Diagnostic and prognostic significance of the lymphocyte/C-reactive protein ratio,neutrophil/lymphocyte ratio,and D-dimer values in patients with COVID-19

In this study,our aim was to examine the diagnostic and prognostic significance of lymphocyte/C-reactiveprotein ratio(LCR),neutrophil/lymphocyte ratio(NLR)and D-dimer parameters in COVID-19 infection.The LCR,NLR,neutrophil count,mean platelet volume(MPV),C-reactive protein(CRP),and D-dimer parameters wereevaluated retrospectively.This was a retrospective cohort study with 1000 COVID-19 positive and 1000 healthycontrol groups,all over the age of 18 years.Odds ratio(OR)and 95%confidence interval(CI)values were calculatedfor each parameter found to be statistically significant in the univariate and multivariate logistic regression models.Herein,127(12.7%)of the COVID-19^(+)patients,whose data was included in this study,died.The neutrophil,MPV,CRP,D-dimer,and NLR values were higher in the COVID-19^(+)/deceased group than in the COVID-19^(+)/alive andcontrol groups(p<0.001,p<0.001,p<0.001,p<0.001,p<0.001).The lymphocyte and LCR values were lower inthe COVID-19^(+)/deceased group than in the COVID-19^(+)/alive and control groups(p<0.001,p<0.001).Variableswith statistically significance in predicting COVID-19 infection were lymphocyte,LCR,D-dimer,NLR,CRP,MPV,PLT,and neutrophil values.Statistically significant variables in predicting mortality due to COVID-19 were LCR,CRP,NLR,lymphocyte,D-dimer,neutrophil,and MPV values.A low LCR and high NLR are associated with thepresence,prognosis,and mortality due to COVID-19.LCR and NLR parameters can thus be used in clinicalmonitoring to reduce morbidity and mortality rates.

Relationship between peripheral blood neutrophil/lymphocyte ratio and the prognosis of patients with brittle femoral neck fracture

Objective:To explore the relationship between peripheral blood neutrophil/lymphocyte ratio(NLR)and osteoporotic femoral neck fractures and to evaluate the prognosis.Methods:The subjects were 102 patients who received osteoporotic femoral neck fracture in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from 2008 to 2017.Patients were divided into three groups according to the BMD values in the diagnostic criteria of primary osteoporosis:normal bone mass group(T≥-1.0),reduced bone mass group(-2.5<T<-1.0)and osteoporosis group(T≤-2.5).In addition,during postoperative follow-up,patients receiving internal fixation were divided into the high NLR group(NLR>2.33)and the low NLR group(NLR≤2.33)according to their NLR values.The clinical data of patients with osteoporotic femoral neck fracture who underwent peripheral blood routine examination were prospectively analyzed.The statistical indicators included age,gender,fracture cause and other general conditions,fracture type,peripheral blood neutrophil/lymphocyte ratio,bone mineral density(BMD)level and blood lipid level,and prognosis of 102 patients who were followed up for more than 2 years after surgery.The relationship between peripheral blood NLR and the above indexes was observed.Statistical methods including normal data analysis of variance between groups,SNK-q test is compared between two groups,the partial correlation analysis between the two factors,the relationship between multiple factors using multi-factor linear regression analysis,and normal data comparison between the two groups using t test,two sets of independent data frequency distribution of binary classification variables compared by chi-square test.Moreover,NLR is also a major factor affecting the prognosis and rehabilitation of osteoporotic femoral neck fractures.Results:The analysis of variance between the two groups(SNK-q test of the comparison between the two groups),single-factor partial correlation analysis,multi-factor linear regression analysis showed that compared with the normal group and the reduced group,the levels of age,triglyceride and NLR in the osteoporosis group were increased,while BMD was significantly decreased.BMD in patients with osteoporotic femoral neck fracture was negatively correlated with NLR and triglyceride(P<0.05).In multi-factor linear regression analysis,NLR and triglyceride were the main influencing factors of BMD in patients with osteoporotic femoral neck(P<0.05).In addition,increased peripheral blood NLR in patients treated with internal fixation may increase the risk of postoperative femoral head necrosis,nonunion of the broken end of the fracture,and prolong the time of postoperative functional recovery.Conclusion:The level of peripheral blood NLR in patients with osteoporotic femoral neck fracture is increased and correlated with bone mineral density,which suggested that peripheral blood NLR can be used as one of the clinical indicators for early screening and prevention of osteoporotic femoral neck fracture.In addition,peripheral blood NLR is also a major factor affecting the prognosis and rehabilitation of osteoporotic femoral neck fractures.

