AB070. Roles of neutrophil to lymphocyte ratio in differentiating glioblastoma from brain metastasis.

BACKGROUND: Glioblastoma and brain metastasis are two types of brain tumors that have a significant impact on the global healthcare system, with high rates of morbidity and mortality. These tumors can be challenging to differentiate from each other, as they often present with similar symptoms and features on medical imaging. The purpose of this study was to investigate whether the neutrophil-to-lymphocyte ratio (NLR) could help distinguish between glioblastoma and brain metastasis. METHODS: This is a retrospective cross-sectional analysis that utilized medical records from six hospitals located in Yogyakarta, Indonesia from the period of 2016 to 2021. The study included patients who were diagnosed with glioblastoma and brain metastasis. Laboratory data was collected upon initial admission, and the diagnosis of glioblastoma and brain metastasis was based on a histopathological examination. RESULTS: This study included a total of 393 subjects, with the glioblastoma group comprising 121 subjects and the brain metastasis group comprising 272 subjects. The group with glioblastoma had a higher NLR (11.12±11.56 vs. 8.75±9.18, P=0.006) than the brain metastasis group. The area under the curve from the receiver operating characteristic analysis was 0.587 (95% confidence Interval: 0.528-0.647, P=0.006). An NLR value greater than 7.14 was found to have 55.4% sensitivity and 62.5% specificity in predicting glioblastoma. CONCLUSIONS: According to this study, the NLR value of patients suffering from glioblastoma was significantly higher when compared to those with brain metastasis. This indicates that there is a higher degree of systemic inflammation in glioblastoma as compared to brain metastasis. Therefore, the NLR value can be a useful diagnostic tool to distinguish between glioblastoma and brain metastasis.

Association of neutrophil-to-lymphocyte ratio with age and 180-day mortality after emergency surgery.

BACKGROUND: To examine the relationship between neutrophil-to-lymphocyte ratio (NLR), age, and mortality rates after emergency surgery. METHODS: In this observational study, a total of 851 patients undergoing emergency surgery between January 2022 and January 2023 were retrospective examined. Using 30 and 180 days mortality data, NLR differences and receiver operating characteristic (ROC) curves were analyzed using a 65-year threshold. A multiple logistic regression model was constructed incorporating age and NLR. Finally, Kaplan-Meier curves were constructed for mortality. RESULTS: Among 851 patients, the 30 and 180 days mortality rates were 5.2% and 10.8%, respectively. Median NLR in 30 days was 5.6 (3.1 to 9.6) in survivors and 8.7 (4.6 to 13.4) in deceased patients (p < 0.0001); in 180 days, it was 5.5 (3.1 to 9.8) and 8.8 (4.8 to 14.5), respectively (p < 0.0001). In the 30- and 180-days mortality analyses, median NLRs were 5.1 (2.9 to 8.9) and 4.9 (2.9 to 8.8) in survivors and 10.6 (6.9 to 16.6) and 9.3 (5.4 to 14.9) in deceased patients aged < 65 years, respectively. The ROC AUC in patients younger than 65 years was higher for 30 days (AUC 0.75; 95% CI 0.72 to 0.87) and 180 days (AUC 0.73; 95% CI 0.64 to 0.81). Multivariate logistic regression revealed that the NLR (odds ratio, 1.03 [95% CI 1.005 to 1.053; p = 0.0133) and age (odds ratio, 1.05 [95% CI 1.034 to 1.064; p < 0.0001) significantly contributed to the model. Survival analysis revealed differences in the 180 days mortality (p = 0.0006). CONCLUSION: We observed differences in preoperative NLR between patients who survived and those who died after emergency surgery. Age impacts the use of NLR as a mortality risk factor. TRIAL REGISTRATION: NCT06549101, retrospectively registered.

Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in diagnosing neonatal sepsis.

