRNAs and transcription factors involved in CAVD pathogenesis. The current results suggest candidate molecules for further research on CAVD.
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4
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Calcific aortic valve stenosis and COVID-19: clinical management, valvular damage, and pathophysiological mechanisms. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Innate immune cells in the pathophysiology of calcific aortic valve disease: lessons to be learned from atherosclerotic cardiovascular disease? Basic Res Cardiol 2022; 117:28. [PMID: 35581364 PMCID: PMC9114076 DOI: 10.1007/s00395-022-00935-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 01/31/2023]
Abstract
Calcific aortic valve disease (CAVD) is the most common valvular disease in the developed world with currently no effective pharmacological treatment available. CAVD results from a complex, multifactorial process, in which valvular inflammation and fibro-calcific remodelling lead to valve thickening and cardiac outflow obstruction. The exact underlying pathophysiology of CAVD is still not fully understood, yet the development of CAVD shows many similarities with the pathophysiology of atherosclerotic cardiovascular disease (ASCVD), such as coronary artery disease. Innate immune cells play a crucial role in ASCVD and might also play a pivotal role in the development of CAVD. This review summarizes the current knowledge on the role of innate immune cells, both in the circulation and in the aortic valve, in the development of CAVD and the similarities and differences with ASCVD. Trained immunity and clonal haematopoiesis of indeterminate potential are proposed as novel immunological mechanisms that possibly contribute to the pathophysiology of CAVD and new possible treatment targets are discussed.
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Bartoli-Leonard F, Zimmer J, Aikawa E. Innate and adaptive immunity: the understudied driving force of heart valve disease. Cardiovasc Res 2021; 117:2506-2524. [PMID: 34432007 PMCID: PMC8783388 DOI: 10.1093/cvr/cvab273] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 12/18/2022] Open
Abstract
Calcific aortic valve disease (CAVD), and its clinical manifestation that is calcific aortic valve stenosis, is the leading cause for valve disease within the developed world, with no current pharmacological treatment available to delay or halt its progression. Characterized by progressive fibrotic remodelling and subsequent pathogenic mineralization of the valve leaflets, valve disease affects 2.5% of the western population, thus highlighting the need for urgent intervention. Whilst the pathobiology of valve disease is complex, involving genetic factors, lipid infiltration, and oxidative damage, the immune system is now being accepted to play a crucial role in pathogenesis and disease continuation. No longer considered a passive degenerative disease, CAVD is understood to be an active inflammatory process, involving a multitude of pro-inflammatory mechanisms, with both the adaptive and the innate immune system underpinning these complex mechanisms. Within the valve, 15% of cells evolve from haemopoietic origin, and this number greatly expands following inflammation, as macrophages, T lymphocytes, B lymphocytes, and innate immune cells infiltrate the valve, promoting further inflammation. Whether chronic immune infiltration or pathogenic clonal expansion of immune cells within the valve or a combination of the two is responsible for disease progression, it is clear that greater understanding of the immune systems role in valve disease is required to inform future treatment strategies for control of CAVD development.
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Affiliation(s)
- Francesca Bartoli-Leonard
- Division of Cardiovascular Medicine, Department of Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jonas Zimmer
- Division of Cardiovascular Medicine, Department of Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Elena Aikawa
- Division of Cardiovascular Medicine, Department of Medicine, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Cardiovascular Medicine, Department of Medicine, Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Human Pathology, Sechenov First Moscow State Medical University, Moscow, Russia
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7
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Mangold A, Ondracek AS, Hofbauer TM, Artner T, Nechvile J, Panagiotides NG, Mirna M, Hammerer M, Fejzic D, Hoppe U, Wernly B, Lauten A, Alushi B, Franz M, Schulze PC, Wohlschläger-Krenn E, Lang IM, Lichtenauer M. Deoxyribonuclease is prognostic in patients undergoing transcatheter aortic valve replacement. Eur J Clin Invest 2021; 51:e13595. [PMID: 34101826 DOI: 10.1111/eci.13595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/24/2022]
Abstract
Degenerative aortic valve stenosis is an inflammatory process that resembles atherosclerosis. Neutrophils release their DNA upon activation and form neutrophil extracellular traps (NETs), which are present on degenerated aortic valves. NETs correlate with pressure gradients in severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) is an established treatment option for aortic valve stenosis. Bioprosthetic valve deterioration promoted by inflammatory, fibrotic and thrombotic processes limits outcome. Deoxyribonuclease is a natural counter mechanism to degrade DNA in circulation. In the present observational study, we investigated plasma levels of double-stranded DNA, deoxyribonuclease activity and outcome after TAVR. 345 consecutive patients undergoing TAVR and 100 healthy reference controls were studied. Double-stranded DNA was measured by fluorescence assays in plasma obtained at baseline and after TAVR. Deoxyribonuclease activity was measured at baseline using single radial enzyme diffusion assays. Follow-up was performed at 12 months, and mean aortic pressure gradient and survival were evaluated. Receiver operating characteristic, Kaplan-Meier curves and Cox regression models were calculated. Baseline double-stranded DNA in plasma was significantly higher compared to healthy controls, was increased at 3 and 7 days after TAVR, and declined thereafter. Baseline deoxyribonuclease activity was decreased compared to healthy controls. Interestingly, low deoxyribonuclease activity correlated with higher C-reactive protein and higher mean transaortic gradient after 12 months. Finally, deoxyribonuclease activity was a strong independent predictor of outcome 12 months after TAVR. Deoxyribonuclease activity is a potential biomarker for risk stratification after TAVR. Pathomechanisms of bioprosthetic valve deterioration involving extracellular DNA and deoxyribonuclease merit investigation.