Clinical application of neutrophil/lymphocyte ratio combined with high sensitive C reactive protein in evaluation of community acquired pneumonia

Objective:To explore the application value of neutrophil/lymphocyte ratio (NLR) combined with high sensitive C reactive protein (hs-CRP) in the evaluation of community acquired pneumonia (CAP). Methods:From November 2015 to October 2016, 58 cases of CAP patients admitted in our department were selected as research objects and were divided into low risk group and high risk group according to the PSI score and CURB-65 standard for evaluation. They were divided into improved group (48 cases) and death group (10 cases) according to prognosis. Hs-CRP was determined by immunoturbidimetric assay, procalcitonin (PCT) by immunofluorescence, NLR by count method of laser scattering, and white blood (WBC) was counted. The differences in WBC, PCT, NLR and hs-CRP between different risk groups were compared, and the correlation was evaluated using Spearman's rank correlation analysis method. The changes in indexes were observed in the improved and death cases. Results:The high risk group had higher NLR, PCT and hs-CRP than low risk group (P<0.05), while no significant difference was found in WBC (P>0.05). No correlation was found between NLR and WBC, while a strong correlation was found between hs-CRP and PCT. The WBC, PCT, NLR and hs-CRP levels were significantly lower in the improved group than the death group (P<0.05). Conclusions:NLR combined with hs-CRP, WBC, and PCT has a good assessment of the severity of CAR, and high levels of NLR, hs-CRP, WBC, and PCT predict the severity of the disease and poor prognosis.

Prognostic value of circulating tumor cells combined with neutrophil-lymphocyte ratio in patients with hepatocellular carcinoma

BACKGROUND Circulating tumor cell(CTC)count and neutrophil-to-lymphocyte ratio(NLR)are both closely associated with the prognosis of hepatocellular carcinoma(HCC).AIM To investigate the prognostic value of combining these two indicators in HCC.METHODS Clinical data were collected from patients with advanced HCC who received im-mune therapy combined with targeted therapy at the Department of Oncology,the Affiliated Hospital of Southwest Medical University,Sichuan,China,from 2021 to 2023.The optimal cutoff values for CTC programmed death-ligand 1(PD-L1)(+)>1 or CTC PD-L1(+)≤1 and NLR>3.89 or NLR≤3.89 were evaluated using X-Tile software.Patients were categorized into three groups based on CTC PD-L1(+)counts and NLR:CTC-NLR(0),CTC-NLR(1),and CTC-NLR(2).The relationship between CTC-NLR and clinical variables as well as survival rates was assessed.RESULTS Patients with high CTC PD-L1(+)expression or NLR at baseline had shorter median progression-free survival(m-PFS)and median overall survival(mOS)than those with low levels of CTC PD-L1(+)or NLR(P<0.001).Mean-while,patients in the CTC-NLR(2)group showed a significant decrease in mPFS and mOS.Cox regression analysis revealed that alpha-fetoprotein(AFP),CTC PD-L1(+),and CTC-NLR were independent predictors of OS.The time-dependent receiver operating characteristic curve showed that the area under the curve of CTC-NLR at 12 months(0.821)and 18 months(0.821)was superior to that of AFP and CTC PD-L1(+).CONCLUSION HCC patients with high CTC PD-L1(+)or NLR expression tend to exhibit poor prognosis,and a high baseline CTC-NLR score may indicate low survival.CTC-NLR may serve as an effective prognostic indicator for patients with advanced HCC receiving immunotherapy combined with targeted therapy.

Correlation of neutrophil to lymphocyte ratio to severity of coronary artery disease and in-hospital clinical outcomes in patients with acute coronary syndrome: A prospective observational study

Objective:To explore correlation of neutrophil-to-lymphocyte ratio(NLR)to severity of coronary artery disease(CAD)and in-hospital clinical outcomes in patients with acute coronary syndrome(ACS).Methods:In this prospective and observational study,we recruited 500 patients with ACS.For all the eligible patients,demographic details were collected,and laboratory parameters were evaluated.The CAD severity was evaluated in terms of the number of involved vessels.The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed.Results:77.2%of Patients was male,and 52%of the patients aged between 55-70 years.Based on the type of ACS,396 out of 500 patients had ST-elevation myocardial infarction.An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among classⅣpatients.The mean NLR value among the non-survivors were higher compared to the survivors(9.52±5.72 vs.4.76±2.36;P<0.01).Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0%and a specificity of 77.3%.Conclusions:The NLR can be used as an independent prognostic marker in ACS.An elevated NLR value serves as a reliable predictor for short-term complications,notably in-hospital mortality.