Clinical manifestations of neonatal sepsis are often unspecified. Therefore, sepsis biomarkers could be used to support diagnosis while waiting for blood culture results, such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). The aim of this study was to evaluate the role of NLR and PLR as diagnostic markers in neonatal sepsis. A cross-sectional study was conducted at Haji Adam Malik General Hospital, Medan, Indonesia, from April to October 2019. This study included neonates aged less than 28 days, diagnosed with suspected sepsis, and had no previous history of antibiotics administration. Patients underwent clinical assessment, laboratory examination, and blood culture. Patients were grouped into sepsis and non-sepsis based on the blood culture results. The median hematological examination and the range of NLR and PLR in both the sepsis and non-sepsis groups were subjected to analysis using the Mann-Whitney U test to assess differences. NLR and PLR optimal cut-off values were determined using a receiver operator curve (ROC) with a confidence interval of 95%. A total of 137 neonates were enrolled, of which 49 were classified as sepsis and 89 as non-sepsis based on blood culture results. The optimal cutoff values for NLR and PLR were 2.75 and 11.73. Using those cutoff values, NLR and PLR could predict neonatal sepsis with sensitivities of 52.1% and 47.9%, specificities of 50.6% and 47.2%, area under the curve (AUC) of 0.46 and 0.47, with p=0.525 and p=0.662, respectively. Further investigation is warranted to refine the NLR and PLR utility and enhance diagnostic accuracy in clinical practices.

Predictive biomarkers of preeclampsia severity in a low resource setting: Role of red blood cell indices, NLR, and albumin-to-creatinine ratio.

Preeclampsia (PE), a serious medical condition with substantial maternal and perinatal implications, poses a significant challenge, particularly in high-incidence countries like Indonesia. Red blood cell (RBC) indices, neutrophil-to-lymphocyte ratio (NLR), and microalbuminuria (albumin-to-creatinine ratio (ACR)) may signal systemic inflammation and endothelial dysfunction, recently recognized as potential indicators for diagnosing and predicting disease severity. The aim of this study was to analyze RBC indices, NLR, and ACR changes in women with PE and their potential for predicting disease severity. A cross-sectional study was conducted at multi-center hospitals across Medan, Indonesia, from June 2022 to June 2023. The patients were grouped into PE cases with and without severe features. Demographic characteristics and complications were recorded while blood and urine were tested. The Chi-squared test, Fisher's exact test and Mann-Whitney test were used to determine biomarkers associated with severe PE. A total of 208 PE patients were included in the study (104 patients for each PE with and without severe features). Our data indicated that PE patients with severe features had higher red cell distribution width (18.5% vs 13.7%; p<0.001), NLR (5.66% vs 4.1%; p<0.001), and ACR (755.97 mg/dL vs 468.63 mg/dL; p<0.001) compared to those without severe features. In contrast, the platelet count was lower in severe features than those without (21.9 × 106/µL vs 27.0 × 106/µL; p=0.002). This study highlighted that PE patients with severe features predominantly had higher levels of RDW, NLR, and ACR and lower platelet counts compared to those without severe features. Therefore, basic tests such as complete blood count and urinalysis, which are inexpensive and feasible in primary care settings with limited resources, offer hope as valuable diagnostic biomarkers for pregnant women diagnosed with PE in a low resource setting.

Relationship between NLR and penile squamous cell carcinoma: a systematic review and meta-analysis.

OBJECTIVE: We conducted this study to summarize the results of studies reporting the role of NLR (neutrophil to lymphocyte ratio) in PSCC (penile squamous cell carcinoma). METHODS: This meta-analysis was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. A systematic search was conducted on PubMed, Scopus, and web of science up to March 10, 2023. Fourteen studies were included in the review. The NOS (Newcastle-Ottawa Scale) was used to determine the quality of the included studies. This meta-analysis was conducted on the studies reporting the relationship between NLR and survival using HR (hazard ratio) and 95% CI (confidence interval). RESULTS: There was a significant association between NLR levels and the prognosis, nodal stage, and anatomical tumor stage of PSCC patients. In the meta-analysis of the association of NLR with survival, NLR level was significantly associated with lower cancer-specific survival (HR = 3.51, 95% CI = 2.07-5.98, p < 0.001) and lower disease-free survival (HR = 2.88, 95% CI = 1.60-5.20, p < 0.001). However, NLR was found to have no association with the stage, grade, location, and size of the tumor. CONCLUSION: NLR has a significant diagnostic and prognostic value in PSCC.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in bacterial infections: contributions to diagnostic strategies in a tertiary care hospital in Tunisia.

