Neutropenia and neutrophil-to-lymphocyte ratio in a healthy Korean population: race and sex should be considered

Significance of Neutrophil to Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) in Diabetic Foot Ulcer and Potential New Therapeutic Targets

Diabetic foot ulcer (DFU) is a well-known complication of diabetes and a significant burden on the national health systems. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio are inexpensive and easily accessible biomarkers that have proved to be useful in several inflammatory, infectious and cardiovascular diseases. We carried out a comprehensive review examining the association of NLR and PLR with the onset and progression of DFU. PLR and NLR were significantly increased in patients with DFU, compared with a control group of T2DM patients without DFU, and correlate well with DFU severity, evaluated by Wagner and IWGDF grading scales. In patients with diabetic foot infections (DFI), elevated NLR and PLR were correlated with osteomyelitis, increased risk of amputation, and septic complications. The significance of the elevated value of these biomarkers in DFU is related to chronic hyperglycemia and low-grade systemic inflammation, atherosclerotic and vascular complications, and also the associated septic factor. Serial, dynamic follow-up can provide useful information in planning and monitoring DFU treatment, as well as in risk stratification of these vulnerable patients. Further randomized studies are needed to set the cut-off values with clinical significance.

Complete blood count derived inflammatory biomarkers and the level of anti-SARS-CoV-2 NAb and S-RBD IgG among cancer survivors receiving COVID-19 vaccines

<b>Background</b>: In the era of coronavirus disease 2019 (COVID-19), it is mandatory to identify vulnerable people with cancers as they have impaired immune system that can lead to high mortality. This study analyzes the complete blood count (CBC) derived inflammatory biomarkers and the level of anti-SARS-CoV-2 neutralizing antibody (NAb) and spike protein’s receptor-binding domain immunoglobulin G (S-RBD IgG) among cancer survivors.<br /> <b>Methods</b>: A cross-sectional study was conducted in patients with either solid or hematological cancers who had received two-doses of COVID-19 vaccinations within six months.<br /> <b>Results</b>: From 119 subjects, the COVID-19 vaccines demonstrated laboratory efficacy (median NAb=129.03 AU/mL; median S-RBD IgG=270.53 AU/mL). The seropositive conversion of NAb reached 94.1% and S-RBD IgG reached 93.3%. Additionally, the S-RBD IgG had very weak correlation with absolute monocyte count (R=-0.185; <i>p</i>-value=0.044). The NAb also had very weak correlation with leukocyte (Kendall’s tau-b (τb)=-0.147; <i>p</i>-value=0.019), absolute neutrophil count (τb=-0.126; <i>p</i>-value=0.044), absolute eosinophil count (τb=-0.132; <i>p</i>-value=0.034).<br /> <b>Conclusion</b>: The seropositivity rate of anti-SARS-CoV-2 NAb and S-RBD IgG were significantly high. However, the CBC derived inflammatory biomarkers had poor correlation with anti-SARS-CoV-2 NAb and S-RBD IgG. Thus, anti-SARS-CoV-2 NAb and S-RBD IgG are currently the only reliable markers for measuring the COVID-19 vaccine efficacy which should be widely accessible.

Subclinical inflammation as a predictor for erectile dysfunction after brachytherapy for localized prostate cancer

PURPOSE

Neutrophil-to-lymphocyte ratio (NLR), a marker for subclinical inflammation, has been previously shown to be associated with erectile dysfunction (ED). We studied the potential predictive value of the NLR on ED after prostate brachytherapy (PB) for PCa.

METHODS AND MATERIALS

Between July 2005 and January 2021, 842 patients were included in this retrospective study of a prospectively maintained database. ED was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) physician-reported scale. ED was defined as a Grade 2 or 3 function. NLR count was determined 1-2 months before PB and separated into values PB <2 and ≥2. Patient characteristics and erectile function at last follow-up were compared for patients with a Univariate and multivariate analyses were performed to evaluate the predictive value of baseline NLR ≥2 on post-PB ED.

RESULTS

Baseline NLR ≥2 was found to be a statistically significant predictor of post-PB ED on both univariate (p = 0.002) and multivariate analyses (p = 0.008). Furthermore, the difference in ED prevalence between the NLR <2 and NLR ≥2 groups became more pronounced with longer follow-up after PB. The ED rate at 5 years post-PB was 43% for the NLR ≥2 groups, compared to 29% for the NLR <2 groups.

CONCLUSIONS

Subclinical systemic inflammation is a potentially important factor for predicting sexual toxicity after pelvic radiotherapy. NLR may be used as a proxy for predicting post-PB ED.