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Affiliation(s)
- Andreas Mangold
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Anna S Ondracek
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Thomas M Hofbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Tyler Artner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Johanna Nechvile
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Noel G Panagiotides
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Hammerer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | | | | | - Alexander Lauten
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Brunilda Alushi
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, Pneumology, and Intensive Medical Care, Friedrich-Schiller-University, Jena, Germany
| | - Paul C Schulze
- Department of Internal Medicine I, Division of Cardiology, Pneumology, and Intensive Medical Care, Friedrich-Schiller-University, Jena, Germany
| | | | - Irene M Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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8
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Erdoğan M, Öztürk S, Kardeşler B, Yiğitbaşı M, Kasapkara HA, Baştuğ S, Erdöl MA, Akar Bayram N, Akçay M, Durmaz T. The relationship between calcific severe aortic stenosis and systemic immune-inflammation index. Echocardiography 2021; 38:737-744. [PMID: 33772853 DOI: 10.1111/echo.15044] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
AIM Calcific aortic stenosis (AS) is a common valvular disease especially in elderly population. Inflammation plays significant role in the pathophysiological mechanism. Systemic immune-inflammation index (SII) is a novel marker of immune system and inflammation that includes neutrophil, lymphocyte, and platelet cell counts. The aim of this study was to investigate the predictive value of SII in calcific severe AS. MATERIALS AND METHODS Severe calcific AS patients were categorized into two groups: High flow-high gradient (HFHG) AS (n = 289) and low flow-low gradient AS (n = 79). Control group included 273 patients with similar clinical and demographic characteristics but without AS. SII was calculated as absolute platelet count × absolute neutrophil count/absolute lymphocyte count. RESULTS SII levels were 525 ± 188, 835 ± 402, and 784 ± 348 in control, HFHG AS, and LFLG AS groups, respectively (P < .001). Correlation analyses revealed significant and positive correlation between SII and mean aortic transvalvular pressure gradient (r = .342, P < .001), and negative and significant correlation between SII and AVA (r = -.461, P < .001). Multivariate analysis performed in separate models demonstrated sex, CAD, LDL, and SII levels (Odds ratio [OR]: 1.004, 95 CI%:1.003-1.004) as independent predictors of severe AS in Model 1. According to Model 2, sex, CAD, LDL, and high SII (>661) (OR:5.78, 95 CI%:3.93-4.89) remained as independent predictors of severe AS. CONCLUSION SII levels can be useful to predict severe calcific AS patients and significantly correlate with AVA and mean aortic transvalvular pressure gradient.
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Affiliation(s)
- Mehmet Erdoğan
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.,Department of Cardiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Selçuk Öztürk
- Department of Cardiology, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Burak Kardeşler
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Murat Yiğitbaşı
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hacı Ahmet Kasapkara
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.,Department of Cardiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Serdal Baştuğ
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.,Department of Cardiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Mehmet Akif Erdöl
- Department of Cardiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Nihal Akar Bayram
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.,Department of Cardiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Murat Akçay
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.,Department of Cardiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Tahir Durmaz
- Department of Cardiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.,Department of Cardiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
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9
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Ma X, Ma H, Yun Y, Chen S, Zhang X, Zhao D, Liu Y, Shen H, Wu C, Zheng J, Zhang T, Xu Z, Sun L, Zhang H, Zhang W, Zou C, Wang Z. Lymphocyte-to-monocyte ratio in predicting the calcific aortic valve stenosis in a Chinese case-control study. Biomark Med 2020; 14:1329-1339. [PMID: 33064019 DOI: 10.2217/bmm-2020-0228] [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: 04/19/2020] [Accepted: 07/15/2020] [Indexed: 11/21/2022] Open
Abstract
Aim: This study examined the role of lymphocyte-to-monocyte ratio (LMR), an inflammatory biomarker, in predicting the severity of calcific aortic valve stenosis (CAVS) in a Chinese case-control study. Results: The LMR significantly decreased in the patients with CAVS compared with healthy controls. An inverse correlation was observed between the severity of stenosis and LMR in the patients. Additionally, the LMR was identified in the multivariate analysis as an independent predictor of severe CAVS. Conclusion: This study provides evidence of an inverse correlation between the severity of CAVS and LMR. LMR could potentially be applied as an independent predictor of severe CAVS and could be incorporated into a novel predictive model.
