Platelet-to-Lymphocyte Ratio May Predict the Severity of Calcific Aortic Stenosis

Severity of Mitral Valve Stenosis - Possible Relationships With Blood Oxidant Markers and Antioxidants

BACKGROUND

This study examined whether the severity of mitral valve stenosis (MVS) is associated with oxidative stress (OS) markers in the blood, and other hematological and clinicodemographic parameters.

METHODS AND RESULTS

This prospective study was conducted between March and May 2022. Seventy-five patients with newly diagnosed MVS (25 mild, 25 moderate, 25 severe) were included. Mild, moderate, and severe MVS was defined as MV area >2, 1.5-2, and <1.5 cm2, respectively. Various OS markers and laboratory parameters were determined in venous blood samples. For predictive analyses, 2 different analyses were performed to detect patients with severe MVS and those with moderate or severe (moderate/severe) MVS. Age (P=0.388) and sex (P=0.372) distribution were similar in the 3 groups. Multiple logistic regression analysis revealed that a high white blood cell (WBC) count (P=0.023) and high malondialdehyde (P=0.010), superoxide dismutase (SOD; P=0.008), and advanced oxidation protein products (AOPP; P=0.007) levels were independently associated with severe MVS. A low platelet count (P=0.030) and high malondialdehyde (P=0.018), SOD (P=0.008), and AOPP (P=0.001) levels were independently associated with having moderate/severe MVS. The best discriminatory factors for severe MVS were SOD (cut-off >315.5 ng/mL) and glutathione (cut-off >4.7 μmol/L).

CONCLUSIONS

MVS severity seems to be affected by oxidant markers (malondialdehyde and AOPP), antioxidant enzymes (SOD), and inflammation-related cells (WBC and platelets). Future studies are needed to examine these relationships in larger populations.

Molecular Mechanisms Underlying the Progression of Aortic Valve Stenosis: Bioinformatic Analysis of Signal Pathways and Hub Genes

The calcification of the aortic valve causes increased leaflet stiffness and leads to the development and progression of stenotic aortic valve disease. However, the molecular and cellular mechanisms underlying stenotic calcification remain poorly understood. Herein, we examined the gene expression associated with valve calcification and the progression of calcific aortic valve stenosis. We downloaded two publicly available gene expression profiles (GSE83453 and GSE51472) from NCBI-Gene Expression Omnibus database for the combined analysis of samples from human aortic stenosis and normal aortic valve tissue. After identifying the differentially expressed genes (DEGs) using the GEO2R online tool, we performed Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses. We also analyzed the protein-protein interactions (PPIs) of the DEGs using the NetworkAnalyst online tool. We identified 4603 upregulated and 6272 downregulated DEGs, which were enriched in the positive regulation of cell adhesion, leukocyte-mediated immunity, response to hormones, cytokine signaling in the immune system, lymphocyte activation, and growth hormone receptor signaling. PPI network analysis identified 10 hub genes: VCAM1, FHL2, RUNX1, TNFSF10, PLAU, SPOCK1, CD74, SIPA1L2, TRIB1, and CXCL12. Through bioinformatic analysis, we identified potential biomarkers and therapeutic targets for aortic stenosis, providing a theoretical basis for future studies.

Aort Kapak Sklerozunun Öngörülmesinde Yeni Hematolojik İnflamatuar Parametrelerin Önemi

Aim: Inflammatory process plays a critical role in the progression of aortic valve sclerosis (AVS). This study aims to evaluate the haematological and biochemical inflammatory markers in AVS patients.Methods: A retrospective observational study was included consecutive 557 patients who underwent an echocardiogram between June 2021 and September 2021. The study population was divided into two groups according to the presence of AVS. The groups were compared in terms of C-reactive protein (CRP), Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-HDL cholesterol ratio (MHR).Results: The mean age was 63 ± 10 years. C-reactive protein (CRP), NLR, PLR and MHR were significantly higher in patients with AVS. The best cut-off values of the NLR were 1.4 (a sensitivity of 84%, a specificity of 74%), PLR was 116 (a sensitivity of 75%, a specificity of 54%), and MHR was 9.5 (a sensitivity of 78%, a specificity of 75%). CRP (OR: 1.246, 95% CI: 1.117 – 1.389; p &lt; 0.001), NLR (OR: 2.10, 95% CI: 1.456 – 3.032; p &lt; 0.001), and MHR (OR: 1.227, 95% CI: 1.125 – 1.339; p &lt; 0.001) were independent predictors of the AVS when NLR and MHR analysed as a continuous variable. Using a cut off level of NLR &gt; 1.4 (OR: 4.825, 95% CI: 2.430 – 9.583; p &lt; 0.001) and MHR &gt; 9.5 (OR: 13.937, 95% CI: 7.464 – 26.023; p &lt; 0.001) were independent predictors of the AVS.Conclusion: Increased CRP levels, NLR and MHR were found to be independent predictors for AVS. Hematological inflammatory biomarkers are cost effective and helpful approach for prediction of AVS presence.

