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Lan D, Zhang X, Huang X, Li J, Song J, Zhou D, Meng R. Anti-inflammatory Effect of Batroxobin Combined With Anticoagulation in Patients With Cerebral Venous Thrombosis. Clin Appl Thromb Hemost 2024:10760296241264516. [PMID: 39033421 DOI: 10.1177/10760296241264516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Inflammation is pivotal in the pathogenesis and development of cerebral venous thrombosis (CVT). Herein, we aimed to assess the anti-inflammatory effects of batroxobin combined with anticoagulation in CVT. Participants were categorized into the batroxobin group (batroxobin combined with anticoagulation) and the control group (anticoagulation only). Regression analysis was employed to explore the association between the number of episodes of batroxobin administration and the fluctuation of inflammatory indicators, as well as the proportion of patients with inflammatory indicators that were reduced after batroxobin use. Twenty-three cases (age: 39.9 ± 13.8 years, female: 39.1%) in the batroxobin group and 36 cases (40.3 ± 9.6 years, 52.8%) in the control group were analyzed. Compared to the control group, batroxobin combined with anticoagulation significantly decreased fibrinogen (P < .001), platelet-lymphocyte ratio (PLR) (P = .016) and systemic immune-inflammation index (SII) (P = .008), and increased the proportion of the patients with lower fibrinogen (P < .001), neutrophil-lymphocyte ratio (NLR) (P = .005), PLR (P = .026), and SII (P = .006). Linear analysis showed that as the number of episodes of batroxobin administration increased, the fibrinogen (P < .001), the PLR (P = .001), and the SII (P = .020) significantly decreased. Logistic regression analysis showed as the number of episodes of batroxobin administration increased, the ratio of the patients with decreased NLR (P = .008) and PLR (P = .015), as well as SII (P = .013), significantly increased. Batroxobin could decrease NLR, PLR, and SII in CVT. The effect was related to the number of episodes of batroxobin administration. Besides reducing fibrinogen and indirect thrombolysis effects, this may be another critical benefit of batroxobin for CVT.
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Affiliation(s)
- Duo Lan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiaoming Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiangqian Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jingrun Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jiahao Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Yaman Kula A, Kurtoğlu AV, Güzel V, Balsak S, Yabacı Tak A, Asil T. Inflammatory biomarkers are correlated with thrombus burden in cerebral venous sinus thrombosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-8. [PMID: 38811022 DOI: 10.1055/s-0044-1787137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Increasing evidence suggests that inflammatory biomarkers play a significant role in cerebral venous sinus thrombosis (CVST). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are related to thrombotic conditions and indicators of systemic inflammation. OBJECTIVE To analyze the correlation between inflammatory biomarkers and the extent of thrombus, determined by the CVST-Score. METHODS A total of 40 patients with CVST (24 female subjects; 60%) and 40 age- and sex-matched healthy controls were retrospectively evaluated. Inflammatory biomarkers, including C-reactive protein (CRP), PLR, NLR, MLR, and the CVST-Score, were recorded to assess the relationship between biomarkers and thrombus burden. The patients were grouped according to symptom duration (group 1: 0-3 days; group 2: 4-7 days; and group 3: 8-30 days) to compare biomarker levels. RESULTS The CRP, NLR, and PLR were significantly higher in the CVST group (p < 0.001; p = 0.003; p = 0.014 respectively). The NLR and PLR presented a significant positive correlation with the CVST-Score (p = 0.003, r = 0.464; p = 0.040, r = 0.326 respectively). The NLR was significantly higher in group 1 compared with groups 2 and 3 (p = 0.016 and p = 0.014 respectively). In group 1, there was a stronger positive correlation between the CVST-Score and the NLR (p = 0.026, r = 0.591) and the PLR (p = 0.012, r = 0.648). The multiple linear regression analysis revealed that the NLR is a key factor in predicting the CVST-Score (p = 0.019). CONCLUSION The NLR and PLR are associated with thrombus burden in CVST, especially in patients admitted to the hospital in the early stages. The NLR is an independent factor to predict the thrombus burden in CVST.