Neutrophil-Selective Fluorescent Probe Development through Metabolism-Oriented Live-Cell Distinction

Human neutrophils are the most abundant leukocytes and have been considered as the first line of defence in the innate immune system. Selective imaging of live neutrophils will facilitate the in situ study of neutrophils in infection or inflammation events as well as clinical diagnosis. However, small-molecule-based probes for the discrimination of live neutrophils among different granulocytes in human blood have yet to be reported. Herein, we report the first fluorescent probe NeutropG for the specific distinction and imaging of active neutrophils. The selective staining mechanism of NeutropG is elucidated as metabolism-oriented live-cell distinction (MOLD) through lipid droplet biogenesis with the help of ACSL and DGAT. Finally, NeutropG is applied to accurately quantify neutrophil levels in fresh blood samples by showing a high correlation with the current clinical method.

The prognostic utility of pre-treatment neutrophil-to-lymphocyte-ratio (NLR) in colorectal cancer: A systematic review and meta-analysis

Background

Inflammation is a hallmark of cancer, and systemic markers of inflammation are increasingly recognised as negative prognostic factors for clinical outcome. Neutrophil‐to‐lymphocyte ratio (NLR) is readily available from routine blood testing of patients diagnosed with cancer.

Methods

Peer‐reviewed publications from PubMed/MEDLINE, Web of Science and EMBASE were identified according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Hazard ratios (HR) for overall survival (OS) and surrogate endpoints (SE; comprising disease‐, recurrence‐ and progression‐free survival) were pooled using a random effects model. Additional analysis was carried out to further investigate NLR as an independent prognostic factor and account for heterogeneity.

Results

Seventy‐one eligible papers comprising 32,788 patients were identified. High NLR was associated with poor clinical outcomes. Significant publication bias was observed, and larger studies also adjusted for more covariates. Correcting for publication bias in multivariate studies brought our best estimate for true effect size to HR = 1.57 (95% CI 1.39–1.78; p < 0.0001) for OS and to HR = 1.38 (95% CI 1.16–1.64; p = 0.0003) for SE.

Conclusions

NLR is confirmed as an easily available prognostic biomarker in colorectal cancer, despite the limitations of some studies previously reporting this finding. As such, it should be routinely collected in prospective clinical trials. While more standardised and rigorous large‐scale studies are needed before high NLR can be fully assessed as an independent predictor of CRC progression and outcome, the data suggest that it may be used to highlight individuals with tumour‐promoting inflammatory context.

Association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume with the risk of gestational diabetes mellitus

OBJECTIVE

In the present study, we aimed to investigate the correlation of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume with the risk of gestational diabetes mellitus.

METHODS

The study enrolled 120 pregnant women who were the 24th and 28th weeks of gestation, including GDM group (n = 58), the control group (n = 62). The NLR, PLR and MPV levels were measured.

RESULTS

NLR, PLR and MPV were significantly higher in GDM compared with control group. Logistic regression analysis showed that elevated WBC, NLR, PLR and MPV was an independent variable for predicting GDM in pregnancy. The OR and 95% CI was (OR: 1.6, 95% CI: 1.2-2.5), (OR: 4.1, 95% CI: 1.3-13.1), (OR: 5.5, 95% CI: 1.5-20.0), (OR: 4.0, 95% CI: 1.2-12.0), respectively.

CONCLUSION

Increased WBC, PLR, NLR, MPV were independent predictors of GDM.

Reference intervals of systemic immune-inflammation index, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume to platelet ratio, mean platelet volume and red blood cell distribution width-standard deviation in healthy Han adults in Wuhan region in central China

Low-grade inflammatory indicators are widely used in the diagnosis and prognosis of different diseases, particularly, in cancers. The establishing of reference intervals (RIs) are necessary to provide baselines for the interpretation and application of the indicators in clinical. A retrospective review was organized to include ostensibly healthy subjects aged >18 years old to establish RIs based on gender and age for systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume-to-platelet ratio (MPV/PLT), MPV and red blood cell distribution width - standard deviation (RDW-SD). Another 5012 healthy persons were included to validate the RIs. The differences among gender, age, and Body Mass Index (BMI) groups were compared to assess their influences on each indicator. A total of 26,242 males and 11,934 females were included. All indicators differed between males and females except NLR. Compared with males, the values of SII, PLR, MPV and RDW-SD were higher while MPV/PLT lower in females. The values of SII, NLR and PLR increased with age in females between 18 and 50 years old, declined in 51-60 years old group, then increased with age again. Values of MPV/PLT and RDW-SD increased with age. The values of SII increased with BMI while PLR, MPV, and MPV/PLT decreased. We effectively established RIs for the indicators. They will help with predicting disease progression in various clinical practices. Gender, age, and BMI were suggested to be taken into consideration when these parameters were applied in clinical.

