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Anees M, Jawed K, Ali Z, Khan AM, Siddiqui NA. Association of neutrophil-to-lymphocyte ratio and hemodialysis access failure in patients with end stage renal disease: A systematic review and meta-analysis. J Vasc Access 2024:11297298241276560. [PMID: 39252475 DOI: 10.1177/11297298241276560] [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: 09/11/2024] Open
Abstract
This systematic review and meta-analysis aimed to assess the association of neutrophil-to-lymphocyte ratio (NLR) with an elevated risk of vascular access failure in end-stage renal disease (ESRD) patients undergoing hemodialysis. A comprehensive database search of MEDLINE (via PubMed), Scopus, and Cochrane Central was performed. Studies reporting the values of NLR in both functional and non-functional AVF groups in ESRD patients were selected. Quality assessment was performed using the Modified Newcastle-Ottawa scale for observational studies. Meta-analysis was performed using an inverse variance random effects model. Seven observational studies met the inclusion criteria, including 1313 participants with 554 cases and 759 controls. Pooled results showed significantly high NLR levels in patients with non-functional arteriovenous fistula (AVF) compared to functional AVF (SMD = 1.19, 95% CI = 0.74-1.65, p < 0.001). Subgroup analysis confirmed the consistency of the association between NLR and AVF failure across study design (SMD = 1.76, 95% CI = 0.78-2.73, p = 0.0004 in prospective vs SMD = 0.87, 95% CI = 0.42-1.32, p = 0.0001 in retrospective studies), etiology (SMD = 1.63, 95% CI = 0.75-2.52, p = 0.0003 in stenosis or thrombosis; and SMD = 0.80, 95% CI = 0.27-1.34, p = 0.003 in failure to mature of AVF), and NLR measurement timing (SMD = 0.98, 95% CI = 0.42-1.54, p = 0.0006 in preoperative vs SMD = 1.58, 95% CI = 0.47-2.69, p = 0.005 in postoperative NLR). The pooled odds ratio revealed high NLR values as a significant predictor of AVF failure in ESRD patients (OR = 3.91, 95% CI = 1.91-7.98, p = 0.0002). The pooled sensitivity and specificity were 89.72% (95% CI = 77.51%-95.67%) and 72.95% (95% CI = 63.82%-80.47%), respectively. The high NLR is a useful and predictive marker for AVF failure in hemodialysis patients. Future studies should prioritize larger cohort studies to validate and reinforce these observations.
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Affiliation(s)
| | - Kinza Jawed
- Aga Khan University Hospital, Karachi, Pakistan
| | - Zuhaib Ali
- Aga Khan University Hospital, Karachi, Pakistan
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Baykara Ulusan M, Meltem E, Mutlu IN, Ulusan K. The predictive value of systemic inflammatory markers in 902 patients with tunneled hemodialysis catheter. J Nephrol 2024; 37:1041-1049. [PMID: 38512368 PMCID: PMC11239775 DOI: 10.1007/s40620-023-01880-w] [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: 08/17/2023] [Accepted: 12/26/2023] [Indexed: 03/23/2024]
Abstract
AIM This study aimed to assess the predictive role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and mean platelet volume, on catheter survival in chronic hemodialysis patients, analyzing both infectious and non-infectious complications. METHODS A retrospective analysis encompassed 1279 tunneled catheter insertion procedures involving 902 patients between March 2014 and October 2018. Patients were categorized into two main groups: (i) initial placement and (ii) exchange. The exchange group was further stratified into four subgroups: infection, dysfunction, displacement, and transitioning temporary hemodialysis catheters to long-term ones. Hematologic ratios were calculated from baseline hemogram data, including neutrophil, lymphocyte, monocyte, and platelet counts, while mean platelet volume was derived from the same hemogram. RESULTS The patients in the exchange group displayed significantly higher lymphocyte and monocyte values (p < 0.001), while lower values were noted for neutrophil-lymphocyte ratio and platelet-lymphocyte ratio (p < 0.001). The transition group displayed higher monocyte values and lower mean platelet volume and lymphocyte-monocyte ratio values (p < 0.05). In the infection-related exchange subgroup, higher neutrophil count, mean platelet volume, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio values were observed compared to other groups (p < 0.05). Cases related to catheter dysfunction exhibited increased lymphocyte-monocyte ratio but lower neutrophil, monocyte, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio values (p < 0.05). CONCLUSION This study highlights the interest of specific inflammatory markers, particularly monocytes, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio, in the management of tunneled catheters, notably in patients undergoing exchanges. However, cut-off values, essential for constructing management algorithms, are currently lacking, and prospective multicenter studies are needed for further elucidation.