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Affiliation(s)
- Aslı Yaman Kula
- Bezmialem Foundation University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Ahmet Volkan Kurtoğlu
- Bezmialem Foundation University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Vildan Güzel
- Bezmialem Foundation University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Serdar Balsak
- Bezmialem Foundation University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Ayşegül Yabacı Tak
- Bezmialem Foundation University, Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey
| | - Talip Asil
- Memorial Hizmet Hospital, Department of Neurology, Istanbul, Turkey
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Agircan D, Bal M, Demir TG, Ethemoglu O. Multi-inflammatory index as a new predictive and prognostic marker of acute symptomatic seizures in patients with cerebral venous sinus thrombosis. J Stroke Cerebrovasc Dis 2023; 32:107453. [PMID: 37922681 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The multi-inflammatory index (MII) is a novel marker that indicates the diagnosis, prognosis, and clinical severeness of inflammation-associated diseases. It is indicated that inflammatory biomarkers may help predict the occurrence of acute symptomatic seizures(ASS) after ischemic stroke. OBJECTIVE Our goal was to search the predictive and prognostic capability of the MII-1 and MII-2 for ASS in cerebral venous sinus thrombosis (CVST) patients. METHOD 91 patients with CVST were retrospectively analyzed from the medical records of patients between 2010 and 2023 and divided into the ASS group and non-ASS group. The MII-1 and MII-2 levels on admission, demographic and clinic features, predisposing risk factors, radiological characteristics involving thrombotic cerebral veins, and the type of parenchymal lesions were documented. Modified Rankin Scale (mRS) on admission and at the 3rd month were evaluated to determine the disability. RESULTS MII-1 and MII-2 were statistically significantly higher in the ASS group and predictors for the occurrence of seizures with CVST in multivariate analysis. The area under the curve (AUC) of the receiver operating characteristics (ROC) curve for MII-1 was 0.791 (95 %CI = 0.691-0.891, p < 0.001), and AUC for MII-2 was 0.761 (95%CI = 0.660-0.861, p < 0.001). When the clinical variables that were included in the multivariate analysis and MII-1 and MII-2 were combined, the predictive power was greater with the AUC of 0.959. A significant positive correlation was found between mRS at the 3rd month and MII-1 and MII-2 in the ASS group. CONCLUSION MII-1 and MII-2 can be used as new predictive and prognostic markers of ASS in patients with CVST.
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Affiliation(s)
- Dilek Agircan
- Department of Neurology, Harran Faculty of Medicine, Harran University, Osmanbey Kampüsü, Sanliurfa-Mardin Karayolu 18.Km, Haliliye, Sanlıurfa 63290, Turkey.
| | - Mehmet Bal
- Department of Neurology, Harran Faculty of Medicine, Harran University, Osmanbey Kampüsü, Sanliurfa-Mardin Karayolu 18.Km, Haliliye, Sanlıurfa 63290, Turkey
| | - Tulin Gesoglu Demir
- Department of Neurology, Harran Faculty of Medicine, Harran University, Osmanbey Kampüsü, Sanliurfa-Mardin Karayolu 18.Km, Haliliye, Sanlıurfa 63290, Turkey
| | - Ozlem Ethemoglu
- Department of Neurology, Harran Faculty of Medicine, Harran University, Osmanbey Kampüsü, Sanliurfa-Mardin Karayolu 18.Km, Haliliye, Sanlıurfa 63290, Turkey
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Li S, Gao Y, Liu K, Zhao J, Fang H, Tao Y, Pei L, Tian M, Liu H, Wang X, Xia Z, Xu Y, Song B. The Novel Biomarkers-Based HALP (Hemoglobin, Albumin, Lymphocyte and Platelet)-Prognostic Model for Acute and Subacute Patients with Cerebral Venous Sinus Thrombosis: A Retrospective Cohort Study. J Atheroscler Thromb 2023; 30:1742-1749. [PMID: 37081612 PMCID: PMC10627762 DOI: 10.5551/jat.64043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
AIM Increasing evidences suggest that HALP is an independent predictor of prognosis in patients with inflammation. However, the relationship between HALP and prognosis in patients with cerebral venous sinus thrombosis (CVST) has not been studied. In this study, we aimed to evaluate the prognosis values of HALP in acute or subacute CVST and explore the new prognostic model for CVST. METHODS Consecutive patients who were diagnosed as having acute and subacute CVST were retrospectively investigated. We determined the patients' functional outcomes by modified Rankin Scale (mRS). Multivariate logistic regression analysis was used to assess the relationship between factors and poor functional outcomes. The area under the ROC curve (AUC) was estimated to evaluate the ability of markers and models in predicting clinical prognosis. The prognostic model was presented as nomogram. In addition, the decision curve analysis (DCA) was used to analyze the benefit of this model. Furthermore, survival curves were described by the Kaplan-Meier analysis. RESULTS A total of 270 patients were included of which 31 had poor outcome. Multivariable logistic regression analysis demonstrated HALP (OR=0.978, 95%CI: 0.958-0.999, P=0.039) was a protective predictor of outcome. The AUC of HALP was 0.749 (95% CI: 0.633-0.865, P=0.044). DCA demonstrated that this model significantly improved risk prediction at threshold probabilities of CVST at 0 to 85% compared to ISCVT-RS scores. Patients with higher HALP (P=0.006) presented higher overall survival rates. CONCLUSION HALP may be a potential protective marker in acute and subacute CVST patients. The new prognostic model with HALP had potentially better value for acute and subacute CVST patients.
