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Xu MS, Xu JL, Gao X, Mo SJ, Xing JY, Liu JH, Tian YZ, Fu XF. Clinical study of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hypertriglyceridemia-induced acute pancreatitis and acute biliary pancreatitis with persistent organ failure. World J Gastrointest Surg 2024; 16:1647-1659. [PMID: 38983313 PMCID: PMC11230014 DOI: 10.4240/wjgs.v16.i6.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/10/2024] [Accepted: 05/14/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammatory indicators that can be used to predict the severity and prognosis of various diseases. We categorize acute pancreatitis by etiology into acute biliary pancreatitis (ABP) and hypertriglyceridemia-induced acute pancreatitis (HTGP). AIM To investigate the clinical significance of NLR and PLR in assessing persistent organ failure (POF) in HTGP and ABP. METHODS A total of 1450 patients diagnosed with acute pancreatitis (AP) for the first time at Shanxi Bethune Hospital between January 2012 and January 2023 were enrolled. The patients were categorized into two groups according to the etiology of AP: ABP in 530 patients and HTGP in 241 patients. We collected and compared the clinical data of the patients, including NLR, PLR, and AP prognostic scoring systems, within 48 h of hospital admission. RESULTS The NLR (9.1 vs 6.9, P < 0.001) and PLR (203.1 vs 160.5, P < 0.001) were significantly higher in the ABP group than in the HTGP group. In the HTGP group, both NLR and PLR were significantly increased in patients with severe AP and those with a SOFA score ≥ 3. Likewise, in the ABP group, NLR and PLR were significantly elevated in patients with severe AP, modified computed tomography severity index score ≥ 4, Japanese Severity Score ≥ 3, and modified Marshall score ≥ 2. Moreover, NLR and PLR showed predictive value for the development of POF in both the ABP and HTGP groups. CONCLUSION NLR and PLR vary between ABP and HTGP, are strongly associated with AP prognostic scoring systems, and have predictive potential for the occurrence of POF in both ABP and HTGP.
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Affiliation(s)
- Mu-Sen Xu
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Jia-Le Xu
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Xin Gao
- Department of Environmental Health, School of Public Health, Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
| | - Shao-Jian Mo
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Jia-Yu Xing
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Jia-Hang Liu
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Yan-Zhang Tian
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
| | - Xi-Feng Fu
- The Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
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Kudou K, Kajiwara S, Motomura T, Yukaya T, Nakanoko T, Kuroda Y, Okamoto M, Koga T, Yamashita YI. Risk Factors of Postoperative Complication and Hospital Mortality after Colorectal Perforation Surgery. J Anus Rectum Colon 2024; 8:118-125. [PMID: 38689779 PMCID: PMC11056533 DOI: 10.23922/jarc.2023-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/10/2024] [Indexed: 05/02/2024] Open
Abstract
Objectives Colorectal perforation is associated with high morbidity and mortality rates after surgery. We investigated various clinical features of patients who underwent emergency surgery for colorectal perforation and explored the risk factors for postoperative complications and hospital mortality. Methods Data from 147 patients who underwent surgery for colorectal perforation were retrospectively reviewed. We investigated various clinical and operative factors, including inflammation-based prognostic scores (IBPSs), and evaluated the risk factors for postoperative complications and hospital mortality due to colorectal perforation. Results Among 147 patients, the most frequent postoperative complication was wound infection (32 cases, 21.8%), followed by intra-abdominal abscesses (27 cases, 18.4%) after surgery for colorectal perforation. Time from onset to surgery ≥ 2 days (Hazard ratio [HR] = 2.810, p = 0.0383) and prognostic nutritional index (PNI) < 30 (HR = 3.190, p = 0.0488) were identified as risk factors for intra-abdominal abscess, while neutrophil-lymphocyte ratio (NLR) < 6.15 (HR = 5.020, p = 0.0009) was identified as a risk factor for wound infection. Time from onset to surgery ≥ 2 days (HR = 7.713, p = 0.0492), severe postoperative complications (Clavien-Dindo grade ≥ IIIa) (HR = 10.98, p = 0.0281), and platelet-lymphocyte ratio (PLR) < 144 (HR = 18.84, p = 0.0190) were independent predictive factors for hospital mortality. Conclusions Time from onset to surgery and IBPSs such as PNI, NLR, and PLR, may be associated with postoperative complications and hospital mortality due to colorectal perforation.
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Affiliation(s)
- Kensuke Kudou
- Department of Surgery, Iizuka Hospital, Iizuka, Japan
| | | | | | | | | | - Yosuke Kuroda
- Department of Surgery, Iizuka Hospital, Iizuka, Japan
| | | | - Tadashi Koga
- Department of Surgery, Iizuka Hospital, Iizuka, Japan
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Gökce SE, Çelik A, Başkan C. The role of blood neutrophil lymphocyte ratio in predicting the initial response to anti-VEGF treatment in neovascular AMD patients. Ir J Med Sci 2024; 193:517-521. [PMID: 37247185 DOI: 10.1007/s11845-023-03379-6] [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: 11/17/2022] [Accepted: 04/18/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Vascular endothelial growth factor (VEGF) has a critical role in age-related macular degeneration (AMD), and intravitreal injection of anti-VEGF drugs is the mainstay of neovascular AMD treatment. Blood neutrophil-to-lymphocyte ratio (NLR) is shown to be a biomarker of inflammation in AMD. We aimed to investigate the role of NLR in predicting favorable short-term anti-VEGF treatment results in neovascular AMD patients. METHODS A total of 112 patients diagnosed with exudative AMD and had taken 3 monthly intravitreal bevacizumab injections were analyzed retrospectively. Medical records were reached to obtain neutrophil and lymphocyte values to calculate NLR. Best-corrected visual acuity and central macular thickness (CMT) measurements were recorded at each visit. T test or Mann-Whitney U test was used to compare continuous variables, and chi-square test was used to compare categorical variables. Receiver operating characteristics curve (ROC) analysis was performed to determine cut-off, sensitivity, and specificity values. P value of ≤ 0.05 was considered statistically significant. RESULTS The mean age was 68.1 ± 7.2 years, and the mean NLR was 2.11 ± 0.81. The ROC analysis revealed a cut off value of 2.0 for NLR to predict at least 100 μm CMT change (sensitivity 87.1%; specificity 87.8%) and a cut off value of 2.4 for NLR to predict at least 0.1 logMAR visual improvement (sensitivity 77.2%; specificity 64.8%) after 3 monthly IVT bevacizumab injections. CONCLUSION NLR can provide additional prognostic information for the identification of patients with a good initial response to anti-VEGF therapy.
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Affiliation(s)
- Sabite Emine Gökce
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, 06550, Yenimahalle, Ankara, Turkey.
| | - Ayşenur Çelik
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, 06550, Yenimahalle, Ankara, Turkey
| | - Ceyda Başkan
- Department of Ophthalmology, Ankara City Hospital, Ankara, Turkey
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Liang C, Zheng R, Liu X, Ma Q, Chen J, Shen Y. Predictive value of hematological parameters in cirrhotic patients with open umbilical hernia repair. Hernia 2024; 28:119-126. [PMID: 37848581 DOI: 10.1007/s10029-023-02908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Patients with liver cirrhosis sometimes suffer from high recurrence rates and postoperative complications. We previously reported that platelet-related hematological parameters are associated with the outcomes after incisional herniorrhaphy, and aim to evaluate the predictive value of these criteria in cirrhotic patients undergoing open umbilical herniorrhaphy. METHODS This is a retrospective study. The data of 95 cirrhotic patients undergoing open umbilical herniorrhaphy were analyzed. Patients were grouped based on the recurrence and defined hematological values. Platelet-multiple-lymphocyte index (PLM), neutrophil-leukocyte ratio, lymphocyte-monocyte ratio, platelet-neutrophil ratio, systemic immune-inflammation index, and aspartate aminotransferase-leukocyte ratio values were calculated based on preoperative blood analyses. The outcomes were obtained from hospital records and follow-up calls to patients. RESULTS Using cutoff values acquired by the Youden Index, we found a PLM value < 27.9, and the history of inguinal herniorrhaphy were revealed to be statistically significant in the recurrence based on univariant and multivariant analyses (p < 0.05). We further divided patients into two groups based on the cutoff value of PLM and found that a PLM value < 27.9 was significantly associated with the recurrence of incisional hernias (p = 0.018) and the occurrence of postoperative foreign sensation (p = 0.044), and tended to result in other postoperative complications such as cardiopathy, respiratory infection, hypoproteinemia, and hepatic diseases (p = 0.089). CONCLUSION The preoperative hematological values, especially PLM, may indicate the outcomes in cirrhotic patients after open umbilical herniorrhaphy. Accurate identification of risks may alert the intraoperative and postoperative care for patients.
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Affiliation(s)
- C Liang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - R Zheng
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - X Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Q Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - J Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
- Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Y Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
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Malheiro F, Ângelo-Dias M, Lopes T, Azeredo-Lopes S, Martins C, Borrego LM. B Cells and Double-Negative B Cells (CD27 -IgD -) Are Related to Acute Pancreatitis Severity. Diseases 2024; 12:18. [PMID: 38248369 PMCID: PMC10814478 DOI: 10.3390/diseases12010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Acute pancreatitis (AP) is an increasingly frequent disease in which inflammation plays a crucial role. Fifty patients hospitalized with AP were included and peripheral blood samples were analyzed for B and T cell subpopulations at the time of hospitalization and 48 h after diagnosis. The Bedside Index of Severity in Acute Pancreatitis (BISAP) and length of hospital stay were also recorded. A healthy control (HC) group of 15 outpatients was included. AP patients showed higher neutrophil/lymphocyte (N/L) ratios and higher percentages of B cells than the HC group. The total B cell percentages were higher in patients with moderate/severe AP than in patients with mild AP. The percentages of B cells as well as the percentages of the CD27-IgD- B cell subset decreased from admission to 48 h after admission. The patients with higher BISAP scores showed lower percentages of peripheral lymphocytes but higher percentages of CD27-IgD- B cells. Higher BISAP scores, N/L ratios, and peripheral blood B cell levels emerged as predictors of hospital stay length in AP patients. Our findings underscore the importance of early markers for disease severity. Additionally, the N/L ratio along with the BISAP score and circulating B cell levels form a robust predictive model for hospital stay duration of AP patients.
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Affiliation(s)
- Filipa Malheiro
- Internal Medicine Department, LUZ SAÚDE, Hospital da Luz Lisboa, 1500-650 Lisboa, Portugal
- CHRC, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal; (M.Â.-D.); (T.L.); (S.A.-L.); (C.M.)
| | - Miguel Ângelo-Dias
- CHRC, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal; (M.Â.-D.); (T.L.); (S.A.-L.); (C.M.)
- Immunology Department, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal
| | - Teresa Lopes
- CHRC, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal; (M.Â.-D.); (T.L.); (S.A.-L.); (C.M.)
- Immunology Department, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal
| | - Sofia Azeredo-Lopes
- CHRC, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal; (M.Â.-D.); (T.L.); (S.A.-L.); (C.M.)
- Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal
| | - Catarina Martins
- CHRC, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal; (M.Â.-D.); (T.L.); (S.A.-L.); (C.M.)
- Immunology Department, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal
| | - Luis Miguel Borrego
- CHRC, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal; (M.Â.-D.); (T.L.); (S.A.-L.); (C.M.)
- Immunology Department, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1099-085 Lisboa, Portugal
- Immunoallergy Department, LUZ SAÚDE, Hospital da Luz Lisboa, 1500-650 Lisboa, Portugal
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Rezaei Shahrabi A, Arsenault G, Nabipoorashrafi SA, Lucke-Wold B, Yaghoobpoor S, Meidani FZ, Rahmati R, Ghaedi A, Khanzadeh S. Relationship between neutrophil to lymphocyte ratio and diabetic peripheral neuropathy: a systematic review and meta-analysis. Eur J Med Res 2023; 28:523. [PMID: 37974254 PMCID: PMC10652461 DOI: 10.1186/s40001-023-01479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The present study aims to review the existing scientific literature on the role of neutrophil to lymphocyte ratio (NLR) in diabetic peripheral neuropathy (DPN) to perform a meta-analysis on the available data. METHODS The electronic repositories Web of Science, PubMed, and Scopus were systematically explored starting from their establishment up until June 9, 2022. RESULTS Fifteen articles were included in the meta-analysis after multiple screening according to the PRISMA guidelines. The combined findings indicated that individuals with DPN had higher levels of NLR in comparison to those without DPN (SMD = 0.61; CI 95% = 0.40-0.81, p < 0.001). In the subgroup assessment based on ethnicity, it was observed that diabetic patients with DPN exhibited increased NLR levels in contrast to those without DPN in studies conducted in India (SMD = 1.30; CI 95% = 0.37-2.24, p = 0.006) and East Asia (SMD = 0.53; CI 95% = 0.34-0.73, p < 0.001) but not in studies conducted in Turkey (SMD = 0.30; CI 95% = - 0.06-0.67, p = 0.104) and Egypt (SMD = 0.34; CI 95% = -0.14-0.82, p = 0.165). The pooled sensitivity of NLR was 0.67 (95% CI = 0.49-0.81), and the pooled specificity was 0.70 (95% CI, 0.56-0.81). The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) of NLR were 2.30 (95% CI = 1.71-3.09), 0.45 (95%CI = 0.30-0.67), and 5.06 (95% CI = 3.16-8.12), respectively. CONCLUSION NLR serves as a distinct marker of inflammation, and its rise in cases of DPN suggests an immune system imbalance playing a role in the development of the disease.