Exploring potential genes and pathways related to calcific aortic valve disease

Calcific aortic valve disease (CAVD) is currently the most prevalent valvular disease. However, the pathological mechanism of CAVD has not yet been fully elucidated, and no drugs can delay or halt the progression of CAVD. This study aimed to screen for potential biomarkers and pathways of CAVD through bioinformatics analysis. The identification of differentially expressed genes (DEGs) between calcific aortic valves and the control group was performed based on four microarray datasets: GSE12644, GSE51472, GSE77287 and GSE83453. Gene Ontology and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway enrichment analysis were conducted. Furthermore, the protein-protein interaction network, and microRNA-target interaction was performed, and hub genes were obtained by using twelve cytoHubba algorithms. As a result, 327 DEGs were identified, including 206 up-regulated and 121 down-regulated genes. KEGG analysis showed that these DEGs were mainly enriched in the PI3K-AKT signaling pathway, ECM-receptor interaction, cytokine-cytokine receptor interaction, and chemokine signaling pathway etc. Moreover, we identified 19 hub genes: CXCL8, CXCL12, CSF1R, HCK, PLEK, CCL5, TLR8, VCAM1, CCR1, CCR7, FPR1, TYROBP, CX3CR1, KIT, PPBP, SPP1, SYK, TLR7, and VWF. And multiple potential miRNAs, including miR-141, miR-34a, miR-155, and miR-486, were identified. And western blot was performed to validate the expression level of hub genes. In conclusion, this study identified several promising biomarkers and pathways for CAVD, which may provide novel molecular markers for diagnosis and targeted therapy.

Relation of Preprocedure Platelet-to-Lymphocyte Ratio and Major Adverse Cardiovascular Events Following Transcatheter Aortic Valve Implantation for Aortic Stenosis

The platelet-to-lymphocyte ratio (PLR) is a novel inflammatory biomarker that has prognostic value in patients presenting with acute coronary syndrome. Transcatheter aortic valve implantation (TAVI) treats the inflammatory disease of aortic stenosis. However, the utility of preprocedure PLR in predicting major adverse cardiovascular events (MACE) after TAVI is not clear. Our study population included 470 patients who underwent TAVI at The Alfred Hospital in Melbourne, Australia from August 2008, to January 2019. Patients were divided into 4 groups based on PLR quartiles. The incidence of 30-day MACE (a composite of stroke, myocardial infarction, and death) was then compared. Outcomes were reported according to the Valve Academic Research Consortium-2 criteria. Of 470 patients, median age 84 years, 54% men, and median Society of Thoracic Surgeons score of 3.5%, 14 (3%) suffered a MACE within 30 days. Rates of MACE were low in all 4 groups (1.7%, 2.5%, 2.6%, 5.1%, respectively) with no statistically significant difference in the different PLR groups (p = 0.46). This nonsignificant association was supported by univariate logistic regression analysis of PLR as a continuous variable (odds ratio 1.01, p = 0.55). Using multivariable logistic regression analysis accounting for age, gender, self-expanding valve, and procedural risk, a higher PLR did not correlate with MACE (odds ratio 1.01, p = 0.60). In this study of a large cohort of TAVI patients, elevated preprocedure PLR was not independently associated with MACE after TAVI. This is a novel finding in comparison with previous studies.

Platelets: Implications in Aortic Valve Stenosis and Bioprosthetic Valve Dysfunction From Pathophysiology to Clinical Care

Aortic stenosis (AS) is the most common heart valve disease requiring surgery in developed countries, with a rising global burden associated with aging populations. The predominant cause of AS is believed to be driven by calcific degeneration of the aortic valve and a growing body of evidence suggests that platelets play a major role in this disease pathophysiology. Furthermore, platelets are a player in bioprosthetic valve dysfunction caused by their role in leaflet thrombosis and thickening. This review presents the molecular function of platelets in the context of recent and rapidly evolving understanding the role of platelets in AS, both of the native aortic valve and bioprosthetic valves, where there remain concerns about the effects of subclinical leaflet thrombosis on long-term prosthesis durability. This review also presents the role of antiplatelet and anticoagulation therapies on modulating the impact of platelets on native and bioprosthetic aortic valves, highlighting the need for further studies to determine whether these therapies are protective and may increase the life span of surgical and transcatheter aortic valve implants. By linking molecular mechanisms through which platelets drive disease of native and bioprosthetic aortic valves with studies evaluating the clinical impact of antiplatelet and antithrombotic therapies, we aim to bridge the gaps between our basic science understanding of platelet biology and their role in patients with AS and ensuing preventive and therapeutic implications.