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Affiliation(s)
- Shen Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Henan Province, China
| | - Yuan Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
| | - Kai Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
| | - Jiawei Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Henan Province, China
| | - Hui Fang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
| | - Yongli Tao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
| | - Lulu Pei
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
| | - Mengke Tian
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
| | - Hongbing Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Henan Province, China
| | - Xin Wang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Henan Province, China
| | - Zongping Xia
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
- Clinical Systems Biology Laboratories, the First Affiliated Hospital of Zhengzhou University, Henan Province, China
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
| | - Bo Song
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- NHC Key Laboratory of Prevention and treatment of Cerebrovascular Diseases, Zhengzhou, Henan Province, China
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Zhong X, Sun Y, Lu Y, Xu L. Immunomodulatory role of estrogen in ischemic stroke: neuroinflammation and effect of sex. Front Immunol 2023; 14:1164258. [PMID: 37180115 PMCID: PMC10167039 DOI: 10.3389/fimmu.2023.1164258] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
Although estrogen is predominantly related to the maintenance of reproductive functioning in females, it mediates various physiological effects in nearly all tissues, especially the central nervous system. Clinical trials have revealed that estrogen, especially 17β-estradiol, can attenuate cerebral damage caused by an ischemic stroke. One mechanism underlying this effect of 17β-estradiol is by modulating the responses of immune cells, indicating its utility as a novel therapeutic strategy for ischemic stroke. The present review summarizes the effect of sex on ischemic stroke progression, the role of estrogen as an immunomodulator in immune reactions, and the potential clinical value of estrogen replacement therapy. The data presented here will help better understand the immunomodulatory function of estrogen and may provide a basis for its novel therapeutic use in ischemic stroke.
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Affiliation(s)
- Xiaojun Zhong
- Department of Neurosurgery, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Yulin Sun
- Department of Neurosurgery, Zhejiang Rongjun Hospital, Jiaxing, China
| | - Yajun Lu
- Department of Internal Medicine, Sunto Women & Children’s Hospital, Jiaxing, China
| | - Lei Xu
- Department of Neurology, Zhejiang Rongjun Hospital, Jiaxing, China
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Complete blood platelet and lymphocyte ratios increase diagnostic accuracy of periprosthetic joint infection following total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:1441-1449. [PMID: 35098356 DOI: 10.1007/s00402-021-04309-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/04/2021] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Systemically, changes in serum platelet to lymphocyte ratio (PLR), platelet count to mean platelet volume ratio (PVR), neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte (MLR) represent primary responses to early inflammation and infection. This study aimed to determine whether PLR, PVR, NLR, and MLR can be useful in diagnosing periprosthetic joint infection (PJI) in total hip arthroplasty (THA) patients. METHODS A total of 464 patients that underwent revision THA with calculable PLR, PVR, NLR, and MLR in 2 groups was evaluated: 1) 191 patients with a pre-operative diagnosis of PJI, and 2) 273 matched patients treated for revision THA for aseptic complications. RESULTS The sensitivity and specificity of PLR combined with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial white blood cell count (WBC) and synovial polymorphonuclear leukocytes (PMN) (97.9%; 98.5%) is significantly higher than only ESR combined with CRP, synovial WBC and synovial PMN (94.2%; 94.5%; p < 0.01). The sensitivity and specificity of PVR combined with ESR, CRP and synovial WBC, and synovial PMN (98.4%; 98.2%) is higher than only ESR combined with CRP, synovial WBC and synovial PMN (94.2%; 94.5%; p < 0.01). CONCLUSION The study results demonstrate that both PLR and PVR calculated from complete blood counts when combined with serum and synovial fluid markers have increased diagnostic sensitivity and specificity in diagnosing periprosthetic joint infection in THA patients. LEVEL OF EVIDENCE III, case-control retrospective analysis.
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Wang CJ, Pang CY, Huan-Yu, Cheng YF, Wang H, Deng BB, Huang HJ. Monocyte-to-lymphocyte ratio affects prognosis in LAA-type stroke patients. Heliyon 2022; 8:e10948. [PMID: 36247122 PMCID: PMC9561738 DOI: 10.1016/j.heliyon.2022.e10948] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/04/2022] [Accepted: 09/29/2022] [Indexed: 11/02/2022] Open
Abstract
Nowadays, the prognostic prediction of acute ischemic stroke (AIS) patients is still challenging because of the limited predictive properties of existing models. Blood-based biomarkers may provide additional information to the established prognostic factors. Markers of atherosclerosis have been identified as one of the most promising biomarkers for predicting prognosis, and inflammation, in turn, affects atherosclerosis. According to previous studies, the ratio of monocytes to lymphocytes (MLR) has been reported as a novel indicator of inflammation. Thus, our study was the first to conduct more in-depth research on the relationship between MLR and the prognosis of large artery atherosclerosis (LAA)-type AIS patients. A total of 296 patients with LAA-type stroke were recruited. Of these, 202 patients were assigned to the development cohort, and 94 patients were assigned to the validation cohort. In the development cohort, 202 patients were divided into groups A, B, C, and D according to the quartile method of MLR levels. The one-year prognosis of patients was tracked, and the modified Rankin scale (MRS, with a score ranging from 0 to 6) was mainly selected as the measurement result of the function. The relationship between MLR and prognosis was analyzed by building logistics regression models. The models showed that MLR made significant predictions in poor outcomes of LAA-type stroke patients (odds ratio: 4.037; p = 0.048). At the same time, receiver operating characteristics (ROC) curves were used to compare the predictive values between MLR and clinical prediction score (Barthel Index). This study demonstrated that patients with LAA-type stroke and high MLR had a poor prognosis. MLR might be a reliable, inexpensive, and novel predictor of LAA-type stroke prognosis.