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Affiliation(s)
- Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Huibo Ma
- Qingdao University Medical College, 308 Ningxia Road, Qingdao University, Qingdao, Shandong 266071, China
| | - Yan Yun
- Department of Radiology, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan 250012, Shandong Province, China
| | - Shanghao Chen
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Xiaofeng Zhang
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, No. 247 Beiyuan Road, Tianqiao District, Jinan 250033, Shandong Province, China
| | - Diming Zhao
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Yanwu Liu
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Hechen Shen
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Chuanni Wu
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Jing Zheng
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Tao Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Zhenqiang Xu
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Liangong Sun
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Wenlong Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Chengwei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
| | - Zhengjun Wang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324 Jingwu Road, Jinan, Shandong 250021, China
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Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as independent predictors of outcome in infective endocarditis (IE). Egypt Heart J 2019; 71:13. [PMID: 31659520 PMCID: PMC6821428 DOI: 10.1186/s43044-019-0014-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Early and accurate risk assessment is an important clinical demand in patients with infective endocarditis (IE). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are independent predictors of prognosis in many infectious and cardiovascular diseases. Very limited studies have been conducted to evaluate the prognostic role of these markers in IE. Results We analyzed clinical, laboratory, and echocardiographic data and outcomes throughout the whole period of hospitalization for a total of 142 consecutive patients with definitive IE. The overall in-hospital mortality was 21%. Major complications defined as central nervous system embolization, fulminant sepsis, acute heart failure, acute renal failure, and major artery embolization occurred in 38 (27%), 34 (24%), 32 (22.5%), 40 (28%), and 90 (63.4%) patients, respectively. The NLR, total leucocyte count (TLC), neutrophil percentage, creatinine, and C-reactive protein (CRP) level obtained upon admission were significantly higher in the mortality group [p ≤ 0.001, p = 0.008, p = 0.001, p = 0.004, and p = 0.036, respectively]. A higher NLR was significantly associated with fulminant sepsis and major arterial embolization [p = 0.001 and p = 0.028, respectively]. The receiver operating characteristic (ROC) curve of the NLR for predicting in-hospital mortality showed that an NLR > 8.085 had a 60% sensitivity and an 84.8% specificity for an association with in-hospital mortality [area under the curve = 0.729, 95% confidence interval (CI) 0.616–0.841; p = 0.001]. The ROC curve of the NLR for predicting severe sepsis showed that an NLR > 5.035 had a 71.8% sensitivity and a 68.5% specificity for predicting severe sepsis [area under the curve 0.685, 95% CI 0.582–0.733; p = 0.001]. The PLR showed no significant association with in-hospital mortality or in-hospital complications. Conclusion A higher NLR, TLC, neutrophil percentage, creatinine level, and CRP level upon admission were associated with increased in-hospital mortality and morbidity in IE patients. Furthermore, a lower lymphocyte count/percentage and platelet count were strong indicators of in-hospital mortality among IE patients. Calculation of the NLR directly from a CBC upon admission may assist in early risk stratification of patients with IE.
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11
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The Neglected Role of Neutrophils in the Severity of Aortic Valve Stenosis. J Cardiovasc Pharmacol 2019; 74:367-368. [PMID: 31517777 DOI: 10.1097/fjc.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Yalta K, Palabiyik O, Gurdogan M, Gurlertop Y. Serum copeptin might improve risk stratification and management of aortic valve stenosis: a review of pathophysiological insights and practical implications. Ther Adv Cardiovasc Dis 2019; 13:1753944719826420. [PMID: 30803406 PMCID: PMC6376527 DOI: 10.1177/1753944719826420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over recent decades, the prevalence of aortic valve stenosis (AVS) has been constantly increasing possibly owing to the aging of general population. Severe AVS as determined by an aortic valve area (AVA) of <1 cm2 has been regarded as a serious clinical condition potentially associated with a variety of adverse outcomes, including sudden cardiac death (SCD). However, patients with severe AVS (in the absence of overt high-risk features) are usually evaluated and managed exclusively based on symptomatology or imperfect prognostic tools including exercise testing and biomarkers, with a potential risk of mismanagement, suggesting the need for further objective risk stratifiers in this setting. Within this context, copeptin (C-terminal pro-vasopressin), a novel neurohormone widely considered as the surrogate marker of the arginine–vasopressin (AVP) system, may potentially serve as a reliable prognostic and therapeutic guide (e.g. timing of aortic valvular intervention) in patients with severe AVS largely based on its hemodynamic, fibrogenic as well as autonomic implications in these patients. Accordingly, the present paper aims to discuss clinical and pathophysiological implications of copeptin in the setting of AVS along with a summary of biomarkers and other prognostic tools used in this setting.
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Affiliation(s)
- Kenan Yalta
- Trakya University, School of Medicine, Cardiology Department, 22030 Edirne, Turkey
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Patel VH, Vendittelli P, Garg R, Szpunar S, LaLonde T, Lee J, Rosman H, Mehta RH, Othman H. Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest. World J Crit Care Med 2019; 8:9-17. [PMID: 30815378 PMCID: PMC6388309 DOI: 10.5492/wjccm.v8.i2.9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation (ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient’s prognosis. The neutrophil-lymphocyte ratio (NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.
AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.
METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value (NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis (area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and 42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.
RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female. In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9 (range 0.6-46.5) compared with 8.9 (0.28-96) in non-survivors (P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55 [odds ratio (OR) = 5.20, confidence interval (CI): 1.5-18.3, P = 0.01], older age (OR = 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level (OR = 1.20, CI: 1.03-1.40, P = 0.02) were independent predictors of death.
CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.