Inflammatory and Biomechanical Drivers of Endothelial-Interstitial Interactions in Calcific Aortic Valve Disease

Calcific aortic valve disease is dramatically increasing in global burden, yet no therapy exists outside of prosthetic replacement. The increasing proportion of younger and more active patients mandates alternative therapies. Studies suggest a window of opportunity for biologically based diagnostics and therapeutics to alleviate or delay calcific aortic valve disease progression. Advancement, however, has been hampered by limited understanding of the complex mechanisms driving calcific aortic valve disease initiation and progression towards clinically relevant interventions.

The relationship between calcific severe aortic stenosis and systemic immune-inflammation index

AIM

Calcific aortic stenosis (AS) is a common valvular disease especially in elderly population. Inflammation plays significant role in the pathophysiological mechanism. Systemic immune-inflammation index (SII) is a novel marker of immune system and inflammation that includes neutrophil, lymphocyte, and platelet cell counts. The aim of this study was to investigate the predictive value of SII in calcific severe AS.

MATERIALS AND METHODS

Severe calcific AS patients were categorized into two groups: High flow-high gradient (HFHG) AS (n = 289) and low flow-low gradient AS (n = 79). Control group included 273 patients with similar clinical and demographic characteristics but without AS. SII was calculated as absolute platelet count × absolute neutrophil count/absolute lymphocyte count.

RESULTS

SII levels were 525 ± 188, 835 ± 402, and 784 ± 348 in control, HFHG AS, and LFLG AS groups, respectively (P < .001). Correlation analyses revealed significant and positive correlation between SII and mean aortic transvalvular pressure gradient (r = .342, P < .001), and negative and significant correlation between SII and AVA (r = -.461, P < .001). Multivariate analysis performed in separate models demonstrated sex, CAD, LDL, and SII levels (Odds ratio [OR]: 1.004, 95 CI%:1.003-1.004) as independent predictors of severe AS in Model 1. According to Model 2, sex, CAD, LDL, and high SII (>661) (OR:5.78, 95 CI%:3.93-4.89) remained as independent predictors of severe AS.

CONCLUSION

SII levels can be useful to predict severe calcific AS patients and significantly correlate with AVA and mean aortic transvalvular pressure gradient.

Neutrophil and platelet to lymphocyte ratio in patients with hypothyroid Hashimoto's thyroiditis

AIM

Chronic lymphocytic thyroiditis is among the most common causes of hypothyroidism along with HT (Hashimoto's thyroiditis) goitre, which is also named as autoimmune thyroiditis. Our study aims to determine the usefulness of PLR (platelet to lymphocyte ratio) and NLR (neutrophil to lymphocyte ratio), which can be obtained with a hemogram, at the clinical course or the severity of the disease in patients with Hashimoto's thyroiditis.

MATERIALS AND METHODS

Our study is a retrospective cross-sectional study that included 121 hypothyroid or subclinical hypothyroid Hashimoto's thyroiditis patients and a healthy control group comprised of 100 individuals. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), anti-thyroid peroxidase (anti-TPO), complete blood count (CBC), and C-reactive protein (CRP) results were obtained from patient files for both HT patients and the control group, and we computed PLR and NLR for both groups.

RESULTS

PLR was lower in patients diagnosed with HT compared to the healthy control group, with statistical significance (respectively, 130.8±50.5 versus 145.3±58.5; p<0,05). NLR was higher in patients diagnosed with HT compared to the control group and a statistically significant relationship was determined (respectively, 2.43±0.94 versus 2,11±0,81; p<0,05). In addition to the present findings, we determined that PLR and NLR were correlated with anti-TPO, TSH, and FT4, although without statistical significance.

CONCLUSION

As values that can be measured with an inexpensive and easily accessible routine hemogram, PLR and NLR can serve as practical and valuable markers at the clinical course or the severity of the disease and other diseases that are autoimmune and progress with chronic inflammation.