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Affiliation(s)
- Melis Baykara Ulusan
- Department of Diagnostic and Interventional Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey.
| | - Emine Meltem
- Department of Diagnostic and Interventional Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey
| | - Ilhan Nahit Mutlu
- Department of Radiology, Department of Diagnostic and Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Kivilcim Ulusan
- Department of General Surgery, Department of Endocrine Surgery, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey
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Pasqui E, de Donato G, Molino C, Abu Leil M, Anzaldi MG, Galzerano G, Palasciano G. Residual Aneurysmal Sac Shrinkage Post-Endovascular Aneurysm Repair: The Role of Preoperative Inflammatory Markers. Biomedicines 2023; 11:1920. [PMID: 37509562 PMCID: PMC10377044 DOI: 10.3390/biomedicines11071920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION In this study, we evaluated the role of preoperative inflammatory markers as Neutrophil-to-Lymphocyte (NLR) and Platelet-to-Lymphocyte (PLR) ratios in relation to post-endovascular aneurysm repair (EVAR) sac shrinkage, which is known to be an important factor for abdominal aortic aneurysm (AAA) healing. METHODS This was a single-center retrospective observational study. All patients who underwent the EVAR procedure from January 2017 to December 2020 were eligible for this study. Pre-operative blood samples of all patients admitted were used to calculate NLR and PLR. Sac shrinkage was defined as a decrease of ≥5 mm in the maximal sac diameter. The optimal NLR and PLR cut-offs for aneurysmal sac shrinkage were obtained from ROC curves. Stepwise multivariate analysis was performed in order to identify independent risk and protective factors for the absence of AAA shrinkage. Kaplan-Meier curves were used to evaluate survival rates with respect to the AAA shrinkage. RESULTS A total of 184 patients were finally enrolled. The mean age was 75.8 ± 8.3 years, and 85.9% were male (158/184). At a mean follow-up of 43 ± 18 months, sac shrinkage was registered in 107 patients (58.1%). No-shrinking AAA patients were more likely to be older, to have a higher level of NLR and PLR, and be an active smoker. Kaplan-Meier curves highlighted a higher rate of survival for shrinking AAA patients with respect to their counterparts (p < 0.03). Multivariate analysis outlined active smoking and NLR as independent risk factors for no-shrinking AAA. CONCLUSIONS Inflammation emerged as a possible causative factor for no-shrinking AAA, playing a role in aneurysmal sac remodeling. This study revealed that inflammatory biomarkers, such as NLR and PLR, can be used as a preoperative index of AAA sac behavior after EVAR procedures.
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Affiliation(s)
- Edoardo Pasqui
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Gianmarco de Donato
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Cecilia Molino
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Mustafa Abu Leil
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Manfredi Giuseppe Anzaldi
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Giuseppe Galzerano
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Giancarlo Palasciano
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
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Kaller R, Russu E, Arbănași EM, Mureșan AV, Jakab M, Ciucanu CC, Arbănași EM, Suciu BA, Hosu I, Demian L, Horváth E. Intimal CD31-Positive Relative Surfaces Are Associated with Systemic Inflammatory Markers and Maturation of Arteriovenous Fistula in Dialysis Patients. J Clin Med 2023; 12:4419. [PMID: 37445452 DOI: 10.3390/jcm12134419] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Arteriovenous fistula dysfunction is a widely disputed subject in the scientific literature on end-stage kidney disease (ESKD). The main cause of mortality and morbidity in these patients is the non-maturation or dysfunction of the arteriovenous fistula. Despite the many complications, the native arteriovenous fistula remains the gold standard in the treatment of these patients requiring renal replacement. This study aims to discuss the predictive role of some systemic inflammatory biomarkers (NLR, PLR, SII, IL-6), intimal hyperplasia, and neoangiogenesis (characterized by intimal-media CD31-positive relative surface) in arteriovenous fistula maturation failure. METHODS The present study was designed as an observational, analytical, and prospective study which included patients diagnosed with ESKD with indications of radio-cephalic arteriovenous fistula (RCAVF). Demographic data, comorbidities, preoperative