Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival.

BACKGROUND: Variations in systemic inflammatory response biomarker levels have been associated with adverse clinical outcome in various malignancies. This study determined the prognostic significance of preoperative neutrophil:lymphocyte (NLR), platelet:lymphocyte (PLR) and monocyte:lymphocyte (MLR) ratios in endometrial cancer. METHODS: Clinicopathological and 5-year follow-up data were obtained for a retrospective series of surgically treated endometrial cancer patients (n=605). Prognostic significance was determined for overall (OS) and cancer-specific survival (CSS) using Cox proportional hazards models and Kaplan-Meier analysis. Receiver-operator characteristic and log-rank functions were used to optimise cut-offs. NLR, PLR and MLR associations with clinicopathological variables were determined using non-parametric tests. RESULTS: Applying cut-offs of ⩾2.4 (NLR), ⩾240 (PLR) and ⩾0.19 (MLR), NLR and PLR (but not MLR) had independent prognostic significance. Combining NLR and PLR scores stratified patients into low (NLR-low and PLR-low), intermediate (NLR-high or PLR-high) and high risk (NLR-high and PLR-high) groups: multivariable hazard ratio (HR) 2.51; P<0.001 (OS); HR 2.26; P<0.01 (CSS) for high vs low risk patients. Increased NLR and PLR were most strongly associated with advanced stage (P<0.001), whereas increased MLR was strongly associated with older age (P<0.001). CONCLUSION: Both NLR and PLR are independent prognostic indicators for endometrial cancer, which can be combined to provide additional patient stratification.

Should cardiac troponins be used as a risk stratification tool for patients with chronic critical limb ischaemia?

OBJECTIVES: Cardiovascular mortality in patients with chronic critical lower limb ischaemia (CCLI) is high and early risk stratification in these patients may aid clinical management improving outcomes. Cardiac troponin I (cTnI) has prognostic significance in patients with unstable angina. The aim of this study was to evaluate the prognostic significance of cardiac troponins in CCLI patients who had no clinical evidence of unstable coronary heart disease. METHODS: Patients (n=152) admitted with CCLI to a single vascular unit over a two-year period were included prospectively in this study. Patients with clinical evidence of unstable coronary disease were excluded from the study. Patient demographics, clinical history, co-morbidity and risk factors for peripheral vascular disease were documented. Admission cTnI levels were recorded using a threshold, 0.1 ng/ml. The primary endpoint was mortality. RESULTS: Fifty-two patients (34.2%) had an elevated cTnI, whilst 100 (65.8%) had cTnI <0.1 ng/ml. Sixty-two patients died during the follow-up period, 38 with an elevated admission cTnI. Death rate in patients with cTnI >0.1 ng/nl was 73% compared with 24% in those with levels below the threshold (p<0.0001). Patients with elevated cTnI were significantly older than those with normal level (median age 76 years vs 71 years, p<0.001). An elevated cTnI was found to independently predict disease-specific mortality on Cox regression analysis (Hazard Ratio 4.2; 95% Confidence Interval 1.3-12.7). CONCLUSION: In this series of patients with CCLI the measurement of cTnI on admission was a significant independent predictor of survival. cTnI has potential as a prognostic test to stratify patients with a high cardiovascular risk and may enable further optimisation of these high-risk patients.

Lumbar fractures in adult blunt trauma: axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films.

BACKGROUND: Our hypothesis was that abdominal and pelvic computed tomographic (AP-CT) scans are equivalent to portable two-view plain films in detecting lumbar spine fractures in adults. Since many trauma patients often undergo AP-CT scanning to evaluate for possible intra-abdominal injuries, using the AP-CT scan to screen for lumbar fractures could make the trauma evaluation process more efficient. METHODS: The institutional trauma registry at a Level I trauma center was used to identify all blunt lumbar fractures during a 6-year period. Medical records were reviewed. RESULTS: A total of 7,216 adult blunt trauma patients were evaluated, and 115 patients were identified as having a lumbar fracture, for an incidence rate of 1.6%. Missed fracture rates were high for both AP-CT scans (23.2%, 13 of 56) and portable two-view films (12.7%, 14 of 110, = 0.08). Fifty-two patients had both AP-CT scans and plain films. In this group, AP-CT scans missed 23.1% (12 of 52) of the lumbar fractures and plain films missed 15.4% (8 of 52). However, the combination of the two diagnostic methods did not miss any fractures (0 of 52). The missed fractures required surgery or brace in 50% (7 of 14) patients who had fractures missed by plain films and 46% (6 of 13) patients whose fractures were missed by AP-CT scanning. CONCLUSION: Both AP-CT scans and plain films failed to diagnose significant lumbar fractures that required therapy. When screening for lumbar fractures, obtaining both AP-CT scans and portable two-view plain films may decrease missed lumbar fractures in blunt adult trauma.