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Natural Compounds for SIRT1-Mediated Oxidative Stress and Neuroinflammation in Stroke: A Potential Therapeutic Target in the Future. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1949718. [PMID: 36105479 PMCID: PMC9467755 DOI: 10.1155/2022/1949718] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 12/06/2022]
Abstract
Stroke is a fatal cerebral vascular disease with a high mortality rate and substantial economic and social costs. ROS production and neuroinflammation have been implicated in both hemorrhagic and ischemic stroke and have the most critical effects on subsequent brain injury. SIRT1, a member of the sirtuin family, plays a crucial role in modulating a wide range of physiological processes, including apoptosis, DNA repair, inflammatory response, and oxidative stress. Targeting SIRT1 to reduce ROS and neuroinflammation might represent an emerging therapeutic target for stroke. Therefore, we conducted the present review to summarize the mechanisms of SIRT1-mediated oxidative stress and neuroinflammation in stroke. In addition, we provide a comprehensive introduction to the effect of compounds and natural drugs on SIRT1 signaling related to oxidative stress and neuroinflammation in stroke. We believe that our work will be helpful to further understand the critical role of the SIRT1 signaling pathway and will provide novel therapeutic potential for stroke treatment.
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Hu S, Lee H, Zhao H, Ding Y, Duan J. Inflammation and Severe Cerebral Venous Thrombosis. Front Neurol 2022; 13:873802. [PMID: 35937062 PMCID: PMC9353263 DOI: 10.3389/fneur.2022.873802] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare type of venous thromboembolism (VTE). It is an important cause of stroke in young adults and children. Severe CVT, which is characterized by cerebral venous infarction or hemorrhage, seizures, or disturbance of consciousness, has more severe clinical manifestations and a worse prognosis. It is commonly believed that the onset of severe CVT gave credit to venous return disorder, with the underlying pathogenesis remaining unclear. There is increasing evidence suggesting that an inflammatory response is closely associated with the pathophysiology of severe CVT. Preclinical studies have identified the components of neuroinflammation, including microglia, astrocytes, and neutrophils. After CVT occurrence, microglia are activated and secrete cytokines (e.g., interleukin-1β and tumor necrosis factor-α), which result in a series of brain injuries, including blood-brain barrier disruption, brain edema, and cerebral venous infarction. Additionally, astrocytes are activated at the initial CVT stage and may interact with microglia to exacerbate the inflammatory response. The extent of cerebral edema and neutrophil recruitment increases temporally in the acute phase. Further, there are also changes in the morphology of inflammatory cells, expression of inflammatory mediators, and inflammatory pathway molecules with CVT progression. Lately, some clinical research suggested that some inflammation-related biomarkers are of great value in assessing the course, severity, and prognosis of severe CVT. Moreover, basic and clinical research suggested that anti-inflammatory therapy might hold promise in severe CVT. This study reviews the current literature regarding the involvement of inflammation in the pathophysiology and anti-inflammatory interventions of severe CVT, which would contribute to informing the pathophysiology mechanism and laying a foundation for exploring novel severe CVT therapeutic strategies.
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Affiliation(s)
- Shuyuan Hu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hangil Lee
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Haiping Zhao
- Cerebrovascular Diseases Research Institute and Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Jiangang Duan
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology and Intracranial Hypertension and Cerebral Venous Disease Center, National Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jiangang Duan
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Taha SI, Samaan SF, Ibrahim RA, Moustafa NM, El-Sehsah EM, Youssef MK. Can Complete Blood Count Picture Tell Us More About the Activity of Rheumatological Diseases? CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441221089182. [PMID: 35481333 PMCID: PMC9036329 DOI: 10.1177/11795441221089182] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/03/2022] [Indexed: 12/13/2022]
Abstract
Background: In clinical practice, distinguishing disease activity in patients with rheumatological illnesses is challenging. Objectives: We aimed to investigate clinical associations of hemogram-derived indices, namely: red cell distribution width (RDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) with disease activity in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS). Methods: In 250 patients with rheumatological disease and 100 healthy age-matched controls, we investigated disease activity scores and indicators and evaluated their association with hemogram-derived indices values. Results: Compared with the control group, RDW, MPV, and PLR significantly increased (P < .001) in the three studied disorders (RA, SLE, and AS), but LMR dramatically decreased. SII was considerably higher in RA and AS patients compared with controls but not in SLE patients. On the other hand, NLR rose dramatically in SLE patients compared with controls (P = .043), but did not change much in RA and AS patients (P > .05). RDW and MPV showed significant changes (P < .001) in the three studied diseases (RA, SLE, and AS) according to disease activity. They significantly increased across worsening activity scores. Only in the SLE group, PLR was significantly increased with disease activity (P < .001), while LMR showed a significant decrease (P = .016). Conclusions: Clinicians must pay close attention to complete blood count (CBC) analysis and its various derived ratios to better characterize the activity of rheumatological disorders and anticipate the disease course and prognosis.