laboratory data and histological/digital morphometry analysis results were processed. The patients included were divided into two groups based on their AVF maturation status at 8 weeks: "Maturation" (Group 1) and "Failed Maturation" (Group 2). RESULTS There was no difference in the demographic data. In terms of comorbidities, the second group had a greater incidence of heart failure (p = 0.03), diabetes (p = 0.04), peripheral artery disease (p = 0.002), and obesity (p = 0.01). Additionally, regarding the laboratory findings, these patients had higher levels of serum uric acid (p = 0.0005), phosphates (p < 0.0001), and creatinine (p = 0.02), as well as lower levels of total calcium (p = 0.0002), monocytes (p = 0.008), and lymphocytes (p < 0.0001). Moreover, all inflammatory markers (p = 0.001; p < 0.0001; p = 0.006, and p = 0.03) and Ca-P product (p < 0.0001) had higher baseline values in Group 2. Upon immunohistochemical analysis, regarding the density of neoformed vessels, there was a higher incidence of CD31-positive surfaces (p = 0.006) and CD31-positive relative surfaces (p = 0.001); the NLR (r = 0.323; p = 0.03), PLR (r = 0.381; p = 0.04), SII (r = 0.376; p = 0.03), and IL-6 (r = 0.611; p < 0.001) are all significantly correlated with vascular density, as evidenced by CD31. CONCLUSIONS Heart failure, peripheral artery disease, obesity, and diabetes, as well as the systemic inflammatory markers (NLR, PLR, SII, IL-6), intimal hyperplasia, and CD31-positive relative surfaces are predictors of arteriovenous fistula maturation failures.
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Affiliation(s)
- Réka Kaller
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Emil Marian Arbănași
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Márk Jakab
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | | | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Bogdan Andrei Suciu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Ioan Hosu
- Department of Nephrology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Liliana Demian
- Center of Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Emőke Horváth
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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Bagyura Z, Kiss L, Lux Á, Csobay-Novák C, Jermendy ÁL, Polgár L, Tabák ÁG, Soós P, Szelid Z, Merkely B, Kőhidai L, Pállinger É. Neutrophil-to-Lymphocyte Ratio Is an Independent Risk Factor for Coronary Artery Disease in Central Obesity. Int J Mol Sci 2023; 24:ijms24087397. [PMID: 37108560 PMCID: PMC10138538 DOI: 10.3390/ijms24087397] [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: 03/13/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Several inflammatory biomarkers were found to be associated with an increased risk of cardiovascular disease. Neutrophil-to-lymphocyte ratio (NLR) is a marker of subclinical inflammation that increases with the stress response. Visceral adiposity index (VAI) calculated as a combination of anthropometric and metabolic parameters reflects both the extent and function of visceral adipose tissue. Given the association of subclinical inflammation with both obesity and cardiovascular diseases, it is plausible that the inflammation-CVD association is modulated by the amount and function of adipose tissue. Thus, our aim was to examine the association between NLR and coronary artery calcium score (CACS), an intermediate marker of coronary artery disease in asymptomatic patients across VAI tertiles. Methods: Data from 280 asymptomatic participants of a cardiovascular screening program were analysed. In addition to the collection of lifestyle and medical history, a non-contrast cardiac CT scan and laboratory tests were performed on all participants. Multivariate logistic regression was conducted with CACS > 100 as the outcome and with conventional cardiovascular risk factors and NLR, VAI, and NLR by VAI tertile as predictors. Results: We found an interaction between VAI tertiles and NLR; NLR values were similar in the lower VAI tertiles, while they were higher in the CACS > 100 in the 3rd VAI tertile (CACS ≤ 100: 1.94 ± 0.58 vs. CACS > 100: 2.48 ± 1.1, p = 0.008). According to multivariable logistic regression, the interaction between NLR and VAI tertiles remained: NLR was associated with CACS > 100 in the 3rd VAI tertile (OR = 1.67, 95% CI 1.06-2.62, p = 0.03) but not in the lower tertiles even after adjustment for age, sex, smoking, history of hypertension, hyperlipidaemia, and diabetes mellitus, as well as high-sensitivity C-reactive protein. Our findings draw attention to the independent association between subclinical, chronic, systemic inflammation and subclinical coronary disease in obesity.
