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Suwadi A, Tandarto K, Laksono S. Systemic immune-inflammation index as a potential biomarker for predicting acute pulmonary embolism: A systematic review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:231-240. [PMID: 38595041 DOI: 10.2478/rjim-2024-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 04/11/2024]
Abstract
BACKGROUND Acute pulmonary embolism (APE) is a life-threatening condition with a high mortality rate. The pathophysiology involves various complex processes. The systemic immune-inflammatory index (SII) is a well-known biomarker that reflects the intricate balance between pro-inflammatory and anti-inflammatory immune components. In this systematic review, we aim to determine the significance of SII as a potential biomarker for APE. METHOD We utilized PubMed, ProQuest, EBSCOHost, and Google Scholar to search for articles. We assessed bias risk using the Newcastle Ottawa Scale (NOS). The outcomes we examined included in-hospital and long-term mortality, the severity of APE, and the sensitivity and specificity of the SII in predicting APE. RESULTS Four studies, involving 2,038 patients, were included for analysis. These studies discuss the use of SII in predicting APE severity, APE mortality, high-risk APE, and the occurrence of APE. SII demonstrates significant results in predicting each of these variables. Furthermore, each study establishes different SII cut-off values. Specifically, a cut-off of 1161 predicts massive APE events with a sensitivity of 91% and a specificity of 90%. A cut-off of >1235.35 differentiates high-risk APE with a sensitivity of 87.32% and a specificity of 68.85%. A cut-off of >1111x109 predicts overall mortality with a sensitivity of 72% and a specificity of 51%. Finally, a cut-off at 1839.91 predicts APE events with a sensitivity of 75.8% and a specificity of 61.9%. CONCLUSION The SII can be employed as a potential new biomarker to predict outcomes in APE patients, particularly the occurrence, severity, and mortality of APE.
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Affiliation(s)
- Andrew Suwadi
- 1Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Kevin Tandarto
- 1Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Sidhi Laksono
- 2Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Muhammadiyah Prof. Dr. Hamka, Tangerang, Indonesia
- 3Department of Cardiology and Vascular Medicine, Pusat Pertamina Hospital, South Jakarta, Indonesia
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Siddiqui F, Tafur A, Hussain M, García-Ortega A, Darki A, Fareed J, Jiménez D, Bikdeli B, Galeano-Valle F, Fernández-Reyes JL, Pérez-Pinar M, Monreal M. The prognostic value of blood cellular indices in pulmonary embolism. Am J Hematol 2024; 99:1704-1711. [PMID: 38816957 DOI: 10.1002/ajh.27379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/08/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024]
Abstract
Prognostication in acute pulmonary embolism (PE) requires reliable markers. While cellular indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) appear promising, their utility in PE prognostication needs further exploration. We utilized data from the RIETE registry and the Loyola University Medical Center (LUMC) to assess the prognostic value of NLR, PLR, and SII in acute PE, using logistic regression models. The primary outcome was 30-day all-cause mortality. We compared their prognostic value versus the simplified Pulmonary Embolism Severity Index (sPESI) alone. We included 10 085 patients from RIETE and 700 from the LUMC. Thirty-day mortality rates were 4.6% and 8.3%, respectively. On multivariable analysis, an elevated NLR (>7.0) was associated with increased mortality (adjusted odds ratio [aOR]: 3.46; 95% CI: 2.60-4.60), outperforming the PLR > 220 (aOR: 2.36; 95% CI: 1.77-3.13), and SII > 1600 (aOR: 2.52; 95% CI: 1.90-3.33). The c-statistic for NLR in patients with low-risk PE was 0.78 (95% CI: 0.69-0.86). Respective numbers were 0.66 (95% CI: 0.63-0.69) and 0.68 (95% CI: 0.59-0.76) for intermediate-risk and high-risk patients. These findings were mirrored in the LUMC cohort. Among 9810 normotensive patients in RIETE, those scoring 0 points in sPESI and with an NLR ≤ 7.0 (35% of the population) displayed superior sensitivity (97.1%; 95% CI: 95.5-98.7) and negative predictive value (99.7%; 95% CI: 99.5-99.8) than sPESI alone (87.1%; 95% CI: 83.9-90.3, and 98.7%; 95% CI: 98.4-99.1, respectively) for 30-day mortality. The NLR is a significant prognostic marker for 30-day mortality in PE patients, especially useful to identify patients with very low-risk PE.
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Affiliation(s)
- Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, Illinois, USA
- Program in Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Alfonso Tafur
- Department of Medicine and Vascular Medicine, Evanston NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Mushtaq Hussain
- Dow College of Biotechnology, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Amir Darki
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, Illinois, USA
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal and Universidad de Alcalá (IRYCIS), CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, USA
- Cardiovascular Research Foundation (CRF), New York, New York, USA
| | - Francisco Galeano-Valle
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Manuel Monreal
- Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Li R, Shen S, Jiang J, Liu Y. Prognostic Value of Neutrophil/Lymphocyte Ratio for Pulmonary Embolism: A Meta-Analysis and External Validation. Ann Vasc Surg 2024; 105:48-59. [PMID: 38582200 DOI: 10.1016/j.avsg.2024.01.019] [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: 11/06/2023] [Revised: 12/26/2023] [Accepted: 01/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Prognostic value of neutrophil/lymphocyte ratio (NLR) for pulmonary embolism (PE) has been reported in several retrospective studies. The purpose of this investigation was to perform a pooled analysis and external validation of predictive value of NLR. METHODS PubMed, Embase, and Cochrane databases were searched from inception to November 5, 2022. A random effects model was used. Grade was used to evaluate the certainty of evidence. External validation was conducted in clinical cohorts before and after a propensity scoring matching (PSM). Covariates include basic clinical characteristics, such as age, gender, etc. The value of NLR in prediction model was also evaluated. RESULTS A total of 15 studies comprising 5,874 patients were included. Pooled risk ratio of NLR was 2.33 (95% confidence interval [CI]: 1.97-2.75), with an area under the curve of 0.78 (95% CI: 0.74-0.81), a sensitivity of 0.75 (95% CI: 0.71-0.79), a specificity of 0.67 (95% CI: 0.61-0.73), and a median cut-off value of 5.7. Grade of Recommendations Assessment Development and Evaluation (GRADE) certainty analysis showed the quality of the evidence was moderate. Before (n = 336) and after (n = 152) propensity scoring matching, risk ratio of NLR was 2.69 (95% CI: 1.04-6.97) and 6.58 (95% CI: 1.99-17.75). A prediction model consisting of NLR, age, D-dimer, and simplified PE severity index had an area under the curve of 0.809 (95% CI: 0.738-0.88), a sensitivity of 0.638 (95% CI: 0.511-0.745), and a specificity of 0.851 (95% CI: 0.709-0.917). Net reclassification index (12%, P = 0.035) and integrated discrimination improvement (17%, P = 0.022) indicated an improvement caused by NLR. CONCLUSIONS Prognostic value of NLR for PE was confirmed by meta-analysis and validated in an independent cohort, deserving further clinical application.
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Affiliation(s)
- Ruihua Li
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shuohao Shen
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jianjun Jiang
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Yang Liu
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Jiang C, Lin J, Xie B, Peng M, Dai Z, Mai S, Chen Q. Causal association between circulating blood cell traits and pulmonary embolism: a mendelian randomization study. Thromb J 2024; 22:49. [PMID: 38863024 PMCID: PMC11167760 DOI: 10.1186/s12959-024-00618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is a life-threatening thromboembolic disease for which there is limited evidence for effective prevention and treatment. Our goal was to determine whether genetically predicted circulating blood cell traits could influence the incidence of PE. METHODS Using single variable Mendelian randomization (SVMR) and multivariate Mendelian randomization (MVMR) analyses, we identified genetic associations between circulating blood cell counts and lymphocyte subsets and PE. GWAS blood cell characterization summary statistics were compiled from the Blood Cell Consortium. The lymphocyte subpopulation counts were extracted from summary GWAS statistics for samples from 3757 individuals that had been analyzed by flow cytometry. GWAS data related to PE were obtained from the FinnGen study. RESULTS According to the SVMR and reverse MR, increased levels of circulating white blood cells (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.81-0.95, p = 0.0079), lymphocytes (OR: 0.90, 95% CI: 0.84-0.97, p = 0.0115), and neutrophils (OR: 0.88, 95% CI: 0.81-0.96, p = 0.0108) were causally associated with PE susceptibility. MVMR analysis revealed that lower circulating lymphocyte counts (OR: 0.84, 95% CI: 0.75-0.94, p = 0.0139) were an independent predictor of PE. According to further MR results, this association may be primarily related to HLA-DR+ natural killer (NK) cells. CONCLUSIONS Among European populations, there is a causal association between genetically predicted low circulating lymphocyte counts, particularly low HLA-DR+ NK cells, and an increased risk of PE. This finding supports observational studies that link peripheral blood cells to PE and provides recommendations for predicting and preventing this condition.