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Affiliation(s)
- Sara I Taha
- Department of Clinical Pathology/Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sara F Samaan
- Department of Internal Medicine/ Rheumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rehab Ali Ibrahim
- Department of Physical Medicine/Rheumatology and Rehabilitation, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Nouran M Moustafa
- Basic Medical Science Department, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia.,Medical Microbiology and Immunology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman M El-Sehsah
- Department of Medical Microbiology and Immunology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Mariam K Youssef
- Department of Clinical Pathology/Hematology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Ding J, Song B, Xie X, Li X, Chen Z, Wang Z, Pan L, Lan D, Meng R. Inflammation in Cerebral Venous Thrombosis. Front Immunol 2022; 13:833490. [PMID: 35444662 PMCID: PMC9013750 DOI: 10.3389/fimmu.2022.833490] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/28/2022] [Indexed: 01/04/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease that impairs people’s wellbeing and quality of life. Inflammation is considered to play an important role in CVT initiation and progression. Several studies have reported the important role of leukocytes, proinflammatory cytokines, and adherence molecules in the CVT-related inflammatory process. Moreover, inflammatory factors exacerbate CVT-induced brain tissue injury leading to poor prognosis. Based on clinical observations, emerging evidence shows that peripheral blood inflammatory biomarkers—especially neutrophil-to-lymphocyte ratio (NLR) and lymphocyte count—are correlated with CVT [mean difference (MD) (95%CI), 0.74 (0.11, 1.38), p = 0.02 and −0.29 (−0.51, −0.06), p = 0.01, respectively]. Moreover, increased NLR and systemic immune-inflammation index (SII) portend poor patient outcomes. Evidence accumulated since the outbreak of coronavirus disease-19 (COVID-19) indicates that COVID-19 infection and COVID-19 vaccine can induce CVT through inflammatory reactions. Given the poor understanding of the association between inflammation and CVT, many conundrums remain unsolved. Further investigations are needed to elucidate the exact relationship between inflammation and CVT in the future.
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Affiliation(s)
- Jiayue Ding
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Baoying Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiran Xie
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xaingyu Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhiying Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhongao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Liqun Pan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Duo Lan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- *Correspondence: Ran Meng,
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Huang WC, Lin HC, Yang YH, Hsu CW, Chen NC, Tsai WC, Cheng BC, Tsai NW. Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio are associated with a 2-year relapse in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 58:103514. [PMID: 35032880 DOI: 10.1016/j.msard.2022.103514] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association between increased neutrophil-to-lymphocyte ratio (NLR) and multiple sclerosis has been demonstrated in several studies. The monocyte-to-lymphocyte ratio (MLR) is an emerging biomarker for disease monitoring. Moreover, there has not been a published Taiwanese study to date. AIM To investigate the correlation of NLR, MLR and white blood cell (WBC) count as possible biomarkers for predicting a 2-year relapse in patients with multiple sclerosis (MS). MATERIALS AND METHODS A total of 641 Taiwanese patients with MS were enrolled in the present study between January 1, 2001, and December 31, 2018. We collected data on NLR, MLR, WBC count, disease-modifying therapy (DMT) use, and the time between first diagnosis and first relapse in all patients within a 2-year duration. RESULTS In the relapse group, there were significantly more patients with NLR >median or MLR >median (p = 0.006 and p = 0.020, respectively). There were also more patients with WBC count >median, although the difference was not statically significant (p = 0.069). The adjusted hazard ratio for relapse and NLR >median was 1.61(p = 0.008). The adjusted hazard ratio for relapse and MLR >median was 1.43 (p = 0.044). Patients with NLR >median or MLR >median had a significantly (p = 0.008 and p = 0.039, respectively) increased risk of MS relapse in the 2 years, compared with those who had NLR <median or MLR <median. CONCLUSION NLR and MLR are widely available, fast and measurable inflammatory markers for predicting the relapse risk of MS patients.
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Affiliation(s)
- Wei-Chin Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Chen Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Che-Wei Hsu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Ching Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wan-Chen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Nephrology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Chim ST, Sanfilippo P, O'Brien TJ, Drummond KJ, Monif M. Pretreatment neutrophil-to-lymphocyte/monocyte-to-lymphocyte ratio as prognostic biomarkers in glioma patients. J Neuroimmunol 2021; 361:577754. [PMID: 34700046 DOI: 10.1016/j.jneuroim.2021.577754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/25/2021] [Accepted: 10/16/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate the ability for pre-treatment NLR and MLR to predict overall survival (OS) and modified Rankin Scale (mRS) and to explore their relationship with clinicopathological parameters. METHODS Retrospective analysis of pretreatment NLR and MLR from 64 glioma patients. RESULTS Higher pretreatment NLR (>4.7) predicted higher mean admission mRS (p < 0.001) and 6-month mRS (p = 0.02). Higher pretreatment MLR (>0.35) was a risk factor for poorer OS in glioma patients (p = 0.024). Higher pretreatment NLR was significantly associated with larger tumor diameter (p = 0.02). CONCLUSION NLR and MLR can serve as prognostic markers to predict functional outcomes and OS in glioma patients.