Predictive Value of the Neutrophil to Lymphocyte Ratio (NLR) to Predict the Development of Preeclampsia and Pregnancy Induced Hypertension at 1st Trimester

Introduction: Hypertensive disorder in pregnancy affects 4 to 6 percent of all pregnancies and carries risks for the both baby and the mother. Only a few groups of women who are at high-risk pregnancies are received prophylaxis Aspirin, more than 15 percent of women develop pre-eclampsia with a single minor risk factor. Methods: This descriptive cross-sectional study was conducted to compare the 1st trimester NLR value of normotensive, pregnancy induced hypertensive and pre-eclamptic pregnant women. The study was conducted with a sample of 416, antenatal patients who were admitted to ward 25, at Colombo North Teaching Hospital Ragama. Data was collected as separated three groups. NLR value was calculated separately and ANOVA test was used to analyze the 3 categorical data. Post HOC test was done to assess the multiple comparison. Results: The prevalence rates of pregnancy induced hypertension and pre-eclampsia among the pregnant women were 8.6% and 5.7%. The mean NLR values of normotensive group was 2.708, pregnancy induced hypertensive group was 2.650 and pre eclamptic group was 3.789. There was a significant difference in NLR value between pre eclamptic group and other two groups with P value of Conclusion: The 1st trimester NLR value of pre eclamptic patients significantly increased compared to normotensive women.

Systemic Immune-Inflammation Index (SII) and Neutrophil-Lymphocyte Ratio (NLR) as Systemic Inflammatory Predictors in the Diagnosis of Bullous Pemphigoid and Pemphigus Vulgaris

Introduction: Autoimmune blistering skin disorders such as Bullous Pemphigoid and Pemphigus Vulgaris present diagnostic challenges. The Systemic Immune-Inflammation Index (SII) and Neutrophil-Lymphocyte Ratio (NLR), are inflammatory markers used to assess the body’s immune-inflammatory response. Objectives: The study aims to evaluate the significance of hematologic markers, specifically the Systemic Immune-Inflammation Index (SII) and Neutrophil-Lymphocyte Ratio (NLR), as diagnostic predictors of bullous pemphigoid (BP) and pemphigus vulgaris (PV). Methods: A retrospective study of 64 patients (36 with BP and 28 with PV). Patient clinical data: age, gender, complete blood count, autoimmune antibody levels (Dsg1, 3 and BP180, 230), IgE and C-reactive protein, and history of hypertension, diabetes, brain infarction, and coronary heart disease. The data was analyzed using SPSS. Results: The study involved 36 (56.3%) diagnosed with bullous pemphigoid (BP) and 28 (43.75%) with pemphigus vulgaris (PV). The average age in BP was 71 ± 8 and 52 ± 13 in PV. Laboratory findings showed high levels of Dsg1, Dsg3, neutrophil count, and lymphocyte count in PV, while high levels of eosinophils with a significant increase in C-reactive protein (CRP) in BP. Blood biomarkers, including NLR, PLR, SII, MPV, CRP, and IgE, proved an overall of 84.4% in disease prediction. Dsg1, Dsg3, BP180, and BP230 showed an overall of 88.1%. No significant relationship was noted between NLR, SII, and patients with comorbidities. Conclusion: The study highlights the diagnostic potential of SII and NLR in addition to hematologic markers in BP and PV, emphasizing their role in early diagnosis and therapeutic interventions, requiring further validation in larger patient cohorts.