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Affiliation(s)
- Vishal H Patel
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Philip Vendittelli
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Rajat Garg
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44915, United States
| | - Susan Szpunar
- Department of Biomedical Investigations and Research, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Thomas LaLonde
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - John Lee
- Department of Critical Care Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Howard Rosman
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 22705, United States
| | - Hussein Othman
- Department of Cardiovascular Medicine, Ascension-St John Hospital and Medical Center, Detroit, MI 48236, United States
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Khalil C, Pham M, Sawant AC, Sinibaldi E, Bhardwaj A, Ramanan T, Qureshi R, Khan S, Ibrahim A, Gowda SN, Pomakov A, Sadawarte P, Lahoti A, Hansen R, Baldo S, Colern G, Pershad A, Iyer V. Neutrophil-to-lymphocyte ratio predicts heart failure readmissions and outcomes in patients undergoing transcatheter aortic valve replacement. Indian Heart J 2019; 70 Suppl 3:S313-S318. [PMID: 30595282 PMCID: PMC6310731 DOI: 10.1016/j.ihj.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/29/2018] [Accepted: 08/01/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Neutrophil-to-lymphocyte ratio (NLR) has prognostic value in acute coronary syndromes. We investigated its utility for predicting heart failure (HF) admissions and major adverse cardiac outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS Data on clinical, laboratory, procedural, HF admissions, and major adverse cardiac events (MACEs) (all-cause mortality, recurrence of myocardial infarction requiring intervention, stroke) for 298 consecutive patients who underwent TAVR between 2012 and 2016 in our tertiary center were collected. RESULTS Analysis included 298 patients. The mean age was 83 ± 8 years, 51% were males, and 95% were Caucasians. The median Society of Thoracic Surgeons risk score was 9 (interquartile range: 6.3-11.8). Receiver-operating curve analysis identified a cutoff value of NLR of 4.0 for MACE after TAVR and sensitivity of 68% and specificity of 68% {area under the curve [AUC] = 0.65 [95% confidence interval (CI): 0.51-0.79], p = 0.03}. An NLR of 4.0 for HF hospitalizations after TAVR and sensitivity of 60% and specificity of 57% [AUC = 0.61 (95% CI: 0.53-0.69), p = 0.01]. NLR ≥4.0 before TAVR significantly predicted MACE after TAVR (68.4% vs. 31.6%, p = 0.02) and HF hospitalizations (58.3% vs. 41.7%, p = 0.03). NLR with TAVR risk score increased the predictive value for MACE after TAVR from AUC = 0.61 (95% CI: 0.50-0.72, p = 0.06) to AUC = 0.69 (95% CI: 0.57-0.80, p = 0.007). CONCLUSION NLR predicts all-cause mortality, MACE, and HF hospitalization 1 year after TAVR. NLR with TAVR risk score improved predictability for MACE. Further studies for prognostication using NLR are warranted.
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Affiliation(s)
- Charl Khalil
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Michael Pham
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Abhishek C Sawant
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Everett Sinibaldi
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Aishwarya Bhardwaj
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Tharmathai Ramanan
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Reema Qureshi
- Dept of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sahoor Khan
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Amira Ibrahim
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Smitha N Gowda
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Alexander Pomakov
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - Ankush Lahoti
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Rosemary Hansen
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Shannon Baldo
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Gerald Colern
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Ashish Pershad
- Division of Interventional Cardiology, Banner University Medical Center, Phoenix, AZ, USA
| | - Vijay Iyer
- Division of Cardiology, State University of New York at Buffalo, Buffalo, NY, USA.
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Zheng Y, Bao LM, Ye J, Pan Y, Wang Q, Gao X. Impact of diabetes mellitus on the prognostic value of the neutrophil-lymphocyte ratio in renal cell carcinoma. Exp Ther Med 2018; 17:1268-1275. [PMID: 30680002 PMCID: PMC6327668 DOI: 10.3892/etm.2018.7093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to evaluate the effect of diabetes mellitus (DM) on the neutrophil-lymphocyte ratio (NLR)-based prediction of the prognosis of patients with renal cell carcinoma (RCC). The data of 662 patients who had undergone nephrectomy for RCC between January 2004 and July 2014 were retrospectively reviewed. X-tile analysis was used to determine the optimal cutoff value for the NLR. Kaplan-Meier curves were drawn and the log-rank test was applied to determine the impact of the NLR (high vs. low) on the overall survival (OS) and metastasis-free survival (MFS). Univariate and multivariate Cox regression analyses were used to identify prognostic factors for OS and MFS. The median follow-up period after surgery was 50.35 months (range, 30.30–85.08 months). The optimal cutoff value of the NLR was determined to be 3.2 using X-tile software. In the analysis of total subjects, patients with a high NLR (≥3.2) had significantly worse OS and MFS rates than those with a low NLR (<3.2) (21.60% vs. 78.40%, P=0.001 for OS and 21.60% vs. 78.40%, P<0.0001 for MFS). In the non-DM subgroup, the OS and MFS rates of patients with a high NLR were significantly worse compared with those of patients with a low NLR (21.69% vs. 78.31%, P=0.003 for OS and 21.69% vs. 78.31%, P<0.001 for MFS). In the DM subgroup, although a high NLR was still associated with the MFS (NLR≥3.2, 21.43% vs. NLR<3.2, 78.57%; P=0.015), it was no longer associated with the OS (NLR≥3.2, 21.43% vs. NLR<3.2, 78.57%; P=0.192). Furthermore, multivariate analysis identified the NLR as a risk factor for OS and MFS in all patients [hazard ratio (HR)=1.77, 95% confidence interval (CI): 1.04–3.01, P=0.037; and HR=2.31, 95% CI: 1.45–3.70, P<0.001, respectively) and in the non-DM subgroup (HR=2.03, 95% CI: 1.05–3.93, P=0.036; and HR=2.57, 95% CI: 1.47–4.49, P=0.001, respectively), but not in the DM subgroup (P>0.05). In conclusion, DM is a factor that impairs the evaluation of the prognosis of RCC using NLR.