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Affiliation(s)
- Zsolt Bagyura
- Heart and Vascular Center, Semmelweis University, Városmajor utca 68, H-1122 Budapest, Hungary
| | - Loretta Kiss
- Heart and Vascular Center, Semmelweis University, Városmajor utca 68, H-1122 Budapest, Hungary
| | - Árpád Lux
- Heart and Vascular Center, Semmelweis University, Városmajor utca 68, H-1122 Budapest, Hungary
| | - Csaba Csobay-Novák
- Heart and Vascular Center, Semmelweis University, Városmajor utca 68, H-1122 Budapest, Hungary
| | - Ádám L Jermendy
- Heart and Vascular Center, Semmelweis University, Városmajor utca 68, H-1122 Budapest, Hungary
| | - Lívia Polgár
- Heart and Vascular Center, Semmelweis University, Városmajor utca 68, H-1122 Budapest, Hungary
| | - Ádám G Tabák
- Department of Public Health, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4, H-1089 Budapest, Hungary
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Korányi S. u. 2/a, H-1083 Budapest, Hungary
- UCL Brain Sciences, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Pál Soós
- Heart and Vascular Center, Semmelweis University, Városmajor utca 68, H-1122 Budapest, Hungary
| | - Zsolt Szelid
- Heart and Vascular Center, Semmelweis University, Városmajor utca 68, H-1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor utca 68, H-1122 Budapest, Hungary
| | - László Kőhidai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Nagyvárad tér 4, H-1089 Budapest, Hungary
| | - Éva Pállinger
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Nagyvárad tér 4, H-1089 Budapest, Hungary
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Gambardella C, Mongardini FM, Paolicelli M, Bentivoglio D, Cozzolino G, Ruggiero R, Pizza A, Tolone S, del Genio G, Parisi S, Brusciano L, Cerbara L, Docimo L, Lucido FS. Role of Inflammatory Biomarkers (NLR, LMR, PLR) in the Prognostication of Malignancy in Indeterminate Thyroid Nodules. Int J Mol Sci 2023; 24:6466. [PMID: 37047439 PMCID: PMC10094849 DOI: 10.3390/ijms24076466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Indeterminate follicular thyroid lesions (Thyr 3A and 3B) account for 10% to 30% of all cytopathologic diagnoses, and their unpredictable behavior represents a hard clinical challenge. The possibility to preoperatively predict malignancy is largely advocated to establish a tailored surgery, preventing diagnostic thyroidectomy. We analyzed the role of the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and the lymphocyte-to-monocyte ratio (LMR) as prognostic factors of malignancy for indeterminate thyroid nodules. In patients affected by cytological Thyr 3A/3B nodules, NLR, PLR and LMR were retrospectively compared and correlated with definitive pathology malignancy, utilizing student's t-test, ROC analysis and logistic regression. One-hundred and thirty-eight patients presented a Thyr 3A and 215 patients presented a Thyr 3B. After the logistic regression, in Thyr 3A, none of the variables were able to predict malignancy. In Thyr 3B, NLR prognosticated thyroid cancer with an AUC value of 0.685 (p < 0.0001) and a cut-off of 2.202. The NLR results were also similar when considering the overall cohort. The use of cytological risk stratification in addressing the management of indeterminate thyroid nodules in patients is not always reliable. NLR is an easy and reproducible inflammatory biomarker capable of improving the accuracy of preoperative prognostication of malignancy.