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Affiliation(s)
- Sher Ting Chim
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC 3800, Australia; Melbourne Brain Centre, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3052, Australia; Department of Neurology, Royal Melbourne Hospital, Grattan St, Parkville, VIC 3050, Australia.
| | - Paul Sanfilippo
- Department of Neuroscience, Monash University, Melbourne, VIC 3000, Australia.
| | - Terence J O'Brien
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC 3800, Australia; Melbourne Brain Centre, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3052, Australia; Department of Neurology, Alfred Health, Prahran, Melbourne, VIC 3000, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3000, Australia.
| | - Kate J Drummond
- Department of Neurosurgery, The University of Melbourne, Parkville, VIC 3050, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
| | - Mastura Monif
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, VIC 3800, Australia; Melbourne Brain Centre, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3052, Australia; Department of Neurology, Royal Melbourne Hospital, Grattan St, Parkville, VIC 3050, Australia; Department of Neurology, Alfred Health, Prahran, Melbourne, VIC 3000, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3000, Australia.
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Balan D, Vartolomei MD, Magdás A, Balan-Bernstein N, Voidăzan ST, Mártha O. Inflammatory Markers and Thromboembolic Risk in Patients with Non-Muscle-Invasive Bladder Cancer. J Clin Med 2021; 10:jcm10225270. [PMID: 34830552 PMCID: PMC8617657 DOI: 10.3390/jcm10225270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Patients with bladder cancer have a high risk of venous thrombosis that represents a key challenge for physicians in the decision-making for initiating anticoagulation therapy. Non-muscle-invasive bladder cancer (NMIBC) represents more than 70% of all diagnosed bladder malignancies; therefore, we aimed to evaluate the relationship of the neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and risk of thrombosis by using the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score as well as the risk of bleeding by using the IMPROVE Bleeding Risk Assessment Score in a study cohort. Material and Methods: This was a retrospective observational study involving 130 patients who met the inclusion criteria: age > 18 years, stage pTa-pT1 NMIBC. The exclusion criteria were age < 18 years; stage pT2 or higher; or a presentation of metastasis, inflammatory, liver or autoimmune diseases, or other systemic neoplasms. In order to evaluate the risk of thromboembolic events as well as those of bleeding, the IMPROVE scores were calculated for each patient. Subjects were categorized in a Low IMPROVE group (< 4 points) or a High IMPROVE group. By using uni- and multivariate regression models, we analyzed CBC-derived parameters which could be associated with a higher risk of venous thrombosis in subjects with low or high IMPROVE scores. Results: Patients with IMPROVE score greater than 4 were associated with higher NLR, LMR and lymphocyte values (p < 0.05). In a multivariate regression model, the IMPROVE score was significantly influenced by lymphocyte count (p = 0.007) as well as the NLR value (p < 0.0001). Conclusions: In our study population, subjects with NMIBC with low lymphocytes and NLR > 3 were at a higher risk of developing venous thromboembolic events, reflected by an IMPROVE score of greater than 4. The IMPROVE and IMPROVE Bleeding Risk Assessment Scores are easy to use, and, complemented with the CBC-derived lymphocyte to monocyte ratio as a prothrombotic marker, could aid in the decision of prophylactic anticoagulation therapy during admission.
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Affiliation(s)
- Daniel Balan
- Department of Urology, University of Medicine, Pharmacy, Science and Technology “G.E.Palade” of Targu-Mures, 540142 Targu-Mures, Romania; (D.B.); (O.M.)
| | | | - Annamária Magdás
- Department of Internal Medicine, University of Medicine, Pharmacy, Science and Technology “G.E.Palade” of Targu-Mures, 540142 Targu-Mures, Romania
- Correspondence:
| | | | - Septimiu Toader Voidăzan
- Department of Epidemiology, “G. E. Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu-Mures, Romania;
| | - Orsolya Mártha
- Department of Urology, University of Medicine, Pharmacy, Science and Technology “G.E.Palade” of Targu-Mures, 540142 Targu-Mures, Romania; (D.B.); (O.M.)
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15
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Zhao J, Liu K, Li S, Gao Y, Zhao L, Liu H, Fang H, Wu J, Sun S, Li Y, Song B, Xu Y. Prognostic nutritional index predicts clinical outcomes in patients with cerebral venous sinus thrombosis. BMC Neurol 2021; 21:404. [PMID: 34674659 PMCID: PMC8529735 DOI: 10.1186/s12883-021-02436-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Lower prognostic nutritional index (PNI) is related to the poor prognosis of cardiovascular diseases. However, little is known about PNI and its relationship with the prognosis of cerebral venous sinus thrombosis (CVST). Methods CVST patients were retrospectively identified from January 2013 till June 2019. Patients in the acute / subacute phase were selected as subjects. Poor prognosis was defined as a modified Rankin Scale (mRS) of 3–6. Multivariate logistic regression analysis was used to confirm if lower PNI was associated with a poor prognosis. Results A total of 297 subjects with follow-up data were enrolled. Thirty-three (11.1%) had a poor outcome. Multivariate logistic regression analysis suggested that PNI was an important predictive factor of poor outcome in acute/subacute CVST (odds ratio, 0.903; 95% CI, 0.833–0.978; P = 0.012). The optimal cut-off value for predicting the poor prognosis of PNI was 44.2. Kaplan-Meier analysis and log-rank test suggested that the lower the PNI value, the higher the mortality rate (P < 0.001). In addition, the nomogram that was set up showed that lower PNI was an index of poor prognosis. The c-index for acute/subacute patients with CVST was 0.872. Conclusion Lower PNI is correlated with a higher risk of adverse clinical outcomes in patients with acute/subacute CVST. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02436-w.