Red cell distribution width and neutrophil-lymphocyte ratio in rheumatoid arthritis

Red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) are potential low-cost markers for detecting rheumatoid arthritis (RA) disease activity, but evidence on their accuracy for this purpose is conflicting. We aimed to determine the relationship between these and the Disease Activity Score of 28 joints (DAS-28) among Filipino RA patients, and to evaluate their ability to discriminate between patients with active RA and those in remission. This was a cross-sectional study done through a 7-year review of medical records of 134 adult patients with RA in a tertiary government hospital. Correlations were analyzed using Spearman analysis, and the receiver operating characteristic (ROC) curve was used to derive the sensitivity, specificity, and optimal cut-off values of RDW and NLR. Most patients were females with a mean disease duration of 7 years. Eighty-one percent (81%) had active disease using DAS-28 ESR. A weak positive correlation was found between NLR and DAS-28 and between NLR and ESR, but RDW did not correlate with either DAS-28 or ESR. The ROC analysis showed that in the differentiation of active RA and inactive RA, both RDW (area under the curve [AUC] 0.516, cut-off of ≥ 14.2% with 55.6% sensitivity and 42.3% specificity) and NLR (AUC 0.629, cut-off of ≥ 2.32 with 54.6% sensitivity and 76.9% specificity) had poor performance. NLR, but not RDW, was positively but weakly correlated with DAS-28 and ESR, making it a helpful marker of disease activity and inflammation in RA. Both NLR and RDW had low sensitivity and specificity for active RA and may not be useful in detecting disease activity.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio among Patients with Vestibular Neuritis

OBJECTIVE

To compare the level of the inflammatory markers (IM) neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) among healthy subjects and those presenting with vestibular neuritis (VN).

METHODS

A cross-sectional retrospective study was conducted in a tertiary hospital setting. The medical records of patients (20-60 years old) who were hospitalized between the years 2005 and 2014 with the diagnosis of VN were retrieved. Inclusion criteria were: (1) acute vertigo lasting for at least 24 h, (2) absence of auditory complaints, (3) presence of horizontal unidirectional nystagmus during physical examination, (4) absence of neurological symptoms or signs. The levels of the IM were compared with levels reported among two large cohorts of healthy subjects, within the same age range.

RESULTS

A statistically significant difference was found between the levels of NLR in VN subjects compared with controls, with higher levels of NLR in VN subjects (p < 0.001), while no significant difference was found between both groups concerning the levels of PLR.

CONCLUSION

Higher levels of IM were found among VN patients, with significantly higher levels of NLR, but not PLR. This may suggest a possible inflammatory etiology of VN.

Sex-Related Differences in Impact on Safety of Pharmacogenetic Profile for Colon Cancer Patients Treated with FOLFOX-4 or XELOX Adjuvant Chemotherapy

Polymorphisms contribute to inter-individual differences and show a promising predictive role for chemotherapy-related toxicity in colon cancer (CC). TOSCA is a multicentre, randomized, non-inferiority, phase III study conducted in high-risk stage II/stage III CC patients treated with 6 vs 3 months of FOLFOX-4 or XELOX adjuvant chemotherapy. During this post-hoc analysis, 218 women and 294 men were genotyped for 17 polymorphisms: TYMS (rs34743033, rs2853542, rs11280056), MTHFR (rs1801133, rs1801131), ERCC1 (rs11615), XRCC1 (rs25487), XRCC3 (rs861539), XPD (rs1799793, rs13181), GSTP1 (rs1695), GSTT1/GSTM1 (deletion +/−), ABCC1 (rs2074087), and ABCC2 (rs3740066, rs1885301, rs4148386). The aim was to assess the interaction between these polymorphisms and sex, on safety in terms of time to grade ≥3 haematological (TTH), grade ≥3 gastrointestinal (TTG) and grade ≥2 neurological (TTN) toxicity. Interactions were detected on TTH for rs1801133 and rs1799793, on TTG for rs13181 and on TTN for rs11615. Rs1799793 GA genotype (p = 0.006) and A allele (p = 0.009) shortened TTH in men. In women, the rs11615 CC genotype worsened TTN (co-dominant model p = 0.008, recessive model p = 0.003) and rs13181 G allele improved the TTG (p = 0.039). Differences between the two sexes in genotype distribution of rs1885301 (p = 0.020) and rs4148386 (p = 0.005) were found. We highlight that polymorphisms could be sex-specific biomarkers. These results, however, need to be confirmed in additional series.