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Affiliation(s)
| | | | - Seyed Ali Nabipoorashrafi
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, Tehran, Iran
| | | | - Shirin Yaghoobpoor
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zari Meidani
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rahem Rahmati
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Cazacu SM, Parscoveanu M, Cartu D, Moraru E, Rogoveanu I, Ungureanu BS, Iordache S, Florescu DN, Iovanescu VF, Dragomir MI. NLR48 is Better Than CRP, and mCTSI, and Similar to BISAP and SOFA Scores for Mortality Prediction in Acute Pancreatitis: A Comparison of 6 Scores. J Inflamm Res 2023; 16:4793-4804. [PMID: 37881651 PMCID: PMC10596122 DOI: 10.2147/jir.s432408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction The neutrophil-lymphocyte ratio (NLR) has been suggested as a reliable marker for predicting inflammation progression and severity of acute pancreatitis, although the role of the NLR stratified by etiology is still insufficiently studied. However, the NLR's role in mortality prediction was poorly evaluated in the literature. Patients and Methods We performed a retrospective, cross-sectional study to analyze the role of NLR0 (at admission) and NLR48 (at 48 hours) in acute pancreatitis as compared with CRP, BISAP, SOFA, and modified CTSI (mCTSI) for the prediction of mortality and severe acute pancreatitis (SAP) in patients admitted into the Emergency Clinical County Hospital of Craiova during 48 months. The primary assessed outcomes were the rate of in-hospital mortality, the rate of persistent organ failure, and ICU admissions. We analyzed mortality prediction for all acute pancreatitis, for biliary, alcoholic, and hypertriglyceridemic acute pancreatitis, for severe forms, and for patients admitted to the ICU. Results A total of 725 patients were selected; 42.4% had biliary acute pancreatitis, 27.7% had alcoholic acute pancreatitis, and 8.7% had hypertriglyceridemia-induced acute pancreatitis. A total of 13.6% had POF during admission. The AUC for NLR48 in predicting mortality risk and SAP was 0.81 and 0.785, superior to NLR0, CRP48, and mCTSI but inferior to BISAP and SOFA scores. The NLR48/NLR0 ratio did not add significantly to the accuracy. NLR0 and NLR48 performed poorly for mortality prediction in severe forms and in patients admitted to the ICU. NLR48 has good accuracy in our study for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis. Conclusion NLR48 was a good indicator in predicting mortality risk and severe forms in all patients with acute pancreatitis, but not of death in SAP and in patients admitted to ICU, with good accuracy for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis.
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Affiliation(s)
- Sergiu Marian Cazacu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Mircea Parscoveanu
- Surgery Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Dan Cartu
- Surgery Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Emil Moraru
- Surgery Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Ion Rogoveanu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Bogdan Silviu Ungureanu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Sevastita Iordache
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Dan Nicolae Florescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Vlad Florin Iovanescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Manuela Iuliana Dragomir
- Public Health Management Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
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Malheiro F, Nascimento ML, Carmo A, Borrego LM. Circulating Blood Lymphocytes and Acute Pancreatitis Severity: A Systematic Review. Cureus 2023; 15:e47532. [PMID: 38022062 PMCID: PMC10664819 DOI: 10.7759/cureus.47532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Acute pancreatitis is an acute inflammatory process of the pancreas with high prevalence and varying degrees of severity that can be potentially life-threatening. Much is still unknown about which mechanisms determine the course and severity of acute pancreatitis. The primary objective of this review is to identify the potential association between circulating lymphocytes and the severity of acute pancreatitis. A systematic search was performed in Medline, Web of Science, Cochrane Central Register of Controlled Trials and ClinicalTrails.gov. The authors independently did the selection process as well as data extraction that was recorded into a flow diagram following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Our initial search identified 27,783 studies which were narrowed down to 13 by applying strict inclusion and exclusion algorithms. The consistent findings across the studies indicated that peripheral blood lymphocytes are related to acute pancreatitis severity.
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Affiliation(s)
| | | | - Ana Carmo
- Internal Medicine, Hospital da Luz Lisboa, Lisboa, PRT
| | - Luis Miguel Borrego
- Immunology, Hospital da Luz Lisboa, Lisboa, PRT
- Immunology, Nova Medical School, Lisboa, PRT
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He Y, Liu X, Zhong S, Fu Q. Neutrophil-to-lymphocyte ratio in relation to trauma severity as prognosis factors in patients with multiple injuries complicated by multiple organ dysfunction syndrome: A retrospective analysis. Immun Inflamm Dis 2023; 11:e1031. [PMID: 37773708 PMCID: PMC10521378 DOI: 10.1002/iid3.1031] [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: 05/17/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE This study aimed to explore potential risk factors for the occurrence of multiple organ dysfunction syndrome (MODS) in patients with multiple injuries by evaluating neutrophil-to-lymphocyte ratio (NLR)-associated trauma severity. METHODS This retrospective case-control study included 95 patients with multiple injuries, who were admitted to our hospital (between January 2018 and December 2020). Clinical data including gender, age, underlying disease, number of injury sites (NIS), injury severity score (ISS), hemoglobin level within 24 h of admission (HL-24h), neutrophil count (NC), white blood cell count, platelet count (PC), NLR, d-dimer level, activated partial thromboplastin time (APTT), complicated shock within 24 h of admission (CS-24h), length of stay, as well as prognostic outcome was systematically analyzed. According to MODS occurrence, patients were divided into a MODS group (n = 27) and a non-MODS group (n = 68). The risk factors affecting patients with multiple injuries complicated by MODS were identified using univariate and multivariate logistic regression analyses. Candidate risk factors were further analyzed using receiver operating characteristic (ROC) curves. RESULTS Univariate analysis revealed a significant difference between the MODS and non-MODA groups in terms of NIS, ISS, HL-24h, PC, APTT, d-dimer level, CS-24h, NLR, NC, prognostic outcome, and other indicators (p < .05). Multivariate logistic regression analysis showed that d-dimer levels within 24 h of admission and ISS, NLR, and CS-24h were significantly associated with multiple injuries complicated by MODS. Compared with the non-MODS controls, the NLR in the MODS group showed a much higher level and tended to rise with the increase in ISS score, indicating a significant intergroup difference (p < .05). The ROC curve analysis results suggested that the NLR had good sensitivity and specificity for predicting the prognosis of patients with MODS with multiple injuries. CONCLUSION d-dimer level, ISS, NLR, and CS-24h are important risk factors for MODS in patients with multiple injuries. Notably, NLR expression may be a good indicator of injury severity and predictor of the occurrence of MODS in patients with multiple injuries. Therefore, assessment of injury severity and coagulation function, active resuscitation, as well as prevention of infection should be emphasized during treatment of multiple injuries, to reduce and prevent the risk of MODS in patients with multiple injuries.
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Affiliation(s)
- Yong‐Ming He
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
| | - Xing Liu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
| | - Si‐Yi Zhong
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
- Department of Public HealthGuangdong Medical UniversityDongguanChina
| | - Qiu‐Hong Fu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
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Johnson MM, Gicking JC, Keys DA. Evaluation of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and other hematologic parameters in canine acute pancreatitis. J Vet Emerg Crit Care (San Antonio) 2023; 33:587-597. [PMID: 37573255 DOI: 10.1111/vec.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To determine if RBC distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and other hematological parameters are associated with increased odds of in-hospital mortality, increased length of hospitalization (LOH), or disease severity as measured by the Canine Acute Pancreatitis Severity (CAPS) score in dogs with acute pancreatitis (AP). DESIGN Retrospective, multicenter study from January 2016 to August 2020. SETTING Four private emergency and specialty referral centers. ANIMALS On initial case search, 118 client-owned dogs were identified with a clinical diagnosis of AP. Out of these cases, 114 dogs met inclusion criteria, defined as sudden onset of ≥2 compatible clinic signs (lethargy, anorexia, vomiting, or abdominal pain), a specific canine pancreatic lipase concentration >400 μg/L, hospital admission, as well as CBC and serum biochemistry run within 48 hours of initial hospitalization. Disease severity was calculated and measured using the CAPS score, in addition to LOH and in-hospital mortality. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Clinical endpoints were in-hospital mortality, LOH, and disease severity, as evaluated by the CAPS score. Overall in-hospital mortality was 36.8%. NLR was significantly associated with survival, with a higher percentage being associated with an increased likelihood of nonsurvival (odds ratio: 1.1, 95% confidence interval: 1.0-1.2; P = 0.006, adjusted P = 0.04). Increased NLR was found to be significantly associated with a longer LOH based on the unadjusted P-value (P = 0.02) but was not statistically significant based on a P-value adjusted for multiple comparisons (P = 0.12). No significant associations were noted when RDW, platelet-to-lymphocyte ratio, WBC count, mean platelet volume, RDW-to-platelet ratio, or RDW-to-total serum calcium ratio was evaluated against outcome measures. CONCLUSIONS This study retrospectively evaluated the prognostic utility of several readily available hematological parameters in dogs hospitalized for AP. Dogs with an increased NLR may have a higher risk of in-hospital mortality and increased LOH, although future prospective studies are necessary to confirm these findings.
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Affiliation(s)
- Meghan M Johnson
- Emergency & Critical Care Service, BluePearl Specialty + Emergency Pet Hospital, Lafayette, Colorado, USA
| | - John C Gicking
- Emergency & Critical Care Service, BluePearl Specialty + Emergency Pet Hospital, Tampa, Florida, USA
| | - Deborah A Keys
- Kaleidoscope Statistics Veterinary Medical Research Consulting, Athens, Georgia, USA
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Doğan Z, Kekilli M. Can neutrophil to lymphocyte ratio be a non-invasive indicator of the presence of duodenal ulcer related Helicobacter pylori in dyspeptic patients? Pract Lab Med 2023; 36:e00319. [PMID: 37649546 PMCID: PMC10462661 DOI: 10.1016/j.plabm.2023.e00319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/19/2023] [Indexed: 09/01/2023] Open
Abstract
Background and aims Neutrophil to lymphocyte ratio (NLR), a novel inflammatory marker, has been shown to increase in various systemic inflammatory conditions. In this way, we want to evaluate the relationship between the presence of H. pylori, duodenal ulcer related H. pylori and NLR in dyspeptic patients. Material and methods The patients were divided into three groups after evaluating of the EGD and histopathology results. The groups were determined as follow; Group A: H. pylori positive and DU negative, Group B: H. pylori positive and DU positive, Group C: H. pylori negative and DU negative. Then, groups were compared with each other for demographic features, laboratory tests and NLR. Results There were significant differences between groups for NLR when groups compared with each other. Significantly high NLR was seen in group A (H. pylori positive, DU negative) and group B (H. pylori positive, DU positive) when compared with group C (H. pylori negative, DU negative) (respectively p < 0.042, p < 0.001). Significantly higher NLR was determined in the group B when compared with group A and group C (respectively p < 0.021, p < 0.001). The cut-off value for NLR was 2,17 with a specificity of 61% and sensitivity of 66% for group B comparing with Group C (AUC:0,66). Conclusions Significantly higher NLR was determined in patients with H. pylori and DU. As a result, NLR may be used as a non-invasive test for documenting the presence of H. pylori and H. pylori related DU.
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Affiliation(s)
- Zeynal Doğan
- Ankara Education and Research Hospital, Department of Gastroenterology, Ankara, Turkey
| | - Murat Kekilli
- Ankara Education and Research Hospital, Department of Gastroenterology, Ankara, Turkey
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Rădulescu PM, Căluianu EI, Traşcă ET, Mercuţ D, Georgescu I, Georgescu EF, Ciupeanu-Călugăru ED, Mercuţ MF, Mercuţ R, Padureanu V, Streba CT, Călăraşu C, Rădulescu D. The Impact of the COVID-19 Pandemic on Outcomes in Acute Pancreatitis: A Propensity Score Matched Study Comparing before and during the Pandemic. Diagnostics (Basel) 2023; 13:2446. [PMID: 37510190 PMCID: PMC10378087 DOI: 10.3390/diagnostics13142446] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
We aimed to evaluate the outcomes and survival of patients with acute pancreatitis who shared the same clinical form, age, and sex before the pandemic, during the pandemic, and among those with confirmed COVID-19 infection upon hospital admission. This consideration used the sparse data in the existing literature on the influence of the pandemic and COVID-19 infection on patients with acute pancreatitis. To accomplish this, we conducted a multicentric, retrospective case-control study using propensity score matching with a 2:1 match of 28 patients with SARS-CoV-2 infection and acute pancreatitis, with 56 patients with acute pancreatitis pre-pandemic, and 56 patients with acute pancreatitis during the pandemic. The study outcome demonstrated a six-fold relative risk of death in patients with acute pancreatitis and SARS-CoV-2 infection compared to those with acute pancreatitis before the pandemic. Furthermore, restrictive measures implemented during the pandemic period led to a partial delay in the care of patients with acute pancreatitis, which likely resulted in an impairment of their immune state. This, in certain circumstances, resulted in a restriction of surgical treatment indications, leading to a three-fold relative risk of death in patients with acute pancreatitis during the pandemic compared to those with acute pancreatitis before the pandemic.