Background: Bacterial infections continue to pose a global health challenge, driven by antibiotic resistance and septicemia. This study aimed to assess the diagnostic utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in bacterial infections versus non-infectious causes of inflammation. Methods: A prospective study included 164 adult patients who were divided into two groups: a group of patients with confirmed bacterial infections and a second group of patients with other diagnoses (inflammatory pathologies, neoplasms, venous thromboembolic diseases, etc.). NLR and PLR values were compared between the bacterial infection group and the non-infectious causes group and the diagnostic performances of NLR and PLR for detecting bacterial infections were evaluated in comparison with other infection markers. Results: NLR and PLR were significantly higher in bacterial infections (p < 10 ^-6), and NLR was correlated positively with inflammation markers. NLR and PLR demonstrated significant potential in diagnosing bacterial infections, with an AUC of 0.72 and 0.60, respectively, using the following cutoff values: 4.3 for NLR and 183 for PLR. Conclusion: These findings underscore the importance of NLR and PLR as adjunctive tools for bacterial infection diagnosis.

Predicting survival in sepsis: The prognostic value of NLR and BAR ratios.

BACKGROUND: Due to the high-risk nature of sepsis, emergency departments urgently need a simple evaluation method to assess the degree of inflammation and prognosis in sepsis patients, providing a reference for diagnosis and treatment. OBJECTIVE: To investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) combined with the blood urea nitrogen-to-serum albumin ratio (BAR) in sepsis. METHODS: A total of 377 sepsis patients admitted to Lishui People's Hospital from June 2022 to June 2023 were selected as the study subjects. Based on their prognosis, they were divided into a survival group (255 cases) and a death group (82 cases). The clinical data of the two groups were compared. Multivariate logistic analysis was used to identify factors influencing sepsis prognosis, and ROC curve analysis was used to assess the predictive efficacy of NLR, BAR, and their combination. RESULTS: Compared with survivors, non-survivors had higher NLR and BAR, with statistically significant differences (p< 0.05). After adjusting for confounding factors, NLR (OR = 1.052) and BAR (OR = 1.095) were found to be independent prognostic factors for sepsis patients (both p< 0.05). The AUC of NLR combined with BAR was 0.798 (95% CI 0.745-0.850, p< 0.05), higher than the AUC of NLR alone (0.776) and BAR alone (0.701). CONCLUSIONS: The combination of NLR and BAR has a high predictive value for the prognosis of sepsis patients. Its simple calculation makes it particularly suitable for use in emergency departments.

Admission Neutrophil-to-Lymphocyte Ratio as a Predictive Factor in the Outcome of Acute Spontaneous Intracerebral Hemorrhage.

Background and Objective: A growing body of evidence supports that inflammatory mechanisms are involved in secondary brain injury after intracerebral hemorrhage (ICH) which has implications on the morbidity and mortality of stroke patients. Neutrophil-to-lymphocyte ratio (NLR) is a comprehensive index marker of inflammation and immune status of a patient. The prognostic value of NLR in predicting in-hospital mortality and functional outcome of patients with spontaneous intracerebral hemorrhage will be assessed in this study. Methods: We retrospectively selected 151 hemorrhagic stroke patients, and demographic and clinical characteristics were collected and computed for NLR. Receiver operating characteristic analysis using Youden's index was utilized to determine the NLR cut-off value with the best sensitivity and specificity. The association of NLR with the in-hospital mortality and functional outcome was assessed using Logistic regression analysis. Pearson Product Model Correlation was employed to evaluate the correlation of NLR with ICH volume. Results: Admission NLR >7 showed a significant association (p=<0.001 OR 7.99) with in-hospital mortality with a sensitivity of 70.83% and specificity of 72.82%. Furthermore, computed NLR of more than 6.4 showed significant association (p=0.040 OR 2.92) with poor functional outcome. However, our study revealed that admission NLR showed a low level of correlation (r=0.2968, p=0.002) with the volume of ICH. CONCLUSION: This study demonstrated that ICH patients with an elevated NLR is associated with increased in-hospital mortality and poor functional outcome and that NLR can be used to predict clinical outcome among patients with spontaneous ICH.

The application of lung immune prognostic index in predicting the prognosis of 302 STS patients.