The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases

The platelet-to-lymphocyte ratio (PLR) has emerged as an informative marker revealing shifts in platelet and lymphocyte counts due to acute inflammatory and prothrombotic states. PLR has been extensively examined in neoplastic diseases accompanied by immune suppression and thrombosis, which can be predicted by combined blood cell counts and their ratios. Several large observational studies have demonstrated the value of shifts in PLR in evaluating the severity of systemic inflammation and predicting infections and other comorbidities, in inflammatory rheumatic diseases. The value of PLR as an inflammatory marker increases when its fluctuations are interpreted along with other complementary hematologic indices, particularly the neutrophil-to-lymphocyte ratio (NLR), which provides additional information about the disease activity, presence of neutrophilic inflammation, infectious complications, and severe organ damage in systemic lupus erythematosus. PLR and NLR have high predictive value in rheumatic diseases with predominantly neutrophilic inflammation (e.g., Behçet disease and familial Mediterranean fever). High PLR, along with elevated platelet count, is potentially useful in diagnosing some systemic vasculitides, particularly giant-cell arteritis. A few longitudinal studies on rheumatic diseases have demonstrated a decrease in PLR in response to anti-inflammatory therapies. The main limitations of PLR studies are preanalytical faults, inadequate standardization of laboratory measurements, and inappropriate subject selection. Nonetheless, accumulating evidence suggests that PLR can provide valuable information to clinicians who encounter multisystem manifestations of rheumatic diseases, which are reflected in shifts in platelet, lymphocyte, neutrophil, or monocyte counts. Interpretation of PLR combined with complementary hematologic indices is advisable to more accurately diagnose inflammatory rheumatic diseases and predict related comorbidities.

Neutrophil-lymphocyte-ratio distributions in a Danish population from general practice

The neutrophil-lymphocyte ratio (NLR) is a novel biomarker, showing promising both diagnostic and prognostic capabilities. The aim of this study was to present NLR distributions in a Danish population from general practice (GP) and compare levels between patients from intensive care units (ICU) and GP. A register-based study was conducted using results from 31,966 blood samples from GP and ICU located in the admission area of Aarhus University Hospital, Denmark. Exclusion of samples with lymphocytes >40 × 10⁹/L, resulted in 28,582 samples from GP and 3,373 from ICU. Distributions for patients from GP with CRP <8 mg/L were age-dependent and were established for the following three age groups; 0-17 years [0.30:3.76], 18-75 years: [0.74:4.94], above 76 years: [0.89:8.80]. Patients from ICU had a significantly higher median NLR than patients from GP when stratified for CRP, [8.48 and 1.99 respectively]. This study describes for the first time the distributions of NLR in a large European population of GP patients.

Normal values of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio among Iranian population: Results of Tabari cohort

BACKGROUND

Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and platelet-lymphocyte ratio (PLR) have a prognostic value in several types of diseases such as cancers and they vary in different races. So, we aimed to evaluate the normal range of these markers among healthy people to determine the normal value in Iranian population.

METHODS

In the present study, cross-sectional data of population-based cohort study named "Tabari cohort study" was utilized. In the first phase of Tabari cohort, 10255 participants aged 35-70 years from urban and rural areas of Sari, Mazandaran, Iran entered into the study. The study included a questionnaire survey and blood collection. Blood samples were collected after 12 hours fasting from all participants during the study. Hematological indices were measured for all samples using Celltac Alpha MEK-6510 K (Tokyo, Japan).

RESULTS

After sample exclusion, 2212 healthy subjects of Tabari's normal cohort population were investigated. The mean age of the samples was 47.9±9.29 years. The mean of NLR, LMR, PLR were 1.70±0.70, 11.15±3.14 and 117.05±47.73, respectively.

CONCLUSION

Our investigation provides preliminary reference values for NLR, LMR, and PMR among Iranian population that can be used for disease progress in various clinical procedures.

Neutrophil to Lymphocyte Ratio as a Predictor of Outcomes after Amputation

BACKGROUND

The neutrophil-to-lymphocyte ratio (NLR) has become a prognostic marker for proinflammatory states. It is associated with outcomes in many clinical processes including critical limb ischemia. We sought to identify predictors of amputation failure and mortality, in addition to the role of NLR in patients undergoing above-knee amputations (AKAs) or below-knee amputations (BKAs).