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Affiliation(s)
| | - Elena Irina Căluianu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Emil Tiberius Traşcă
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dorin Mercuţ
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ion Georgescu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Eugen Florin Georgescu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Maria Filoftea Mercuţ
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Răzvan Mercuţ
- Department of Plastic and Reconstructive Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Vlad Padureanu
- Internal Medicine Department, Country Hospital of Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Costin Teodor Streba
- Department of Pneumology, University of Pharmacy and Medicine Craiova, 200349 Craiova, Romania
| | - Cristina Călăraşu
- Department of Pneumology, University of Pharmacy and Medicine Craiova, 200349 Craiova, Romania
| | - Dumitru Rădulescu
- General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Larouche M, Brisson D, Morissette MC, Gaudet D. Post-prandial analysis of fluctuations in the platelet count and platelet function in patients with the familial chylomicronemia syndrome. Orphanet J Rare Dis 2023; 18:167. [PMID: 37370069 DOI: 10.1186/s13023-023-02743-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The familial chylomicronemia syndrome (FCS) is an ultra rare disease caused by lipoprotein lipase (LPL) deficiency associated with potentially lethal acute pancreatitis risk. Thrombocytopenia (platelet count < 150,000 × 109/L) has been reported in patients with FCS, treated or not with volanesorsen, a second generation APOC3 anti-sense oligonucleotide. Chylomicrons are the lipoproteins delivering fat after a meal and FCS thus has a post-prandial origin. Platelet count and function have not been studied post-prandially in FCS. OBJECTIVE To evaluate post-prandial fluctuations in the platelet count (PLC) and functional defects of hemostasis in FCS. METHODS PLC, functional defects in hemostasis and hematologic variables were measured up-to 5 h after a meal in 6 homozygotes for FCS causing gene variants (HoLPL), 6 heterozygotes for LPL loss-of-function variants (HeLPL) and 7 normolipidemic controls. RESULTS Hourly post-prandial PLC was significantly lower in HoLPL than in controls (P < 0.009). Compared to the other groups, the PLC tended to decrease rapidly (in the first hour) post-meal in HoLPL (P = 0.03) and remained lower than baseline 5-h post-meal (P = 0.02) whereas it tended to slightly increase in normolipidemic controls (P = 0.02). Platelet function was not affected by the prandial status. In HoLPL, post-prandial fluctuations in the PLC positively correlated with the lymphocyte count (P = 0.005) and negatively with neutrophil/lymphocyte ratio (NLR). CONCLUSION The PLC decreases post-prandially in FCS (HoLPL), is not associated with changes in functional defects of hemostasis and correlates with the NLR, a marker of acute pancreatitis severity.
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Affiliation(s)
- Miriam Larouche
- Department of Medicine, Université de Montréal, ECOGENE-21, 930 Jacques Cartier Est, Chicoutimi, G7H 7K9, Canada
| | - Diane Brisson
- Department of Medicine, Université de Montréal, ECOGENE-21, 930 Jacques Cartier Est, Chicoutimi, G7H 7K9, Canada
| | - Marie-Claude Morissette
- Department of Medicine, Université de Montréal, ECOGENE-21, 930 Jacques Cartier Est, Chicoutimi, G7H 7K9, Canada
| | - Daniel Gaudet
- Department of Medicine, Université de Montréal, ECOGENE-21, 930 Jacques Cartier Est, Chicoutimi, G7H 7K9, Canada.
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Wang N, He S, Zheng Y, Wang L. The value of NLR versus MLR in the short-term prognostic assessment of HBV-related acute-on-chronic liver failure. Int Immunopharmacol 2023; 121:110489. [PMID: 37327515 DOI: 10.1016/j.intimp.2023.110489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Systemic inflammation is associated with the development and progression of hepatitis B-associated acute-on-chronic liver failure (HBV-ACLF). The neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic biomarker in patients with HBV-ACLF. However, the role of the monocyte-to-lymphocyte ratio (MLR) as a prognostic inflammatory biomarker in multiple diseases is rarely mentioned in HBV-ACLF. METHODS We included a total of 347 patients with HBV-ACLF who met the definition of the Chinese Guidelines for the Diagnosis and Treatment of Liver Failure (2018 edition). Among them, 275 cases were included retrospectively, and 72 cases were collected prospectively. Clinical characteristics and laboratory examination data were collected from medical records within 24 h after diagnosis to calculate MLR and NLR levels, and lymphocyte subpopulation counts were collected in prospectively included patients. RESULTS Of the 347 patients with HBV-ACLF, 128 patients in the non-surviving group had a mean age of 48.87 ± 12.89 years; 219 patients in the survival group had a mean age of 44.80 ± 11.80 years and a combined 90-day mortality rate of 36.9%. The median MLR was higher in the non-survivors than in the survivors (0.690 vs 0.497, P < 0.001). MLR values were significantly associated with 90-day mortality in HBV-ACLF (OR 6.738; 95% CI 3.188-14.240, P < 0.001). The AUC for the predictive power of the combined MLR and NLR analysis for HBV-ACLF was 0.694, and the calculated MLR threshold was 4.495. In addition, in the analysis of peripheral blood lymphocyte subsets in HBV-ACLF, a significant decrease in the number of circulating lymphocytes was found in HBV-ACLF patients in the non-surviving group (P < 0.001), with a predominant decrease in the number of CD8 + T cells and no significant difference in the number of CD4 + T cells, B cells or NK cells. CONCLUSION Increased MLR values are associated with 90-day mortality in patients with HBV-ACLF, and the MLR may serve as a potential prognostic indicator for patients with HBV-ACLF. Decreased CD8 + T-cell counts may be associated with poor survival in patients with HBV-ACLF.
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Affiliation(s)
- Neng Wang
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Sike He
- West China School of Medicine, Sichuan University, Chengdu, PR China
| | - Yu Zheng
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Lichun Wang
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
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Lu H, Yu C, Maimaiti M, Li G. The predictive value of perioperative circulating markers on surgical complications in patients undergoing robotic-assisted radical prostatectomy. World J Surg Oncol 2023; 21:179. [PMID: 37308992 DOI: 10.1186/s12957-023-03049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The occurrence of postoperative complications was associated with poor outcomes for patients undergoing robotic-assisted radical prostatectomy. A prediction model with easily accessible indices could provide valuable information for surgeons. This study aims to identify novel predictive circulating biomarkers significantly associated with surgical complications. METHODS We consecutively assessed all multiport robotic-assisted radical prostatectomies performed between 2021 and 2022. The clinicopathological factors and perioperative levels of multiple circulating markers were retrospectively obtained from the included patients. The associations of these indices with Clavien-Dindo grade II or greater complications, and surgical site infection were assessed using univariable and multivariable logistic regression models. Further, the models were validated for the overall performance, discrimination, and calibration. RESULTS In total, 229 patients with prostate cancer were enrolled in this study. Prolonged operative time could independently predict surgical site infection (OR, 3.39; 95% CI, 1.09-10.54). Higher RBC (day 1-pre) implied lower risks of grade II or greater complications (OR, 0.24; 95% CI, 0.07-0.76) and surgical site infection (OR, 0.23; 95% CI, 0.07-0.78). Additionally, RBC (day 1-pre) independently predicted grade II or greater complications of obese patients (P value = 0.005) as well as those in higher NCCN risk groups (P value = 0.012). Regarding the inflammatory markers, NLR (day 1-pre) (OR, 3.56; 95% CI, 1.37-9.21) and CRP (day 1-pre) (OR, 4.16; 95% CI, 1.69-10.23) were significantly associated with the risk of grade II or greater complications, and both the indices were independent predictors in those with higher Gleason score, or in higher NCCN risk groups (P value < 0.05). The NLR (day 0-pre) could also predict the occurrence of surgical site infection (OR, 5.04; 95% CI, 1.07-23.74). CONCLUSIONS The study successfully identified novel circulating markers to assess the risk of surgical complications. Postoperative increase of NLR and CRP were independent predictors for grade II or greater complications, especially in those with higher Gleason score, or in higher NCCN risk groups. Additionally, a marked decrease of RBC after the surgery also indicated a higher possibility of surgical complications, especially for the relatively difficult procedures.
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Affiliation(s)
- Haohua Lu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Chenhao Yu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Muzhapaer Maimaiti
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China.
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Prediction of acute lung injury in severe acute pancreatitis by routine clinical data. Eur J Gastroenterol Hepatol 2023; 35:36-44. [PMID: 36468567 DOI: 10.1097/meg.0000000000002458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
AIM Acute lung injury (ALI) is a common complication of severe acute pancreatitis (SAP) with a high mortality. Early prediction of patients at risk in initial stage can improve the long-term survival. METHODS A total of 91 patients with SAP out of 1647 acute pancreatitis patients from January 2015 to December 2020 were considered. A predictive model for SAP-associated ALI was constructed based on the valuable risk factors identified from routine clinical characteristics and plasma biomarkers. The value of the model was evaluated and compared with Lung Injury Prediction Score (LIPS). A nomogram was built to visualize the model. RESULTS Diabetes, oxygen supplementation, neutrophil count and D-dimer were found to be associated with ALI in SAP. The predictive model based on these factors had an area under the receiver operating characteristic curve [AUC: 0.88, 95% confidence interval (CI): 0.81-0.95], which was superior to LIPS (AUC: 0.71, 95% CI: 0.60-0.83), also with the higher sensitivity (65%) and specificity (96%) than LIPS (62%, 74%, respectively). Decision curve analysis of the model showed a higher net benefit than LIPS. Visualization by a nomogram facilitated the application of the model. CONCLUSION Diabetes, oxygen supplementation, neutrophil count and D-dimer were risk factors for SAP-associated ALI. The combination of these routine clinical data and the model visualization by a nomogram provided a simple and effective way in predicting ALI in the early phase of SAP.
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Liang C, Zhang R, Xing X, Chen J, Yang H. Predictive value of platelet-related hematological markers in indicating the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM). Surg Endosc 2022; 37:3471-3477. [PMID: 36575222 DOI: 10.1007/s00464-022-09845-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The predictive value of hematological markers in the outcomes after laparoscopic intraperitoneal onlay mesh repair (IPOM) remains to be investigated. We aim to evaluate the role of platelet-related parameters after laparoscopic IPOM in patients with incisional hernias. METHODS The data of 95 patients who underwent laparoscopic IPOM for appendicectomy-related incisional hernias were retrospectively analyzed. The complete blood count analyses were measured preoperatively, and the outcomes were obtained from hospital records and follow-up calls to patients. Platelet-multiple-lymphocyte index (PLM), neutrophil-leukocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) values were calculated. The patients were grouped based on the recurrence and the postoperative complications after surgery. RESULTS Using cutoff values acquired by the Youden Index, we found platelet levels < 212.0 × 1000/μl, NLR > 2.33, LMR < 3.17, and PLM < 365.5 were revealed to be statistically significant in the recurrence of hernias based on univariant or multivariant analysis (p = < 0.05). We further divided the patients into two groups based on the cutoff value of PLM and found that a PLM value < 365.5 was significantly associated with the recurrence of incisional hernia (p = 0.018), the occurrence of postoperative seroma (p = 0.044), and there is a tendency that patients with PLM < 365.5 may suffer from other postoperative complications such as cardiopathy, respiratory infection, and hypoproteinemia (p = 0.089). CONCLUSION The preoperative hematological values, especially PLM, may indicate the outcomes in incisional hernias after laparoscopic IPOM.
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Affiliation(s)
- Chen Liang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Rongjie Zhang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Xiaowei Xing
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.,Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Huiqi Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, No. 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
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Has COVID-19 Modified the Weight of Known Systemic Inflammation Indexes and the New Ones (MCVL and IIC) in the Assessment as Predictive Factors of Complications and Mortality in Acute Pancreatitis? Diagnostics (Basel) 2022; 12:diagnostics12123118. [PMID: 36553125 PMCID: PMC9777733 DOI: 10.3390/diagnostics12123118] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
We aimed at evaluating the prognostic capacity of the inflammatory indices derived from routine complete blood cell counts in two groups of patients with acute pancreatitis from two different time periods, before and during the COVID-19 pandemic, when a high incidence of complications with surgical risk and mortality was found. Two new markers were introduced: the mean corpuscular volume to lymphocyte ratio (MCVL) and the cumulative inflammatory index (IIC), which were calculated at a baseline in the two groups of patients. Of the already established markers, none of them managed to effectively predict the complications with surgical risk and mortality, with a decrease of less than 50% in specificity in the peri-COVID group. The MCVL had the best prediction of complications with surgical risk in both the pre-COVID and peri-COVID groups, validated it as an independent factor by multivariate analysis. The IIC had the best prediction of mortality in both periods and was proven to be an independent factor by multivariate analysis. As the IIC predicted death best, we tested the occurrence of death and found that patients with PA who had an IIC > 12.12 presented a risk of death 4.08 times higher in the pre-COVID group and 3.33 times higher in the peri-COVID group. The new MCVL and IIC independent markers had a superior sensitivity and specificity in predicting surgical risk complications and, respectively, mortality in the group of patients with acute pancreatitis during the COVID-19 pandemic, which makes them widely applicable in populations with modified immune and inflammatory status. Conclusions: In patients with acute pancreatitis, MCVL has a significant predictive value regarding complications with surgical risk (abscess, necrosis, and pseudocyst), and the IIC has a significant predictive value for mortality.