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Affiliation(s)
- Jiawei Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Kai Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Shen Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yuan Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Lu Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Hongbing Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Hui Fang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Jun Wu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Shilei Sun
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yusheng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Bo Song
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
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Acute Inflammation in Cerebrovascular Disease: A Critical Reappraisal with Focus on Human Studies. Life (Basel) 2021; 11:life11101103. [PMID: 34685473 PMCID: PMC8540384 DOI: 10.3390/life11101103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Recent attention has been focused on the field of inflammatory biomarkers associated with vascular disorders, regarding diagnosis, prognosis, and possible therapeutical targets. In this study, we aimed to perform a comprehensive review of the literature regarding the use of inflammatory biomarkers in stroke patients. We searched studies that evaluated inflammation biomarkers associated with Cerebrovascular Disease (CVD), namely, ischemic Stroke (IS), Intracerebral Hemorrhage (ICH) and Cerebral Venous Thrombosis (CVT). As of today, neutrophil–lymphocyte ratio (NLR) seems the be the most widely studied and accepted biomarker for cerebrovascular disease due to its easy access and availability. Although demonstrated as a prognostic risk factor, in IS, ICH and CVT, its diagnostic role is still under investigation. Several other prognostic factors could be used or even combined together into a diagnostic or prognostic index. Multiple inflammatory biomarkers appear to be involved in IS, ICH, and CVT. Blood inflammatory cells, easily measured and accessible at admission may provide information regarding accurate diagnosis and prognosis. Although not yet a reality, increasing evidence exists to suggest that these may become potential therapeutic targets, likely influencing or mitigating complications of CVD and improving prognosis. Nevertheless, further larger, well-designed randomized clinical trials are still needed to follow up this hypothesis.
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17
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Zhang Z, Hu Q, Hu T. Association of Lymphocyte to Monocyte Ratio and Risk of in-Hospital Mortality in Patients with Cardiogenic Shock: A Propensity Score Matching Study. Int J Gen Med 2021; 14:4459-4468. [PMID: 34408483 PMCID: PMC8367081 DOI: 10.2147/ijgm.s325907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Lymphocyte to monocyte ratio (LMR) has been long implicated in the prediction of many inflammatory-related diseases. However, the possible value as prognostic marker of LMR have not been evaluated in cardiogenic shock (CS) patients. The aim of the study was to assess the relationship between LMR on admission and in-hospital mortality in CS patients. Methods Data on patients diagnosed with CS were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. We performed a single-institution, retrospective study of 1487 CS patients and determined the optimal cut-off for LMR by X-tile software. Propensity score matching (PSM) and inverse probabilities of treatment weighting (IPTW) were conducted to control confounders. Cox proportional hazards model was performed to evaluate the relationship between LMR and in-hospital mortality. Kaplan-Meier curves and receiver operating characteristics (ROC) analysis were applied to assess the prognostic value of LMR. Results The optimal cut-off value for LMR was 0.9. Cox proportional hazards model demonstrated that lower LMR (< 0.9) was independently associated with in-hospital mortality with hazard ratio (HR) of 1.40 (1.12-1.74, P = 0.003). The results were consistent with survival analyses (P < 0.001, Log rank test). Adding LMR< 0.9 to the sequential organ failure assessment (SOFA) score improved discrimination and risk stratification for in-hospital mortality. Conclusion Lower level of LMR is related to higher risk of in-hospital mortality of patients with CS. As an easily available biomarker, LMR can independently predict the in-hospital mortality in CS patients.
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Affiliation(s)
- Zhengwei Zhang
- Department of Critical Care Medicine, Chengdu Second People's Hospital, Chengdu, People's Republic of China
| | - Qionghua Hu
- Department of Critical Care Medicine, Chengdu Second People's Hospital, Chengdu, People's Republic of China
| | - Tianyang Hu
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
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Dias L, Pinto MJ, Castro P, Carvalho M. Inflammatory Biomarkers Correlate with Time Evolution in Cerebral Venous Thrombosis. J Stroke Cerebrovasc Dis 2021; 30:105844. [PMID: 33984744 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105844] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/01/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES We aimed to analyse the relationship between specific inflammatory biomarkers' levels and the temporal pattern of cerebral venous thrombosis (CVT) symptoms. MATERIALS AND METHODS We performed a retrospective study of adult CVT patients admitted between Jan 01 2006 and Dec 31 2019. We excluded patients with infection at admission, autoimmune, inflammatory or haematological disorders. We evaluated serum inflammatory biomarkers at admission: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), absolute neutrophil count, absolute lymphocyte count, platelet count, monocyte count, neutrophile-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), bilirubin and monocyte-to-HDL ratio (M-HDLR). These were evaluated according to the time from symptom onset (acute, subacute or chronic). RESULTS We included 78 patients with CVT (mean age 41 ± 13 years). Neutrophil count (p = 0.017), monocyte (p = 0.024), CRP (p = 0.004), NLR (p<0.001) and LMR (p = 0.004) showed significant variation with CVT duration. Acute onset CVT exhibited higher absolute neutrophil count and NLR but lower LMR. The subacute group had higher monocyte values, and the chronic phase patients displayed higher LMR, but lower CRP. ESR, PLR and M-HDLR showed a tendency to decrease in the chronic phase. We did not observe any statistical difference between the duration of symptoms and levels of bilirubin. CONCLUSIONS CVT patients present a differential inflammatory pattern along the time course of the disease: higher NLR and lower LMR in acute phase, and higher LMR and lower CRP level during the chronic phase. These differences may help to ascertain the onset of poorly defined symptoms and provide input regarding anticoagulation management.