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Affiliation(s)
- Chen Jiang
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jianing Lin
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Bin Xie
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Meijuan Peng
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Ziyu Dai
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Suyin Mai
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Qiong Chen
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Piech P, Haratym M, Borowski B, Węgłowski R, Staśkiewicz G. Beyond the fractures: A comprehensive Comparative analysis of Affordable and Accessible laboratory parameters and their coefficients for prediction and Swift confirmation of pulmonary embolism in high-risk orthopedic patients. Pract Lab Med 2024; 40:e00397. [PMID: 38737854 PMCID: PMC11088337 DOI: 10.1016/j.plabm.2024.e00397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Abstract
Background Pulmonary embolism (PE) poses a significant challenge in diagnosis and treatment, particularly in high-risk patient populations such as those hospitalized for orthopedic reasons. This study explores the predictive and diagnostic potential of laboratory parameters in identifying PE among orthopedic patients. Objectives The purpose of this study was to determine whether selected (inexpensive and readily available) laboratory parameters and their coefficients can be used to diagnose pulmonary embolism and whether they are applicable in predicting its occurrence. Material and methods Selected laboratory parameters were determined twice in 276 hospitalized orthopedic patients with suspected PE: PLT, MPV, NEU, LYM, D-dimer, troponin I, age-adjusted D-dimer and their coefficients. Depending on the angio-CT results, patients were divided into groups. Selected popular laboratory coefficients were calculated and statistically analyzed. Optimal cutoff points were determined for the above laboratory tests and ROC curves were plotted. Results D-dimer/troponin I [p = 0.008], D-dimer [p = 0.001], age-adjusted D-dimer [p = 0.007], NLR/D-dimer [p = 0.005] and PLR [p = 0.021] are statistically significant predictors of PE. D-dimer/troponin I [p < 0.001], troponin I [p = 0.005] and age-adjusted D-dimer [p = 0.001] correlated with the diagnosis of PE after the onset of clinical symptoms. Conclusions In the context of orthopedic patients, cost-effective laboratory parameters, particularly the D-dimer/troponin I ratio and age-adjusted D-dimer, exhibit considerable potential in predicting and diagnosing PE. These findings suggest that combining readily available laboratory tests with clinical observation can offer a viable and cost-effective diagnostic alternative, especially in resource-constrained settings. Further studies with larger and diverse patient populations are recommended to validate these results.
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Affiliation(s)
- Piotr Piech
- Department of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
- Department of Orthopedics and Traumatology, Medical University of Lublin, Poland
| | - Mateusz Haratym
- Research Group of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
| | - Bartosz Borowski
- Research Group of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
| | - Robert Węgłowski
- Department of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
| | - Grzegorz Staśkiewicz
- Department of Normal, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
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Pay L, Çetin T, Keskin K, Dereli Ş, Tezen O, Yumurtaş AÇ, Kolak Z, Eren S, Şaylık F, Çınar T, Hayıroğlu Mİ. Evaluation of Naples prognostic score to predict long-term mortality in patients with pulmonary embolism. Biomark Med 2024; 18:253-263. [PMID: 38487977 PMCID: PMC11216614 DOI: 10.2217/bmm-2023-0741] [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: 11/20/2023] [Accepted: 02/20/2024] [Indexed: 06/26/2024] Open
Abstract
Background: The Naples prognostic score (NPS), which reflects the inflammatory and nutritional status of patients, is often used to determine prognosis in cancer patients. The aim of this study was to determine the long-term prognostic value of the NPS in acute pulmonary embolism (APE) patients. Methods: Two hundred thirty-nine patients diagnosed with APE were divided into two groups according to their NPS, and long-term mortality was compared. Results: The long-term mortality was observed in 38 patients out of 293 patients in the mean follow-up of 24 months. Multivariate analysis showed that NPS as a categorical parameter and NPS as a numeric parameter were independent predictors of long-term mortality. Conclusion: This study highlights that NPS may have the potential to predict long-term mortality in APE patients.
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Affiliation(s)
- Levent Pay
- Department of Cardiology, Ardahan State Hospital, Ardahan, 75000, Turkey
| | - Tuğba Çetin
- Department of Cardiology, Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training Hospital, Istanbul, 34668, Turkey
| | - Kıvanç Keskin
- Department of Cardiology, Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training Hospital, Istanbul, 34668, Turkey
| | - Şeyda Dereli
- Department of Cardiology, Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training Hospital, Istanbul, 34668, Turkey
| | - Ozan Tezen
- Department of Cardiology, Bayrampasa State Hospital, Istanbul, 34040, Turkey
| | - Ahmet Ç Yumurtaş
- Department of Cardiology, Kars Harakani State Hospital, Kars, 36200, Turkey
| | - Zeynep Kolak
- Department of Cardiology, Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training Hospital, Istanbul, 34668, Turkey
| | - Semih Eren
- Department of Cardiology, Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training Hospital, Istanbul, 34668, Turkey
| | - Faysal Şaylık
- Department of Cardiology, Van Education & Research Hospital, Van, 65300, Turkey
| | - Tufan Çınar
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD 21201, USA
| | - Mert İ Hayıroğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training Hospital, Istanbul, 34668, Turkey
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Uslu MF, Yilmaz M, Ateşçelik M, Atilgan FA. The utility of the systemic immune inflammation and systemic inflammation response indices in suspected intermediate-risk pulmonary embolism. Croat Med J 2024; 65:13-19. [PMID: 38433508 PMCID: PMC10915762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/05/2024] [Indexed: 03/05/2024] Open
Abstract
AIM To evaluate the utility of the systemic immune inflammation index (SII) and systemic inflammation response index (SIRI) in diagnosing pulmonary embolism (PE) in emergency medicine. METHODS We retrospectively reviewed the data of patients who presented to the emergency department and underwent contrast-enhanced computed tomography pulmonary angiography for suspected PE between January 1 and December 31, 2021. In 81/168 patients, the diagnosis of PE was confirmed and in 87/168 it was rejected. The data were analyzed with receiver operating characteristic analysis and binary logistic regression analysis. RESULTS Patients with PE had a higher white blood cell count (P<0.001), neutrophils (P=0.002), monocytes (P=0.013), neutrophil/lymphocyte ratio (P<0.001), SII (P<0.001), and SIRI (P<0.001), and a lower lymphocyte count (P=0.002). The SII had a sensitivity of 75.31% and a specificity of 71.26%, while the SIRI had a sensitivity of 82.72% and a specificity of 68.97%. Binary logistic regression analysis showed that the Wells score, D-dimer level, and SII independently influenced the diagnosis of PE. CONCLUSION The SII and SIRI may be used to support the diagnosis of PE in the emergency department.
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Affiliation(s)
- Muhammed Fuad Uslu
- Muhammed Fuad Uslu, Department of Internal Medicine, Elazig City Hospital, 23100-Elazig, Turkey,
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Teodoru M, Negrea MO, Cozgarea A, Cozma D, Boicean A. Enhancing Pulmonary Embolism Mortality Risk Stratification Using Machine Learning: The Role of the Neutrophil-to-Lymphocyte Ratio. J Clin Med 2024; 13:1191. [PMID: 38592029 PMCID: PMC10931603 DOI: 10.3390/jcm13051191] [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: 12/21/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Acute pulmonary embolism (PE) is a significant public health concern that requires efficient risk estimation to optimize patient care and resource allocation. The purpose of this retrospective study was to show the correlation of NLR (neutrophil-to-lymphocyte ratio) and PESI (pulmonary embolism severity index)/sPESI (simplified PESI) in determining the risk of in-hospital mortality in patients with pulmonary thromboembolism. (2) Methods: A total of 160 patients admitted at the County Clinical Emergency Hospital of Sibiu from 2019 to 2022 were included and their hospital records were analyzed. (3) Results: Elevated NLR values were significantly correlated with increased in-hospital mortality. Furthermore, elevated NLR was associated with PESI and sPESI scores and their categories, as well as the individual components of these parameters, namely increasing age, hypotension, hypoxemia, and altered mental status. We leveraged the advantages of machine learning algorithms to integrate elevated NLR into PE risk stratification. Utilizing two-step cluster analysis and CART (classification and regression trees), several distinct patient subgroups emerged with varying in-hospital mortality rates based on combinations of previously validated score categories or their defining elements and elevated NLR, WBC (white blood cell) count, or the presence COVID-19 infection. (4) Conclusion: The findings suggest that integrating these parameters in risk stratification can aid in improving predictive accuracy of estimating the in-hospital mortality of PE patients.
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Affiliation(s)
- Minodora Teodoru
- Medical Clinical Department, Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (M.T.); (A.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
| | - Mihai Octavian Negrea
- Medical Clinical Department, Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (M.T.); (A.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
| | - Andreea Cozgarea
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania;
- Cardiology Department, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dragoș Cozma
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania;
- Cardiology Department, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timișoara, 300310 Timisoara, Romania
| | - Adrian Boicean
- Medical Clinical Department, Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (M.T.); (A.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
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Yazdi H, Eslami A, Torkaman A, Elahifar O, Kasaeian A, Alimoghadam S, Alimoghadam R, Abolghasemian M. Aspirin is as effective as low molecular weight heparins in preventing symptomatic venous thromboembolism following arthroscopic anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:154. [PMID: 38373950 PMCID: PMC10875785 DOI: 10.1186/s12891-024-07282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE The optimal agent for thromboprophylaxis following arthroscopic anterior cruciate ligament reconstruction (ACLR) remains unclear, particularly in patients with a low baseline risk for venous thromboembolism (VTE). This retrospective cohort study aims to compare the effectiveness and safety of aspirin versus low molecular weight heparins (LMWHs) in this specific patient population. METHODS We analyzed data from patients who underwent ACLR between March 2016 and March 2021, focusing on those with a low risk for VTE. High-risk individuals, identified by factors such as cardiac disease, pulmonary disease, diabetes mellitus, previous VTE, inflammatory bowel disease, active cancer, and a BMI > 40, were excluded (n = 33). Our approach included a thorough review of medical charts, surgical reports, and pre-operative assessments, complemented by telephone follow-up conducted over a 3-month period by a single investigator. We assessed the incidence of symptomatic VTE, including deep vein thrombosis and pulmonary thromboembolism, as the primary outcome. The secondary outcomes included to complications related to the surgery and thromboprophylaxis. Statistical analysis included descriptive statistics, univariate logistic regression models, and calculations of incidence rates. RESULT In our study, 761 patients (761 knees) were included, with 458 (60.18%) receiving aspirin and 303 (39.82%) receiving LMWH. The two groups showed no significant differences in demographic factors except for age. The incidence of VTE was reported at 1.31% (10 individuals). Specifically, five patients in the aspirin group (1.09%) and five patients in the LMWH group (1.65%) developed a symptomatic VTE event (p = 0.53). Additionally, the two groups did not significantly differ in terms of other complications, such as hemarthrosis or surgical site infection (p > 0.05). Logistic regression analysis revealed no statistically significant difference in VTE risk between the two groups. CONCLUSION This study, focusing on isolated ACLR in patients with a low baseline risk for venous thromboembolism, demonstrated that aspirin is equally effective as low molecular weight heparins for VTE prophylaxis following this surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hamidreza Yazdi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Arvin Eslami
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
| | - Ali Torkaman
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Omid Elahifar
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Digestive Diseases Research Center, Digestive Diseases Research Institute; Research Center for Chronic Inflammatory Diseases; Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaya Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Rojina Alimoghadam
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Abolghasemian
- Bone and Joint Reconstruction Research Center, Department of Orthopedics; Department of Orthopedic, School of Medicine; Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran.