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Affiliation(s)
- Yangqin Zheng
- Department of Hematology, The Third Clinical Institute Affiliated to Wenzhou Medical University, People's Hospital of Wenzhou, Wenzhou, Zhejiang 325006, P.R. China
| | - Lian Min Bao
- Department of Respiratory Medicine, Ruian People's Hospital, The Third Affiliated Hospital of The Wenzhou Medical University, Wenzhou, Zhejiang 325200, P.R. China
| | - Junjie Ye
- Department of Urology, Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People's Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Yue Pan
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, P.R. China
| | - Qinquan Wang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, P.R. China
| | - Xiaomin Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
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Habib M, Thawabi M, Hawatmeh A, Habib H, ElKhalili W, Shamoon F, Zaher M. Value of neutrophil to lymphocyte ratio as a predictor of mortality in patients undergoing aortic valve replacement. Cardiovasc Diagn Ther 2018; 8:164-172. [PMID: 29850407 DOI: 10.21037/cdt.2018.03.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Neutrophil to lymphocyte ratio (NLR) has been studied as a measure of inflammation and as a prognosticating factor in various medical conditions including neoplastic, inflammatory and cardiovascular. The prognostic role of NLR in predicting mortality in patients with aortic stenosis undergoing surgical aortic valve replacement (AVR) has not been studied. The aim of our study is to explore the utility of NLR as a predictor of both, short and long-term mortality, in patients undergoing surgical AVR. Methods Consecutive patients with aortic stenosis admitted for AVR to our institution were evaluated for study inclusion. Of the 335 patients admitted from January 2007 to September 2011, 234 met study inclusion criteria. Patients were divided into two groups depending on their initial preoperative NLR level with a cutoff value of 3. Three-year vital status was accessed with electronic medical records and Social Security Death Index. Survival analysis, stratified by NLR, was used to evaluate the predictive value of preoperative NLR levels. Results Patients with NLR ≥3, when compared to those with NLR <3, had a significantly higher short-term (9.40% vs. 0, P=0.0006), 6-month (19.54% vs. 0.95%, P<0.0001), and 3-year mortality (27.35% vs. 3.78%, P<0.0001). After adjustment for baseline characteristics, co-morbidities, symptomatology, echocardiographic findings, and blood tests, NLR level remained a significant independent predictor of 3-year mortality; Hazard ratios (HRs) increased by a factor of 1.18 (1.05-1.33, P=0.0068) and patients with a NLR ≥3 had 4.77 fold increase in 3-year mortality (1.48-15.32, P=0.0090). Conclusions NLR is an independent predictor of short-term and long-term mortality in patients with aortic stenosis undergoing AVR surgery, especially those with NLR ≥3. We strongly suggest the use of NLR as a tool to risk stratify patients with aortic stenosis undergoing AVR surgery.
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Affiliation(s)
- Mirette Habib
- Department of Cardiology, New York Medical College, Saint Joseph Regional Medical Center, Paterson, NJ, USA
| | - Mohammad Thawabi
- Department of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Amer Hawatmeh
- Department of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Habib Habib
- Department of Cardiology, New York Medical College, Saint Joseph Regional Medical Center, Paterson, NJ, USA
| | - Walid ElKhalili
- Department of Cardiology, New York Medical College, Saint Joseph Regional Medical Center, Paterson, NJ, USA
| | - Fayez Shamoon
- Department of Cardiology, New York Medical College, Saint Joseph Regional Medical Center, Paterson, NJ, USA
| | - Medhat Zaher
- Department of Cardiology, New York Medical College, Saint Joseph Regional Medical Center, Paterson, NJ, USA
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Fukuda Y, Okamoto M, Tomomori S, Matsumura H, Tokuyama T, Nakano Y, Kihara Y. In Paroxysmal Atrial Fibrillation Patients, the Neutrophil-to-lymphocyte Ratio Is Related to Thrombogenesis and More Closely Associated with Left Atrial Appendage Contraction than with the Left Atrial Body Function. Intern Med 2018; 57:633-640. [PMID: 29151509 PMCID: PMC5874332 DOI: 10.2169/internalmedicine.9243-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objective The neutrophil-to-lymphocyte ratio (NLR) is an inflammation marker that can be used to detect atrial inflammatory changes, which may contribute to a reduced left atrial (LA) function and thrombosis. Our study aimed to determine whether or not the association of NLR with the LA appendage (LAA) function in relation to thrombogenesis differs from the association with the LA body function in paroxysmal atrial fibrillation (PAF) patients. Methods A total of 183 PAF patients were studied. The LA volume index, mitral flow velocity (A), and mitral annular motion velocity (A') were examined using transthoracic echocardiography. The LAA area, LAA wall motion velocity, and presence of spontaneous echo contrast (SEC) were examined using transesophageal echocardiography. Results The NLR of patients with cerebral embolism was significantly greater than in patients without the disorder. A cut-off point of 2.5 for the NLR had a sensitivity of 71% and a specificity of 74% in predicting cerebral embolism. The patients with an NLR ≥2.5 had a higher CHADS2 score and greater LA volume index or LAA area than those with an NLR <2.5. The NLR was an independent risk factor for SEC and was significantly correlated with the LAA wall motion velocity (r=-0.409) in 153 patients without SEC and with the LAA wall motion velocity and LAA area (r=-0.583, r=0.654, respectively) in 30 patients with SEC, but not with the LA volume index, A, or A' in either group. Conclusion In PAF patients, a high NLR indicates thrombogenesis with a high degree of certainty and is associated with reduced LAA contraction rather than with the LA body function.
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Affiliation(s)
- Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | | | - Shunsuke Tomomori
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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Teishima J, Ohara S, Sadahide K, Fujii S, Kitano H, Kobatake K, Shinmei S, Hieda K, Inoue S, Hayashi T, Mita K, Matsubara A. Impact of neutrophil-to-lymphocyte ratio on effects of targeted therapy for metastatic renal cell carcinoma patients with extrapulmonary metastasis. Can Urol Assoc J 2017; 11:E207-E214. [PMID: 28503236 DOI: 10.5489/cuaj.4106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of our present study was to investigate the impact of the pretreatment neutrophil-to-lymphocyte ratio (NLR) on the antitumour effects of targeted agents in patients with metastatic renal cell carcinoma (mRCC). METHODS The NLRs in 283 cases of molecular targeted therapy for mRCC were measured before starting the prescription of the molecular targeted agent. The significance of pretreatment NLR on the site of metastatic organs and on progression-free survival (PFS) in each case was analyzed. RESULTS Metastases other than lung, which is defined as "extrapulmonary metastasis," were observed in 190 cases (67.1%). The median of pretreated NLR was 2.39 (0.49-68.7). In 97 of the 283 cases, pretreated NLR was 3.0 or higher. These cases were categorized as the high NLR group and the rest as the low NLR group. When the cases with extrapulmonary metastasis were investigated and classified based on their pretreated NLR, 50% PFS in the high NLR and low NLR groups was 6.7 months and 12 months (p=0.0001), respectively. Multivariate analysis revealed that high NLR (>3.0) was an independent predictive factor for PFS in the cases with extrapulmonary metastasis (hazard ratio 2.762; p<0.0001), while there was no significant difference between PFS in the high and low NLR groups in cases with no extrapulmonary metastasis (p=0.3457). CONCLUSIONS Our data indicate that the predictive significance of the NLR in mRCC cases involving targeted therapy depends on the metastatic organs. NLR is an independent predictive factor of PFS in cases of mRCC with extrapulmonary metastasis treated with targeted therapy.