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Affiliation(s)
- Claudio Gambardella
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Maddalena Paolicelli
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Davide Bentivoglio
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giovanni Cozzolino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Roberto Ruggiero
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alessandra Pizza
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Salvatore Tolone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Gianmattia del Genio
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Simona Parisi
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Luigi Brusciano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Loredana Cerbara
- Institute for Research on Population and Social Policies, National Research Council of Italy, 00185 Rome, Italy
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Francesco Saverio Lucido
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Proximal Femur Fractures in the Elderly-A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio. J Clin Med 2023; 12:jcm12020456. [PMID: 36675385 PMCID: PMC9865272 DOI: 10.3390/jcm12020456] [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: 11/24/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
Background: The assessment and identification of elderly patients with proximal femur fractures (PFF) who are at high risk of postoperative mortality may influence the treatment decision-making process. The purpose of this study was to determine whether the neutrophil-to-lymphocyte ratio (NLR) could be used to predict postoperative mortality in the elderly population. Methods: A four-year retrospective cohort study of electronic medical records was conducted at a single tertiary care hospital between 2015 and 2018. Data from 1551 patients aged 65 years and older who underwent surgical treatment for PFF were collected and analyzed. The data included complete blood counts at admission, demographic information, underlying illnesses, type of surgery, and postoperative mortality and complications during the first year of follow-up. A survival analysis model was utilized. Results: The mean age was 90.76 ± 1.88 years, 1066 (68.7%) women. Forty-four (2.8%) patients experienced postoperative infection. A higher NLR0 was independently associated with higher all-cause mortality rates in patients who underwent surgical treatment for PFF (p = 0.041). Moreover, the mean NLR0 value was higher when the death occurred earlier after surgery (p < 0.001). Conclusions: When combined with other clinical and laboratory findings, NLR0 levels may serve as a potentially valuable, inexpensive, and reliable prognostic biomarker to improve risk stratification for elderly patients who are candidates for PFF surgery. Furthermore, with additional research, we could potentially develop a treatment algorithm to identify patients at high risk of postoperative mortality.
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Feng D, Wang D, Gu C, Lv M, Liu Z, Wang Y. Effectiveness of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in predicting the incidence of nausea and vomiting after total knee arthroplasty in patients with hemophilia A. Front Surg 2023; 10:1120930. [PMID: 37139191 PMCID: PMC10149928 DOI: 10.3389/fsurg.2023.1120930] [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: 12/10/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
Objective To investigate the ability of preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) to predict postoperative nausea and vomiting (PONV) after total knee arthroplasty (TKA). Methods The clinical data of 108 male patients with hemophilia A who underwent TKA an our institution were collected and analyzed. Confounding factors were adjusted by propensity score matching. The best cutoffs of the NLR and PLR were determined by the area under the receiver operating characteristic curve (ROC). The predictive ability of these indexes was assessed by measuring the sensitivity, specificity, and positive and negative likelihood ratios. Results There were significant differences in the use of antiemetics (p = 0.036) and the incidence of nausea (p < 0.001) and vomiting (p = 0.006) between the two groups (NLR <2 and ≥2). An increase in preoperative NLR was an independent risk factor for PONV in patients with hemophilia A (p < 0.05). ROC analysis showed that NLR significantly predicted the occurrence of PONV (cutoff value: 2.20, ROC: 0.711, p < 0.001). In turn, the PLR did not strongly predict PONV. Conclusions The NLR is an independent risk factor for PONV in patients with hemophilia A and can significantly predict this event. Thus, follow-up monitoring is essential for these patients.
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Affiliation(s)
- Denghe Feng
- School of Anesthesiology, Weifang Medical University, Weifang, China
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Dong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Changping Gu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Meng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Zaibo Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yuelan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Correspondence: Yuelan Wang
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Wang LYT, Tan CS, Lai MKP, Hilal S. Factors Associated with RANTES, EMMPIRIN, MMP2 and MMP9, and the Association of These Biomarkers with Cardiovascular Disease in a Multi-Ethnic Population. J Clin Med 2022; 11:jcm11247281. [PMID: 36555898 PMCID: PMC9782242 DOI: 10.3390/jcm11247281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The growing cardiovascular disease (CVD) epidemic calls for further research to identify novel biomarkers for earlier detection and as potential therapeutic targets. Biomarkers Regulated on Activation, Normal T Cell Expressed and Secreted (RANTES), extracellular matrix metalloproteinase inducer (EMMPRIN), and matrix metalloproteinases (MMP-2, and MMP-9) are linked to proatherogenic and proinflammatory pathways of CVD development, the majority of which are coronary artery disease (CAD) and stroke. We evaluated potential factors affecting these four biomarkers and established their association with CVD. METHODS This is a cross-sectional analysis using a nested case-control design involving 580 participants aged 21-75 years from the prospective multi-ethnic cohort study. A total of 290 CVD cases and 290 age-and sex-matched controls were identified. All participants underwent interviews, health screenings, and provided blood samples, including biomarkers RANTES, EMMPRIN, and MMPs. CVD was defined based on previous medical history. RESULTS The average age of the participants was 55.7(SD = 10.3) years of age, and 34.6% were female. Arrhythmia history and low-density lipoprotein (LDL) levels were significant factors of logEMMPRIN (β = -0.124 [-0.245, -0.003] and β = 0.111 [0.0, 0.191], respectively). Only female sex (β = 0.189 [0.078, 0.300]) for logRANTES and age (β = 0.033 [0.010, 0.055]) for logMMP-2 and logMMP-9 were significant. The Indian ethnicity (β = 0.192 [0.048, 0.335]) and highly sensitive C-reactive protein (hs-CRP) levels (β = 0.063 [0.011, 0.116]) were statistically significant for logMMP-9. No association was detected between biomarkers and CVD. CONCLUSIONS In this multi-ethnic study cohort, RANTES was associated with sex, EMMPRIN was associated with a history of arrhythmia and LDL levels, MMP-2 with age, and MMP-9 with ethnicity and hs-CRP levels. The biomarker serum levels were not associated with CVD.