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Bhikram T, Sandor P. Neutrophil-lymphocyte ratios as inflammatory biomarkers in psychiatric patients. Brain Behav Immun 2022; 105:237-246. [PMID: 35839998 DOI: 10.1016/j.bbi.2022.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE There is a growing amount of evidence to suggest that inflammation may have a role in the onset and prognosis of psychiatric disorders. We reviewed the literature of studies investigating neutrophil-lymphocyte ratios (NLR), a biomarker of inflammation, in both adult and youth psychiatric populations. The limitations of NLR, in addition to the potential mechanisms underlying its relationship with psychiatric disorders, are also discussed. RECENT FINDINGS Unlike in the general population, NLR is elevated in a proportion of adult patients with schizophrenia, major depressive disorder and bipolar disorder, though associations with symptom severity and other clinical parameters are less clear. When compared to baseline, reductions in NLR are sometimes reported after treatment and remission. Results in youth populations largely resemble findings obtained from adult samples, even though youth studies are far fewer in number. SUMMARY The consistent findings of elevated NLR across the reviewed psychiatric disorders suggest that abnormal NLR is not specific to any one disorder but may reflect a pathological brain process that leads to brain dysfunction. These findings support hypotheses of neuroinflammation being important to the etiology of psychiatric disorders. More research is needed to further elucidate the relationship between specific diagnostic and behavioural constructs and NLR. Future work is also needed to determine the specific neuroinflammatory mechanisms that give rise to specific disorders.
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Affiliation(s)
- Tracy Bhikram
- Tourette Syndrome Neurodevelopmental Clinic, University Health Network, Toronto, Ontario, Canada.
| | - Paul Sandor
- Tourette Syndrome Neurodevelopmental Clinic, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Child Psychiatry, Department of Psychiatry, Youthdale Treatment Centers, Toronto, Ontario, Canada; Youthdale Treatment Centers, Toronto, Ontario, Canada
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Halaseh SA, Kostalas M, Kopec C, Toubasi AA, Salem R. Neutrophil-to-Lymphocyte Ratio as an Early Predictor of Complication and Mortality Outcomes in Individuals With Acute Pancreatitis at a UK District General Hospital: A Retrospective Analysis. Cureus 2022; 14:e29782. [PMID: 36340538 PMCID: PMC9621742 DOI: 10.7759/cureus.29782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Aim The purpose of this study was to evaluate the predictive usefulness of the neutrophil-to-lymphocyte ratio (NLR) in patients with acute pancreatitis (AP) and establish a threshold for the prediction of poor outcomes. Methods For this investigation, we looked back at all cases of acute pancreatitis treated at Torbay Hospital in Torquay, UK, between January 1st, 2019, and December 31st, 2020. Those who were found to have chronic pancreatitis or whose baseline laboratory values could not be obtained were not included. Each patient’s entire hospital stay was analyzed, including up to 72 hours of medical and laboratory data. Results According to the Glasgow Coma Scale scoring system, 28 of the 314 included patients had severe acute pancreatitis, and 81 patients had pancreatitis with complications. Those with complications had a substantially higher NLR on day 1 (9.43 ± 7.57) than patients who recovered without complications (7.37 ± 5.88) (P-value = 0.028). The NLR on day 0 (>18.71) exhibited a sensitivity of 80%, a specificity of 90.2%, and an accuracy of 83.9% in forecasting the death of patients with pancreatitis. Conclusion Elevated baseline NLR corresponds with pancreatitis with complications and can predict mortality.
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NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit. Sci Rep 2022; 12:15974. [PMID: 36153405 PMCID: PMC9509334 DOI: 10.1038/s41598-022-20385-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThe neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) are emerging biomarkers to predict outcomes in general ward patients. However, their role in the prognostication of critically ill patients with pneumonia is unclear. A total of 216 adult patients were enrolled over 2 years. They were classified into viral and bacterial pneumonia groups, as represented by influenza A virus and Streptococcus pneumoniae, respectively. Demographics, outcomes, and laboratory parameters were analysed. The prognostic power of blood parameters was determined by the respective area under the receiver operating characteristic curve (AUROC). Performance was compared using the APACHE IV score. Discriminant ability in differentiating viral and bacterial aetiologies was examined. Viral and bacterial pneumonia were identified in 111 and 105 patients, respectively. In predicting hospital mortality, the APACHE IV score was the best prognostic score compared with all blood parameters studied (AUC 0.769, 95% CI 0.705–0.833). In classification tree analysis, the most significant predictor of hospital mortality was the APACHE IV score (adjusted P = 0.000, χ2 = 35.591). Mechanical ventilation was associated with higher hospital mortality in patients with low APACHE IV scores ≤ 70 (adjusted P = 0.014, χ2 = 5.999). In patients with high APACHE IV scores > 90, age > 78 (adjusted P = 0.007, χ2 = 11.221) and thrombocytopaenia (platelet count ≤ 128, adjusted P = 0.004, χ2 = 12.316) were predictive of higher hospital mortality. The APACHE IV score is superior to all blood parameters studied in predicting hospital mortality. The single inflammatory marker with comparable prognostic performance to the APACHE IV score is platelet count at 48 h. However, there is no ideal biomarker for differentiating between viral and bacterial pneumonia.
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Isolated and Combined Effect of Age and Gender on Neutrophil-Lymphocyte Ratio in the Hyperglycemic Saudi Population. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081040. [PMID: 36013507 PMCID: PMC9412958 DOI: 10.3390/medicina58081040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 12/16/2022]
Abstract
Inflammation is pivotal to the pathogenesis of diabetes mellitus (DM), but pathological alterations of the neutrophil−lymphocyte ratio (NLR), an emerging inflammatory index in DM management, remains understudied. The aim of this study is to examine the relationship between NLR and glycemic control in the Saudi population. Gender, age, WBC count, and fasting blood glucose (FBG) were obtained from Al-Borg Medical Laboratories for 14,205 subjects. Means, prevalence, risk measures, and the diagnostic accuracy of elevated NLR and hyperglycemia (HG) were evaluated. Subjects with elevated NLR (>3) had significantly higher FBG (105.10 ± 0.33 vs. 114.0 ± 2.81) and NLR was significantly elevated in impaired fasting glycemia (IFG; 1.21 ± 0.01 vs. 1.25 ± 0.01) and HG (1.21 ± 0.01 vs. 1.39 ± 0.02). Elevations of NLR in HG but not in IFG persisted across all age groups except young males and elderly females. The prevalence of elevated NLR in hyperglycemic subjects was 4.12% compared to 2.16% in subjects with normal FBG. HG was more prevalent in subjects with elevated NLR (17.33% vs. 12.46%) who had a relative risk (RR) of 1.68 (95% CI = 1.38−2.06, p < 0.0001) and an odds ratio (OR) of 1.94 (95% CI = 1.48−2.56, p < 0.0001) to be hyperglycemic. Nevertheless, NLR failed to discriminate individuals with normal FBG from those with HG based on ROC curve analysis. Pathological fluctuations in NLR may serve as supportive evidence in DM management.
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Neutrophil-Lymphocyte Ratio in Patients with Hypertriglyceridemic Pancreatitis Predicts Persistent Organ Failure. Gastroenterol Res Pract 2022; 2022:8333794. [PMID: 35340692 PMCID: PMC8942680 DOI: 10.1155/2022/8333794] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background The neutrophil–lymphocyte ratio (NLR) has been proposed as a surrogate marker of inflammation with prognostic value in various diseases. Our objective was to investigate the predictive value of the NLR as an indicator of persistent organ failure (POF) in patients with hypertriglyceridemic pancreatitis (HTGP). Methods We retrospectively reviewed the data from patients with HTGP between 2016 and 2019. The NLR was obtained at admission. The diagnostic performance of the NLR for POF was evaluated by the area under the receiver operator characteristics curve (AUROC). Multivariate logistic regression determined whether elevated NLR was independently associated with POF. Results Of the 446 patients enrolled, 89 (20.0%) developed POF. Patients with POF showed a significantly higher NLR than those without POF (P < 0.001). A positive trend for the association across increasing NLR quartiles and the incidence of POF was observed (Ptrend < 0.001). The AUROC of NLR to predict POF was 0.673 (95% confidence interval, 0.627-0.716). With a cut-off of NLR > 6.56, the sensitivity and specificity were 73.0% and 55.7%, respectively. Multivariate analysis suggested that high NLR (>6.56) was independently associated with POF (odds ratio, 2.580; 95% confidence interval, 1.439-4.626; P = 0.001). Patients with a high NLR (>6.56) had a worse overall clinical course in HTGP. Conclusion Elevated NLR was significantly associated with an increased risk of developing POF and could be an early independent predictor of POF in patients with HTGP.
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Peripheral lymphocyte count as a surrogate marker of immune checkpoint inhibitor therapy outcomes in patients with non-small-cell lung cancer. Sci Rep 2022; 12:626. [PMID: 35022510 PMCID: PMC8755768 DOI: 10.1038/s41598-021-04630-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Degree of expression of programmed death-ligand 1 (PD-L1) is related with Immune check point inhibitors (ICIs) response but it needs sufficient tumor tissue. There is unmet need for easily accessible and prognostic peripheral blood (PB) biomarkers. We investigated the application of serum peripheral lymphocyte count (PLC) as a predictive PB biomarker for ICI response in patients with NSCLC. We conducted a retrospective study and reviewed the patients with NSCLC who were treated with ICIs from April 1, 2016, to March 31, 2019. The PLC before and after 1 month of immunotherapy was collected. We evaluated the association between PLC and progression-free survival (PFS), overall survival (OS) and adverse events. A total of 231 patients were treated with ICIs for NSCLC. The median follow-up period was 4.7 months and the disease progressed in 138 patients (59.7%). Compared with the lowest quartile (Q1: the lowest 25%), the highest quartile (Q4: the highest 25%) of post-treatment PLC showed a significantly higher PFS (HR 0.28, 95% CI 0.16–0.52) and OS (HR 0.35, 95% CI 0.19–0.65) in the adjusted model. An association between adverse events and PLC was not observed. We revealed that an increased pre- and post-treatment PLC was associated with favorable PFS and OS with NSCLC patients treated with ICIs. PLC could be a helpful for ICI responses in NSCLC.
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Gupta P, Das GC, Bansal A, Samanta J, Mandavdhare HS, Sharma V, Naseem S, Gupta V, Yadav TD, Dutta U, Varma N, Sandhu MS, Kochhar R. Value of neutrophil-lymphocyte ratio in evaluating response to percutaneous catheter drainage in patients with acute pancreatitis. World J Clin Cases 2022; 10:91-103. [PMID: 35071509 PMCID: PMC8727280 DOI: 10.12998/wjcc.v10.i1.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early prediction of response to percutaneous catheter drainage (PCD) of necrotic collections in acute pancreatitis (AP) using simple and objective tests is critical as it may determine patient prognosis. The role of white blood cell (WBC) count and neutrophil-lymphocyte ratio (NLR) has not been assessed as a tool of early prediction of PCD success and is the focus of this study.
AIM To assess the value of WBC and NLR in predicting response to PCD in AP.
METHODS This retrospective study comprised consecutive patients with AP who underwent PCD between June 2018 and December 2019. Severity and fluid collections were classified according to the revised Atlanta classification and organ failure was defined according to the modified Marshall Score. WBC and NLR were monitored 24 h prior PCD (WBC-0/NLR-0) and 24 h (WBC-1/NLR-1), 48 h (WBC-2/NLR-2) and 72 h (WBC-3/NLR-3) after PCD. NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. The association of success of PCD (defined as survival without the need for surgery) with WBC and NLR was assessed. The trend of WBC and NLR was also assessed post PCD.
RESULTS One hundred fifty-five patients [median age 40 ± 13.6 (SD), 64.5% males, 53.5% severe AP] were included in the final analysis. PCD was done for acute necrotic collection in 99 (63.8%) patients and walled-off necrosis in 56 (36.1%) patients. Median pain to PCD interval was 24 ± 69.89 d. PCD was successful in 109 patients (group 1) and 46 patients (group 2) who failed to respond. There was no significant difference in the baseline characteristics between the two groups except the severity of AP and frequency of organ failure. Both WBC and NLR showed an overall decreasing trend. There was a significant difference between WBC-0 and WBC-1 (P = 0.0001). WBC-1 and NLR-1 were significantly different between the two groups (P = 0.048 and 0.003, respectively). The area under the curve of WBC-1 and NLR-1 for predicting the success of PCD was 0.602 and 0.682, respectively. At a cut-off value of 9.87 for NLR-1, the sensitivity and specificity for predicting the success of PCD were calculated to be 75% and 65.4% respectively.