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Affiliation(s)
- Jun Teishima
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinya Ohara
- Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima, Japan
| | - Kousuke Sadahide
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinsuke Fujii
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Kitano
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kohei Kobatake
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Shinmei
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keisuke Hieda
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Inoue
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Koji Mita
- Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Institute of Biomedical and Health Sciences, Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
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Efe TH, Gayretli Yayla K, Yayla C, Ertem AG, Cimen T, Erken Pamukcu H, Bilgin M, Erat M, Dogan M, Yeter E. Calcific aortic stenosis and its correlation with a novel inflammatory marker, the lymphocyte/monocyte ratio. Rev Port Cardiol 2016; 35:573-578. [DOI: 10.1016/j.repc.2016.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 02/07/2023] Open
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Condado JF, Junpaparp P, Binongo JN, Lasanajak Y, Witzke-Sanz CF, Devireddy C, Leshnower B, Mavromatis K, Stewart J, Guyton R, Wheeler D, Forcillo J, Patel A, Block PC, Thourani V, Rangaswami J, Babaliaros V. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) can risk stratify patients in transcatheter aortic-valve replacement (TAVR). Int J Cardiol 2016; 223:444-449. [DOI: 10.1016/j.ijcard.2016.08.260] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
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Efe TH, Gayretli Yayla K, Yayla C, Ertem AG, Cimen T, Erken Pamukcu H, Bilgin M, Erat M, Dogan M, Yeter E. Calcific aortic stenosis and its correlation with a novel inflammatory marker, the lymphocyte/monocyte ratio. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Falcão-Pires I, Leite-Moreira AF. Biomarkers of aortic valve stenosis: Should we rely on a single one? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Edem E, Reyhanoğlu H, Küçükukur M, Kırdök AH, Kınay AO, Tekin Üİ, Özcan K, Ertürk M, Şentürk Ç, Kırılmaz B, Güngör H, Durmaz İ. Predictive value of platelet-to-lymphocyte ratio in severe degenerative aortic valve stenosis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:93. [PMID: 28163739 PMCID: PMC5244652 DOI: 10.4103/1735-1995.192509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/06/2016] [Accepted: 06/12/2016] [Indexed: 11/08/2022]
Abstract
Background: Aortic valve stenosis (AVS) is the most common cause of left ventricular outflow obstruction, and its prevalence among elderly patients causes a major public health burden. Recently, platelet-to-lymphocyte ratio (PLR) has been recognized as a novel prognostic biomarker that offers information about both aggregation and inflammation pathways. Since PLR indicates inflammation, we hypothesized that PLR may be associated with the severity of AVS due to chronic inflammation pathways that cause stiffness and calcification of the aortic valve. Materials and Methods: We retrospectively enrolled 117 patients with severe degenerative AVS, who underwent aortic valve replacement and 117 control patients in our clinic. PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. Severe AVS was defined as calcification and sclerosis of the valve with a mean pressure gradient of >40 mmHg. Results: PLR was 197.03 ± 49.61 in the AVS group and 144.9 ± 40.35 in the control group, which indicated a statistically significant difference (P < 0.001). A receiver operating characteristic (ROC) curve analysis demonstrated that PLR values over 188 predicted the severity of aortic stenosis with a sensitivity of 87% and a specificity of 70% (95% confidence interval = 0.734–0.882; P < 0.001; area under ROC curve: 0.808). Conclusion: We suggest that the level of PLR elevation is related to the severity of degenerative AVS, and PLR should be used to monitor patients' inflammatory responses and the efficacy of treatment, which will lead us to more closely monitor this high-risk population to detect severe degenerative AVS at an early stage.