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Affiliation(s)
- Laureen Yi-Ting Wang
- National University Heart Centre, National University Hospital Singapore, Singapore 119074, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Mitchell K. P. Lai
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore
- Memory, Aging and Cognition Centre, National University Health System, Singapore 117600, Singapore
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore
- Correspondence: ; Tel.: +65-6516-4988
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Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients. Diagnostics (Basel) 2022; 12:diagnostics12112757. [PMID: 36428817 PMCID: PMC9689150 DOI: 10.3390/diagnostics12112757] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Numerous tools, including nutritional and inflammatory markers, have been evaluated as the predictors of poor outcomes in COVID-19 patients. This study aims to verify the predictive role of the prognostic nutritional index (PNI), CONUT Score, and inflammatory markers (monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)) in cases of deep vein thrombosis (DVT) and acute pulmonary embolism (APE) risk, as well as mortality, in COVID-19 patients. Methods: The present study was designed as an observational, analytical, retrospective cohort study, and included 899 patients over the age of 18 who had a COVID-19 infection, confirmed through real time-polymerase chain reaction (RT-PCR), and were admitted to the County Emergency Clinical Hospital and Modular Intensive Care Unit of UMFST “George Emil Palade” of Targu Mures, Romania between January 2020 and March 20212. Results: Non-Surviving patients were associated with a higher incidence of chronic kidney disease (p = 0.01), cardiovascular disease (atrial fibrillation (AF) p = 0.01; myocardial infarction (MI) p = 0.02; peripheral arterial disease (PAD) p = 0.0003), malignancy (p = 0.0001), tobacco (p = 0.0001), obesity (p = 0.01), dyslipidemia (p = 0.004), and malnutrition (p < 0.0001). Multivariate analysis showed that both nutritional and inflammatory markers had a high baseline value and were all independent predictors of adverse outcomes for all enrolled patients (for all p < 0.0001). The presence of PAD, malignancy, and tobacco, were also independent predictors of all outcomes. Conclusions: According to our findings, higher MLR, NLR, PLR, SII, SIRI, AISI, CONUT Score, and lower PNI values at admission strongly predict DVT risk, APE risk, and mortality in COVID-19 patients. Moreover, PAD, malignancy, and tobacco, all predicted all outcomes, while CKD predicts APE risk and mortality, but not the DVT risk.