Role of lymphocyte-to-monocyte ratio as a predictive marker for diabetic coronary artery disease: A cross-sectional study

BACKGROUND The lymphocyte to monocyte ratio(LMR)is considered a marker of systemic inflammation in cardiovascular disease and acts as predictor of mortality in coronary artery disease.AIM To investigate the predictive role of LMR in diabetic coronary artery disease patients.METHODS This cross-sectional study was conducted at tertiary care super-specialty hospital at New Delhi,India.A total of 200 angiography-proven coronary artery disease(CAD)patients were enrolled and grouped into two categories:Group I[CAD patients with type 2 diabetes mellitus(T2DM)and glycated hemoglobin(HbA1c)levels≥6.5%],and Group II(CAD patients without T2DM and HbA1c levels<6.5%).Serum lipoproteins,HbA1c,and complete blood count of enrolled patients were analyzed using fully automatic analyzers.RESULTS The logistic regression analysis showed an odds ratio of 1.48(95%CI:1.28-1.72,P<0.05)for diabetic coronary artery disease patients(Group I)in unadjusted model.After adjusting for age,gender,diet,smoking,and hypertension history,the odds ratio increased to 1.49(95%CI:1.29-1.74,P<0.01)in close association with LMR.Further adjustment for high cholesterol and triglycerides yielded the same odds ratio of 1.49(95%CI:1.27-1.75,P<0.01).Receiver operating characteristic curve analysis revealed 74%sensitivity,64%specificity,and 0.74 area under the curve(95%CI:0.67-0.80,P<0.001),suggesting moderate predictive accuracy for diabetic CAD patients.CONCLUSION LMR showed positive association with diabetic coronary artery disease,with moderate predictive accuracy.These findings have implications for improving CAD management in diabetics,necessitating further research and targeted interventions.

Analysis of the Peripheral Blood Helper T-Cell 17- Cell Level and Monocyte/Lymphocyte Ratio for Colorectal Cancer Prognosis Prediction

Objective: To investigate the value of peripheral blood helper T cell 17 cell level and monocyte/lymphocyte ratio to predict the prognosis of colorectal cancer patients. Methods: 74 colorectal cancer patients who attended Hospital 960 from January 2021 to January 2022 were retrospectively analyzed. Clinical data of the patients were collected, including gender, age, and histologic type. Immunohistochemical indexes such as Th17 cell level and monocyte/ lymphocyte ratio in the peripheral blood of patients were also collected. The prognosis of patients after treatment, as well as peripheral blood Th17 and MLR levels, were observed and analyzed. Results: After follow-up after treatment, in the final 74 patients, the prognosis was good in 32 patients, accounting for 43.24%, and the prognosis was bad in 42 patients, accounting for 56.76%. There were no significant differences between the average age and tumor diameters of the good prognosis and poor prognosis groups (P > 0.05). However, the TNM staging, intervention taken, differentiation degree, presence of distant metastasis, presence of lymph node metastasis, Th17 level, and MLR level are significantly different between the two groups (P < 0.05). Conclusion: Peripheral blood Th17 and MLR have predictive value for the prognosis of colorectal cancer patients, and high levels of peripheral blood Th17 and MLR imply poor prognosis. The detection of peripheral blood Th17 and MLR levels is simple and convenient and can be used as indicators to provide a reference for the prognostic assessment of colorectal cancer patients.

Pretreatment Neutrophil/Lymphocytes Ratio in Non-Metastatic Colon Cancer as a Prognostic and Predictive Factor: A Retrospective Study

Background: In developed countries, colon cancer is the second most prevalent cancer, only exceeded by prostate cancer in men and breast cancer in women. After Hepatocellular carcinoma, breast cancer, bladder cancer, lung cancer, Non-Hodgkin Lymphoma and brain tumors, colon cancer is the 7th most common cancer in Egypt, in both sexes, representing 3.47% and 3%, in both male and female cancers, respectively. Aim of the Work: The aim of this study was to evaluate the prognostic and predictive significance of pretreatment Neutrophil/lymphocytes ratio (NLR), in terms of disease-free survival (DFS) and recurrence, in high-risk stage II and stage III Colorectal cancer patients who underwent curative resection. Patients and Methods: We retrospectively evaluated 103 patients, who were submitted to upfront surgery as first therapeutic option in curative intent, between January 2017 and December 2018. Pretreatment Neutrophil/lymphocytes ratio (NLR), as well as demographics, clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with disease free survival (DFS) and recurrence. Results: The cutoff point of Neutrophils/lymphocytes ratio (NLR) was calculated with Kaplan-Meier curves and log-rank test to 3. This study revealed that neutrophils/lymphocytes ratio (NLR) was significantly associated with disease free survival (p as no difference in efficacy between both chemotherapy regimens FOLFOX and XELOX in both high-risk stage II and stage III colon cancer regarding disease free survival & the toxicity profile associated with each regimen and its grades between patients. Conclusion: Our study suggests that preoperative Neutrophils/lymphocytes ratio (NLR) more than 3 may be an independent prognostic marker for TTR (time to recurrence) in high-risk stage II and stage III colon cancer patients.