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Affiliation(s)
- Efe Edem
- Department of Cardiology, Tınaztepe Hospital, Izmir, Turkey
| | - Hasan Reyhanoğlu
- Department of Cardiovascular Surgery, Tınaztepe Hospital, Izmir, Turkey
| | - Murat Küçükukur
- Department of Cardiology, Bergama State Hospital, Bergama, Turkey
| | | | | | | | - Kaan Özcan
- Department of Cardiovascular Surgery, Tınaztepe Hospital, Izmir, Turkey
| | - Murat Ertürk
- Department of Cardiovascular Surgery, Tınaztepe Hospital, Izmir, Turkey
| | - Çağın Şentürk
- Department of Interventional Radiology, Tınaztepe Hospital, Izmir, Turkey; Department of Radiological Sciences, Neurointerventional Radiology Division, University of California, Irvine, CA, USA
| | - Bahadır Kırılmaz
- Department of Cardiology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Hasan Güngör
- Department of Cardiology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - İsa Durmaz
- Department of Cardiovascular Surgery, Tınaztepe Hospital, Izmir, Turkey
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Cho KI, Cho SH, Her AY, Singh GB, Shin ES. Prognostic Utility of Neutrophil-to-Lymphocyte Ratio on Adverse Clinical Outcomes in Patients with Severe Calcific Aortic Stenosis. PLoS One 2016; 11:e0161530. [PMID: 27548384 PMCID: PMC4993489 DOI: 10.1371/journal.pone.0161530] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inflammation is an important factor in the pathogenesis of calcific aortic stenosis (AS). We aimed to evaluate the association between an inflammatory marker, neutrophil-to-lymphocyte ratio (NLR) and major adverse cardiovascular events (MACE) in patients with severe calcific AS. METHODS A total of 336 patients with isolated severe calcific AS newly diagnosed between 2010 and 2015 were enrolled in this study. Using Cox proportional hazards (PH) regression models, we investigated the prognostic value of NLR adjusted for baseline covariates including logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE-I) and undergoing aortic valve replacement (AVR). We also evaluated the clinical relevance of NLR risk groups (divided into low, intermediate, high risk) as categorized by NLR cutoff values. MACE was defined as a composite of all-cause mortality, cardiac death and non-fatal myocardial infarction during the follow-up period. RESULTS The inflammatory marker NLR was an independent prognostic factor most significantly associated with MACE [hazard ratio (HR), 1.06; 95% confidence interval (CI), 1.04-1.09; p-value <0.001]. The goodness-of-fit and discriminability of the model including EuroSCORE-I and AVR (loglikelihood difference, 15.49; p-value <0.001; c-index difference, 0.035; p-value = 0.03) were significantly improved when NLR was incorporated into the model. The estimated Kaplan-Meier survival rates at 5 years for the NLR risk groups were 84.6% for the low risk group (NLR ≤ 2), 67.7% for the intermediate risk group (2 < NLR ≤ 9), and 42.6% for the high risk group (NLR > 9), respectively. CONCLUSION The findings of the present study demonstrate the potential utility of NLR in risk stratification of patients with severe calcific AS.
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Affiliation(s)
- Kyoung Im Cho
- Department of Cardiology, Kosin University School of Medicine, Busan, South Korea
| | - Sang Hoon Cho
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Gillian Balbir Singh
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- * E-mail:
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Yayla Ç, Açikgöz SK, Yayla KG, Açikgöz E, Canpolat U, Kirbaş Ö, Öksüz F, Özcan F, Akboğa MK, Topaloğlu S, Aras D. The association between platelet-to-lymphocyte ratio and inflammatory markers with the severity of aortic stenosis. Biomark Med 2016; 10:367-73. [PMID: 26974393 DOI: 10.2217/bmm-2015-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIM Platelet-to-lymphocyte ratio (PLR) was proposed as a novel indirect marker of inflammation. We aimed to evaluate the relationship between PLR and aortic stenosis (AS). PATIENTS & METHODS The study population included 453 patients of which 98 patients with severe AS, 206 patients with mild-to-moderate AS and 149 patients as control. RESULTS PLR was significantly increased in parallel to the severity of AS (p < 0.001). There was significant positive correlation between PLR and maximum, and mean systolic transaortic gradient (all p < 0.001). Also, PLR was correlated with C-reactive protein and neutrophil-to-lymphocyte ratio (all p < 0.001) and PLR was independently associated with the presence of AS (p < 0.001). CONCLUSION We found a significant relationship between PLR and AS.
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Affiliation(s)
- Çağrı Yayla
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Sadık Kadri Açikgöz
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- Dışkapı Yıldırım Beyazıt Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Eser Açikgöz
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Uğur Canpolat
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Özgür Kirbaş
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Fatih Öksüz
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Fırat Özcan
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mehmet Kadri Akboğa
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Serkan Topaloğlu
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Dursun Aras
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
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27
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Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther 2016; 14:573-7. [PMID: 26878164 DOI: 10.1586/14779072.2016.1154788] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As we know, inflammatory and oxidative stresses have a role in the pathogenesis of cardiovascular disease. This knowledge has triggered many investigations targeted to inflammatory markers. One such example, the neutrophil to lymphocyte ratio (NLR), is an inexpensive and easily accessible inflammatory marker whose role in cardiovascular disease has been studied extensively in the past few years. The neutrophil lymphocyte ratio has been shown to predict cardiac arrhythmias as well as short- and long-term mortality in patients with acute coronary syndromes (ACS). It has correlated well with ACS risk prediction models such as the GRACE and SYNTAX scores. A higher NLR has also been associated with frequent congestive heart failure decompensation and long-term mortality. The neutrophil to lymphocyte ratio also appears to have a prognostic role in patients undergoing transaortic valve replacement and the progression of valvular heart diseases. Despite the science of inflammatory biomarkers having been described decades ago, NLR appears to be enjoying a renaissance as a cost-effective biomarker with immediate clinical predictability and prognostication.