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio in Patients with Retinal Artery Occlusion

Purpose

This study aimed to compare the neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in patients with retinal artery occlusion (RAO) with those from a healthy control population and to identify the relationship between them.

Methods

Forty-six patients with RAO and fifty-one healthy control subjects were included in this retrospective case-control study. RAO was diagnosed following an ophthalmic examination and fluorescein angiography (FA). Blood neutrophil, lymphocyte, and platelet counts were recorded for each of the 97 subjects, from which NLR and PLR values were calculated.

Results

There were 46 patients (28 male [M], 18 female [F]) in the RAO group and 51 patients (27 M, 24 F) in the control group. No significant differences were found between patients with RAO and the control subjects in terms of gender and age (P > 0.05). Patients with RAO had significantly increased NLR values (2.85 ± 1.70) than the control subjects (1.63 ± 0.59, P < 0.001). The mean PLR in patients with RAO was 123.69 ± 64.98, while that in control subjects was 103.08 ± 36.95; there was no significant difference between the two groups (P = 0.055). A logistic regression analysis revealed that NLRs were 3.8 times higher in patients with RAO than in control subjects (odds ratio = 3.880; 95% confidence interval = 1.94 to 7.74; P < 0.001).

Conclusion

NLRs were significantly increased in patients with RAO compared to the control subjects.

Relationship of arteriovenous fistula stenosis and thrombosis with the platelet-lymphocyte ratio in hemodialysis patients

BACKGROUND

The platelet-lymphocyte ratio, which was reported to have a strong relationship with chronic inflammation and thrombosis, is a useful biomarker. The purpose of this study was to evaluate the relationship between the platelet-lymphocyte ratio, arteriovenous stenosis, and thrombosis in patients with chronic renal failure.

METHODS

Patients who were referred to our interventional radiology department due to arteriovenous fistula dysfunction from dialysis units between August 2015 and December 2018 were retrospectively reviewed. In the study, 95 patients with arteriovenous fistula access problems were included. Patients were divided into two groups: stenosis (n = 52) and thrombosis (n = 43). Thirty-six subjects with a patent left radiocephalic arteriovenous fistula proven by both color Doppler ultrasonography and clinically were added to the control group. Blood samples were obtained on the same day before the fistulography.

RESULTS

Platelet counts, lymphocyte counts, and platelet-lymphocyte ratio were found to be significantly different between the three groups. After the Bonferroni post hoc analysis, there was a significant difference between the stenosis and control group (p = 0.017), and the thrombosis and control group (p < 0.001) in terms of the platelet-lymphocyte ratio. No significant difference for any parameter was found between stenosis and thrombosis group.

CONCLUSION

High levels of the platelet-lymphocyte ratio may be a supportive finding of arteriovenous fistula stenosis and thrombosis and can be taken into consideration during hemodialysis-dependent patients' follow-up.

Predictive Value of the Platelet-to-Lymphocyte Ratio in Cancer Patients Undergoing Transcatheter Aortic Valve Replacement

Objectives

The purpose of this study is to investigate the predictive value of the platelet-to-lymphocyte ratio (PLR)in cancer patients undergoing transcatheter aortic valve replacement (TAVR).

Background

The PLR is a promising marker to predict clinical outcomes in various cancer types as well as in cardiovascular disease.

Methods

Consecutive TAVR patients were enrolled in the study. We stratified patients into 2 groups: cancer and noncancer. Baseline complete blood counts with a differential hemogram were collected before TAVR. The primary outcome was all-cause death within a 3-year follow-up.

Results

In total, 240 of 1,204 patients (19.9%) had a cancer history. Cancer patients had a significantly higher baseline PLR than noncancer patients (median [interquartile range], 159.8 [109.6 to 244.6] vs. 150.3 [108.7 to 209.0]; p = 0.024). Kaplan-Meier analysis revealed that cancer patients had worse outcomes than noncancer patients (log-rank p < 0.001). Patients who died had a significantly higher baseline PLR than those who survived both in the cancer (p = 0.009) and noncancer (p = 0.027) groups. Multivariable analyses showed that the PLR (by 100 increase) was an independent predictor of adverse outcomes in both cancer (hazard ratio: 1.07; 95% confidence interval: 1.02 to 1.13; p = 0.006) and noncancer (hazard ratio: 1.20; 95% confidence interval: 1.06 to 1.36; p = 0.004). The highest mortality was observed for patients with cancer and increased PLR (above the median) (log-rank p < 0.001).