Prognostic Value of Neutrophil to Lymphocyte Ratio in Acute Myeloid Leukemia

Objective: Acute myeloid leukemia (AML) is a heterogeneous, hematologic malignancy at which short survival may be seen. Our study aims to evaluate the effect of the neutrophil-to-lymphocyte ratio (NLR) on the course of the disease, response to therapy, and overall survival (OS). Materials and Methods: A total of 124 patients followed-up with the diagnosis of AML from 2016 to 2019 were retrospectively examined. Results: 69 of the cases (55.6%) were men and 55 (44.3%) were women. The average age at the time of diagnosis was 53.44 ± 30.3 years old. We determined the NLR as median 0.46 (0.16 - 1.1). In AML, 69 patients were responsive to the induction regimen (57.9%) while 46 patients were unresponsive (37.8%). 5 patients died before completing the regimen. D-dimer was found to be higher and fibrinogen was found to be lower in the responsive group. Lower OS was observed in cases of >60 years of age, male gender, non-APL AML, high NLR, and recurrence at diagnosis. Recurrences were detected in 23 patients (18.5%) and the median time to the recurrence was 416 (236 - 639) days. Fibrinogen level and the bone marrow blast ratio at the time of application were determined to be associated with recurrence. The median follow-up time was 856 (143 - 1276) days. Final condition analysis reveals that 74 patients (59.6%) are alive. Conclusion: We determined in our study that the NLR is effective on survival. Medical literature on this subject is scanty and prospective studies with large patient groups are needed.

Association of neutrophil/lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention

Background Primary percutaneous coronary interventions （PCI） have been proposed as a novel superior management strategy in patients with ST elevation myocardial infarction （STEMI）. This study tested the hypothesis that in the acute phase of myocardial infarction with ST-segment elevation, the neutrophil/lymphocyte （N/L） ratio is a predictor of long-term prognosis.Methods We analyzed 551 consecutive STEMI patients treated with primary PCl at a single university center. Patients were stratified according to quartiles of the mean neutrophil/lymphocyte ratio.Results Kaplan-Meier survival analysis showed a cumulative eight-year survival of 94.2% in the first quartile, 92.0% in the second quartile, 91.3% in the third quartile, and 75.4% in the fourth quartile （P ＜0.001 by log rank）. Relative to patients in the other three lower N/L ratio quartiles, patients in the highest quartile were more than four times more likely to die during hospitalization （P ＜0.001） and during long-term follow-up （P ＜0.001）. By multivariate Cox regression analysis including baseline demographic, clinical, and angiographic covariables, the N/L ratio in the highest quartile remained an independent predictor of mortality （hazard ratio 2.38, 95% confidence interval （CI） 1.42 to 3.98; P=0.001）.Conclusion The neutrophil/lymphocyte ratio is a strong independent predictor of long-term mortality after ST elevation myocardial infarction treated with very early revascularization.

Correlation between Neutrophil Percentage-to-albumin Ratio and Coronary Heart Disease Complicated with Diabetes Mellitus

[Objectives]This study was conducted to explore the relationship between neutrophil percentage-to-albumin ratio(NPAR)and coronary heart disease complicated with diabetes.[Methods]A total of 603 patients with coronary heart disease who underwent coronary angiography in Pingquan County Hospital from January,2023 to December,2023 and met the inclusion criteria were included as the research object.All the patients were divided into a coronary heart disease complicated with diabetes group(CAD+T2DM group)(n=298 cases)and a control group(CAD group)(n=305 cases),according to patients medical history,heart color ultrasound and biochemical test results.The clinical data,biochemical test results and coronary artery imaging data of patients were recorded,and the Gensini score was calculated.The neutrophil percentage(NEUT%)and albumin count were determined to calculate NPAR.[Results]The NPAR value of the coronary heart disease complicated with diabetes mellitus group was(1.6±0.42),which was significantly higher than that of the control group(1.47±0.49),and the difference was statistically significant(P<0.05).The area under the ROC curve was 0.619(95%CI:0.591-0.675,P<0.05),and the prediction of coronary heart disease complicated with diabetes using NPAR showed a Youden index of 0.31,a sensitivity of 60.4%,a specificity of 40.3%,and a best cut-off score of 1.4506.[Conclusions]The neutrophil percentage-to-albumin ratio(NPAR)is closely related to coronary heart disease complicated with diabetes mellitus,and NPAR has clinical application value in the diagnosis of coronary heart disease complicated with diabetes mellitus.