- University of Alberta, Alberta, Canada.
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Marginean A, Arora P, Walsh K, Bruno E, Sawalski C, Gupta R, Greathouse F, Clarke J, Mallery Q, Choi MH, Malas W, Shah P, Sutherland D, Kumar A, Wroblewski I, Elkaryoni A, Desai P, Brailovsky Y, Darki A. Utilization of a Novel Scoring System in Predicting 30-day Mortality in Acute Pulmonary Embolism, the CLOT-5 Pilot Study. Clin Appl Thromb Hemost 2024; 30:10760296241278353. [PMID: 39183532 PMCID: PMC11348478 DOI: 10.1177/10760296241278353] [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: 05/27/2024] [Revised: 07/24/2024] [Accepted: 08/09/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVES To construct a new scoring system utilizing biomarkers, vitals, and imaging data to predict 30-day mortality in acute pulmonary embolism (PE). BACKGROUND Acute PE, a well-known manifestation of venous thromboembolic disease, is responsible for over 100,000 deaths worldwide yearly. Contemporary management algorithms rely on a multidisciplinary approach to care via PE response teams (PERT) in the identification of low, intermediate, and high-risk patients. The PESI and sPESI scores have been used as cornerstones of the triage process in assigning risk of 30-day mortality for patients presenting with acute PE; however, the specificity of these scoring systems has often come into question. METHODS This study retrospectively analyzed 488 patients with acute PE who were managed at a tertiary care institution with either conservative therapy consisting of low molecular weight or unfractionated heparin, advanced therapies consisting of catheter directed therapies, aspiration thrombectomy, or a combination of these therapies, or surgical embolectomy. The CLOT-5 score was designed to include vital signs, biomarkers, and imaging data to predict 30-day mortality in patients presenting with acute PE. RESULTS The CLOT-5 score had an area under the curve (AUC) of 0.901 with a standard error of 0.29, while the PESI and sPESI scores had an AUC and standard errors of 0.793 ±- 0.43 and 0.728 ± 0.55, respectively. CONCLUSIONS When incorporated into the management algorithms of national PERT programs, the CLOT-5 score may allow for rapid and comprehensive assessment of patients with acute PE at high risk for clinical decompensation, leading to early escalation of care where appropriate.
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Affiliation(s)
- Alexandru Marginean
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Punit Arora
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Kevin Walsh
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Elizabeth Bruno
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Cathryn Sawalski
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Riya Gupta
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Frances Greathouse
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Jacob Clarke
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Quinn Mallery
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Myoung Hyun Choi
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Waddah Malas
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Parth Shah
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - David Sutherland
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Amudha Kumar
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Igor Wroblewski
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Ahmed Elkaryoni
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Parth Desai
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | | | - Amir Darki
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
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11
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Karakurt G, Guven O, Aynaci E, Kerget B, Senkardesler G, Duger M. Evaluation of Hemogram Parameters in the Diagnosis of Pulmonary Embolism: Immature Granulocytes and Other New Tips. Clin Appl Thromb Hemost 2024; 30:10760296241227212. [PMID: 38348584 PMCID: PMC10865945 DOI: 10.1177/10760296241227212] [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: 10/09/2023] [Revised: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 02/15/2024] Open
Abstract
Pulmonary embolism (PE) is an important cause of sudden death and is difficult to diagnose. Therefore unnecessary radiological investigations are often resorted to. Although some inflammatory parameters in the hemogram have been found to play a role in the diagnosis of PE, many parameters have not been adequately investigated. We aimed to evaluate potential inflammatory parameters in hemogram in the diagnosis of PE and to determine the parameters with the highest diagnostic value. This single-center, retrospective study was performed by evaluating 114 cases with suspected PE admitted to the emergency department between January 2017 and June 2022. Among 114 cases, 62 cases with a definitive diagnosis of PE by pulmonary computed tomography angiography served as the PE group and 52 cases without PE served as the control group. Admission hemogram parameters of both groups were recorded. Potential chronic diseases and acute conditions affecting hemogram were excluded from the study. In the multivariate model; immature granulocyte (IG), neutrophil/lymphocyte ratio (NLR), monocyte % and platelet large cell ratio (P-LCR) were found to be significantly and independently effective in differentiating cases with and without PE (P˂.05). Our findings suggest that high IG, high NLR, high monocyte %, and low P-LCR values have diagnostic value in cases with suspected PE. However the usability of IGs in the diagnosis of PE is a new finding. Hemogram is cheap, easily accessible, and potential inflammatory biomarkers in hemograms may increase physicians' awareness in the diagnosis of PE.
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Affiliation(s)
- Gokhan Karakurt
- Chest Diseases Department, Kirklareli Training and Research Hospital, Kirklareli, Turkey
| | - Oya Guven
- Emergency Medicine Department, Kirklareli University, Kirklareli, Turkey
| | - Engin Aynaci
- Chest Diseases Department, Beykent University, Istanbul, Turkey
| | - Bugra Kerget
- Chest Diseases Department, Ataturk University, Erzurum, Turkey
| | - Gizem Senkardesler
- Chest Diseases Department, Kirklareli Training and Research Hospital, Kirklareli, Turkey
| | - Mustafa Duger
- Chest Diseases Department, Medipol University, Istanbul, Turkey
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12
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Zhu N, Lin S, Cao C. A novel prognostic prediction indicator in patients with acute pulmonary embolism: Naples prognostic score. Thromb J 2023; 21:114. [PMID: 37932805 PMCID: PMC10629175 DOI: 10.1186/s12959-023-00554-8] [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: 07/07/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023] Open
Abstract
Acute pulmonary embolism (APE) is a potentially fatal disease. Early risk stratification is essential to determining appropriate treatment. We aimed to investigate the predictive value of the Naples Prognostic Score (NPS) for 30-day all-cause mortality in patients with APE. In this retrospective analysis, 325 hospitalized patients with APE were divided into Groups 0 (n = 131), 1 (n = 153), and 2 (n = 41) according to the NPS. The primary outcome event was all-cause mortality during 30 days of follow-up from the day of admission. The correlation between NPS, clinical features, and outcomes in each group was evaluated. The patients were divided into two groups, survivor (n = 294) and nonsurvivor (n = 31), according to their prognosis. The results of the comparison between the three NPS groups revealed that patients with older age, faster heart rate, lower systolic blood pressure, low albumin and total cholesterol levels, high neutrophil to lymphocyte ratio (NLR), low lymphocyte-to-monocyte ratio (LMR), right heart dilatation, heart failure, malignancy, and lower extremity venous thrombosis had significantly higher 30-day all-cause mortality (P < 0.05). Area under the receiver operating characteristic curve (AUC) for NPS to predict all-cause death within 30 days in patients with APE was 0.780 (95% confidence interval [CI] = 0.678-0.855), with sensitivity being 80.6% (95% CI = 0.667-0.946) and specificity being 72.1% (95% CI = 0.670-0.772). Kaplan-Meier (KM) curves showed that Group 2 APE patients had the highest risk of all-cause mortality compared with the other two groups (log-rank test, P = 0.0004). Forest plot visualization using the Cox proportional hazard model showed a significant increase in the risk of 30-day all-cause mortality by 239% (hazard ratio [HR] = 3.385 [1.115-10.273], P = 0.031) and 338% (HR = 4.377 [1.228-15.598], P = 0.023), and the trend test showed a statistical difference (P = 0.042). The study concluded that NPS is a novel, reliable, and multidimensional prognostic scoring system with good prediction of 30-day all-cause mortality in patients with APE.
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Affiliation(s)
- Ning Zhu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, 315010, Zhejiang, China
| | - Shanhong Lin
- Department of Ultrasound, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, 315010, Zhejiang, China.
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13
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Bakiera J, Strzelec-Pawełczak K, Czarnek K, Osuchowska-Grochowska I, Bogucki J, Markiewicz-Gospodarek A, Górska A, Chilimoniuk Z, Radej S, Szymański M, Portincasa P, Grochowski C. Novel inflammatory markers in patients with severe COVID-19 and a pulmonary thrombotic event. Cent Eur J Immunol 2023; 48:167-173. [PMID: 37901866 PMCID: PMC10604642 DOI: 10.5114/ceji.2023.131382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/09/2023] [Indexed: 10/31/2023] Open
Abstract
Venous thromboembolism (VTE), clinically manifested as deep vein thrombosis (DVT) or acute pulmonary embolism (PE), is the third most common acute cardiovascular syndrome following myocardial infarction and stroke. The annual incidence of PE is between 39 and 115 per 100,000 inhabitants. The incidence of VTE is almost eight times higher in people aged 80 and older than in the fifth decade of life. We performed a retrospective study of 226 COVID-19 patients and selected group of patients who experienced a pulmonary thrombotic event. The incidence of PE in hospitalized COVID-19 patients was approximately 1.9-8.9%. The retrospective nature of the analyzed cohorts and relatively short observation periods could have led to underestimation of the actual incidence of PE. This study underlines the role of novel inflammatory biomarkers such as neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with a pulmonary thrombotic event in COVID-19. We suggest that these biomarkers may have high assessment value and complement routinely used biomarkers.