Conclusions

Cancer patients undergoing TAVR had a significantly higher PLR than those without cancer. Higher PLR was associated with a worse outcome following TAVR.

The association between platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and carotid artery stenosis and stroke following carotid endarterectomy

Objectives

Platelet/lymphocyte ratio is considered to be a recent biomarker which is not only related with inflammation but also associated with the atherosclerotic process. In this study, we aimed to investigate the relationship between carotid artery stenosis, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and mean platelet volume in patients undergoing carotid endarterectomy.

Methods

A total of 160 patients (127 males, 33 females; mean age 69.98 ± 9.76 years; range 48–92 years), who were undergoing carotid endarterectomy due to severe carotid artery stenosis, were evaluated and compared with 201 patients (140 males, 61 females, mean age 66.30 ± 9.24 years, range 41–90 years) without severe carotid artery stenosis. The patients were divided into four groups with respect to the carotid artery stenosis as: Group I (<50% stenosis), Group II (50–70% stenosis), Group III (70–90% stenosis), and Group IV (90–99% stenosis).

Results

Platelet/lymphocyte ratio, neutrophil/lymphocyte ratio and mean platelet volume were found higher in Group IV (patients with severe carotid artery stenosis) (p < 0.01) and were positively correlated with the degree of stenosis (p < 0.01). Platelet/lymphocyte ratio is an independent predictor for post operative stroke (p = 0.047) at multivariate analysis. A threshold level of 145.304 of platelet/lymphocyte ratio combined with a sensitivity 83.3% and specificity 73.8% (95% CI, 0.802–0.921, area under the curve = 0.862 ± 0.03; p = 0.002) for the identification of post operative stroke.

Conclusions

This retrospective study suggests that platelet/lymphocyte ratio in the blood which was taken preoperatively could be considered as an additional, easy, and inexpensive method to predict a possible higher incidence of postoperative stroke after carotid endarterectomy.

Can hematological parameters in type 2 diabetes predict microvascular complication development?

OBJECTIVE

To examine potential associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, mean platelet volume (MPV), HbA1c and microvascular complications in diabetic patients from a cost-effectiveness perspective.

METHODS

One hundred patients with type 2 diabetes attending our outpatient unit between May 2018 and October 2018 were included, and 100 healthy individuals served as the control group. A retrospective file search was performed to collect information on hemoglobin, mean platelet volume (MPV), glycosylated haemoglobin (HbA1c), hematocrit (Hct), neutrophil and lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelets (Plt), platelet/lymphocyte ratio (PLR), and microvascular complications (neuropathy, retinopathy, nephropathy).

RESULTS

Demographic and laboratory data were retrospectively controlled between diabetes (n=100) and healthy control (n=100) groups. The mean age in diabetic patients and healthy controls was 56.34 and 36.68 years, respectively. The mean NLR in diabetics and healthy controls was 2.48 and 2.11, the difference in NLR being significant (p=0.002). MPV in diabetics and controls was 8.54 and 8.53, respectively, and the difference was not significant (p=0.93). PLR was also similar, i.e. 149.7 and 145.3 in diabetics and healthy controls (p=0.067). With respect to microvascular complications, retinopathy was found to be significantly associated with MPV and NLR (p=0.015, and p=0.051), and nephropathy showed a significant association with NLR (p=0.027) among diabetics. In contrast with the two other microvascular complications, no significant association between neuropathy and NLR could be detected, while PLR and neuropathy was significantly associated (p=0.003).

CONCLUSION

Microvascular complications may be associated with certain hematologic parameters, as suggested by comparisons both between diabetics and healthy individuals and within the group of diabetic individuals. We believe that hematologic parameters such as hematocrit, MPV, NLR, and PLR, which can be obtained through a simple complete blood count, may be utilized as cost-effective predictors of diabetic microvascular complications. Further prospective studies with larger sample size are required to better delineate these associations.

Platelet to lymphocyte ratio predicts all-cause mortality in patients with carotid arterial disease

BACKGROUND

Platelet to lymphocyte ratio (PLR) has been demonstrated as a risk and prognostic marker in many of cardiovascular diseases. A relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease.

METHODS

This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of platelets to lymphocytes. The end point of the study was all-cause mortality.

RESULTS

During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients (34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7 ± 1.6 g/dL vs. 13.7 ± 1.7 g/dL, p = 0.031) and they were older than survivors (74.2 ± 8.4 years vs. 68.6 ± 8.5 years, p = 0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3 ± 85.6 and 126.8 ± 53.8, p = 0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis.