Value of neutrophil/lymphocyte ratio,N-terminal pro-B-type natriuretic peptide,urea,and creatinine for the prediction of acute kidney injury in acute heart failure:a retrospective observational study

Objective:Early identification of acute kidney injury(AKI)is essential to improve the prognosis of patients with acute heart failure(AHF).We aimed to determine the utility of neutrophil/lymphocyte ratio(NLR),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),urea,and creatinine(Cr),as well as combinations of these,for the prediction of AKI in patients with AHF.Methods:A total of 153 patients with AHF under the care of Sun Yat-sen Memorial Hospital,Sun Yat-sen University from October 2009 to October 2019 were included in this retrospective observational study.Their NLR,NT-proBNP,urea,and Cr concentrations were measured on admission.AKI was defined using the Acute Kidney Injury Network criteria.Receiver operating characteristic(ROC)curves,the areas under the curves(AUCs),sensitivity,and specificity were employed to evaluate the ability of each biomarker and their combinations to identify AKI.This study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital,Sun Yat-sen University(approval No.SYSEC-KY-KS-2021-126)on June 22,2021.Results:Forty-six(30.1%)participants developed AKI during hospitalization.The NLR and NT-proBNP of the participants with AKI were higher than those without(NLR:median 7.886 vs 4.717,P<0.0001;NT-proBNP,median 6774 vs 2786pg/mL,P<0.0001).ROC analyses demonstrated that high NLR and NT-proBNP were associated with higher incidences of AKI(NLR:cut-off 5.681,AUC 0.716,sensitivity 58.9%,specificity 80.4%;NT-proBNP:cut-off 5320pg/mL,AUC 0.700,sensitivity 72.9%,specificity 65.2%).Moreover,a combination of NLR,NT-proBNP,urea,and Cr yielded an AUC of 0.815,sensitivity 80.4%,and specificity of 74.8%.In addition,the AUCs for the prediction of AKI in the participants with New York Heart Association(NYHA)classes II,III,and IV were 0.936,0.860,and 0.772,respectively,using this combination.Conclusion:A combination of NLR,NT-proBNP,urea,and Cr,measured at admission,may represent a promising tool for the prediction of AKI in patients with AHF.This method performs best for AKI risk assessment in patients with NYHA II,followed by those with NYHA III or IV.

Prognostic significance of neutrophil to lymphocyte ratio in pancreatic cancer: A meta-analysis

AIM:To conduct a meta-analysis evaluating theassociation between the peripheral blood neutrophil to lymphocyte ratio(NLR) and the outcome of patients with pancreatic cancer.METHODS:Studies evaluating the relationship between the peripheral blood NLR and outcome of patients with pancreatic cancer published up to May 2014 were searched using electronic databases, including Pub Med, Web of Science, Embase and Ovid.A meta-analysis was performed to pool the hazard ratios(HRs) or odds ratios(ORs) and their 95% confidence intervals(CIs) using either a fixed-effects model or a random-effects model to quantitatively assess the prognostic value of NLR and its association with clinicopathological parameters.RESULTS:Eleven studies containing a total of 1804 patients were eligible according to our selection criteria, and combined hazard ratios indicated that high NLR was a poor prognostic marker for pancreatic cancer patients because it had an unfavorable impact on the overall survival(OS)(HR =2.61, 95%CI:1.68-4.06, P =0.000) and cancer specific survival(HR =1.66, 95%CI:1.08-2.57, P =0.021).Subgroup analysis revealed that high NLR was associated with poor OS in patients with mixed treatment(HR =4.36, 95%CI:2.50-7.61, P =0.000), chemotherapy(HR =2.08, 95%CI:1.49-2.9, P =0.000), or surgical resection(HR =1.2, 95%CI:1.00-1.44, P =0.048).Additionally, high NLR was significantly correlated with tumor metastasis(OR =1.69, 95%CI:1.10-2.59, P =0.016), poor tumor differentiation(OR =2.75, 95%CI:1.19-6.36, P =0.016), poor performance status(OR =2.56, 95%CI:1.63-4.03, P =0.000), high cancer antigen 199(OR =2.62, 95%CI:1.49-4.60, P =0.000), high C-reactive protein(OR =4.32, 95%CI:2.71-6.87, P =0.000), and low albumin(OR =3.56, 95%CI:1.37-9.27, P =0.009).CONCLUSION:High peripheral blood NLR suggested a poor prognosis for patients with pancreatic cancer,and it could be a novel marker of survival evaluation and could help clinicians develop therapeutic strategies for pancreatic cancer patients.