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Affiliation(s)
- Jarosław Bakiera
- Department of Laboratory Diagnostics, Coagulation and Microbiology, Stefan Wyszyński Regional Specialist Hospital, Lublin, Poland
| | | | - Katarzyna Czarnek
- Institute of Health Sciences, The John Paul II Catholic University of Lublin, Lublin, Poland
| | | | - Jacek Bogucki
- Department of Organic Chemistry, Medical University of Lublin, Lublin, Poland
| | | | - Aleksandra Górska
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | | | - Sebastian Radej
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
- Institute of Health Sciences, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Mateusz Szymański
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
| | - Piero Portincasa
- Clinica Medica “A. Murri”, Department of Biomedical Sciences & Human Oncology, University of Bari “Aldo Moro” Medical School, Bari, Italy
| | - Cezary Grochowski
- Department of Human Anatomy, Medical University of Lublin, Lublin, Poland
- Institute of Health Sciences, The John Paul II Catholic University of Lublin, Lublin, Poland
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14
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Radkhah H, Mansouri ES, Rahimipour Anaraki S, Gholizadeh Mesgarha M, Sheikhy A, Khadembashiri MM, Khadembashiri MA, Eslami M, Mahmoodi T, Inanloo B, Pour Mohammad A. Predictive value of hematological indices on incidence and severity of pulmonary embolism in COVID-19 patients. Immun Inflamm Dis 2023; 11:e1012. [PMID: 37773719 PMCID: PMC10540144 DOI: 10.1002/iid3.1012] [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: 03/30/2023] [Revised: 07/28/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Pulmonary thromboembolism (PTE) is a common complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which raises the COVID-19 disease's fatality rate from 3% to 45%. Nevertheless, due to fairly indistinguishable clinical symptoms and a lack of validated clinical prediction models, PTE diagnosis in COVID-19 patients is challenging. This study aims to investigate the applicability of hematological indices to predict PTE incidence and its severity in SARS-CoV-2 patients. METHODS A retrospective cohort study was conducted on hospitalized patients with a confirmed diagnosis of SARS-CoV-2 infection who underwent CT angiography to assess probable PTE in them. The correlation between complete blood count parameters 1 day before CT angiography and CT angiography outcomes, and simplified pulmonary embolism severity index (s-PESI) was investigated. RESULTS We discovered that among individuals with a probable PTE, males and those with higher platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios had a greater likelihood of PTE incidence (p < .001, .027, and .037, respectively). PLR was a significant and independent predictor of PTE with a p value of .045. Moreover, a higher neutrophil count was associated with a higher s-PESI score in COVID-19 patients developing PTE (p: .038). CONCLUSIONS Among hematological indices, NLR and more precisely PLR are cost-effective and simply calculable markers that can assist physicians in determining whether or not COVID-19 patients with clinically probable PTE require CT angiography and the higher neutrophil count can be employed as an indicator of PTE severity in COVID-19 patients. Further large multicenter and prospective studies are warranted to corroborate these observations.
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Affiliation(s)
- Hanieh Radkhah
- Department of Internal Medicine, School of Medicine, Sina HospitalTehran University of Medical Sciences (TUMS)TehranIran
| | - Ensieh Sadat Mansouri
- Department of Internal Medicine, School of Medicine, Sina HospitalTehran University of Medical Sciences (TUMS)TehranIran
| | | | | | - Ali Sheikhy
- Students' Scientific Research CenterTehran University of Medical Sciences (TUMS)TehranIran
| | | | | | - Mohamad Eslami
- Students' Scientific Research CenterTehran University of Medical Sciences (TUMS)TehranIran
| | - Tara Mahmoodi
- Students' Scientific Research CenterTehran University of Medical Sciences (TUMS)TehranIran
| | - Behnaz Inanloo
- Sina HospitalTehran University of Medical Sciences (TUMS)TehranIran
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15
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Alsubhi YM, Alhadi AH, Hammudah AM, Alahmadi RA, Aljohani AM, Dubai SA, Susi AI, Almuwallad K, Alwasaidi TA. Comparison of laboratory biomarkers for the prediction of in-hospital mortality and severity of acute pulmonary embolism: A multi-center study. Saudi Med J 2023; 44:898-903. [PMID: 37717976 PMCID: PMC10505296 DOI: 10.15537/smj.2023.44.9.20230441] [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: 06/12/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES To assess the specificity and sensitivity of prognostic biomarkers in individuals diagnosed with acute pulmonary embolism (PE). METHODS This study retrospectively enrolled 162 patients from the 741 patients who were hospitalized with acute PE and diagnosed using pulmonary computed tomography (CT) angiogram at 5 hospitals in Saudi Arabia between January 2015 and December 2019. Pulmonary embolism patients classified into survivor and non-survivor groups. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) were all recorded and were compared between the groups. The evaluation of mortality prediction, sensitivity, and specificity was carried out by employing receiver operating characteristic curves. RESULTS The variables NLR and RDW exhibited a statistically significant correlation with increased mortality and disease severity. A total of 8 patients among the 162 patients died. At the cut-off value of 5.5, NLR was showed an association with all-cause mortality, demonstrating a sensitivity of 75% and a specificity of 82%. At the cut-off value of 18.15, RDW was found to be significantly associated with all-cause mortality, displaying a sensitivity of 63% and a specificity of 88%. CONCLUSION Multiple parameters have been implicated in the mortality and severity of PE. Our study revealed a statistically significant association between NLR, RDW, and PE mortality. These tests are easily accessible and may provide insights into the mortality associated with PE.
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Affiliation(s)
- Yasir M. Alsubhi
- From the Department of Medicine (Alsubhi, Hammudah, Alahmadi); from the Department of Critical Care (Almuwallad), King Fahad General Hospital, from the Department of Medicine (Alhadi); from the Division of Hematology (Alwasaidi), Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, from the Department of Preventive Medicine (Aljohani), Division of Infection Prevention and Control; from the Preventive Medicine Joint Program (Al Dubai), Post Graduate Studies, Ministry of Health, from the Department of Medicine (Alwasaidi), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, and from the Department of Emergency Medicine (Susi), King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Ahmed H. Alhadi
- From the Department of Medicine (Alsubhi, Hammudah, Alahmadi); from the Department of Critical Care (Almuwallad), King Fahad General Hospital, from the Department of Medicine (Alhadi); from the Division of Hematology (Alwasaidi), Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, from the Department of Preventive Medicine (Aljohani), Division of Infection Prevention and Control; from the Preventive Medicine Joint Program (Al Dubai), Post Graduate Studies, Ministry of Health, from the Department of Medicine (Alwasaidi), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, and from the Department of Emergency Medicine (Susi), King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Abdulaziz M. Hammudah
- From the Department of Medicine (Alsubhi, Hammudah, Alahmadi); from the Department of Critical Care (Almuwallad), King Fahad General Hospital, from the Department of Medicine (Alhadi); from the Division of Hematology (Alwasaidi), Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, from the Department of Preventive Medicine (Aljohani), Division of Infection Prevention and Control; from the Preventive Medicine Joint Program (Al Dubai), Post Graduate Studies, Ministry of Health, from the Department of Medicine (Alwasaidi), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, and from the Department of Emergency Medicine (Susi), King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Riyadh A. Alahmadi
- From the Department of Medicine (Alsubhi, Hammudah, Alahmadi); from the Department of Critical Care (Almuwallad), King Fahad General Hospital, from the Department of Medicine (Alhadi); from the Division of Hematology (Alwasaidi), Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, from the Department of Preventive Medicine (Aljohani), Division of Infection Prevention and Control; from the Preventive Medicine Joint Program (Al Dubai), Post Graduate Studies, Ministry of Health, from the Department of Medicine (Alwasaidi), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, and from the Department of Emergency Medicine (Susi), King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Azhar M. Aljohani
- From the Department of Medicine (Alsubhi, Hammudah, Alahmadi); from the Department of Critical Care (Almuwallad), King Fahad General Hospital, from the Department of Medicine (Alhadi); from the Division of Hematology (Alwasaidi), Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, from the Department of Preventive Medicine (Aljohani), Division of Infection Prevention and Control; from the Preventive Medicine Joint Program (Al Dubai), Post Graduate Studies, Ministry of Health, from the Department of Medicine (Alwasaidi), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, and from the Department of Emergency Medicine (Susi), King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Sami Al Dubai
- From the Department of Medicine (Alsubhi, Hammudah, Alahmadi); from the Department of Critical Care (Almuwallad), King Fahad General Hospital, from the Department of Medicine (Alhadi); from the Division of Hematology (Alwasaidi), Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, from the Department of Preventive Medicine (Aljohani), Division of Infection Prevention and Control; from the Preventive Medicine Joint Program (Al Dubai), Post Graduate Studies, Ministry of Health, from the Department of Medicine (Alwasaidi), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, and from the Department of Emergency Medicine (Susi), King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Abdulqader I. Susi
- From the Department of Medicine (Alsubhi, Hammudah, Alahmadi); from the Department of Critical Care (Almuwallad), King Fahad General Hospital, from the Department of Medicine (Alhadi); from the Division of Hematology (Alwasaidi), Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, from the Department of Preventive Medicine (Aljohani), Division of Infection Prevention and Control; from the Preventive Medicine Joint Program (Al Dubai), Post Graduate Studies, Ministry of Health, from the Department of Medicine (Alwasaidi), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, and from the Department of Emergency Medicine (Susi), King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Kholoud Almuwallad