CONCLUSION WBC and NLR can be used as simple tests for predicting response to PCD in patients with acute necrotizing pancreatitis.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Gaurav Chayan Das
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Bansal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Li Y, Hao W, Guan J, Li B, Meng L, Sun S, Sheng T, Dong S, Zhou Q, Liu M, Zhang Z, Shen T, Shen Y, Zhao B. Relationship between indices of circulating blood cells and bone homeostasis in osteoporosis. Front Endocrinol (Lausanne) 2022; 13:965290. [PMID: 36133307 PMCID: PMC9483170 DOI: 10.3389/fendo.2022.965290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Bone development have been shown to play an important role in regulating hematopoiesis as one major component of bone marrow microenvironment. Recent studies support the notion that there is an intricate relationship between hematopoiesis and bone homeostasis, however, little is known about the alterations in the hematopoietic lineages in pathologic conditions. Using various osteoporotic mouse models, we show here that bone microarchitecture abnormalities alter parameters of peripheral blood cells. The level of white blood cells is dynamics and negatively correlated with bone mineral density during the progression of osteoporosis. Furthermore, our clinical data confirm that osteoporosis is associated with abnormal circulating blood cell counts. These results demonstrated a causal link that osteoporosis is accompanied by the altered circulating blood cells, supporting the idea of a close interplay between hematopoiesis and bone homeostasis. Our study would propose that routine complete blood count might be applied as a potential diagnostic and putative marker for osteoporosis.
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Affiliation(s)
- Yuan Li
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- Suzhou Research Institute, Shandong University, Suzhou, China
- National Medical Products Administration (NMPA) Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Baobing Zhao, ; Yuan Li,
| | - Weimin Hao
- Department of Spine Surgery, Heze Municipal Hospital, Heze, Shandong, China
| | - Jianming Guan
- Department of Hematology, Heze Municipal Hospital, Heze, Shandong, China
| | - Bo Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li Meng
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shuangjiao Sun
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tianyuan Sheng
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shuangxi Dong
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qian Zhou
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mingjie Liu
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhongkai Zhang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tao Shen
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Medical Products Administration (NMPA) Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuemao Shen
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Medical Products Administration (NMPA) Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Baobing Zhao
- Key Lab of Chemical Biology, Ministry of Education (MOE), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Medical Products Administration (NMPA) Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Baobing Zhao, ; Yuan Li,
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Prediction of hospital mortality after colorectal perforation surgery from inflammation-based prognostic scores. Surg Open Sci 2022; 8:40-46. [PMID: 35280120 PMCID: PMC8914212 DOI: 10.1016/j.sopen.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 11/09/2022] Open
Abstract
Background Inflammation-based prognostic scores have prognostic value in cancer or cardiovascular disease patients. This study evaluated the prognostic value of inflammation-based prognostic scores in colorectal perforation patients. Methods Data of 97 patients who underwent surgery for colorectal perforation were reviewed. We calculated various inflammation-based prognostic scores and analyzed the relationship between inflammation-based prognostic score and hospital mortality due to colorectal perforation. Results Multivariate analyses of hospital mortality revealed neutrophil–lymphocyte ratio (P = .0021), C-reactive protein/albumin ratio (P = .0224), and prognostic nutritional index (P = .0078) as independent predictive factors. The Kaplan–Meier analysis showed that patients who met all of the following parameters avoided hospital death: neutrophil–lymphocyte ratio < 30, prognostic nutritional index ≥ 27.2, age < 75 years, and perforation of the left colon. Conclusion Neutrophil–lymphocyte ratio, C-reactive protein/albumin ratio, and prognostic nutritional index were superior to other inflammation-based prognostic scores in predicting mortality of colorectal perforation. Neutrophil–lymphocyte ratio, prognostic nutritional index, patient's age, and sidedness of the perforation site may be useful parameters to identify subgroups in which a favorable prognosis can be expected. NLR, CAR, and PNI are superior in predicting colorectal perforation surgery patients. Mortality is associated with high NLR, low PNI, older age, and right-side perforation. Favorable prognosis may depend upon NLR, PNI, patient's age, and perforation site side.
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Formanchuk T, Lapshyn H, Pokidko M, Formanchuk A, Vovchuk I. The relationship between neutrophil-lymphocyte ratio and clinal laboratory data in acute pancreatitis. ACTA FACULTATIS MEDICAE NAISSENSIS 2022. [DOI: 10.5937/afmnai39-34988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction: Neutrophil-lymphocyte ratio (NLR) is one of the laboratory biomarkers used in clinical practice to predict severity and mortality of acute pancreatitis (AP), however, there is currently insufficient information about the changes of NLR in the dynamics in relationship with other clinical and laboratory data. Aims: To assess the relationship between NLR values and other demographics, clinical and simple laboratory data in patients with acute pancreatitis. Methods: The data of two hundred twenty-nine patients with AP were analyzed. All patients were divided into two groups: the group with a positive outcome and the group with a fatal outcome. NLR was counted on the 1st, 3rd and 5th day after admission in each group. The dynamics of NLR index by groups and days, as well as its correlation with other 18 simple laboratory parameters were evaluated. Results: The level of NLR rate itself was significantly higher on the 1st, 3rd and 5th day in the group with the fatal result compared with the group with the positive result (p < 0.05). In patients with AP with the positive result of treatment, there was a gradual decrease in the rate between the 1st and the 3rd day (-21.8%) (p < 0.05). The overall dynamics of the indicator between the 1st and the 5th day was -21.5%. In contrast to the group of patients with the fatal outcome, despite the infusion therapy, there was an increase in NLR rate between the 1st and 3rd day of +15.7%. The overall dynamics between the 1st and 5th day was -34.0%. A significant negative relationship of the Spearman's rank correlation coefficient between NLR on the 1st and 3rd day with the fatal outcome was revealed. The highest reliability of this indicator was found on the 3rd day after admission (p < 0.0001). In the group of patients with a positive result, a correlation between NLR on the 1st day and stabs on the 1st day, segmental forms on the 1st day, serum amylase on the 1st day was found. A very high correlation was found with the level of lymphocytes on the 1st day (rs = -0.98, p < 0001). In the group of patients with the fatal outcome, a statistically significant correlation (p < 0.05) of moderate strength was found between the value of NLR and the following indicators: glucose level on the 1st day, total protein on the 5th day, prothrombin index on the 5th day. A high correlation was found with the level of segmental forms on the 1st day (rs = 0.7) and a very high correlation with the level of lymphocytes on the 1st day (rs = -0.99). Conclusions: There was a significant increase in NLR on the 1st, 3rd, and 5th day in the group of patients with AP with the fatal outcome compared with the group of patients with AP with the positive result. Elevated NLR levels on the 1st and 3rd day seem to be associated with hospital mortality in patients with AP. No correlation was found between NLR rate and clinical data in the group with fatal outcome. The main indicators among simple laboratory parameters for determining the predictors of lethal outcome in AP in different periods after hospitalization were: the level of blood glucose, lymphocytes, total protein, serum amylase, prothrombin index.
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Alavi Naeini N, Emami Ardestani M. Evaluation of the prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute exacerbation of chronic obstructive pulmonary disease. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2022; 27:50. [PMID: 36092488 PMCID: PMC9450251 DOI: 10.4103/jrms.jrms_512_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/06/2020] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
Background: The present study aimed at determining and comparing the prognostic value and the relationship of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios (PLRs) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Materials and Methods: The present case–control study was performed on 100 chronic obstructive pulmonary disease patients and 100 healthy subjects (controls). Age, gender, and laboratory results of complete blood count tests including lymphocyte count, neutrophil count, platelet count, hemoglobin level, neutrophil-to-lymphocyte ratio (NLR), PLR, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were obtained from the patient report and then recorded. The mentioned information was also completed for the control group. Following hospitalization, the patients that were discharged with clinically stable general status were re-examined, and the aforementioned laboratory information was rerecorded. Results: The results of the present study revealed that NLR with the sensitivity and specificity of 83.00% (74.2%–89.8%) and 93.00% (86.1%–97.1%) (cutoff value of 2.3), PLR with the sensitivity and specificity of 56.00% (46.0%–66.3%) and 83.00% (74.2%–89.8%) (cutoff value of 135.8), white blood cell (WBC) with the sensitivity and specificity of 69.00% (57.7%–77.8%) and 78.00% (68.6%–85.7%) (cutoff value of 8.5 × 103 μl), ESR with the sensitivity and specificity of 84.00% (75.3%–90.6%) and 99.00% (94.6%–100.0%) (cutoff value of 7.8), and CRP with the sensitivity and specificity of 52.00% (41.8%–62.1%) and 81.00% (71.9%–88.2%) (cutoff value of 1.9), respectively, had a significant prognostic value of AECOPD (P < 0.001). In addition to NLR had higher area under the curve (AUC) than PLR, WBC, and CRP. Therefore NLR had a better diagnostic value than the above three markers (P < 0.001). ESR also has higher AUC levels compared to PLR, WBC, and CRP and has a statistically better diagnostic value than them (P < 0.001), but did not differ significantly from ESR (difference between AUC: 0.02; P = 0.059). Conclusion: According to the results of the current study, NLR and PLR had a significant direct relationship with the two main markers of ESR and CRP, and both ratios had a significant prognostic value in AECOPD.
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Chen B, Cao J, Yan C, Zheng C, Chen J, Guo C. A promising new predictive factor for detecting bowel resection in childhood intussusception: the lymphocyte-C-reactive protein ratio. BMC Pediatr 2021; 21:577. [PMID: 34915876 PMCID: PMC8675458 DOI: 10.1186/s12887-021-03068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background The most critical concern for the management of childhood intussusception is bowel resection due to intestinal ischemia and necrosis. The early prediction of this problem is of great importance. We investigated the value of various combinations of inflammatory factors to predict intestinal necrosis and resection. Methods We retrospectively reviewed the medical records of pediatric patients with intussusception who underwent surgical management. During the research period, 47 patients who underwent intestinal resection due to intestinal necrosis and 68 patients who did not undergo intestinal resection were enrolled. We evaluated the diagnostic value of various combinations of inflammatory markers from preoperative laboratory analyses using the receiver operating characteristic (ROC) method. Results In the current cohort, 115 patients underwent operations for intussusception; among them, 47 patients (40.9%) underwent intestinal resections. In the patients with intestinal resection, the neutrophil count(p = 0.013), CRP level(p = 0.002), platelet–lymphocyte ratio (PLR, p = 0.008), NLR (neutrophil–lymphocyte ratio, p = 0.026), and LCR (lymphocyte–CRP ratio, p < 0.001) values were significantly higher than those in the patients without any resection. The receiver operating characteristic (ROC) analysis results showed that the combination of lymphocytic count along with C-reactive protein levels (LCR) demonstrated the highest correlation with intestinal resection due to intussusception compared with other parameters in the patients, with a sensitivity of 0.82 (0.73–0.86) and specificity of 0.80 (0.57–0.94) for the diagnosis of strangulation. Conclusion The preoperative LCR level is a useful marker to predict the need for intestinal resection due to intestinal necrosis in patients with intussusception.
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Affiliation(s)
- Bailin Chen
- Department of Pediatric General Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jian Cao
- Department of Pediatric General Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chengwei Yan
- Department of Pediatric General Surgery, Chongqing University Three Gorges Hospital, Chongqing, People's Republic of China
| | - Chao Zheng
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Department II of Orthopedics, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People's Republic of China
| | - Jingyu Chen
- Department of Pediatric General Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,Department of Ultrasound, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People's Republic of China.
| | - Chunbao Guo
- Department of Pediatric General Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,Department of Pediatric General Surgery, Chongqing University Three Gorges Hospital, Chongqing, People's Republic of China. .,Department of Ultrasound, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People's Republic of China.
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Hu S, Wang D, Ma T, Yuan F, Zhang Y, Gao X, Lei Q, Cheng J. Association between Preoperative Monocyte-to-Lymphocyte Ratio and Late Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Cohort Study. Am J Nephrol 2021; 52:854-860. [PMID: 34749361 DOI: 10.1159/000519822] [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: 07/23/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inflammation appears to be at the biological core of arteriovenous fistula (AVF) dysfunction, and the occurrence of AVF dysfunction is related to high death and disability in hemodialysis (HD) patients. Despite several studies on the correlations between AVF dysfunction and inflammatory indicators, how AVF dysfunction is related to the monocyte-to-lymphocyte ratio (MLR) is much unclear. We hypothesize that preoperative MLR is associated with AVF dysfunction in Chinese HD patients. METHODS In this single-center retrospective cohort study, totally 769 adult HD patients with a new AVF created between 2011 and 2019 were included. Association of preoperative MLR with AVF dysfunction (thrombosis or decrease of normal vessel diameter by >50%, requiring either surgical revision or percutaneous transluminal angioplasty) was assessed by multivariable Cox proportional hazard regression. RESULTS The patients were aged 55.8 ± 12.2 years and were mostly males (55%). During the average 32-month follow-up (maximum 119 months), 223 (29.0%) patients had permanent vascular access dysfunction. In adjusted multivariable Cox proportional hazard regression analyses, the risk of AVF dysfunction was 4.32 times higher with 1 unit increase in MLR (hazard ratio [HR]: 5.32; 95% confidence interval [CI]: 3.1-9.11). Compared with patients with MLR <0.28, HRs associated with an MLR of 0.28-0.41 and ≥0.41 are 1.54 (95% CI: 1.02-2.32) and 3.17 (2.18-4.62), respectively. CONCLUSIONS A higher preoperative MLR is independently connected with a severer risk of AVF dysfunction in HD patients. Its clinical value should be determined in the future.