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Niculescu R, Russu E, Arbănași EM, Kaller R, Arbănași EM, Melinte RM, Coșarcă CM, Cocuz IG, Sabău AH, Tinca AC, Stoian A, Vunvulea V, Mureșan AV, Cotoi OS. Carotid Plaque Features and Inflammatory Biomarkers as Predictors of Restenosis and Mortality Following Carotid Endarterectomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113934. [PMID: 36360814 PMCID: PMC9654888 DOI: 10.3390/ijerph192113934] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is the first-line surgical intervention for cases of severe carotid stenoses. Unfortunately, the restenosis rate is high after CEA. This study aims to demonstrate the predictive role of carotid plaque features and inflammatory biomarkers (monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)) in carotid restenosis and mortality at 12 months following CEA. METHODS The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a minimum of 70% carotid stenosis and surgical indications for CEA admitted to the Vascular Surgery Clinic, Emergency County Hospital of Targu Mures, Romania between 2018 and 2021. RESULTS According to our results, the high pre-operative values of inflammatory biomarkers-MLR (OR: 10.37 and OR: 6.11; p < 0.001), NLR (OR: 34.22 and OR: 37.62; p < 0.001), PLR (OR: 12.02 and OR: 16.06; p < 0.001), SII (OR: 18.11 and OR: 31.70; p < 0.001), SIRI (OR: 16.64 and OR: 9.89; p < 0.001), and AISI (OR: 16.80 and OR: 8.24; p < 0.001)-are strong independent factors predicting the risk of 12-month restenosis and mortality following CEA. Moreover, unstable plaque (OR: 2.83, p < 0.001 and OR: 2.40, p = 0.04) and MI (OR: 3.16, p < 0.001 and OR: 2.83, p = 0.005) were independent predictors of all outcomes. Furthermore, AH (OR: 2.30; p = 0.006), AF (OR: 1.74; p = 0.02), tobacco (OR: 2.25; p < 0.001), obesity (OR: 1.90; p = 0.02), and thrombotic plaques (OR: 2.77; p < 0.001) were all independent predictors of restenosis, but not for mortality in all patients. In contrast, antiplatelet (OR: 0.46; p = 0.004), statin (OR: 0.59; p = 0.04), and ezetimibe (OR:0.45; p = 0.03) therapy were protective factors against restenosis, but not for mortality. CONCLUSIONS Our data revealed that higher preoperative inflammatory biomarker values highly predict 12-month restenosis and mortality following CEA. Furthermore, age above 70, unstable plaque, cardiovascular disease, and dyslipidemia were risk factors for all outcomes. Additionally, AH, AF, smoking, and obesity were all independent predictors of restenosis but not of mortality in all patients. Antiplatelet and statin medication, on the other hand, were protective against restenosis but not against mortality.
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Affiliation(s)
- Raluca Niculescu
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139, Targu Mures, Romania
| | - Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Réka Kaller
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Răzvan Marian Melinte
- Department of Orthopedics, Regina Maria Health Network, 540098 Targu Mures, Romania
- Department of Orthopedics, Humanitas MedLife Hospital, 400664 Cluj Napoca, Romania
| | - Cătălin Mircea Coșarcă
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Iuliu Gabriel Cocuz
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Adrian Horațiu Sabău
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Andreea Cătălina Tinca
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Vlad Vunvulea
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139, Targu Mures, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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Melinte RM, Arbănași EM, Blesneac A, Zolog DN, Kaller R, Mureșan AV, Arbănași EM, Melinte IM, Niculescu R, Russu E. Inflammatory Biomarkers as Prognostic Factors of Acute Deep Vein Thrombosis Following the Total Knee Arthroplasty. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101502. [PMID: 36295662 PMCID: PMC9608310 DOI: 10.3390/medicina58101502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/08/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
Background and objectives: Deep vein thrombosis (DVT) is one of the most serious post-operative complications in the case of total knee arthroplasty (TKA). This study aims to verify the predictive role of inflammatory biomarkers [monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI)] in acute DVT following TKA. Materials and methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with surgical indications for TKA, admitted to the Department of Orthopedics, Regina Maria Health Network, Targu Mures, Romania, and the Department of Orthopedics, Humanitas MedLife Hospital, Cluj-Napoca, Romania between January 2017 and July 2022. The primary endpoint was the risk of acute DVT following the TKA, and the secondary endpoint was the length of hospital stay, and the outcomes were stratified for the baseline’s optimal MLR, NLR, PLR, SII, SIRI, and AISI cut-off value. Results: DVT patients were associated with higher age (p = 0.01), higher incidence of cardiac disease [arterial hypertension (p = 0.02), atrial fibrillation (p = 0.01)], malignancy (p = 0.005), as well as risk factors [smoking (p = 0.03) and obesity (p = 0.02)]. Multivariate analysis showed a high baseline value for all hematological ratios: MLR (OR: 11.06; p < 0.001), NLR (OR: 10.15; p < 0.001), PLR (OR: 12.31; p < 0.001), SII (OR: 18.87; p < 0.001), SIRI (OR: 10.86; p < 0.001), and AISI (OR: 14.05; p < 0.001) was an independent predictor of DVT after TKA for all recruited patients. Moreover, age above 70 (OR: 2.96; p = 0.007), AH (OR: 2.93; p = 0.02), AF (OR: 2.71; p = 0.01), malignancy (OR: 3.98; p = 0.002), obesity (OR: 2.34; p = 0.04), and tobacco (OR: 2.30; p = 0.04) were all independent predictors of DVT risk. Conclusions: Higher pre-operative hematological ratios MLR, NLR, PLR, SII, SIRI, and AISI values determined before operations strongly predict acute DVT following TKA. Moreover, age over 70, malignancy, cardiovascular disease, and risk factors such as obesity and tobacco were predictive risk factors for acute DVT.