- From the Department of Medicine (Alsubhi, Hammudah, Alahmadi); from the Department of Critical Care (Almuwallad), King Fahad General Hospital, from the Department of Medicine (Alhadi); from the Division of Hematology (Alwasaidi), Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, from the Department of Preventive Medicine (Aljohani), Division of Infection Prevention and Control; from the Preventive Medicine Joint Program (Al Dubai), Post Graduate Studies, Ministry of Health, from the Department of Medicine (Alwasaidi), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, and from the Department of Emergency Medicine (Susi), King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Turki A. Alwasaidi
- From the Department of Medicine (Alsubhi, Hammudah, Alahmadi); from the Department of Critical Care (Almuwallad), King Fahad General Hospital, from the Department of Medicine (Alhadi); from the Division of Hematology (Alwasaidi), Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, from the Department of Preventive Medicine (Aljohani), Division of Infection Prevention and Control; from the Preventive Medicine Joint Program (Al Dubai), Post Graduate Studies, Ministry of Health, from the Department of Medicine (Alwasaidi), College of Medicine, Taibah University, Al-Madinah Al-Munawarah, and from the Department of Emergency Medicine (Susi), King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
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16
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Feng X, Duan Y, Lv X, Li Q, Liang B, Ou X. The Impact of Lung Cancer in Patients with Combined Pulmonary Fibrosis and Emphysema (CPFE). J Clin Med 2023; 12:jcm12031100. [PMID: 36769748 PMCID: PMC9917551 DOI: 10.3390/jcm12031100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 02/02/2023] Open
Abstract
Given the high risk of lung cancer (LC) in patients with combined pulmonary fibrosis and emphysema (CPFE), and the difficulty of early diagnosis, it is important to understand the impact of LC in these patients. The effect of LC on the development of acute exacerbation (AE) as a natural course of CPFE is still unknown. We retrospectively reviewed medical records of patients at the West China Hospital and enrolled 59 patients with CPFE combined with LC and 68 CPFE patients without LC for initial diagnosis matched in the same period. We compared the clinical characteristics and imaging features of CPFE patients with LC and without LC, and analyzed the associated factors for the prevalence of LC using binary logistic regression. Cox proportional hazards regression analysis was performed to explore risk factors of AE as a natural course of CPFE. Patients with CPFE combined with LC were more common among elderly male smokers. The most common pathological type of tumor was adenocarcinoma (24/59, 40.7%) and squamous cell carcinoma (18/59, 30.5%). Compared with those in the without LC group, the proportions of men, and ex- or current smokers, and the levels of smoking pack-years, serum CRP, IL-6, fibrinogen, complement C3 and C4 in patients with LC were significantly higher (p < 0.05). There was no significant difference in the proportion of natural-course-related AE (10.2% vs. 16.2%, p > 0.05) between the two groups. Logistic regression analysis demonstrated that pack-years ≥ 20 (OR: 3.672, 95% CI: 1.165-11.579), family history of cancer (OR: 8.353, 95% CI: 2.368-10.417), the level of fibrinogen > 4.81 g/L (OR: 3.628, 95% CI: 1.403-9.385) and serum C3 > 1.00 g/L (OR: 5.299, 95% CI: 1.727-16.263) were independently associated with LC in patients with CPFE. Compared to those without AE, CPFE patients with AE had significantly higher levels of PLR and serum CRP, with obviously lower DLCO and VC. The obviously increased PLR (HR: 3.731, 95% CI: 1.288-10.813), and decreased DLCO%pred (HR: 0.919, 95% CI: 0.863-0.979) and VC%pred (HR: 0.577, 95% CI: 0.137-0.918) rather than the presence of LC independently contributed to the development of natural-course-related AE in patients with CPFE. Pack-years, family history of cancer, the levels of fibrinogen and serum C3 were independently associated with LC in patients with CPFE. The presence of LC did not significantly increase the risk of AE as a natural course of CPFE. Clinicians should give high priority to CPFE patients, especially those with more severe fibrosis and systemic inflammation, in order to be alert for the occurrence of AE.
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Affiliation(s)
- Xiaoyi Feng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yishan Duan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xiafei Lv
- Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Qinxue Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Binmiao Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xuemei Ou
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
- Correspondence:
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17
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Hu C, Zhao B, Ye Q, Zou J, Li X, Wu H. The Diagnostic Value of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Deep Venous Thrombosis: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2023; 29:10760296231187392. [PMID: 37487186 PMCID: PMC10369103 DOI: 10.1177/10760296231187392] [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: 05/04/2023] [Revised: 06/12/2023] [Accepted: 06/24/2023] [Indexed: 07/26/2023] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are emerging tools that can be used in the diagnosis of deep venous thrombosis (DVT). This study aims to evaluate the diagnostic value of NLR and PLR for patients with DVT. Our meta-analysis included 11 eligible studies and extracted relevant diagnostic indicators. Of these studies, 4 focused on the NLR, 1 on the PLR, while 6 evaluated both. For the 10 studies on NLR, the pooled sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio were 74%, 66%, 2.16, and 0.4, respectively. The estimated diagnostic odds ratio (DOR) was 5.3, and the area under the curve (AUC) of the summary receiver operating characteristic (SROC) curves was 0.74. For the 7 studies on the PLR, the pooled sensitivity, specificity, positive-likelihood ratio, and negative-likelihood ratio were 0.65, 0.77, 2.89, and 0.45, respectively. The estimated DOR was 6.64, and the SROC-AUC was 0.79. Our findings showed that the NLR and PLR exhibit moderate diagnostic accuracy and may be helpful biomarkers for the diagnosis of DVT. Future prospective, well-designed studies with large sample sizes will be required to provide additional evidence to establish cutoff values and clinical value of these indicators.
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Affiliation(s)
- Chenming Hu
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Bin Zhao
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qianling Ye
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Jun Zou
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Xiang Li
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Huaping Wu
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
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Hu J, Cai Z, Zhou Y. The Association of Neutrophil-Lymphocyte Ratio with Venous Thromboembolism: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2022; 28:10760296221130061. [PMID: 36189877 PMCID: PMC9530558 DOI: 10.1177/10760296221130061] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The neutrophil–lymphocyte ratio(NLR) has been used for diagnosing venous
thromboembolism (VTE). We aimed to assess the accuracy of NLR to diagnose VTE by
meta-analysis. Systematic electronic searches were conducted June 2, 2021 in
PubMed, Embase(Ovid), and Cochrane Library. The search did not have any language
or time restriction applied. Our search strategy was based on keywords in
combination with both medical subject headings (MeSH) terms and text words. The
diagnostic odds ratio, summary receiver operating characteristics, sensitivity,
specificity, positive likelihood ratio, and negative likelihood ratio were
estimated. 10 articles with 1513 VTE participants and 2593 control participants
were included for quantitative synthesis. The pooled values were as follows:
sensitivity = 0.68(95% CI 0.45-0.84), specificity = 0.73(95% CI 0.6-0.83),
positive likelihood ratio = 2.5(95% CI 1.8-3.4), negative likelihood
ratio = 0.44(95% CI 0.26-0.75), diagnostic odds ratio = 6(95% CI 3-11), and
SROC = 0.76(95% CI: 0.73-0.8). NLR could be diagnostic factor for the detection
of potential VTE, the accuracy thereof in the current meta-analysis exhibited
moderate accuracy for diagnosing VTE. Furthermore, further large cohort studies
are needed to determine optimal cut-off values of NLR.
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Affiliation(s)
- Jingjing Hu
- Department of Emergency Medicine, Hangzhou Third People's
Hospital, Hangzhou, Zhejiang, China
| | - Zhaobin Cai
- Department of Emergency Medicine, Hangzhou Third People's
Hospital, Hangzhou, Zhejiang, China,Zhaobin Cai, Department of Emergency
Medicine, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China.
| | - Yidan Zhou
- Department of Emergency Medicine, Hangzhou Third People's
Hospital, Hangzhou, Zhejiang, China,Yidan Zhou, Department of Emergency
Medicine, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China.
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Peripheral Neutrophil-to-Lymphocyte Ratio in Bronchiectasis: A Marker of Disease Severity. Biomolecules 2022; 12:biom12101399. [PMID: 36291608 PMCID: PMC9599714 DOI: 10.3390/biom12101399] [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: 08/04/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Most patients with bronchiectasis have a predominantly neutrophilic inflammatory profile, although other cells such as lymphocytes (as controllers of bronchial inflammation) and eosinophils also play a significant pathophysiological role. Easy-to-interpret blood biomarkers with a discriminative capacity for severity or prognosis are needed. The objective of this study was to assess whether the peripheral neutrophil-to-lymphocyte ratio (NLR) is associated with different outcomes of severity in bronchiectasis. A total of 1369 patients with bronchiectasis from the Spanish Registry of Bronchiectasis were included. To compare groups, the sample was divided into increasing quartiles of NLR ratio. Correlations between quantitative variables were established using Pearson's P test. A simple linear regression (with the value of exacerbations as a quantitative variable) was used to determine the independent relationship between the number and severity of exacerbations and the NLR ratio. The area under the curve (AUC)-ROC was used to determine the predictive capacity of the NLR for severe bronchiectasis, according to the different multidimensional scores. Mean age: 69 (15) years (66.3% of women). The mean NLR was 2.92 (2.03). A higher NLR was associated with more severe bronchiectasis (with an especially significant discriminative power for severe forms) according to the commonly used scores (FACED, E-FACED and BSI), as well as with poorer quality of life (SGRQ), more comorbidities (Charlson index), infection by pathogenic microorganisms, and greater application of treatment. Furthermore, the NLR correlated better with severity scores than other parameters of systemic inflammation. Finally, it was an independent predictor of the incident number and severity of exacerbations. In conclusion, the NLR is an inexpensive and easy-to-measure marker of systemic inflammation for determining severity and predicting exacerbations (especially the most severe) in patients with bronchiectasis.