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Affiliation(s)
- Shouliang Hu
- Division of Nephrology, The First Hospital of Yangtze University, Jingzhou, China,
| | - Dan Wang
- Central Laboratory, The First Hospital of Yangtze University, Jingzhou, China
| | - Tean Ma
- Division of Nephrology, The First Hospital of Yangtze University, Jingzhou, China
| | - Fanli Yuan
- Division of Nephrology, The First Hospital of Yangtze University, Jingzhou, China
| | - Yong Zhang
- Division of Nephrology, Jianli County People's Hospital, Jingzhou, China
| | - Xiaoli Gao
- Division of Nephrology, The First Hospital of Yangtze University, Jingzhou, China
| | - Qingfeng Lei
- Division of Nephrology, The First Hospital of Yangtze University, Jingzhou, China
| | - Junzhang Cheng
- Division of Nephrology, The First Hospital of Yangtze University, Jingzhou, China
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Gökce SE, Başkan C. Neutrophil lymphocyte ratio as a predictor of perioperative complications in patients with PEX Syndrome during cataract surgery. Int Ophthalmol 2021; 42:1311-1316. [PMID: 34739629 DOI: 10.1007/s10792-021-02118-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pseudoexfoliation syndrome (PES) is an age-related process associated with glaucoma and cataracts. It increases the risk of complications during cataract surgery. Blood neutrophil-to-lymphocyte ratio (NLR) is shown to be an effective biomarker of inflammation in PES. We aimed to investigate association of NLR and pseudoexfoliation (PEX) related cataract surgery complications. METHODS A total of 210 eyes who underwent cataract surgery between January 2016 and January 2020 in our department were analyzed retrospectively. Patients were grouped with respect to developing complications and the two groups were compared. Medical records were reached to obtain neutrophil and lymphocyte values to calculate NLR. Data obtained were analyzed using chi-square test. Receiver operating characteristics curve analysis was performed to determine cutoff, sensitivity and specificity values. p value of ≤ 0.05 was considered statistically significant. RESULTS The mean age was 68.1 ± 7.2 years and mean NLR was 2.11 ± 0.81. Complications were observed in 32 (15.2%) of the patients (group 1). Neutrophil counts (5.19 ± 0.64 vs. 4.43 ± 0.86, p < 0.001) and the NLR (2.68 ± 0.73 vs. 2.01 ± 0.81, p < 0.001) of group 1 were significantly higher than group 2. The ROC analysis revealed a cutoff value of 2.33 for NLR to predict cataract surgery complications with sensitivity of 87.5% and specificity of 78.1%. CONCLUSION There is an association between NLR and increased risk of complications during cataract surgery in PES patients. NLR can be used as an easy method to help ophthalmologists in predicting the risks associated with cataract surgery in PEX eyes.
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Affiliation(s)
- Sabite Emine Gökce
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Turkey.
| | - Ceyda Başkan
- Department of Ophthalmology, Ankara City Hospital, Ankara, Turkey
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Sung HM, Lee SH, Oh AR, Kim S, Kim J, Gook J, Jang JN, Park J. Association between preoperative neutrophil-lymphocyte ratio and mortality after plastic and reconstructive surgery. Sci Rep 2021; 11:21541. [PMID: 34728689 PMCID: PMC8564523 DOI: 10.1038/s41598-021-00901-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022] Open
Abstract
Predictive factors associated with postoperative mortality have not been extensively studied in plastic and reconstructive surgery. Neutrophil-lymphocyte ratio (NLR), a systemic inflammation index, has been shown to have a predictive value in surgery. We aimed to evaluate association between preoperative NLR and postoperative outcomes in patients undergoing plastic and reconstructive surgery. From January 2011 to July 2019, we identified 7089 consecutive adult patients undergoing plastic and reconstructive surgery. The patients were divided according to median value of preoperative NLR of 1.84. The low NLR group was composed of 3535 patients (49.9%), and 3554 patients (50.1%) were in the high NLR group. The primary outcome was mortality during the first year, and overall mortality and acute kidney injury were also compared. In further analysis, outcomes were compared according to quartile of NLR, and a receiver operating characteristic curve was constructed to estimate the threshold associated with 1-year mortality. This observational study showed that mortality during the first year after plastic and reconstructive surgery was significantly increased in the high NLR group (0.7% vs. 3.5%; hazard ratio, 4.23; 95% confidence interval, 2.69-6.63; p < 0.001), and a graded association was observed between preoperative NLR and 1-year mortality. The estimated threshold of preoperative NLR was 2.5, with an area under curve of 0.788. Preoperative NLR may be associated with 1-year mortality after plastic and reconstructive surgery. Further studies are needed to confirm our findings.
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Affiliation(s)
- Ha Min Sung
- Link Plastic Surgery Clinic, Seoul, South Korea
| | - Seung-Hwa Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Heart Vascular Stroke Institute, Seoul, South Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea
| | - Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.,Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, South Korea
| | - Sojin Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Joonhee Gook
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. .,Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea.
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Systemic Inflammatory Markers for Predicting Overall Survival in Patients with Osteosarcoma: A Systematic Review and Meta-Analysis. Mediators Inflamm 2021; 2021:3456629. [PMID: 34720749 PMCID: PMC8553478 DOI: 10.1155/2021/3456629] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/06/2021] [Accepted: 09/25/2021] [Indexed: 12/23/2022] Open
Abstract
Background Inflammatory markers are associated with tumor genesis and progression, but their prognostic significance in osteosarcoma remains unclear. Therefore, we discussed the prognostic value of related inflammatory markers in osteosarcoma through a meta-analysis and systematic review. These inflammatory markers include C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), and Glasgow prognostic score (GPS). Methods The Chinese National Knowledge Infrastructure (CNKI), Wanfang, Chinese Scientific Journals (VIP), PubMed, Embase, and Cochrane libraries were searched. The design of meta-analysis was made based on the PICOS (population, intervention/exposure, control, outcomes, and study design) principles, and STATA 15.1 was used to analyze the data. The Newcastle-Ottawa scale (NOS) was used to assess the quality of included studies. Hazard ratios (HRs) for overall survival (OS) and disease-specific survival (DPS) were extracted for the investigation of the prognostic value of inflammatory markers. Results Twelve researches with 2162 osteosarcoma patients were included in total. The pooled results showed that elevated NLR, CRP, and GPS are all greatly related to shortening of OS among patients with osteosarcoma (HR = 1.68, P = 0.007, 95% CI: 1.15-2.45; HR = 1.96, P = 0.002, 95% CI: 1.28-3.00; HR = 2.54, P < 0.0001, 95% CI: 1.95-3.31, respectively), and CRP level is significantly associated with shortening of DPS among patients with osteosarcoma (HR = 2.76, 95% CI:2.01-3.80, P < 0.0001), additionally. However, the correlation between LMR or PLR and the prognosis of osteosarcoma is not statistically significant (HR = 0.60, 95% CI: 0.30-1.18, P = 0.138; HR = 1.13, 95% CI: 0.85-1.49, P = 0.405, respectively). The outcomes of subgroup analysis to NLR and CRP suggested that histology, ethnicity, metastasis, and sample size all have an impact on its prognosis of patients with osteosarcoma. Conclusion Worsened prognosis may be related to high levels of NLR, CRP, and GPS before treatment rather than LMR or PLR, which can provide the basis for clinicians to judge the outcomes of prognosis. Trial Registration. PROSPERO (CRD42021249954), https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249954.
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Bulut NS, Yorguner N, Çarkaxhiu Bulut G. The severity of inflammation in major neuropsychiatric disorders: comparison of neutrophil-lymphocyte and platelet-lymphocyte ratios between schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and obsessive compulsive disorder. Nord J Psychiatry 2021; 75:624-632. [PMID: 34319861 DOI: 10.1080/08039488.2021.1919201] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As non-specific markers of immune dysregulation, neutrophil-lymphocyte and platelet-lymphocyte ratios (NLR and PLR) have been consistently shown to be increased in major neuropsychiatric disorders. Although this increase seems to be trans-diagnostic, the extent to which its magnitude differs between disorders remains largely unclear. AIM The aim of this study was to directly compare the severity of inflammation (as reflected by NLR and PLR) between schizophrenia (Sch), bipolar mania (BD-M), bipolar depression (BD-D), major depressive disorder (MDD) and obsessive compulsive disorder (OCD). METHODS NLR and PLR were obtained for a total of 417 subjects (91 Sch, 70 BD-D, 37 BD-M, 93 MDD, 37 OCD, and 95 controls) and analyzed for group differences. RESULTS Sch, BD-M, BD-D and MDD presented with significantly higher NLR compared with both OCD and HC. NLR in BD-M was significantly higher than all the remaining groups, whereas Sch, BD-D and MDD presented with comparably elevated NLR. Moreover, BD-M, Sch and MDD had significantly higher PLR compared with HC. CONCLUSION These results suggest that the underlying inflammation may be most severe in BD-M, followed by Sch, BD-D and MDD. On the other hand, inflammation may be of negligible intensity in OCD, or at least undetectable by means of NLR or PLR.
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Affiliation(s)
- Necati Serkut Bulut
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Neşe Yorguner
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Gresa Çarkaxhiu Bulut
- Department of Child and Adolescent Psychiatry, Maltepe University Medical School, Istanbul, Turkey
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Zhu W, Ding Z, Zhang Z, Wu X, Liu X, Zhang Y, Li S, Zhou L, Tian G, Qin J. Enhancement of Oxytocin in the Medial Prefrontal Cortex Reverses Behavioral Deficits Induced by Repeated Ketamine Administration in Mice. Front Neurosci 2021; 15:723064. [PMID: 34566567 PMCID: PMC8462509 DOI: 10.3389/fnins.2021.723064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Ketamine is a popular recreational substance of abuse that induces persistent behavioral deficits. Although disrupted oxytocinergic systems have been considered to modulate vulnerability to developing drugs of abuse, the involvement of central oxytocin in behavioral abnormalities caused by chronic ketamine has remained largely unknown. Herein, we aimed to investigate the potential role of oxytocin in the medial prefrontal cortex (mPFC) in social avoidance and cognitive impairment resulting from repeated ketamine administration in mice. We found that ketamine injection (5 mg/kg, i.p.) for 10 days followed by a 6-day withdrawal period induced behavioral disturbances in social interaction and cognitive performance, as well as reduced oxytocin levels both at the periphery and in the mPFC. Repeated ketamine exposure also inhibited mPFC neuronal activity as measured by a decrease in c-fos-positive cells. Furthermore, direct microinjection of oxytocin into the mPFC reversed the social avoidance and cognitive impairment following chronic ketamine exposure. In addition, oxytocin administration normalized ketamine-induced inflammatory cytokines including TNF-α, IL-6, and IL-1β levels. Moreover, the activation of immune markers such as neutrophils and monocytes, by ketamine was restored in oxytocin-treated mice. Finally, the reversal effects of oxytocin on behavioral performance were blocked by pre-infusion of the oxytocin receptor antagonist atosiban into the mPFC. These results demonstrate that enhancing oxytocin signaling in the mPFC is a potential pathway to reverse social avoidance and cognitive impairment caused by ketamine, partly through inhibition of inflammatory stimulation.
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Affiliation(s)
- Weili Zhu
- National Institute on Drug Dependence, Peking University & Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Zengbo Ding
- National Institute on Drug Dependence, Peking University & Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Zhihui Zhang
- Department of Stomatology, Peking University Third Hospital, Beijing, China
| | - Xiao Wu
- National Institute on Drug Dependence, Peking University & Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Xiaoya Liu
- Precision Medicine Research Center, School of Pharmacy, Binzhou Medical University, Yantai, China
| | - Ya Zhang
- Precision Medicine Research Center, School of Pharmacy, Binzhou Medical University, Yantai, China
| | - Suxia Li
- National Institute on Drug Dependence, Peking University & Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Liping Zhou
- Department of Pharmaceutics, School of Pharmacy, Fudan University & Key Laboratory of Smart Drug Delivery, Ministry of Education, Shanghai, China
| | - Geng Tian
- Precision Medicine Research Center, School of Pharmacy, Binzhou Medical University, Yantai, China
| | - Jing Qin
- Department of Pharmaceutics, School of Pharmacy, Fudan University & Key Laboratory of Smart Drug Delivery, Ministry of Education, Shanghai, China
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Marazziti D, Torrigiani S, Carbone MG, Mucci F, Flamini W, Ivaldi T, Osso LD. Neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte ratios in mood disorders. Curr Med Chem 2021; 29:5758-5781. [PMID: 34551689 DOI: 10.2174/0929867328666210922160116] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022]
Abstract
Major depressive disorder (MDD) and bipolar disorders (BDs), the most severe types of mood disorders (MDs), are considered as among the most disabling illnesses worldwide. Several studies suggested that inflammatory neuroinflammation might be involved in the pathophysiology of MDs, while reporting increasing data on the relationships between these processes and classical neurotransmitters, hypothalamus-pituitary-adrenal axis (HPA), and neurotrophic factors. The assessment of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and monocyte/lymphocyte ratio (MLR) in peripheral blood represents a simple method to evaluate the inflammatory status. The aim of the present paper was to review the literature on the possible relationships between NLR, PLR and MLR in MDs, and to comment on their possible wider use in clinical research. Thirty-five studies were included in the present review. The majority of them higher values of these parameters, particularly NLR values, in patients with MDs, when compared to healthy subjects. The increase would appear more robust in patients with BD during a manic episode, thus indicating that it could be considered as both state and trait markers. In addition, increased NLR and PLR levels seem to represent prognostic elements for the early discovery of post-stroke depression. The findings of the present review would indicate the need to carry our further studies in this field. In particular, NLR, PLR and MLR seem to be promising tools to detect economically and easily the activation of the inflammatory system, and to perhaps evaluate the etiology and course of MDs. Again, they could suggest some information to better understand the relationship between inflammatory and cardiovascular disease and MDs, and thus, to provide clinical implications in terms of management and treatment.