Background: Soft tissue sarcoma (STS) are heterogeneous and rare tumors, and few studies have explored predicting the prognosis of patients with STS. The Lung Immune Prognostic Index (LIPI), calculated based on baseline serum lactate dehydrogenase (LDH) and the derived neutrophils/(leukocytes minus neutrophils) ratio (dNLR), was considered effective in predicting the prognosis of patients with pulmonary cancer and other malignancies. However, the efficacy of the LIPI in predicting the prognosis of patients with STS remains unclear. Methods: This study retrospectively reviewed patients with STS admitted to our center from January 2016 to January 2021. Their hematological and clinical characteristics were collected and analyzed to construct the LIPI specific to STS. The correlations between various predictive factors and overall survival (OS) were examined using Kaplan-Meier and Cox regression analyses. Independent risk factors for OS were identified using univariate and multivariate analyses. Finally, a LIPI nomogram model for STS was established. Results: This study enrolled 302 patients with STS, of which 87 (28.9%), 162 (53.6%), and 53 (17.5%) were classified into three LIPI-based categories: good, moderate, and poor, respectively (P < 0.0001). The time-dependent operator curve showed that the LIPI had better prognostic predictive ability than other hematological and clinical characteristics. Univariate and multivariate analyses identified the Fédération Nationale des Centres de Lutte Contre le Cancer grade (FNCLCC/G), tumor size, and LIPI as independent risk factors. Finally, a nomogram was constructed by integrating the significant prognostic factors. Its C-index was 0.72, and the calibration curve indicated that it could accurately predict the three- and five-year OS of patients with STS. The decision and clinical impact curves also indicated that implementing this LIPI-nomogram could significantly benefit patients with STS. Conclusion: This study explored the efficacy of the LIPI in predicting the prognosis of 302 patients with STS, classifying them into three categories to evaluate the prognosis. It also reconstructed a LIPI-based nomogram to assist clinicians in predicting the three- and five-year OS of patients with STS, potentially enabling timely intervention and customized management.

Inflammation indices in association with periodontitis and cancer.

Inflammation is a complex physiological process that plays a pivotal role in many if not all pathological conditions, including infectious as well as inflammatory diseases, like periodontitis and autoimmune disorders. Inflammatory response to periodontal biofilms and tissue destruction in periodontitis is associated with the release of inflammatory mediators. Chronic inflammation can promote the development of cancer. Persistence of inflammatory mediators plays a crucial role in this process. Quantification and monitoring of the severity of inflammation in relation to cancer is essential. Periodontitis is mainly quantified based on the severity and extent of attachment loss and/or pocket probing depth, in addition with bleeding on probing. In recent years, studies started to investigate inflammation indices in association with periodontal diseases. To date, only few reviews have been published focusing on the relationship between blood cell count, inflammation indices, and periodontitis. This review presents a comprehensive overview of different systemic inflammation indices, their methods of measurement, and the clinical applications in relation to periodontitis and cancer. This review outlines the physiological basis of inflammation and the underlying cellular and molecular mechanisms of the parameters described. Key inflammation indices are commonly utilized in periodontology such as the neutrophil to lymphocyte ratio. Inflammation indices like the platelet to lymphocyte ratio, platelet distribution width, plateletcrit, red blood cell distribution width, lymphocyte to monocyte ratio, delta neutrophil index, and the systemic immune inflammation index are also used in hospital settings and will be discussed. The clinical roles and limitations, relationship to systemic diseases as well as their association to periodontitis and treatment response are described.

Increased Systemic Immune-Inflammation Index as a Novel Indicator of Alzheimer's Disease Severity.

INTRODUCTION: Inflammatory processes and neurodegeneration are common features of Alzheimer's disease (AD). The systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are easily accessible, cost-effective prognostic indicators of inflammation status. We assessed the diagnostic value of SII and compared the efficacies of NLR, PLR, and SII in predicting AD severity. MATERIALS AND METHODS: Between January 2021 and December 2022, this prospective, cross-sectional clinical study included 175 patients with AD and 61 controls. SII, NLR, and PLR were calculated. RESULTS: Age, white blood cell and lymphocyte counts, and NLR and PLR values were significantly different between the patient and control groups (P <.05). Age, hemoglobin, neutrophil, NLR, and SII values were significantly different among dementia severity subgroups (P <.05). Compared with PLR and SII, NLR was more strongly correlated with dementia severity. In the analysis of adjusted data by gender, it was found that hemoglobin level is significantly negatively associated with dementia severity in males, while in females, age and PLR are significantly positively associated with dementia severity, and lymphocyte count and SII are negatively associated. CONCLUSION: SII, a novel inflammatory marker, was associated with dementia severity in patients with AD. Compared with PLR and SII, NLR was more strongly correlated with dementia severity. In future studies with larger populations, SII and NLR values can be used to determine dementia severity and establish follow-up plans for patients with high dementia risk.

Application value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting stress ulcer after acute cerebral hemorrhage surgery.