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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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Effects of Momordica charantia exosomes on platelet activation, adhesion, and aggregation. Blood Coagul Fibrinolysis 2022; 33:372-380. [PMID: 35834718 DOI: 10.1097/mbc.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The platelets play a crucial role in the progression of multiple medical conditions, such as stroke and tumor metastasis, where antiplatelet therapy may be a boon for treating these diseases. In this study, we have attempted to study the effects of extracted Momordica charantia exosomes (MCEs) on platelet activation, adhesion, and aggregation. Adult platelets isolated from healthy individuals were dose-dependently treated with MCEs (0.1, 40, and 200 μg/ml). We performed flow cytometry to detect the expression of platelet activation protein marker-activated GP IIb/IIIa (PAC-1) and P-selectin (CD62P). Platelet adhesion was analyzed through fluorescence labeling assays. The effect of MCEs on platelet-mediated cell migration of HCT116 cells was observed by transwell. Furthermore, the MCAO model of Sprague-Dawley rats was used to observe the effect of MCEs (200, 400, and 800 μg/kg) on platelet aggregation and maximum thrombotic agglutination in vivo. The results showed that 200 μg/ml MCEs exerted the most pronounced effect on platelet activation, adhesion, and aggregation. Experiments on animals showed that MCEs significantly inhibited platelet aggregation and attenuated the maximum thrombus agglutination. We concluded that MCEs inhibited platelet activation, adhesion, aggregation, and platelet-mediated migration of HCT116 cells, indicating the potential role MCEs may play in the treatment of stroke and tumor metastasis.
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22
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The Neutrophil-to-Lymphocyte Ratio’s Predictive Utility in Acute Pulmonary Embolism: Systematic Review. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Acute pulmonary embolism is a cardiovascular emergency with a significant morbidity and mortality. In the last decade, attempts have been made to find prognostic markers for pulmonary embolism. We conducted a systematic review of the literature for studies that assess the relationship between the neutrophil-to-lymphocyte ratio (NLR) and disease progression in patients with pulmonary embolism. We included a total of seven studies published between 2016 and 2021, reporting on a total of 4,272 patients. The mean NLR observed in these studies was 5.93, with values ranging from 5.12 to 7.3. Elevated NLR was significantly associated with an increased rate of mortality in all studies. Furthermore, the collected data revealed a 2-to-15 times higher mortality rate in the group with NLR values higher than the mean. Due to its accessibility and the simplicity with which it can be calculated, as well as the outcomes revealed in this review, we strongly emphasize that NLR should be used more in medical practice.
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Alparslan Bekir S, Sonkaya E, Ozbaki F, Aydogan Eroglu S, Sertcelik L, Duman D, Kavas M, Agca M, Erdem I, Ozmen I, Boga S, Hazar A, Sevim T, Turker H, Tuncay E, Gungor S, Karakurt Z. The utility of neutrophil-to-lymphocyte ratio determined at initial diagnosis in predicting disease stage and discriminating between active and stable disease in patients with sarcoidosis: cross-sectional study. Postgrad Med 2022; 134:603-608. [PMID: 35619233 DOI: 10.1080/00325481.2022.2082805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the utility of neutrophil-lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis. METHODS A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cut-off value via ROC analysis. RESULTS Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34-4.31) vs. 2.29 (1.67- 3.23), p=0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p=0.001). ROC analysis revealed a NLR cut-off value of ≥2.39 (AUC (95% CI): 0.70(0.62 - 0.79), p<0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥ 2.39 (74.0 vs. 47.0%, p=0.002). CONCLUSION Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.
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Affiliation(s)
- Sumeyye Alparslan Bekir
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Esin Sonkaya
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Fatma Ozbaki
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Selma Aydogan Eroglu
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Lale Sertcelik
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Dildar Duman
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Murat Kavas
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Meltem Agca
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Ipek Erdem
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Ipek Ozmen
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Sibel Boga
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Armagan Hazar
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Tulin Sevim
- Acıbadem Hospital Chest Diseases, Department of Pulmonary Disease, Istanbul, Turkey
| | - Hatice Turker
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Eylem Tuncay
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Sinem Gungor
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
| | - Zuhal Karakurt
- University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Disease, Istanbul, Turkey
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Boyuk F. The Predictor Potential Role of the Glucose to Potassium Ratio in the Diagnostic Differentiation of Massive and Non-Massive Pulmonary Embolism. Clin Appl Thromb Hemost 2022; 28:10760296221076146. [PMID: 35187962 PMCID: PMC8864281 DOI: 10.1177/10760296221076146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Acute pulmonary embolism (PE) is one of the main causes of death and has a
course as massive (MPE) or non-massive (NMPE). The study investigates the
indicator potential of Glucose to Potassium ratio (GPR) in the differential
diagnosis of MPE and NMPE. Materials and Methods The study was designed as a retrospective cross-sectional clinical cohort in
patients with PE. A total of 111 participants enrolled in the research
separating two groups: MPE (n:54) and NMPE (n:67). The GPR was calculated by
dividing serum glucose by potassium levels and its results were compared
with D-Dimer, Pulmonary Artery Pressure (PAP), and C-Reactive Protein Test
(CRP). Results D-Dimer was measured as 6.5 ± 5.7 µg/L in the MPE and found higher than the
NMPE (3.9 ± 5.2 µg/L) (P = .019). CRP (100 ± 83.5 to
30.9 ± 42.7 mg/L; P = .0001) and PAP (49.5 ± 11.9 to
34.8 ± 7.3 mmHg; P = .0001) were found increased in the
MPE. GPR strongly increased in the MPE (30.7 ± 7.5 to 24.9 ± 4.3;
P = .0003) in line with CRP, D-Dimer and PAP. GPR
showed a stronger diagnostic value (AUC: 0.733; P = .00001;
Sensitivity:72%; Spesifity:70%; Cut-off: 26.5). PAP and GPR showed
significant efficiency on occurrence of the MPE according to the binary
logistic regression. Conclusion The GPR, as a novel and cheap marker, can be useful for diagnostic
differentiation of MPE from NMPE, but weaker than PAP and better than
D-dimer. Type of Study and Level of Evidence Level-II, Retrospective clinical cohort study.
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Affiliation(s)
- Ferit Boyuk
- 147022Department of Cardiology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Asik Z, Özen M. Evaluation of frailty and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios relationship in elderly people. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:101-110. [PMID: 35392007 PMCID: PMC8971038 DOI: 10.18999/nagjms.84.1.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022]
Abstract
It was aimed to evaluate the relationship between frailty and inflammation in people receiving home health care. It was a cross-sectional study. Edmonton Frail Scale was used to determine the level of frailty and, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were used to determine inflammation. Of 332 people included in the study, 54.82% were females and 45.18% were males. Participants' ages were between 65 and 106. When we examined the frailty of the participants according to the Edmonton Frail Scale, the mean score was 9.403 ± 2.032. The mean neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of the participants were 4,397±5,038 and 169,363±101,461 respectively. Accordingly, neutrophil-to-lymphocyte ratio was high in men, frail elderly, 75-84 age range, hypertension patients, malnutrition patients; and neutrophil-to-lymphocyte ratio was low in diabetes mellitus, dementia, cerebrovascular accident and hemiplegia. Platelet-to-lymphocyte ratio, another inflammatory marker, was high in men, non-frail elderly, 75-84 age range, hypertension patients and cerebrovascular accident patients; it was low in hemiplegia, malnutrition, dementia, diabetes mellitus. In the study, no statistically significant difference was found between Edmonton Frail Scale and inflammatory markers. More studies are needed on this subject. In addition, we think that examining NLR and PLR values will be useful for monitoring inflammation in frail elderly.
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Affiliation(s)
- Zeynep Asik
- The Clinic of Family Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Mehmet Özen
- The Clinic of Family Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
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Siddiqui F, García-Ortega A, Kantarcioglu B, Sinacore J, Tafur A, Demelo-Rodríguez P, Antonio Nieto J, Usandizaga E, Fareed J, Monreal M, The Riete Investigators. Cellular Indices and Outcome in Patients with Acute Venous Thromboembolism. Clin Appl Thromb Hemost 2022; 28:10760296221113346. [PMID: 35866197 PMCID: PMC9310273 DOI: 10.1177/10760296221113346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Cellular indices provide integrative information about systemic inflammation status which is readily available from routine laboratory parameters. This study aimed to evaluate the prognostic role of three cellular indices in patients with venous thromboembolism (VTE). Methods The RIETE registry database was used to determine the association between the baseline neutrophil-to-lymphocyte-ratio (NLR), platelet-to-lymphocyte-ratio (PLR) and systemic-immune-inflammation-index (SII) for 90-day adverse outcomes in patients with acute VTE. Results From January 2020 to April 2021, 4487 patients with acute VTE were recruited in the RIETE registry. Of these, 2683 presented with symptomatic pulmonary embolism (PE); 283 with incidental PE; 1129 with lower-limb deep vein thrombosis (DVT); 175 with upper-limb DVT; 69 with splanchnic vein thrombosis; 142 with superficial vein thrombosis and 20 with retinal vein thrombosis. Mean values were: NLR 5.9 ± 7.1, PLR 190 ± 158 and SII 1459 ± 2028. During the first 90-days, 38 patients (0.8%) developed recurrent DVT, 45 (1.0%) had recurrent PE, 152 (3.4%) suffered major bleeding, and 484 (11%) died. On multivariable analysis, patients with NLR >4.41 were at an increased risk for major bleeding and patients with NLR >4.96 were at the risk of death, while those with SII >1134.5 were at increased risk for death. Conclusions This study reports the results of a large cohort to date which evaluate the prognostic value of three cellular indices simultaneously in patients with acute VTE. Results support that none of the three baseline cellular indices were sufficient for prediction of VTE recurrences in acute VTE patients. The patients with higher baseline NLR values were at an increased risk of major bleeding or death, those with high SII values were only at an increased risk for mortality.