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Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa. Italy
| | - Samuele Torrigiani
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa. Italy
| | - Manuel G Carbone
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese. Italy
| | - Federico Mucci
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese. Italy
| | - Walter Flamini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa. Italy
| | - Tea Ivaldi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa. Italy
| | - Liliana Dell' Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa. Italy
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Comparative Analysis of the Kinetic Behavior of Systemic Inflammatory Markers in Patients with Depressed versus Preserved Left Ventricular Function Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2021; 10:jcm10184148. [PMID: 34575259 PMCID: PMC8467631 DOI: 10.3390/jcm10184148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/20/2021] [Accepted: 09/05/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Prior studies have proven the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with reduced left ventricular (LV) function. This study's aim was to investigate periprocedural inflammatory responses after TAVI. METHODS Patients with severe symptomatic aortic stenosis and reduced LV function who underwent transfemoral TAVI were enrolled. A paired-matched analysis (1:2 ratio) was performed using patients with preserved LV function. Whole white blood cells (WBC) and subpopulation dynamics as well as the neutrophil to lymphocyte ratio (NLR) were evaluated at different times. RESULTS A total of 156 patients were enrolled, including 52 patients with LVEF < 40% 35.00 [30.00, 39.25] and 104 with LVEF > 50% 55.00 [53.75, 60.0], p < 0.001. Baseline NLR in the reduced LV function group was significantly higher compared to the preserved LV function group, 2.85 [2.07, 4.78] vs. 3.90 [2.67, 5.26], p < 0.04. After a six-month follow-up, the inflammatory profile was found to be similar in the two groups, NLR 2.94 [2.01, 388] vs. 3.30 [2.06, 5.35], p = 0.288. No significant mortality differences between the two groups were observed in the long-term outcome. CONCLUSIONS TAVI for severe symptomatic aortic stenosis, with reduced LV function, was associated with an improvement in the inflammatory profile that may account for some of the observable benefits of the procedure in this subset of patients.
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Yang L, Gao C, Li F, Yang L, Chen J, Guo S, He Y, Guo Q. Monocyte-to-lymphocyte ratio is associated with 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study. J Intensive Care 2021; 9:49. [PMID: 34362458 PMCID: PMC8342981 DOI: 10.1186/s40560-021-00564-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/15/2021] [Indexed: 01/28/2023] Open
Abstract
Background Systemic inflammation relates to the initiation and progression of acute respiratory distress syndrome (ARDS). Neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW)/albumin ratio have been reported to be predictive prognostic biomarkers in ARDS patients. However, the role of monocyte-to-lymphocyte ratio (MLR) as a prognostic inflammatory biomarker in a variety of diseases is rarely mentioned in ARDS. In this study, we explored the relationship between MLR and disease severity in ARDS patients and compared it with other indicators associated with 28-day mortality in patients with ARDS. Methods We retrospectively included 268 patients who fulfilled the Berlin definition of ARDS and were admitted to a single institute from 2016 to 2020. Clinical characteristics and experimental test data were collected from medical records within 24 h after the ARDS diagnosis. MLR, NLR, and RDW/albumin ratio levels were calculated. The primary clinical outcome was 28-day mortality. Logistic regression analysis was used to illustrate the relationship between indicators and 28-day mortality. Receiver operating characteristic (ROC) curve was used to evaluate the area under the curve (AUC), and propensity score matching (PSM) was employed to validate our findings. Results The median MLR values were higher for non-survivors than for survivors before and after matching (P<0.001, P=0.001, respectively). MLR values were significantly associated with 28-day mortality (OR 2.956; 95% CI 1.873–4.665; P<0.001). MLR and NLR indicators were combined for predictive efficacy analysis, and its AUC reached 0.750. There was a significant increase in 28-day mortality depending on the increasing MLR level: low MLR group 38 (20.4%), high MLR group 47 (57.3%) (P<0.001). Conclusions Higher MLR values were associated with 28-day mortality in patients with ARDS. Further investigation is required to verify this relationship with prospectively collected data. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00564-6.
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Affiliation(s)
- Lijuan Yang
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chang Gao
- Department of Critical Care Medicine, Suzhou Dushuhu Public Hospital (Dushuhu Public Hospital Affiliated to Soochow University, Medical Center of Soochow University), Suzhou, Jiangsu, China
| | - Fengyuan Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ling Yang
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jiahao Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shiqi Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ying He
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qiang Guo
- Pneumology Department, Department of Emergency, Department of Critical Care Medicine, Suzhou Dushuhu Public Hospital (Dushuhu Public Hospital Affiliated to Soochow University, Medical Center of Soochow University), The First Affiliated Hospital of Soochow University, No.9 Chongwen Road, Suzhou Industrial Park, Suzhou, Jiangsu, China.
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Altas OF, Kizilkaya M. The Effects of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Prognostic Markers in Determining the Mortality in Patients Diagnosed With Pneumonia in Intensive Care. Medeni Med J 2021; 36:130-137. [PMID: 34239765 PMCID: PMC8226410 DOI: 10.5222/mmj.2021.64160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/29/2021] [Indexed: 11/22/2022] Open
Abstract
Objective In this study, we aimed to reveal the level of predicting mortality of the Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratios (TLR) calculated in patients hospitalized with the diagnosis of pneumonia in the intensive care unit when compared with other prognostic scores. Method The hospital records of 112 patients who were admitted to the intensive care unit between January 2015 and January 2018 and met the inclusion criteria were retrospectively reviewed. The patients’ demographic data, the NLR and PLR levels, and the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores were calculated from the patient files. Results Of the 112 patients examined, 70 were males. The risk analysis showed that the male gender had 2.7 times higher risk of mortality. The NLR, PLR, APACHE II, and SOFA values were found statistically significant in predicting mortality (p<0.001). An evaluation of the risk ratios demonstrated that each one point increase in the NLR increased the mortality risk by 5%, and each one point increase in the SOFA score increased the mortality risk by 13% (p<0.05). In the ROC (receiver operating characteristic) analysis, the NLR assessment proved to be the most powerful, most specific, and sensitive test. The cut-off values were 11.3 for the NLR, 227 for the PLR, 29.8 for the APACHE II scores, and 5.5 for the SOFA scores Conclusion We believe that NLR and PLR are strong and independent predictors of mortality that can be easily and cost-effectively tested.
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Affiliation(s)
- Omer Faruk Altas
- Izmir Bakircay University Cigli Training and Research Hospital, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Mehmet Kizilkaya
- Amasya University Sabuncuoğlu Serafettin Training and Research Hospital, Department of Anesthesiology and Reanimation, Amasya, Turkey
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Crispino F, Grova M, Maida M, Renna S, Mocciaro F, Casà A, Rizzuto G, Tesè L, Scimeca D, Di Mitri R, Macaluso FS, Orlando A. Blood-based prognostic biomarkers in Crohn's Disease patients on biologics: a promising tool to predict endoscopic outcomes. Expert Opin Biol Ther 2021; 21:1133-1141. [PMID: 34042009 DOI: 10.1080/14712598.2021.1935857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE There is a growing need for biomarkers to predict therapeutic outcome in Crohn's disease (CD). MAIN OUTCOME MEASURES The aim was to evaluate whether NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), ELR (eosinophil-to-lymphocyte ratio), and ENLR (eosinophil*neutrophil-to-lymphocyte ratio), could be prognostic biomarkers of endoscopic response (ER) when starting biologics. RESEARCH DESIGN AND METHODS Patients with CD who started biologics were enrolled. Multivariate analysis was used to evaluate whether NLR, PLR, ELR and ENLR at baseline and at w12 could predict ER (Simple Endoscopic Score for Crohn's disease [SES-CD] ≤2 or SES-CD≤2 and Rutgeerts i0-i1) after 52 weeks of treatment. Area under the curve (AUC) was calculated to find the cutoffs. RESULTS 107 patients were included. Patients who achieved ER had significantly lower baseline NLR (p = 0.025), ELR (p = 0.013), and ENLR (p = 0.020) compared with those without ER; results after 12 weeks of treatment for ELR (p = 0.006) and ENLR (p = 0.003). AUC was 0.64 (p = 0.003), 0.67 (p = 0.006) and 0.65 (p = 0.014) for NLR, ELR and ENLR. CONCLUSIONS Low NLR, ELR and ENLR can predict ER and could be used in clinical practice for a better management of CD patients.
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Affiliation(s)
- Federica Crispino
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology & Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Italy.,Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Mauro Grova
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology & Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Italy.,Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Marcello Maida
- Section of Gastroenterology, "S.Elia-Raimondi" Hospital, Caltanissetta, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo,Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Lorenzo Tesè
- Radiology Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo,Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo,Italy
| | | | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
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Nery AF, de Camargo ZP, Rodrigues AM, Portela TF, Hoffmann-Santos HD, Dambros PVK, de Souza JFR, Garcia AC, Santos CAD, Hagen F, Hahn RC. Paracoccidioidomycosis due to P lutzii: The importance of neutrophil/lymphocyte ratio in the symptomatic and asymptomatic phases in severe cases. Mycoses 2021; 64:874-881. [PMID: 33829534 DOI: 10.1111/myc.13282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND PCM is a neglected systemic mycosis endemic in Brazil. The middle-west region of Brazil has shown the highest number of PCM by Paracoccidioides lutzii (P lutzii) cases. Differentiating cases of severe PCM from non-severe ones should be a concern at the bedside. Diagnosis of severe PCM by P lutzii is based on the subjectivity of clinical manifestations, which can result in a delay in starting its treatment and, consequently evolution to severe sequelae. There is not laboratory biomarker available to support the early diagnosis of severe PCM that is feasible for all the realities that coexist in Brazil. OBJECTIVES The aim of this study was to investigate the usefulness of laboratory biomarkers as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the diagnosis of severe PCM. PATIENTS/METHODS ESR, CRP and NLR were analysed for 44 patients with PCM by P lutzii and a Receiver Operation Characteristic (ROC) curve were generated to identify the NLR cut-off point and point out the presence of severe PCM. RESULTS Sixteen (36.4%) had severe PCM and 28 (63.6%) had non-severe PCM. The mean NLR was higher and statistically significant among patients with severe PCM than among those with non-severe PCM. The area under the ROC curve was 0.859 for the diagnosis of severe PCM. The cut-off point for NLR for the diagnosis of severe PCM was 3.318 (sensitivity of 100%, specificity of 77%). CONCLUSIONS According to results, it is plausible to conclude that NLR represents a potential biomarker for the diagnosis of severe PCM.
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Affiliation(s)
- Andreia Ferreira Nery
- Internal Medicine Department, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, MT, Brazil.,Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, MT, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, SP, Brazil.,Discipline of Infectious Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, SP, Brazil.,Discipline of Infectious Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.,Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Rosane Christine Hahn
- Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, MT, Brazil.,Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, MT, Brazil
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Shimoyama Y, Kadono N, Umegaki O, Minami T. Urinary neutrophil gelatinase-associated lipocalin was a predictor from the day after intensive care unit entry, but not on the day of intensive care unit entry. Clin Chim Acta 2021; 517:117-121. [PMID: 33667482 DOI: 10.1016/j.cca.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Sepsis is the main cause of death from infection. This study aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL) values better predict mortality in septic patients when combined with inflammation-based prognostic scores. MATERIAL AND METHODS Forty-four adult patients diagnosed according to the Sepsis-3 definition and who were admitted to the ICU were prospectively examined from June 2018 to November 2018. Urine samples were collected from each patient with a urethral balloon bag to measure NGAL after ICU entry at the following time points: immediately after and 2, 3, and 4 days after ICU entry. The Glasgow Prognostic Score, the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio, the Prognostic Nutritional Index, the Prognostic Index (PI), the Sequential Organ Failure Assessment (SOFA), and quick SOFA were examined immediately after ICU entry. Predictors of mortality were assessed by receiver operating characteristics curve (ROC) analysis, log-rank test, and multivariate logistic regression analysis. RESULTS NGAL on day 4 (AUC: 0.94) and ΔNGAL from day 4 to day 1 (AUC: 0.9) for 28-day mortality; NGAL on day 4 (AUC: 0.94) and inflammation-NGAL score (iNS) NGAL-PI (AUC: 0.69) for 60-day mortality; ΔNGAL from day 3 to day 1 (AUC: 0.82) for 90-day mortality; and iNS NGAL-NLR (AUC: 0.71) and iNS NGAL-PI (AUC: 0.68) for in-hospital mortality were found to be predictors of mortality by ROC curve analysis. NLR (p = 0.02) for 28-day mortality; NGAL on day 2 (p = 0.031), ΔNGAL from day 2 to day 1 (p = 0.013), and NLR (p < 0.0001) for 60-day mortality; NGAL on day 2 (p = 0.017), ΔNGAL from day 2 to day 1 (p = 0.014), and NLR (p = 0.033) for 90-day mortality; and NGAL on day 2 (p = 0.007) for in-hospital mortality were found to be predictors of mortality by log-rank test. iNS NGAL-NLR (OR, 0.024; p = 0.019) for 60-day mortality and NGAL from day 3 to day 1 (OR, 1.005; p = 0.013) for 90-day mortality were found to be predictors of mortality by multivariate logistic regression analysis. CONCLUSIONS NGAL and ΔNGAL were predictors of mortality in sepsis patients on day 2 after ICU entry and thereafter, but not on day 1.