OBJECTIVE: The Platelet-to-Lymphocyte Ratio (PLR) and Neutrophil-to-Lymphocyte Ratio (NLR) are established biomarkers that are associated with the severity, progression, and fatality of diseases. This study aimed to determine their predictive value for the occurrence of stress ulcers (SU) following surgery for acute cerebral hemorrhage. METHODS: Retrospective data from 210 patients with acute cerebral hemorrhage hospitalized between June 2020 and March 2023 were analyzed. Patients were categorized into two groups based on the occurrence of SU post-surgery: the SU group (42 patients) and the non-SU group (168 patients). Clinical characteristics of both groups were compared, and a multivariate logistic regression was conducted to identify independent risk factors for SU. The study evaluated the predictive value of NLR and PLR, individually and in combination, for predicting SU using Receiver Operating Characteristic (ROC) curves. RESULTS: We observed significant differences between the SU and non-SU groups in several parameters, including GCS score, absolute neutrophils, NLR, PLR, postoperative tracheotomy, and intracranial infection (P < 0.05). Our multivariate logistic regression analysis identified four independent risk factors for SU in patients undergoing surgery for acute cerebral hemorrhage: GCS score, NLR, PLR, and fasting blood glucose (P < 0.05). Furthermore, ROC analysis demonstrated that the combination of NLR and PLR exhibited the highest AUC, sensitivity, and specificity in predicting SU following surgery for acute cerebral hemorrhage (P < 0.001), with values of 0.864 (95 % CI: 0.776-0.953), 0.778 (95 % CI: 0.658-0.899), and 0.941 (95 % CI: 0.889-0.993) respectively. CONCLUSION: This study highlighted the combined application of PLR and NLR as a significant predictor of SU in patients post-acute cerebral hemorrhage surgery.

Systemic Immune-Inflammation Indices Could Be Additional Predictive Markers for Cesarean Scar Pregnancy.

PROBLEM: Cesarean scar pregnancy (CSP) is characterized by a gestational sac fully or partially implanted in the scar from a previous cesarean section. Systemic immune-inflammation indices (SIIs) have recently been discussed as additional diagnostic markers in placenta accreta and preeclampsia. CSP shares a similar pathogenesis with these diseases, suggesting that assessing the SIIs and neutrophil-to-lymphocyte ratio (NLR) could enhance additional predictability in diagnosing CSP. METHOD OF STUDY: In this study, we analyzed the complete blood counts between 264 women who were confirmed with CSP by ultrasound and 295 women who underwent elective termination. RESULTS: The mean counts of total white cells and neutrophils were significantly higher, whereas the counts of monocytes, lymphocytes, and platelets were significantly lower in the CSP group compared to the control group (p < 0.001). Additionally, the SII, systemic inflammation response index (SIRI), or NLR was significantly higher in the CSP group compared to the control group (p < 0.0001). Given the limited effect of SII and SIRI on the increased risk of developing CSP, the optimal cut-off value for NLR in predicting CSP was 2.87 (area under the curve [AUC] 0.656, 68% sensitivity). The optimal cut-off value for NLR in predicting type 2 CSP was 2.91 (AUC 0.690, 71% sensitivity). CONCLUSIONS: Although ultrasound or magnetic resonance imaging images are a gold standard for visualizing the gestational sac's location in the diagnosis of CSP, assessing peripheral blood tests is cost-effective, and NLR may provide additional diagnosis value for CSP.

The relationship of COVID-19 severity with laboratory findings and neutrophil-to-lymphocyte ratio in patients admitted to a large teaching hospital in Iran: A cross-sectional study.

Background and Aims: COVID-19 patients might be admitted to the hospital based on their clinical manifestations or to the intensive care unit (ICU) due to the severity of their symptoms or critical situation. Our main objective was to investigate clinical and demographic factors influencing COVID-19 patients' admission to the ICU and length of stay (LOS) using extracted data from the hospital information systems in Iran. Methods: The data of hospitalized patients with confirmed COVID-19 were retrieved from the health information system of Imam Khomeini Hospital Complex, Tehran, Iran between March 2020 and February 2022. The primary outcome was the ICU admission, and the secondary outcome was the LOS. The correlation analysis between laboratory findings and demographic data with ICU admission and LOS was done using SPSS 21.0, and p < 0.05 was considered significant. Results: Of all the 4156 patients, 2391 (57.5%) were male and the mean age was 58.69 ± 8.19 years. Of these, 9.5% of patients were admitted to ICU at any time point during their hospital stay. Age and laboratory variables such as neutrophil-to-lymphocyte ratio (NLR), ALT (U/L), albumin (g/dL), plasma glucose (mg/dL), ferritin levels (ng/mL), and phosphorous levels (mg/dL) shown the significant relationship with ICU admission. Also, being a smoker and having hypoxemia had a significant relationship with longer stays in the hospital. In this study, we validated a cut-off value of 4.819 for NLR, calculated at hospitalization, as a useful predictor of disease progression and occurrence of serious clinical outcomes, such as ICU admission. Conclusion: The study examined various clinical factors associated with ICU admission in COVID-19 patients. The findings suggest that certain factors can increase the risk of ICU admission and influence the length of hospital stay which should be focused in future studies.