METHODS

All patients undergoing BKA or AKA between 2004 and 2014 at 3 institutions were identified and analyzed (n = 513). Patients were excluded if they did not have a complete blood count with differential within 7 days prior to their operations. Comparison groups were formed between patients requiring unplanned revision and those who did not, and additionally between survivors and nonsurvivors at 30 days postamputation. Patient demographics, intraoperative data, and postoperative courses were compared. A multinomial logistic regression model was created to further compare the groups.

RESULTS

Four hundred and ten patients were included for analysis, of which 142 (35%) required unplanned revision. Nearly 5% of patients (19/410) died within 30 days of the initial amputation. On univariate analysis, those requiring revision were more likely to be current smokers compared to former smokers (P = 0.004 and P = 0.021, respectively), have a lower ankle-brachial index (ABI) (P = 0.019), and have undergone a BKA (P < 0.001). Patients with congestive heart failure (CHF) were less likely to require a revision after an amputation (P = 0.007). Postoperative NLR was higher in patients requiring revision (9.9 vs. 7.0, P < 0.001) and both preoperative and postoperative NLRs were higher in those with 30-day mortality (21.0 vs. 7.0, P < 0.001; 19.4 vs. 7.5, P < 0.001). A multinomial logistic regression model identified CHF (P = 0.004), ABI (P = 0.041), and elevated body mass index (BMI, P = 0.045) as predictors of revision, while coronary artery disease (CAD, P = 0.031), CHF (P = 0.029), and postoperative NLR (P < 0.001) were predictive of 30-day mortality.

CONCLUSIONS

Postoperative elevated NLR, CAD, and CHF are predictors of 30-day mortality in patients undergoing major limb amputation, while CHF, elevated ABI, and high BMI are predictors of revision. This study suggests that NLR may have a role as a biomarker for poor outcomes in patients with underlying peripheral vascular disease and warrants further investigation.

Baseline peripheral blood neutrophil-to-lymphocyte ratio could predict survival in patients with adult polymyositis and dermatomyositis: A retrospective observational study

Recent studies have suggested that neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein-to-albumin ratio (CAR) are emerging markers of disease activity and prognosis in patients with chronic inflammatory diseases, cardiovascular diseases, or malignancies. Therefore, we investigated the clinical significance and prognostic value of the NLR and CAR in adult patients with polymyositis and dermatomyositis. The medical records of 197 patients with newly diagnosed polymyositis/dermatomyositis between August 2003 and November 2016 were retrospectively reviewed. Survival and causes of death were recorded during an average 33-month observational period. Clinical and laboratory findings were compared between survivors and non-survivors. Using receiver operating characteristic curves, the NLR and CAR cut-off values for predicting survival were calculated. Univariate and multivariate analyses using Cox proportional hazard models were performed to identify factors associated with survival. Twenty-six patients (13.2%) died during the study period, and the 5-year survival-rate was estimated to be 82%. The non-survivor group exhibited older age and a higher prevalence of interstitial lung disease (ILD), acute interstitial pneumonia, and acute exacerbation of ILD compared to that in the survivor group. NLR and CAR values were significantly higher in the non-survivors and in patients with polymyositis/dermatomyositis-associated ILD, and the death rates increased across NLR and CAR quartiles. Furthermore, when stratified according to the NLR or CAR optimal cut-off values, patients with a high NLR (>4.775) or high CAR (>0.0735) had a significantly lower survival rate than patients with low NLR or CAR, respectively. In addition, old age (>50 years), the presence of acute interstitial pneumonia, hypoproteinemia (serum protein <5.5 g/dL), and high NLR (but not high CAR) were independent predictors for mortality. The results indicate that a high NLR is independently associated with worse overall survival. Thus, the baseline NLR level may be a simple, cost-effective prognostic marker in patients with polymyositis/dermatomyositis.

The connections among suicidal behavior, lipid profile and low-grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio

OBJECTIVES

The role of inflammation and lipid metabolism in the pathophysiology of suicidal behavior has received particular attention in recent years. The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a new and more reliable indicator of low-grade inflammation. NLR has been found to be altered in major depressive disorder (MDD) and has been related to various factors, including chronic stress and impulsivity that were previously reported to be related to suicidal behavior. We aimed to explore the roles of NLR, C-reactive protein (CRP) and serum lipid levels on suicidal behavior in patients with MDD.