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Affiliation(s)
- Yuichiro Shimoyama
- Department of Anesthesiology, Osaka Medical College, Intensive Care Unit, Osaka Medical College Hospital, Takatsuki, Osaka 569-8686, Japan.
| | - Noriko Kadono
- Department of Anesthesiology, Osaka Medical College, Intensive Care Unit, Osaka Medical College Hospital, Takatsuki, Osaka 569-8686, Japan
| | - Osamu Umegaki
- Department of Anesthesiology, Osaka Medical College, Intensive Care Unit, Osaka Medical College Hospital, Takatsuki, Osaka 569-8686, Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Osaka Medical College Hospital, Takatsuki, Osaka 569-8686, Japan
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Junare PR, Debnath P, Nair S, Chandnani S, Udgirkar S, Thange R, Jain S, Deshmukh R, Debnath P, Rathi P, Contractor Q, Deshpande A. Complete hemogram: simple and cost-effective in staging and predicting outcome in acute pancreatitis. Wien Klin Wochenschr 2021; 133:661-668. [PMID: 33620577 DOI: 10.1007/s00508-021-01821-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND An important goal in management of acute pancreatitis (AP) is early prediction and recognition of disease severity. Various predictive scoring systems are in clinical use with their own limitations and there is always a quest for simple, practical, quantifiable, dynamic and readily available markers for predicting disease severity and outcome. Complete hemogram is routinely ordered in all patients with AP. In recent years red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and platelet lymphocyte ratio (PLR) have been found to be independent predictors of prognosis in various benign and malignant conditions. This prospective study evaluated complete hemogram based markers in AP. MATERIAL AND METHODS Complete hemogram analysis was done and NLR, LMR, PLR values were calculated. Development of organ failure, the need for intensive care unit (ICU) admission and interventions, development of complications (local/systemic) and 100-day mortality were assessed. RESULTS In this study 160 subjects of AP were included. Complete hemogram analysis was performed within 24 h after admission. C‑reactive protein, RDW, NLR, PLR and bedside index of severity in acute pancreatitis (BISAP) values were higher in severe AP than moderate AP group than mild AP group, while LMR values were decreased in the corresponding severe, moderate and mild AP groups (p < 0.001). The NLR performed best for prediction of ICU admission, organ failure, interventions and mortality with area under receiver operating curve (AUROC) were 0.943, 0.940, 0.902 and 0.910, respectively. CONCLUSION Hemogram based markers are simple, objective, dynamic and readily available. They can be considered in addition to conventional multifactorial scoring systems for prediction of outcome and prognosis of AP.
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Affiliation(s)
- Parmeshwar Ramesh Junare
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India.
| | - Prasanta Debnath
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Sujit Nair
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Suhas Udgirkar
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Ravi Thange
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Rahul Deshmukh
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Partha Debnath
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Qais Contractor
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room number 202, New RMO Building, Mumbai, India
| | - Akshay Deshpande
- Department of Surgery, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
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Association between neutrophil-lymphocyte ratio change during living donor liver transplantation and graft survival. Sci Rep 2021; 11:4199. [PMID: 33603124 PMCID: PMC7892541 DOI: 10.1038/s41598-021-83814-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 11/08/2022] Open
Abstract
Preoperative neutrophil-lymphocyte ratio (NLR), has shown a predictive value in living donor liver transplantation (LDLT). However, the change in the NLR during LDLT has not been fully investigated. We aimed to compare graft survival between the NLR increase and decrease during LDLT. From June 1997 to April 2019, we identified 1292 adult LDLT recipients with intraoperative NLR change. The recipients were divided according to NLR change: 103 (8.0%) in the decrease group and 1189 (92.0%) in the increase group. The primary outcome was graft failure in the first year. In addition, variables associated with NLR change during LDLT were evaluated. During 1-year follow-up, graft failure was significantly higher in the decrease group (22.3% vs. 9.1%; hazard ratio 1.87; 95% confidence interval 1.10-3.18; p = 0.02), but postoperative complications did not differ between two groups. This finding was consistent for the overall follow-up. Variables associated with NLR decrease included preoperative NLR > 4, model for end-stage liver disease score, intraoperative inotropic infusion and red blood cell transfusion, and operative duration. The least absolute shrinkage and selection operator model yielded similar results. NLR decrease during LDLT appeared to be independently associated with graft survival. Further studies are needed to confirm our findings.
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NLR and CRP to albumin ratio as a predictor of in-hospital mortality in the geriatric ED patients. Am J Emerg Med 2021; 44:50-55. [PMID: 33578332 DOI: 10.1016/j.ajem.2021.01.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION We aimed to investigate the role of neutrophil to lymphocyte ratio (NLR) and the C-Reactive Protein/Albumin Ratio (CAR), which are obtained from the first laboratory values of the elderly patients at admission to the emergency department (ED), in predicting in-hospital mortality. METHODS This retrospective observational study includes the patients aged 65 and above who applied to the emergency department for two months. The patients' neutrophil, lymphocyte, C-reactive protein (CRP), albumin, NLR and CAR values were recorded. Statistical analysis of NLR and CAR values was performed according to in-hospital mortality and ED outcome. RESULTS 784 patients were included in the statistical analysis of the study. Increased NLR (8.82 (4.16-16.63), 4.76 (2.62-8.56), p˂0.001) and increased CAR (21.39 (6.02-55.07), 4.82 (1.17-17.03), p < 0.001) values were found to be statistically significant in the group with mortality compared to the group without mortality. Increased NLR (AUC: 0.642) and increased CAR (AUC: 0.723) were a predictor of in-hospital mortality. It was found that in-hospital mortality risk in patients with concurrent high NLR and CAR values (CAR˃12.3, NLR˃7.1) was 9.87 times more than the patients with concurrent low NLR and CAR values (CAR<12.3, NLR < 7.1). NLR and CAR values of the patients hospitalized in intensive care and service (NLR 7.21 (4.07-13.36), 5.77 (3.45-11.22); CAR 12.65 (2.79-36.8), 9.56 (1.74-33.97)) were found to be statistically significantly higher than those who were discharged (NLR 3.64 (2.26-7.02); CAR 2.88 (0.9-10.59)). CONCLUSION According to our results, the concurrent high levels of NLR and CAR values were found to be more effective in predicting in-hospital mortality compared to a separate evaluation.
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Zhu C, Liu Y, Kang W, Zhang Z, Zeng Z, Liu D. Exploration of the role of serum ghrelin in the diagnosis and treatment of digestive tract malignancies. J Int Med Res 2021; 48:300060520920441. [PMID: 32366148 PMCID: PMC7221476 DOI: 10.1177/0300060520920441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective The incidence of digestive tract malignancies (DTMs) is increasing, early
diagnosis is limited, and treatment effects are unsatisfactory. DTMs express
ghrelin, which might be involved in tumor formation and development; whether
serum ghrelin can provide useful guidance remains unknown. Methods Sera of healthy individuals were obtained from October 2017 through March
2018; serum samples from patients with gastric (GC), colon (CC), and rectal
(RC) cancers were collected during the same period. Serum ghrelin was tested
by ELISA and correlated with clinicopathology of patients with DTMs. Results Serum ghrelin was higher in patients (GC, 38 patients; CC, 24; RC, 26) than
in 69 healthy individuals and decreased significantly after tumor resection.
Nutrition Risk Screening 2002 score and neutrophil:lymphocyte ratio affected
perioperative serum ghrelin levels. The epithelial cell marker AE1/AE3 (pan
keratin) in patients with GC, tumor location in the colon in patients with
CC, and age in patients with RC also affected perioperative serum
ghrelin. Conclusions Serum ghrelin might provide early warning of occurrence and guide prognosis
of DTMs. Ghrelin can be used when screening for nutritional risk and
inflammation. The clinicopathological influence on serum ghrelin in patients
with DTMs is related to tumor location in the digestive tract.
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Affiliation(s)
- Changzhen Zhu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuqin Liu
- Department of Pathology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zimu Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ziyang Zeng
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dong Liu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Abstract
OBJECTIVES Acute pancreatitis (AP) is an inflammatory disease of the pancreas. We analyzed changes in inflammation markers to explore the clinical significance of using these markers to predict the severity of AP. METHODS The study included 169 patients (severe AP = 50 and nonsevere AP = 119) admitted to Yanbian University Hospital between January 2015 and July 2017. The neutrophil-to-lymphocyte ratio (NLR), prognostic nutrition index (PNI), lymphocyte-to-monocyte ratio, red blood cell distribution width coefficient of variation, mean platelet volume, platelet-to-lymphocyte ratio, and red blood cell distribution width-to-platelet ratio of the patients were detected after admission. Correlations between AP severity and various inflammatory markers were statistically analyzed. RESULTS The results indicated that the NLR on the first day after admission (area under the curve, 0.824; 95% confidence interval, 0.753-0.896) and the PNI on the third day after admission (area under the curve, 0.814; 95% confidence interval, 0.753-0.896) had more significance than other inflammation markers in predicting the severity of AP. In AP patients, the NLR showed a gradual decline, and the PNI initially decreased and then increased. CONCLUSIONS The NLR and PNI can provide new reference values for predicting the severity of AP.
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Affiliation(s)
- Guangzhe Pian
- From the Department of General Surgery, Yanbian University Hospital, Yanji, Jilin
| | - Hao Li
- From the Department of General Surgery, Yanbian University Hospital, Yanji, Jilin
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Simadibrata DM, Calvin J, Wijaya AD, Ibrahim NAA. Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis. Am J Emerg Med 2021; 42:60-69. [PMID: 33453617 PMCID: PMC7832118 DOI: 10.1016/j.ajem.2021.01.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/13/2020] [Accepted: 01/02/2021] [Indexed: 12/25/2022] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, was suggested to be predictive of severity and mortality in COVID-19 patients. Here, we investigated whether NLR levels on admission could predict the severity and mortality of COVID-19 patients. Methods A literature search was conducted on 23 July 2020 to retrieve all published articles, including grey literature and preprints, investigating the association between on-admission NLR values and severity or mortality in COVID-19 patients. A meta-analysis was performed to determine the overall standardized mean difference (SMD) in NLR values and the pooled risk ratio (RR) for severity and mortality with the 95% Confidence Interval (95%CI). Results A total of 38 articles, including 5699 patients with severity outcomes and 6033 patients with mortality outcomes, were included. The meta-analysis showed that severe and non-survivors of COVID-19 had higher on-admission NLR levels than non-severe and survivors (SMD 0.88; 95%CI 0.72–1.04; I2 = 75.52% and 1.87; 95%CI 1.25–2.49; I2 = 97.81%, respectively). Regardless of the different NLR cut-off values, the pooled mortality RR in patients with elevated vs. normal NLR levels was 2.74 (95%CI 0.98–7.66). Conclusion High NLR levels on admission were associated with severe COVID-19 and mortality. Further studies need to focus on determining the optimal cut-off value for NLR before clinical use.
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Affiliation(s)
| | - Julius Calvin
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Cifci M, Halhalli HC. The Relationship Between Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios With Hospital Stays and Mortality in the Emergency Department. Cureus 2020; 12:e12179. [PMID: 33489590 PMCID: PMC7816547 DOI: 10.7759/cureus.12179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Most acute pancreatitis scoring is made in the first 48-72 hours or later. Like many inflammatory processes, Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) can be useful in showing the severity and extent of inflammation in acute pancreatitis. Our study aimed to evaluate whether these rates affect mortality according to the NLR and PLR values of patients diagnosed with acute pancreatitis by examining the blood samples taken within the first hour after admission to the emergency department rates are useful in predicting the length of stay. Methods In our retrospective study, 557 patients applied to our clinic for 4.5 years, whose amylase and lipase values were higher than two times the cut-off value in blood tests and whose CT imaging was compatible with acute pancreatitis were included in the study. Results The median length of hospitalization of the patients was 4.0 (3.0-6.0) days. Gallstones were detected in 320 (57.5%) patients. Mortality of less than a year was observed in 45 (8.1%) of the study population. Eighteen of the patients (3.2%) showed the need for follow-up in the intensive care unit. A statistically significant relationship was found between mortality and variables hematocrit (HCT), red cell distribution width (RDW),c-reactive protein CRP), glucose, urea, potassium, albumin, PLR, and NLR (p <0.05). A statistically significant correlation was observed between RDW, NLR, glucose, and CRP levels in the two groups divided according to the median value of 4 days we found on hospitalization (p <0.05). According to the graphics and test results obtained by ROC analysis, the mortality status can be predicted at a statistically significant level with PLR and NLR diagnostic tests (p <0.05). Conclusion High levels of NLR, PLR, RDW, glucose, CRP, urea, potassium, low albumin and hematocrit values at the first admission in the Emergency Service seem to be associated with increased 1-year mortality in acute pancreatitis.
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Affiliation(s)
- Mustafa Cifci
- Emergency Medicine, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, TUR
| | - Huseyin C Halhalli
- Emergency Medicine, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, TUR
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