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Affiliation(s)
- Fakiha Siddiqui
- Department of Pathology & Laboratory Medicine, Cardiovascular Research Institute, 550858Health Science Division, 2456Loyola University Chicago, Maywood, Illinois, USA.,Program in Health Sciences, 16728UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Alberto García-Ortega
- Respiratory Department, 16273Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Bulent Kantarcioglu
- Department of Pathology & Laboratory Medicine, Cardiovascular Research Institute, 550858Health Science Division, 2456Loyola University Chicago, Maywood, Illinois, USA
| | - James Sinacore
- Department of Public Health, 2456Loyola University Chicago, Maywood, Illinois, USA
| | - Alfonso Tafur
- Department of Medicine and Vascular Medicine, 3271Evanston NorthShore University Health System. Evanston, Illinois, USA
| | - Pablo Demelo-Rodríguez
- Department of Internal Medicine, 16483Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Antonio Nieto
- Department of Internal Medicine, 16297Hospital General Virgen de la Luz, Cuenca, Spain
| | - Esther Usandizaga
- Department of Internal Medicine, 223474Hospital Sant Joan Despí-Moises Broggi, Barcelona, Spain
| | - Jawed Fareed
- Department of Pathology & Laboratory Medicine, Cardiovascular Research Institute, 550858Health Science Division, 2456Loyola University Chicago, Maywood, Illinois, USA
| | - Manuel Monreal
- Department of Internal Medicine, 16514Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM, 16728Universidad Católica San Antonio de Murcia, Murcia, Spain
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Chen Y, Tian J, Chi B, Zhang S, Wei L, Wang S. Factors Associated with the Development of Coagulopathy after Open Traumatic Brain Injury. J Clin Med 2021; 11:jcm11010185. [PMID: 35011926 PMCID: PMC8745860 DOI: 10.3390/jcm11010185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The incidence of coagulopathy after open traumatic brain injury (TBI) is high. Coagulopathy can aggravate intracranial hemorrhage and further increase morbidity and mortality. The purpose of this study was to determine the clinical characteristics of coagulopathy after open TBI and its relationship with the prognosis. Methods: This study retrospectively evaluated patients with isolated open TBI from December 2018 to December 2020. Coagulopathy was defined as international normalized ratio (INR) > 1.2, activated thromboplastin time (APTT) > 35 s, or platelet count <100,000/μL. We compared the relationship between the clinical, radiological, and laboratory parameters of patients with and without coagulopathy, and the outcome at discharge. Logistic regression analysis was used to evaluate the risk factors associated with coagulopathy. We then compared the effects of treatment with and without TXA in open TBI patients with coagulopathy. Results: A total of 132 patients were included in the study; 46 patients developed coagulopathy. Patients with coagulopathy had significantly lower platelet levels (170.5 × 109/L vs. 216.5 × 109/L, p < 0.001), and significantly higher INR (1.14 vs. 1.02, p < 0.001) and APTT (30.5 s vs. 24.5 s, p < 0.001) compared to those with no coagulopathy. A Low Glasgow Coma Scale (GCS) score, high neutrophil/lymphocyte ratio (NLR), low platelet/lymphocyte ratio (PLR), and hyperglycemia at admission were significantly associated with the occurrence of coagulopathy. Conclusions: Coagulopathy often occurs after open TBI. Patients with a low GCS score, high NLR, low PLR, and hyperglycemia at admission are at greater risk of coagulopathy, and therefore of poor prognosis. The efficacy of TXA in open TBI patients with coagulopathy is unclear. In addition, these findings demonstrate that PLR may be a novel indicator for predicting coagulopathy.
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Slajus B, Brailovsky Y, Darwish I, Fareed J, Darki A. Utility of Blood Cellular Indices in the Risk Stratification of Patients Presenting with Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2021; 27:10760296211052292. [PMID: 34846193 PMCID: PMC8649084 DOI: 10.1177/10760296211052292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary embolism (PE) clinical manifestations vary widely, and that scope is not fully captured by current all-cause mortality risk models. PE is associated with inflammatory, coagulation, and hemostatic imbalances so blood cellular indices may be prognostically useful. Complete blood count (CBC) data may improve current risk models like the simplified pulmonary embolism severity index (sPESI) for all-cause mortality, offering greater accuracy and analytic ability. Acute PE patients (n = 228) with confirmatory diagnostic imaging were followed for all-cause mortality. Blood cellular indices were assessed for association to all-cause mortality and were supplemented into sPESI using multivariate logistic regression. Multiple blood cellular indices were found to be significantly associated with all-cause mortality in acute PE. sPESI including red cell distribution width, hematocrit and neutrophil-lymphocyte ratio had better predictive ability as compared to sPESI alone (AUC: 0.852 vs 0.754). Blood cellular indices contribute an inflammatory and hemodynamic perspective not currently included in sPESI. CBC with differential is a widely used, low-cost test that can augment current risk stratification tools for all-cause mortality in acute PE patients.
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Affiliation(s)
- Brett Slajus
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Yevgeniy Brailovsky
- Advanced Heart Failure, Mechanical Circulatory Support, Heart Transplant, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Iman Darwish
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Amir Darki
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
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Xue J, Ma D, Jiang J, Liu Y. Diagnostic and Prognostic Value of Immune/Inflammation Biomarkers for Venous Thromboembolism: Is It Reliable for Clinical Practice? J Inflamm Res 2021; 14:5059-5077. [PMID: 34629886 PMCID: PMC8494998 DOI: 10.2147/jir.s327014] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/19/2021] [Indexed: 12/17/2022] Open
Abstract
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), has been an important cause of sudden in-hospital death. Studies have shown that the immune/inflammatory response plays an important role in the pathogenesis of vascular disease, with representative markers in the blood including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune/inflammatory index (SII), etc. However, there is a variety of immune/inflammatory indicators. Moreover, most previous studies have been single-center investigations involving one or two indicators, with varying nature of cases, number of cases and study objectives, thereby making it difficult to reach consensus conclusions with good clinical guidelines. This article reviews the clinical value of immunoinflammatory indicators for VTE based on previous studies, including the diagnostic and prognostic capabilities. In conclusion, NLR provides promising predictive capability for the onset and prognosis of VTE and deserves extensive application in clinical practice. PLR also has certain diagnostic and prognostic value, but further studies are warranted to identify its reliability and stability. Monocytes, eosinophils and platelet-related indicators show some clinical association with VTE, although the predictive capabilities are mediocre. SII is of promising potential value for VTE and deserves further investigations. This review will provide new clues and valuable clinical guidance for the diagnosis and therapy of VTE.
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Affiliation(s)
- Junshuai Xue
- Department of General Surgery, Vascular Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China
| | - Delin Ma
- Department of General Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China
| | - Jianjun Jiang
- Department of General Surgery, Vascular Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China
| | - Yang Liu
- Department of General Surgery, Vascular Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China
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Efros O, Beit Halevi T, Meisel E, Soffer S, Barda N, Cohen O, Kenet G, Lubetsky A. The Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients Hospitalized with Acute Pulmonary Embolism. J Clin Med 2021; 10:jcm10184058. [PMID: 34575170 PMCID: PMC8469500 DOI: 10.3390/jcm10184058] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 01/22/2023] Open
Abstract
Early risk stratification is essential for determining the appropriate therapeutic management approach of pulmonary embolism (PE). This study aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients hospitalized with acute pulmonary embolism by investigating its association with mortality in a large-scale population diagnosed and hospitalized with acute PE. We retrieved all consecutive patients hospitalized in an internal medicine department or an intensive care unit in a tertiary medical center from December 2007 to April 2021 with a discharge diagnosis of pulmonary embolism. A total of 2072 patients were included. Patients with above-median NLR (i.e., 5.12) had a higher 30-day mortality risk (adjusted odds ratio (aOR), 2.82; 95% confidence interval (CI) 2.14–3.70) and higher one-year mortality risk (aOR, 2.51; 95% CI 2.04–3.08). Similar trends were demonstrated in a sub-analysis of patients without cancer and hemodynamically stable (i.e., systolic blood pressure over 90 mmHg). Furthermore, the median hospital length of stay in patients with an elevated NLR was higher, and so was the in-hospital mortality rate. Elevated NLR in acute PE is associated with a worse short-term and long-term prognosis and with a longer duration of hospitalization.
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Affiliation(s)
- Orly Efros
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat-Gan 5262000, Israel; (O.C.); (G.K.); (A.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
- Correspondence:
| | - Tal Beit Halevi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
| | - Eshcar Meisel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
- Department of Internal Medicine “D”, Sheba Medical Center, Ramat-Gan 5262000, Israel
| | - Shelly Soffer
- Assuta Medical Center, Ashdod 7747629, Israel;
- Ben-Gurion University of the Negev, Be’er Sheva 8410501, Israel
| | - Noam Barda
- Clalit Research Institute, Clalit Health Services, Ramat-Gan 6578898, Israel;
- Department of Biomedical Informatics, Harvard Medical School, Boston, MS 02115, USA
| | - Omri Cohen
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat-Gan 5262000, Israel; (O.C.); (G.K.); (A.L.)