METHODS

The study group consisted of 139 inpatients diagnosed with MDD [37 suicide attempters (SA); 102 suicide non-attempters (NSA)], 50 healthy controls and matched according to age, gender and education. NLR, PLR, CRP and lipid values were obtained from digital inpatient records.

RESULTS

CRP levels and NLR were substantially higher in patients with SA than in subjects with NSA and healthy comparison subjects after adjusting the confounding factors. The logistic regression included two predictive variables for suicide status in patients with depressive disorder (A) previous suicidal history; (B) NLR.

CONCLUSIONS

This is the first study suggesting that NLR may be a trait marker for suicidal vulnerability via a relationship between NLR and a recent suicide attempt in depressed inpatients. Future prospective studies are needed to determine the exact roles of NLR, and other inflammatory markers on suicidality in MDD.

Prognostic value of platelet-to-lymphocyte ratios among critically ill patients with acute kidney injury

Background

Inflammation plays an important role in the initiation and progression of acute kidney injury (AKI). However, evidence regarding the prognostic effect of the platelet-to-lymphocyte ratio (PLR), a novel systemic inflammation marker, among patients with AKI is scarce. In this study, we investigated the value of the PLR in predicting the outcomes of critically ill patients with AKI.

Methods

Patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3. PLR cutoff values were determined using smooth curve fitting or quintiles and were used to categorize the subjects into groups. The clinical outcomes were 30-day and 90-day mortality in the intensive care unit (ICU). Cox proportional hazards models were used to evaluate the association between the PLR and survival.

Results

A total of 10,859 ICU patients with AKI were enrolled. A total of 2277 thirty-day and 3112 ninety-day deaths occurred. A U-shaped relationship was observed between the PLR and both 90-day and 30-day mortality, with the lowest risk being at values ranging from 90 to 311. The adjusted HR (95% CI) values for 90-day mortality given risk values < 90 and > 311 were 1.25 (1.12–1.39) and 1.19 (1.08–1.31), respectively. Similar trends were observed for 30-day mortality or when quintiles were used to group patients according to the PLR. Statistically significant interactions were found between the PLR and both age and heart rate. Younger patients (aged < 65 years) and those with more rapid heart rates (≥89.4 beats per minute) tended to have poorer prognoses only when the PLR was < 90, whereas older patients (aged ≥ 65 years) and those with slower heart rates (<89.4 beats per minute) had higher risk only when the PLR was > 311 (P < 0.001 for age and P < 0.001 for heart rate).

Conclusions

The preoperative PLR was associated in a U-shaped pattern with survival among patients with AKI. The PLR appears to be a novel, independent prognostic marker of outcomes in critically ill patients with AKI.

Routine hematological parameters are associated with short- and long-term prognosis of patients with ischemic stroke

BACKGROUND

Previous studies indicated that some routine hematological parameters are associated with the prognosis of ischemic stroke (IS), but none of study has evaluated them simultaneously. The aim of this study was to investigate the prognostic value of routine hematological parameters in IS patients.

METHODS

Using medical record database, we retrospectively reviewed the patients with IS admitted in Gansu Province Hospital between June 2014 and July 2015. The prognostic value of routine hematological parameters on admission was analyzed using logistic regression model, receiver operating characteristic (ROC) curve analysis and Cox proportional hazards model.

RESULTS

Patients with hospital mortality had significantly higher white blood cell (WBC), neutrophil, neutrophil to lymphocyte ratio (NLR), red blood cell distribution width (RDW) and National Institutes of Health Stroke Scale (NIHSS), while their lymphocyte, monocyte, and eosinophil were significantly lower. The area under ROC curve (AUC) for eosinophil, neutrophil, WBC, RDW, NLR, monocyte, and lymphocyte were 0.74 (95% CI, 0.67-0.82), 0.76 (95% CI, 0.67-0.84), 0.72 (95% CI, 0.64-0.81), 0.65 (95% CI, 0.56-0.73), 0.76 (95% CI, 0.68-0.84), 0.67 (95% CI, 0.59-0.76), and 0.75 (95% CI, 0.67-0.83), respectively. In a multivariable logistical regression model, only WBC, NLR, and NIHSS were independently associated with hospital mortality. In a multivariable model, age, NIHSS, RDW, NLR, and eosinophil were independent prognostic factors for all-cause mortality.

CONCLUSION

Red blood cell distribution width, NLR and eosinophil are independent prognostic factors for IS.