Association of benign and malignant neoplastic lesions of the eyelid with systemic inflammatory markers.

CLINICAL RELEVANCE: The role and prognostic significance of systemic inflammatory markers in various malignancies have been the subject of investigation. The role of these inflammatory markers in eyelid lesions remains to be elucidated. BACKGROUND: Benign and malignant lesions of the eyelid are common presentations in eye clinics. Systemic inflammatory markers derived from a complete blood count may provide insight into the benign-malignant differentiation of the lesion. METHODS: This study included 134 patients who underwent surgery for eyelid lesions between 2021-2023. The lesions were evaluated by oculoplastic surgeons and operated on with a preliminary diagnosis of benign or malignant. According to the histopathological diagnosis, benign lesions were included in Group 1 and malignant lesions in Group 2. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII) (NxP/L) based on neutrophil, lymphocyte, and platelet counts were calculated from the preoperative complete blood count of all patients. RESULTS: Eighty-eight patients were included in Group 1 and 46 patients in Group 2. There were 41/47 (Female/Male) in Group 1 and 19/27 (F/M) males in Group 2 (p = 0.345). The mean age was 62.91 ± 9.04 years in Group 1 and 65.41 ± 8.76 years in Group 2 (p = 0.127). The preliminary diagnosis and histopathological diagnosis were incompatible in 5 cases in both groups. In Group 1: NLR = 1.82 ± 0.72, PLR = 124.50 ± 45.19 and SII = 454.51 ± 220.20, in Group 2: NLR = 2.48 ± 0.89, PLR = 128.12 ± 49.58 and SII = 590.22 ± 271.09. NLR and SII differences between groups were statistically significant, while PLR was similar (p < 0.001, p = .002, p = .671). ROC curve analysis showed that the optimal cut-off values for NLR, PLR, and SII were 1.99, 119.16, and 475.21, respectively. CONCLUSION: High levels of NLR and SII in eyelid tumours can be used as an adjunct to examination findings in the preliminary diagnosis of the lesion as benign or malignant and may influence surgical planning.

Determination of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index in dogs with leptospirosis.

Leptospirosis is a globally distributed zoonosis with multisystemic involvement in canine species, capable of causing a pulmonary hemorrhagic syndrome (LPHS) in the most severe cases. In humans, the neutrophil to lymphocyte ratio (NLR), platelets to lymphocytes (PLR) and systemic immune-inflammation index (SII) have been described as predictors of morbidity and mortality in various pathologies, but no such studies have been developed for canine leptospirosis. Hence, we aimed to assess the usefulness of NLR, PLR and SII in dogs affected with leptospirosis, focusing on those that died or survived after hospitalization, whether or not they developed LPHS. The leptospirosis group was composed by 36 dogs while the control group consisted of 32 healthy dogs. The NLR, associated with inflammation, demonstrated a threefold or greater increase in all leptospirosis groups compared to the control group (median 2.44 ± 1.66) (developing or not LPHS). Dogs that died (median 67.78 ± 158.67), developed LHPS (median 85.17 ± 143.77), or both developed LHPS and died (median 67.78 ± 155,14) had a lower PLR in comparison to the control group (median 101,82 ± 53,75) and the rest of groups, but no statistically significant differences were observed (p > 0.05). The SII was higher in leptospirosis-affected dogs that survived (median 1356,92 ± 2726,29) and statistically significant differences were observed in those who did not develop LPHS (median 1770,41 ± 2630,77; p < 0.05) compared to the control group (median 555,21 ± 313,26). Our data shows that NLR may be used as inflammation indicator, while more studies are needed for PLR and SII in canine leptospirosis.

Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio as predictors of refractory anaphylaxis.