| | - Gili Kenet
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat-Gan 5262000, Israel; (O.C.); (G.K.); (A.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
- Amalia Biron Research Institute of Thrombosis & Hemostasis, Sheba Medical Center, Ramat-Gan 5262000, Israel
| | - Aharon Lubetsky
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat-Gan 5262000, Israel; (O.C.); (G.K.); (A.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
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ÖSKEN A, ÇAM N. The predictive value of systemic immune inflammation index on long-term outcomes among acute pulmonary embolism patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.931405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Rinaldi I, Hamonangan R, Azizi MS, Cahyanur R, Wirawan F, Fatya AI, Budiananti A, Winston K. Diagnostic Value of Neutrophil Lymphocyte Ratio and D-Dimer as Biological Markers of Deep Vein Thrombosis in Patients Presenting with Unilateral Limb Edema. J Blood Med 2021; 12:313-325. [PMID: 34295202 PMCID: PMC8290850 DOI: 10.2147/jbm.s291226] [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: 11/09/2020] [Accepted: 03/26/2021] [Indexed: 01/25/2023] Open
Abstract
Introduction Patients with deep vein thrombosis (DVT) pose high morbidity and mortality risk thus needing fast and accurate diagnosis. Wells clinical prediction scores with D-dimer testing are traditionally used to rule out patients with low probability of DVT. However, D-dimer testing has a few limitations regarding its relatively low specificity. Neutrophil-lymphocyte ratio (NLR), a marker of inflammation, was found to increase in DVT. Hence, we aimed to evaluate the role of NLR for DVT diagnosis. Methods Data were collected from medical records of patients with suspected DVT at Cipto Mangunkusumo National General Hospital during January–December 2014. Diagnosis of DVT was conducted using lower limb ultrasonography. Diagnostic values for NLR, D-dimer, and NLR + D-dimer were determined by receiver operating characteristic (ROC) analysis to obtain area under the curve (AUC), sensitivity, specificity, negative predictive value, and positive predictive values. Sensitivity and specificity analyses of NLR and D-dimer were also conducted based on Wells score and divided into groups of low and high probability of DVT. Results The AUC values for NLR, D-dimer, and NLR + D-dimer were 72.6%, 70.4%, and 76.1%, respectively. The optimal cut-off value determined for NLR was 5.12 with sensitivity of 67.7%, specificity of 67.9%, PPV of 68.85%, and NPV of 64.91% in differentiating subjects with and without DVT. This study also found that D-dimer had sensitivity of 69.4%, specificity of 71.4%, PPV of 72.88%, and NPV of 67.8%. Meanwhile, the NLR + D-dimer combination had sensitivity of 66.1% and specificity of 72.6%. Multivariate analysis showed that NLR (OR: 2.636; 95% CI: 1.144–6.076; p: 0.023) and D-dimer (OR: 4.175; 95% CI: 1.810–9.633; p: 0.001) were associated with DVT. Conclusion NLR value has wider AUC than D-Dimer and is relatively easier to obtain and does not require specific assay, thus enabling rapid evaluation of symptomatic patients suspected of having DVT. Adding NLR to D-dimer increased AUC to detect DVT. Therefore, NLR could serve as a complementary diagnostic tool for D-dimer to exclude DVT, especially in low clinical probability patients.
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Affiliation(s)
- Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Rachmat Hamonangan
- Department of Internal Medicine, PGI Cikini Hospital, Jakarta, Indonesia
| | - Mohamad Syahrir Azizi
- Division of Cardiology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rahmat Cahyanur
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Fadila Wirawan
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Atikah Isna Fatya
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ageng Budiananti
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kevin Winston
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Wu P, Ye H, Cai X, Li C, Li S, Chen M, Wang M, Heidari AA, Chen M, Li J, Chen H, Huang X, Wang L. An Effective Machine Learning Approach for Identifying Non-Severe and Severe Coronavirus Disease 2019 Patients in a Rural Chinese Population: The Wenzhou Retrospective Study. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:45486-45503. [PMID: 34786313 PMCID: PMC8545214 DOI: 10.1109/access.2021.3067311] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/15/2021] [Indexed: 06/13/2023]
Abstract
This paper has proposed an effective intelligent prediction model that can well discriminate and specify the severity of Coronavirus Disease 2019 (COVID-19) infection in clinical diagnosis and provide a criterion for clinicians to weigh scientific and rational medical decision-making. With indicators as the age and gender of the patients and 26 blood routine indexes, a severity prediction framework for COVID-19 is proposed based on machine learning techniques. The framework consists mainly of a random forest and a support vector machine (SVM) model optimized by a slime mould algorithm (SMA). When the random forest was used to identify the key factors, SMA was employed to train an optimal SVM model. Based on the COVID-19 data, comparative experiments were conducted between RF-SMA-SVM and several well-known machine learning algorithms performed. The results indicate that the proposed RF-SMA-SVM not only achieves better classification performance and higher stability on four metrics, but also screens out the main factors that distinguish severe COVID-19 patients from non-severe ones. Therefore, there is a conclusion that the RF-SMA-SVM model can provide an effective auxiliary diagnosis scheme for the clinical diagnosis of COVID-19 infection.
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Affiliation(s)
- Peiliang Wu
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhou325000China
| | - Hua Ye
- Department of Pulmonary and Critical Care MedicineAffiliated Yueqing Hospital, Wenzhou Medical UniversityYueqing325600China
| | - Xueding Cai
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhou325000China
| | - Chengye Li
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhou325000China
| | - Shimin Li
- College of Computer Science and Artificial IntelligenceWenzhou UniversityWenzhou325035China
| | - Mengxiang Chen
- Department of Information TechnologyWenzhou Vocational College of Science and TechnologyWenzhou325006China
| | - Mingjing Wang
- College of Computer Science and Artificial IntelligenceWenzhou UniversityWenzhou325035China
| | - Ali Asghar Heidari
- School of Surveying and Geospatial Engineering, College of EngineeringUniversity of TehranTehran1417466191Iran
- Department of Computer ScienceSchool of ComputingNational University of SingaporeSingapore117417
| | - Mayun Chen
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhou325000China
| | - Jifa Li
- Department of Pulmonary and Critical Care MedicineAffiliated Yueqing Hospital, Wenzhou Medical UniversityYueqing325600China
| | - Huiling Chen
- College of Computer Science and Artificial IntelligenceWenzhou UniversityWenzhou325035China
| | - Xiaoying Huang
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhou325000China
| | - Liangxing Wang
- Department of Pulmonary and Critical Care MedicineThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhou325000China
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34
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Üçsular F, Polat G, Karadeniz G, Ayranci A, Keskin M, Buyukşirin M, Güldaval F, Yalniz E. Predictive value of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with hypersensitivity pneumonia. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:e2020012. [PMID: 33597799 PMCID: PMC7883515 DOI: 10.36141/svdld.v37i4.9966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/15/2020] [Indexed: 11/13/2022]
Abstract
Aim: To evaluate Platelet-to-Lymphocyte Ratio (PLR) and Neutrophil-to-Lymphocyte Ratio (NLR) in patients with HP. Method: A sample of 140 total patients, 50 having chronic HP and 20 having acute HP, and a control group of 70 more patients were included in this retrospective study conducted with hospital Ethical Committee approval. Results: PLR and NLR values were significantly higher in all HP patients than in the control group ( p <0.001). In addition, these biomarkers were significantly higher in patients with acute HP than in the chronic HP group (p = 0.017 and p = 0.044, respectively). The cutoff values for PLR and NLR were: (1) 177 (p = 0.020) and 2.76 (p <0.0001) between the HP patients and the control group, and, (2) 110 (p = 0.0054) and 2.15 (p = 0.03), between the acute and chronic HP groups. Conclusion: PLR and NLR values are inexpensive and easy parameters that can guide in diagnosing hypersensitivity pneumonia in combination with clinical, radiological and pathology findings.and the acute-chronic differentiation of the disease. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (4): e2020012)
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Affiliation(s)
- Fatma Üçsular
- Department of Pulmonology, Health Siences University Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Gülru Polat
- Department of Pulmonology, Health Siences University Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Gülistan Karadeniz
- Department of Pulmonology, Health Siences University Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Aysu Ayranci
- Department of Pulmonology, Health Siences University Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Merve Keskin
- Department of Pulmonology, Health Siences University Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Melih Buyukşirin
- Department of Pulmonology, Health Siences University Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Filiz Güldaval
- Department of Pulmonology, Health Siences University Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Enver Yalniz
- Department of Pulmonology, Health Siences University Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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Gok M, Kurtul A. A novel marker for predicting severity of acute pulmonary embolism: systemic immune-inflammation index. SCAND CARDIOVASC J 2020; 55:91-96. [DOI: 10.1080/14017431.2020.1846774] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Murat Gok
- Cardiology Clinic, Edirne Sultan 1.Murat State Hospital, Edirne, Turkey
| | - Alparslan Kurtul
- Faculty of Medicine, Department of Cardiology, Hatay Mustafa Kemal University, Hatay, Turkey
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Schrottmaier WC, Mussbacher M, Salzmann M, Assinger A. Platelet-leukocyte interplay during vascular disease. Atherosclerosis 2020; 307:109-120. [DOI: 10.1016/j.atherosclerosis.2020.04.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/08/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023]
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Diagnostic Sensitivity of NLR and PLR in Early Diagnosis of Gastric Cancer. J Immunol Res 2020; 2020:9146042. [PMID: 32211444 PMCID: PMC7081040 DOI: 10.1155/2020/9146042] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are markers of systemic inflammation. However, there is little evidence of the value of inflammation in the early diagnosis of gastric cancer (GC). A total of 2,606 patients diagnosed with GC in the past three years and 3,219 healthy controls over the same period were included in this study. Peripheral blood samples were obtained to analyze the NLR, PLR, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9). The optimal cutoff levels for the NLR and PLR were defined by receiver operating characteristic (ROC) curve analysis (NLR = 2.258, PLR = 147.368). The value of different biomarkers for diagnosing GC was compared by the area under the curve (AUC). The NLR and PLR showed diagnostic sensitivity in GC (AUC = 0.715, AUC = 0.707). Using the Bonferroni correction, the NLR and PLR were superior to CEA and CA19-9 in the diagnosis of GC (P < 0.0001). The systemic inflammatory markers were significantly higher in the early stage of GC than tumor markers. After grouping patients and healthy controls by gender, we found that the diagnostic significance of combined NLR and PLR for GC was greater in male patients than in female patients (P < 0.0001). The diagnostic value of the NLR and PLR in GC is higher than that of the traditional tumor markers CEA and CA19-9. Systemic markers of inflammation are more valuable in male than female patients.
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