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Affiliation(s)
- Răzvan Marian Melinte
- Department of Orthopedics, Regina Maria Health Network, 540098 Targu Mures, Romania
- Department of Orthopedics, Humanitas MedLife Hospital, 400664 Cluj Napoca, Romania
| | - Emil Marian Arbănași
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Adrian Blesneac
- Department of Orthopedics, Regina Maria Health Network, 540098 Targu Mures, Romania
| | - Dan Nicolae Zolog
- Department of Orthopedics, Regina Maria Health Network, 540098 Targu Mures, Romania
| | - Réka Kaller
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Correspondence:
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Ioana Marta Melinte
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Raluca Niculescu
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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Li C, Wan S, Li W, Wang Y, Li B, Chen Y, Sun P, Lyu J. Higher Neutrophil to Lymphocyte Ratio at Admission is Association with Post-PCI Depressive Symptoms in Patients with ACS. Neuropsychiatr Dis Treat 2022; 18:2981-2990. [PMID: 36578901 PMCID: PMC9792112 DOI: 10.2147/ndt.s387582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Depression and elevated blood biomarkers of inflammation are common in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Neutrophil to lymphocyte ratio (NLR) is an indicator of peripheral inflammation and has been proved to be associated with both ACS and depression. PURPOSE Our aim was to evaluate the possible association between NLR at admission and post-PCI depressive symptoms at 1 month. PATIENTS AND METHODS A total of 224 patients with ACS who underwent PCI for the first time were recruited and completed 1-month follow-up. The 24-item Hamilton Depression Scale (HAMD-24) was used to measure depressive symptoms at 1 month after PCI. Logistic regression was used to analyze the relationship between different NLR levels and post-PCI depressive symptoms. A receiver operating characteristic (ROC) curve analysis was performed to assess the value of NLR for predicting post-PCI depressive symptoms and to determine its critical value. RESULTS Of the 224 enrolled patients, 52 (23.2%) patients were diagnosed with depressive symptoms at 1 month after PCI. Patients with depressive symptoms showed significantly higher level of NLR at admission than patients without depressive symptoms (4.33 (3.26, 7.01) vs 2.57 (1.72, 3.91), P < 0.001). The proportion of depressive symptoms in post-PCI patients increases progressively along with NLR quartile. In the results of multivariate-adjusted logistic regression analysis, the odds ratio (OR) of post-PCI depressive symptoms was 12.028 (95% CI, 2.642-54.752) for the lowest quartile of NLR compared with the highest quartile. According to the receiver operating characteristic curve (ROC), the area under the curve (AUC) for predicting post-PCI depressive symptoms was 0.716 (95% CI, 0.641-0.791; P < 0.001), and the optimal cutoff of NLR levels was 3.235 (sensitivity: 76.9%, specificity: 66.9%). CONCLUSION Higher NLR levels at admission were associated with post-PCI depressive symptoms at 1 month, suggesting that NLR might be useful inflammatory markers to predict post-PCI depressive symptoms at 1 month.
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Affiliation(s)
- Cexing Li
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Shaozhi Wan
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Wenqian Li
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Yue Wang
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Bingqing Li
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Yuwen Chen
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Peiyuan Sun
- ChinaThree Gorges University, Yichang, People's Republic of China
| | - Jianfeng Lyu
- Affiliated Renhe Hospital of China Three Gorges University, Department of Cardiology, Yichang, People's Republic of China
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