Background: Refractory anaphylaxis poses an ongoing, lethal hypersensitivity response that unpredictably involves multiple organs despite appropriate intramuscular (IM) adrenaline injections. Studies on the association of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) concerning anaphylactic severity have yet to be carried out. The study aimed to evaluate the association between blood PLR and NLR levels and refractory anaphylaxis. Methods: We carried out a retrospective cross-sectional study in which medical records of patients with anaphylaxis who sought urgent care at the Emergency Department (ED) of Tertiary Hospital in Hanoi, Vietnam, were evaluated. Based on the United Kingdom Resuscitation Council guidelines in 2021, patients were classified as refractory anaphylaxis if they needed more than two appropriate doses of intramuscular adrenaline for anaphylactic symptoms resolution. Clinical data and laboratory results were obtained in the medical records. Logistic regression analysis determined the association between contributing factors and refractory anaphylaxis. Results: One-hundred eighteen adults (age 51.80 ± 18.25 years) were analyzed, including 38 refractory anaphylaxis patients (32.2%). Refractory anaphylaxis patients exhibited notably elevated platelet-to-lymphocyte ratio (PLR) (P = 0.006) and increased neutrophil-to-lymphocyte ratio (NLR) (P < 0.001) in comparison to non-refractory anaphylaxis patients. Receiver operating characteristic curve (ROC) analysis demonstrated an optimal PLR cutoff value of 129.5 (area under the ROC curve [AUC] 0.658, sensitivity 73.68%, specificity 61.25%, P = 0.004) and an optimal NLR cutoff value of 4 (AUC 0.736, sensitivity 65.79%, specificity 73.75%, P < 0.001) for refractory anaphylaxis. Multivariate logistic regression analysis revealed a PLR≥129.5 (OR = 4.83, 95% CI: 1.87-12.48) and an NLR≥4 (OR = 4.60, 95% CI: 1.86-11.41) were independently associated with refractory anaphylaxis. Conclusion: Elevated PLR and NLR serve as independent indicators significantly associated with refractory anaphylaxis.

Potential prognostic predictors of treatment with immune checkpoint inhibitors for advanced endometrial cancer.

BACKGROUND: Prognostic predictors of immunotherapy in patients with advanced endometrial cancer remain unclear. The potential role of inflammatory predictors, including pretreatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and hemoglobin, albumin, lymphocyte and platelet scores, was investigated. METHODS: Between August 2018 and December 2023, 35 patients were retrospectively analyzed. Prognostic predictors were compared, and optimal cut-off values that exhibited the greatest discrimination for overall response, disease control, progression-free survival and overall survival were determined. Multivariate analysis was used to assess the prognostic significance of the predictors. RESULTS: The greatest discrimination for overall response, progression-free survival and overall survival included platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio and hemoglobin, albumin, lymphocyte and platelet; the areas under the curve were 0.638, 0.649 and 0.641, respectively. The precise cut-off values of neutrophil-to-lymphocyte ratio for progression-free survival and overall survival were 4.92 and 5.40, respectively. The lower neutrophil-to-lymphocyte ratio group had a significantly longer progression-free survival (P = 0.001, median survival; 4.0 months vs. 19 months) and longer overall survival (P = 0.002, median survival; 5.0 months vs. 21 months). Of the risk factors assessed, neutrophil-to-lymphocyte ratio (hazard ratio = 4.409; 95% CI = 1.10-17.64; P = 0.036) and regimen (hazard ratio = 5.559; 95% CI = 1.26-24.49; P = 0.023) were independently correlated with overall survival. CONCLUSION: In patients with advanced endometrial cancer, pretreatment neutrophil-to-lymphocyte ratio may be a prognostic predictor of those who would benefit from immunotherapy.

Neutrophil to lymphocyte ratio and five-year mortality in patients with acute ischemic stroke.