Is the neutrophil to lymphocyte ratio associated with liver fibrosis in patients with chronic hepatitis B?

AIM: To determine the association between the neutrophil to lymphocyte(N/L) ratio and the degree of liver fibrosis in patients with chronic hepatitis B(CHB) infection. METHODS: Between December 2011 and February 2013, 129 consecutive CHB patients who were admitted to the study hospitals for histological evaluation of chronic hepatitis B-related liver fibrosis were included in this retrospective study. The patients were divided into two groups based on the fibrosis score: individuals with a fibrosis score of F0 or F1 were included in the "no/minimal liver fibrosis" group, whereas patients with a fibrosis score of F2, F3, or F4 were included in the "advanced liver fibrosis" group. The Statistical Package for Social Sciences 18.0 for Windows was used to analyze the data. A P value of < 0.05 was accepted as statistically significant.RESULTS: Three experienced and blinded pathologists evaluated the fibrotic status and inflammatory activity of 129 liver biopsy samples from the CHB patients. Following histopathological examination, the "no/minimal fibrosis" group included 79 individuals, while the "advanced fibrosis" group included 50 individuals. Mean(N/L) ratio levels were notably lower in patients with advanced fibrosis when compared with patients with no/minimal fibrosis. The mean value of the aspartate aminotransferase-platelet ratio index was markedly higher in cases with advanced fibrosis compared to those with no/minimal fibrosis.CONCLUSION: Reduced levels of the peripheral blood N/L ratio were found to give high sensitivity, specificity and predictive values in CHB patients with significant fibrosis. The prominent finding of our research suggests that the N/L ratio can be used as a novel noninvasive marker of fibrosis in patients with CHB.

Prognostic significance of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with stage Ⅲ and Ⅳcolorectal cancer

AIM To evaluate the prognostic value of the neutrophil-tolymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) in patients with colorectal cancer(CRC).METHODS Between April 1996 and December 2010, medical records from a total of 1868 patients with CRC were retrospectively reviewed. The values of simple inflammatory markers including NLR and PLR in predicting the long-term outcomes of these patients were evaluated using Kaplan-Meier curves and Cox regression models.RESULTS The median follow-up duration was 46 mo(interquartile range, 22-73). The estimation of NLR and PLR was based on the time of diagnosis. In multivariate Cox regression analysis, high NLR (≥ 3.0) and high PLR(≥ 160) were independent risk factors predicting poor long-term outcomes in patients with stage Ⅲ and Ⅳ CRC. However, high NLR and high PLR were not prognostic factors in patients with stage Ⅰ and Ⅱ CRC.CONCLUSION In this study, we identified that high NLR (≥ 3.0) and high PLR (≥ 160) are useful prognostic factors to predict long-term outcomes in patients with stage Ⅲ and Ⅳ CRC.

Prognostic Value of Neutrophil to Lymphocyte Ratio for In-hospital Mortality in Elderly Patients with Acute Myocardial Infarction