CONCLUSION

In our study, higher PLR was associated with increased all-cause mortality.

Adaptive immune cells in calcific aortic valve disease

Calcific aortic valve disease (CAVD) is highly prevalent and has no pharmaceutical treatment. Surgical replacement of the aortic valve has proved effective in advanced disease but is costly, time limited, and in many cases not optimal for elderly patients. This has driven an increasing interest in noninvasive therapies for patients with CAVD. Adaptive immune cell signaling in the aortic valve has shown potential as a target for such a therapy. Up to 15% of cells in the healthy aortic valve are hematopoietic in origin, and these cells, which include macrophages, T lymphocytes, and B lymphocytes, are increased further in calcified specimens. Additionally, cytokine signaling has been shown to play a causative role in aortic valve calcification both in vitro and in vivo. This review summarizes the physiological presence of hematopoietic cells in the valve, innate and adaptive immune cell infiltration in disease states, and the cytokine signaling pathways that play a significant role in CAVD pathophysiology and may prove to be pharmaceutical targets for this disease in the near future.

Platelet to Lymphocyte Ratio in Cardiovascular Diseases: A Systematic Review

The platelet to lymphocyte ratio (PLR) is an integrated reflection of 2 opposite thrombotic/inflammatory pathways that are easily calculated from a complete blood count. The PLR initially served as a systemic inflammatory biomarker to predict the prognosis of neoplastic diseases. In recent years, the PLR has been used as a prognostic marker in cardiovascular (CV) conditions. In this review, we consider the evidence regarding the association of the PLR with CV disease (CVD) and its possible use as a prognostic marker of CVD. The role of PLR has been investigated in CV conditions in several studies. We assessed clinical trials using PubMed, EMBASE, and Web of Science (up to April 18, 2018) to evaluate the association between PLR and mortality/major adverse cardiac events in these conditions. Most of these studies reported significant relationships between a high PLR and diverse outcomes. In conclusion, we suggest that PLR is a cheap and easily available systemic inflammatory marker that can predict distinct outcomes in different types of CVD.

The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease

Objectives

Platelet-to-lymphocyte ratio is a novel biomarker, recently shown to be correlated with atherosclerotic inflammation. This study investigated the role of platelet-to-lymphocyte ratio in patients with carotid artery stenosis and stroke.

Methods

Patients, who underwent carotid angiography with Multiple Detector Computed Tomography Angiography at our hospital, were retrospectively screened. Patients enrolled were divided into three groups based on the platelet-to-lymphocyte ratio. Patients with a platelet-to-lymphocyte ratio value between 55.0 and 106.71 were assigned to Group I, patients with a platelet-to-lymphocyte ratio value between 106.79 and 160.61 were assigned to Group II and patients with a platelet-to-lymphocyte ratio value between 162.96 and 619.61 were assigned to Group III. The carotid arterial stenosis calculated was classified as per the criteria of North American Symptomatic Carotid Endarterectomy Trial.

Results

One hundred fifty patients were included in our trial (mean age 61.9 ± 13.1 with 104 males). The rate of carotid arterial stenosis was detected to be higher in patients with a high platelet-to-lymphocyte ratio value (p = 0.010). Additionally, the platelet-to-lymphocyte ratio was positively correlated with the carotid arterial stenosis percentage (r = 0.250, p = 0.002). In the multi-variate regression analysis, platelet-to-lymphocyte ratio was detected to be an independent variable with respect to stroke (odd’s ratio = 1.012, confidence interval = 1.001–1.024, p = 0.031).

Conclusions

Increased platelet-to-lymphocyte ratio could be a simple and practical marker of the clinical course in patients with carotid arterial stenosis.

The association between platelet-to-lymphocyte ratio and inflammatory markers with the severity of aortic stenosis

AIM

Platelet-to-lymphocyte ratio (PLR) was proposed as a novel indirect marker of inflammation. We aimed to evaluate the relationship between PLR and aortic stenosis (AS).

PATIENTS & METHODS

The study population included 453 patients of which 98 patients with severe AS, 206 patients with mild-to-moderate AS and 149 patients as control.

RESULTS

PLR was significantly increased in parallel to the severity of AS (p < 0.001). There was significant positive correlation between PLR and maximum, and mean systolic transaortic gradient (all p < 0.001). Also, PLR was correlated with C-reactive protein and neutrophil-to-lymphocyte ratio (all p < 0.001) and PLR was independently associated with the presence of AS (p < 0.001).

CONCLUSION

We found a significant relationship between PLR and AS.