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Affiliation(s)
- Leonor Dias
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto.
| | - Maria João Pinto
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto
| | - Pedro Castro
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto
| | - Marta Carvalho
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto
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Oylumlu M, Oylumlu M, Arik B, Demir M, Ozbek M, Arslan B, Acun B, Polat N, Akil MA, Bilik MZ. Monocyte to high-density lipoprotein cholesterol and lymphocyte to monocyte ratios are predictors of in-hospital and long-term mortality in patients with acute coronary syndrome. Int J Clin Pract 2021; 75:e13973. [PMID: 33368882 DOI: 10.1111/ijcp.13973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/21/2020] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE We aimed to determine the relationship between LMR and MHR and in-hospital and long-term mortality in patients with ACS. METHODS We retrospectively collected patients with ACS undergoing coronary angiography between January 2012 and December 2013. RESULTS In total, 825 patients with a mean age of 62.4 ± 12.9 years (71.3% male) were enrolled in the study. Patients were divided into three tertiles based on MHR levels and LMR levels. In-hospital mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [30 (10.9%) vs 8 (2.9%) and 14 (5.1%); P < .001, P = .009, respectively]. Five-year mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [84 (30.5%) vs 48 (17.5%) and 57 (20.7%); P < .001, P = .005, respectively]. In-hospital mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [25 (9.1%) vs 10 (3.6%) and 17 (6.2%); P = .007, P = .130, respectively]. Five -year mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [77 (28.0%) vs 47 (17.1%) and 65 (23.6%); P = .001, P = .142, respectively]. CONCLUSION We have shown that high MHR and low LMR were significant and independent predictors of in-hospital and long-term mortality in patients with ACS.
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Affiliation(s)
- Muhammed Oylumlu
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mustafa Oylumlu
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Baran Arik
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Muhammed Demir
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mehmet Ozbek
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Bayram Arslan
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Baris Acun
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Nihat Polat
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mehmet Ata Akil
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Mehmet Zihni Bilik
- Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
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Li S, Liu K, Gao Y, Zhao L, Zhang R, Fang H, Tao Y, Liu H, Zhao J, Xia Z, Xu Y, Song B. Prognostic value of systemic immune-inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol 2020; 5:368-373. [PMID: 32586971 PMCID: PMC7804059 DOI: 10.1136/svn-2020-000362] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/28/2020] [Accepted: 05/03/2020] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the prognosis values of systemic immune–inflammation index (SII) in non-chronic cerebral venous sinus thrombosis (CVST). Methods patients with CVST, admitted to the First Affiliated Hospital of Zhengzhou University, were retrospectively identified from January 2013 to December 2018. We selected patients in acute/subacute phase from database. Functional outcomes of patients were evaluated with the modified Rankin Scale (mRS)—mRS 3–6 as poor outcomes and mRS 6 as death. The overall survival time was defined as the date of onset to the date of death or last follow-up date. Survival analysis was described by the Kaplan-Meier curve and Cox regression analysis. Multivariate logistic regression analysis assessed the relationship between SII and poor functional outcome. The area under the Receiver Operating Curve curve (AUC) was estimated to evaluate the ability of SII in prediction. Results A total of 270 patients were included and their duration of follow-up was 22 months (6–66 months), of whom 31 patients had poor outcomes and 24 patients dead. Cox regression analysis showed that SII (HR=1.304, 95% CI: 1.101 to 1.703, p=0.001) was a predictor of death in non-chronic CVST. Patients with higher SII presented lower survival rates (p=0.003). The AUC of SII was 0.792 (95% CI: 0.695 to 0.888, p=0.040) with a sensitivity of 69.6% and specificity of 80.1%. Subgroups analysis demonstrated that SII was an important predictor of poor outcomes in male (OR=1.303, 95% CI: 1.102 to 1.501, p=0.011) and pregnancy/puerperium female (OR=1.407, 95% CI: 1.204 to 1.703, p=0.034). Conclusions SII was a potential predictor in the poor prognosis of patients with acute/subacute CVST, especially in male and pregnancy/puerperium female.
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Affiliation(s)
- Shen Li
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Kai Liu
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yuan Gao
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Lu Zhao
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Rui Zhang
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Hui Fang
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yongli Tao
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Hongbing Liu
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Jiawei Zhao
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Zongping Xia
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yuming Xu
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Bo Song
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
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