Coronary artery disease （CAD） is a multifactorial disease in which inflammation plays a central role. This study aimed to investigate the association of inflammatory markers such as the neutrophil to lymphocyte ratio （NLR）, the Global Registry of Acute Coronary Events （GRACE） score with in-hospital mortality of elderly patients with acute myocardial infarction （AMI） in an attempt to explore the prognostic value of these indices for elderly AMI patients. One thousand consecutive CAD patients were divided into two groups based on age 60. The laboratory and clinical characteristics were assessed retrospectively by reviewing the medical records. The NLR and GRACE score were calculated. In the elderly （〉60 years）, patients with non-ST-elevation myocardial infarction （NSTEMI） and ST-elevation myocardial infarction （STEMI） had significantly higher NLR than did those with unstable angina （UA） and stable angina pectoris （SAP） （P〈0.01）. The NLR was considerably elevated in older AMI patients compared with their younger counterparts （〈60 years） （P〈0.05）. In elderly AMI patients, the NLR was considerably higher in the high-risk group than in both the low-risk and mediumrisk groups based on the GRACE score （P〈0.05 and P〈0.01, respectively）, and the NLR was positively correlated with the GRACE score （r=0.322, P〈0.001）. Either the NLR level or the GRACE score was significantly higher in the death group than in the surviving group （P〈0.05）. By curve receiver operator characteristic curve （ROC） analysis, the optimal cut-off levels of 9.41 for NLR and 174 for GRACE score predicted in-hospital death [ROC area under the curve （AUC） 0.771 and 0.787, respectively, P〈0.001]. It was concluded that an elevated NLR is a potential predictor of in-hospital mortality in elderly patients with AMI.

Postablation neutrophil/lymphocyte ratio correlates with arrhythmiarecurrence after catheter ablation of lone atrial fibrillation

Background Neutrophil/lymphocyte ratio(NLR) has been proposed as a novel marker of systemic inflammation and oxidative stress. The objective of this study was to ascertain the relationship between levels of NLR and recurrence of lone atrial fibrillation(AF) after catheter ablation.Methods A total of 379 lone AF patients who underwent catheter ablation were enrolled in the study. The NLR before and after catheter ablation was determined. Cox regression analyses were used to estimate the relationship between NLR and the recurrence of lone AF.Results After a mean follow-up of(30.5±5.3) months, 124(32.7%) patients had AF recurrences. The patients who developed AF recurrence had a higher postablation NLR(post-NLR) than patients with no recurrence(5.74±1.55 vs. 4.66±1.27, P <0.001). Multivariate Cox regression analysis revealed that post-NLR(hazard ratio(HR) 1.514, 95% confidence interval(CI) 1.364–1.680, P <0.001), left atrium diameter(HR 1.035, 95% CI 1.001–1.071, P=0.04) and body mass index(HR 1.028, 95% CI 1.002–1.054, P=0.03) were independent predictors of AF recurrence. Using a cut-off level of 5.15, post-NLR predicted AF recurrence with a sensitivity of 73% and specificity of 67%.Conclusions Our results indicate that an elevated post-NLR is associated with a high rate of lone AF recurrence. A simple measurement of NLR may help us to identify high-risk patients who need pharmacologic intervention to prevent recurrence.

Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio Cannot Predict Lymph Node Metastasis and Prognosis in Patients with Early Gastric Cancer:a Single Institution Investigation in China

In the present study,we aimed at exploring the applied value of preoperative neutrophil lymphocyte ratio(NLR)and platelet lymphocyte ratio(PLR)in the prediction of lymph node metastasis(LNM)and prognosis in patients with early gastric cancer(EGC).We retrospectively analyzed a total of 248 consecutive patients who underwent curative gastrectomy to be identified T1 stage gastric adenocarcinoma between January 1,2010 and May 1,2016 in a single institution.According to median preoperative NLR and PLR value,we divided the patients into four groups:high NLR≥1.73 and low NLR〈1.73,high PLR≥117.78 and low PLR〈117.78.Furthermore,to evaluate the relationship between preoperative NLR and PLR values,we categorized patients according to cutoff preoperative NLR-PLR score of 2[high NLR(≥1.73)and high PLR(≥117.78)],1[either high NLR or high PLR],and 0[neither high NLR nor high PLR].Statistical analyses were conducted using SPSS 20.0 software.The results showed that the preoperative NLR or PLR values,lower or higher,could not predict the LNM in patients with EGC(both P=0.5440.05).The invasive depth of tumor was significantly correlated with LNM of EGC(P〈0.001).Kaplan-Meier plots illustrated that preoperative NLR and PLR values were not associated with overall survival(OS)in patients with EGC.It was concluded that the preoperative NLR and PLR may be the predictors for LNM and prognosis in patients with advanced gastric cancer;nevertheless,they cannot predict LNM and prognosis in patients with EGC.