Background: Previous studies linked neutrophil to lymphocyte ratio (NLR) with short-term mortality after acute ischemic stroke (AIS), but its relationship with long-term mortality remains unclear. This study investigates the association between NLR and five-year mortality in AIS patients. Method: We analyzed 416 AIS patients from April 2012 to January 2016 at Zhangjiagang TCM Hospital. Admission NLR was divided into quartiles: Q1 (<2.00), Q2 (2.00-3.05), Q3 (3.06-5.46), and Q4 (≥5.46). We assessed 5-year all-cause and vascular mortality using Kaplan-Meier, Cox regression, and receiver operating characteristic (ROC) curve analyses. Results: Over five years, 134 (32.2 %) all-cause deaths and 114 (27.4 %) vascular deaths occurred. Elevated NLR was significantly associated with increased risks of all-cause and vascular mortality. Multivariate Cox analysis identified stroke history (HR: 1.57, 95 % CI 1.08-2.30), baseline National Institutes of Health Stroke Scale (NIHSS) score (HR: 1.09, 95 % CI 1.05-1.12), and NLR (HR: 1.09, 95 % CI 1.05-1.12) as independent risk factors for all-cause mortality. These factors also predicted 5-year vascular mortality: stroke history (HR: 1.65, 95 % CI 1.10-2.49), NIHSS score (HR: 1.10, 95 % CI 1.06-1.13), and NLR (HR: 1.08, 95 % CI 1.05-1.10). NLR quartiles were significantly linked to both outcomes: all-cause mortality HRs were Q2 (1.87, 95 % CI 1.00-3.51), Q3 (2.40, 95 % CI 1.31-4.39), Q4 (2.77, 95 % CI 1.47-5.24), P for trend = 0.001; vascular mortality HRs were Q2 (1.76, 95 % CI 0.88-3.55), Q3 (2.34, 95 % CI 1.14-4.40), Q4 (2.57, 95 % CI 1.28-5.16), P for trend = 0.002. Kaplan-Meier survival analysis revealed significantly higher mortality rates in higher NLR quartiles (log-rank p < 0.001). ROC analysis identified optimal NLR cutoff values of 3.42 for predicting 5-year all-cause mortality (AUC 0.689) and 3.51 for vascular-cause mortality (AUC 0.700), with moderate sensitivity and specificity. Conclusions: Higher NLR at admission was linked with five-year all-cause mortality and mortality attributed explicitly to vascular causes in AIS patients.

Efficacy and prognostic factors of stereotactic body radiotherapy combined with immunotherapy for pulmonary oligometastases: a preliminary retrospective cohort study.

Background: Stereotactic body radiotherapy (SBRT) combined immunotherapy has a synergistic effect on patients with stage IV tumors. However, the efficacy and prognostic factors analysis of SBRT combined immunotherapy for patients with pulmonary oligometastases have rarely been reported in the studies. The purpose of this study is to explore the efficacy and prognostic factors analysis of SBRT combined immunotherapy for patients with oligometastatic lung tumors. Methods: A retrospective analysis was conducted on 43 patients with advanced tumors who received SBRT combined with immunotherapy for pulmonary oligometastases from October 2018 to October 2021. Local control (LC), progression-free survival (PFS), and overall survival (OS) were assessed using the Kaplan-Meier method. Univariate and multivariate analyses of OS were performed using the Cox regression model, and the P value <0.05 was considered statistically significant. The receiver operating characteristic (ROC) curve of neutrophil-to-lymphocyte ratio (NLR) after SBRT was generated. Spearman correlation analysis was used to determine the relationship of planning target volume (PTV) with absolute lymphocyte count (ALC) before and after SBRT and with neutrophil count (NE) after SBRT. Additionally, linear regression was used to examine the relationship between ALC after SBRT and clinical factors. Results: A total of 43 patients with pulmonary oligometastases receiving SBRT combined with immunotherapy were included in the study. The change in NLR after SBRT was statistically significant (P<0.001). At 1 and 2 years, respectively, the LC rates were 90.3% and 87.5%, the OS rates were 83.46% and 60.99%, and the PFS rates were 69.92% and 54.25%, with a median PFS of 27.00 (17.84-36.13) months. Univariate and multivariate Cox regression analyses showed that a shorter interval between radiotherapy and immunization [≤21 days; hazard ratio (HR) =1.10, 95% confidence interval (CI): 0.06-0.89; P=0.02] and a low NLR after SBRT (HR =0.24, 95% CI: 1.01-1.9; P=0.03) were associated with improved OS. The ROC curve identified 4.12 as the cutoff value for predicting OS based on NLR after SBRT. NLR after SBRT ≤4.12 significantly extended OS compared to NLR after SBRT >4.12 (log-rank P=0.001). Spearman correlation analysis and linear regression analysis showed that PTV was negatively correlated with ALC after SBRT. Conclusions: Our preliminary research shows that SBRT combined with immunotherapy has a good effect, and NLR after SBRT is a poor prognostic factor for OS. Larger PTV volume is associated with decreased ALC after SBRT.