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Affiliation(s)
- Maxwell E Afari
- a Division of Cardiovascular Medicine , St. Elizabeth's Medical Center, Tufts University School of Medicine , Boston , MA , USA
| | - Tariq Bhat
- a Division of Cardiovascular Medicine , St. Elizabeth's Medical Center, Tufts University School of Medicine , Boston , MA , USA
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Sun J, Ning H, Sun J, Qu X. Effect of hypertension on preoperative neutrophil-lymphocyte ratio evaluation of prognosis of renal cell carcinoma. Urol Oncol 2016; 34:239.e9-15. [PMID: 26803433 DOI: 10.1016/j.urolonc.2015.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/14/2015] [Accepted: 12/14/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES As an indicator of inflammatory reaction of immune system, the neutrophil-lymphocyte ratio (NLR) is a significantly independent prognostic factor of renal cell carcinoma (RCC). However, the NLR was not added in any well-established prognostic models. Many physiologic factors were also associated with NLR, such as hypertension. As such, we evaluated the effect of hypertension on NLR evaluation of prognosis of RCC. MATERIALS AND METHODS Hematological parameters and clinicopathological data during diagnosis were retrospectively recorded for 401 patients with RCC between the years 1999 and 2009. The standardized cutoff-finder algorithm was used to find the suitable NLR cutoff value for recurrence. The Log-rank test and Kaplan-Meier method were used to compare and estimate the recurrence-free survival. Univariate and multivariate Cox regression analyses were used to evaluate the association between NLR and clinicopathologic outcomes. RESULTS In the analysis of total subjects, recurrence-free survival was significantly worse among patients with a preoperative NLR (>3.139 [21.9%] vs.≤3.139 [78.1%]; P<0.001). High NLR value was associated with high pathological TNM stage (P = 0.009, 0.018, 0.001, respectively). In the normotensive subgroup, recurrence-free survival was also significantly worse among patients with a preoperative NLR (>3.139 [22.6%] vs.≤3.139 [77.4%]; P<0.001). However, in the subgroup with hypertension, the difference of recurrence-free survival was not significant between patients with preoperative NLR (>3.139 [21.2%] vs.≤3.139 [78.8%]; P = 0.093). Moreover, multivariate analysis identified increased NLR as a poor prognosis index for recurrence-free survival in total group (hazard ratio [HR] = 2.27; 95% CI: 1.50-3.44; P<0.001) and normotensive subgroup (HR = 2.97; 95% CI: 1.74-5.07; P<0.001), but not in hypertensive subgroup (HR = 1.25; 95% CI: 0.59-2.65; P = 0.566). CONCLUSIONS Hypertension is a disturbance factor in the evaluation of prognosis of RCC by preoperative NLR.
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Affiliation(s)
- Jia Sun
- Institute of Basic Medical Sciences, Qilu Hospital, Shandong University, Shandong, PR China
| | - Hao Ning
- Department of Urology, Provincial Hospital, Shandong University, Shandong, PR China.
| | - Jintang Sun
- Institute of Basic Medical Sciences, Qilu Hospital, Shandong University, Shandong, PR China
| | - Xun Qu
- Institute of Basic Medical Sciences, Qilu Hospital, Shandong University, Shandong, PR China.
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Guo X, Zhang S, Zhang Q, Liu L, Wu H, Du H, Shi H, Wang C, Xia Y, Liu X, Li C, Sun S, Wang X, Zhou M, Huang G, Jia Q, Zhao H, Song K, Niu K. Neutrophil:lymphocyte ratio is positively related to type 2 diabetes in a large-scale adult population: a Tianjin Chronic Low-Grade Systemic Inflammation and Health cohort study. Eur J Endocrinol 2015; 173:217-25. [PMID: 25953830 DOI: 10.1530/eje-15-0176] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/07/2015] [Indexed: 12/29/2022]
Abstract
AIM It is widely known that inflammation is related to type 2 diabetes (T2D), but few studies have shown a direct relationship between the immune system and T2D using a reliable biomarker. Neutrophil:lymphocyte ratio (NLR) is an easy-to-analyze inflammation biomarker, but few studies have assessed the relationship between NLR and T2D. In order to evaluate how NLR is related to T2D, we designed a large-scale cross-sectional and prospective cohort study in an adult population. SUBJECTS AND METHODS Participants were recruited from the Tianjin Medical University General Hospital-Health Management Centre. Both a baseline cross-sectional (n=87,686) and a prospective (n=38,074) assessment were performed. Participants without a history of T2D were followed up for ∼ 6 years (with a median follow-up of 2.7 years). Adjusted logistic and Cox proportional hazards regression models were used to assess relationships between the quintiles of NLR and T2D (covariates: age, sex, BMI, smoking status, drinking status, hypertension, hyperlipidemia, and family history of cardiovascular disease, hypertension, hyperlipidemia, or diabetes). RESULTS The prevalence and incidence of T2D were 4.9% and 6.8/1000 person-years respectively. The adjusted odds ratio and hazard ratio (95% CI) of the highest NLR quintile were 1.34 (1.21, 1.49) and 1.39 (1.09, 1.78) (both P for trend <0.01) respectively as compared to the lowest quintile of NLR. Leukocyte, neutrophil, and lymphocyte counts do not significantly predict the eventual development of T2D. CONCLUSION The present study demonstrates that NLR is related to the prevalence and incidence of T2D, and it suggests that NLR may be an efficient and accurate prognostic biomarker for T2D.
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Affiliation(s)
- Xiaoyan Guo
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Shu Zhang
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Qing Zhang
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Li Liu
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Hongmei Wu
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Huanmin Du
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Hongbin Shi
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Chongjin Wang
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Yang Xia
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Xing Liu
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Chunlei Li
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Shaomei Sun
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Xing Wang
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Ming Zhou
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Guowei Huang
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Qiyu Jia
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Honglin Zhao
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Kun Song
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public HealthTianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaHealth Management CentreTianjin Medical University General Hospital, Tianjin 300052, China
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30
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Koza Y. What is the clinical benefit of neutrophil-lymphocyte ratio in cardiovascular patients? J Cardiovasc Thorac Res 2014; 6:131-2. [PMID: 25031831 PMCID: PMC4097855 DOI: 10.5681/jcvtr.2014.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/14/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yavuzer Koza
- Ataturk University Faculty of Medicine, Department of Cardiology, Erzurum, Turkey
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