Maternal blood count parameters of chronic inflammation by gestational age and their associations with risk of preterm delivery in the Japan Environment and Children’s Study

AbstractNeutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR), are three reportedly predictive biomarkers that reflect subclinical chronic inflammatory burden. However, how these biomarkers change during pregnancy and its clinical utility among pregnant women have been rarely studied. Among 76,853 singleton pregnancies delivered at 28–41 weeks of gestation that were enrolled in the Japan Environment and Children’s Study, we observed the distribution of maternal NLR, PLR, and LMR values from week 0 to week 36 using spline curves, as well as their predictive values for preterm delivery with and without hypertensive disorders in pregnancy, placental abruption and intrauterine growth restriction (collectively termed ischemic placental disease due to their shared pathological and pathophysiological features) for measurements at 8–11 weeks, 12–17 weeks, and 18–21 weeks. NLR and PLR increased, whereas LMR decreased, with increasing gestation. High LMR and low NLR observed at 18–21 weeks, but not at earlier gestations, were associated with higher risk of preterm delivery with IPD (odds ratio 1.80 [95% CI 1.02, 3.19] per log[LMR]; odds ratio 0.49 [95% CI 0.29, 0.82] per log[NLR]). All parameters were not predictive of preterm delivery without IPD. We provide a robust reference curve for maternal blood count parameters NLR, PLR, and LMR by gestational week.

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Predictive values of the postoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio for the diagnosis of early periprosthetic joint infections: a preliminary study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02107-5 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Guanglei Zhao ◽

Jie Chen ◽

Jin Wang ◽

Siqun Wang ◽

Jun Xia ◽

...

Keyword(s):

Predictive Ability ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet To Lymphocyte Ratio ◽

Predictive Values ◽

Great Ability ◽

Laboratory Parameters ◽

Lymphocyte Ratio ◽

Lymphocyte To Monocyte Ratio ◽

Joint Infections ◽

Age Range

Abstract Background Several studies have been conducted to report diagnostic values of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in the many diseases, such as oncological, inflammatory, and some infectious diseases. However, the predictive value of these laboratory parameters for early periprosthetic joint infections (PJIs) has not yet been reported. The aim of this study was to determine predictive values of the postoperative NLR, PLR, and LMR for the diagnosis of PJIs. Methods In this retrospective study, 104 patients (26 early PJI cases and 78 non-PJI cases) who underwent total joint arthroplasty were enrolled in this study. All the patients were then categorized into two groups: PJI group, patients with the diagnosis of PJI (26 patients; 14 males, 12 females; mean age = 65.47 ± 10.23 age range = 51–81 ) and non-PJI group, patients without PJI (78 patients; 40 males, 38 females; mean age = 62.15 ± 9.33, age range = 41–92). We defined “suspected time” as the time that any abnormal symptoms or signs occurred, including fever, local swelling, or redness around the surgical site between 2 and 4 weeks after surgery and before the diagnosis. Suspected time and laboratory parameters, including NLR, PLR, LMR, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), were compared between both groups. The trends of postoperative NLR, LMR, PLR, CRP, and ESR were also reviewed. The predictive ability of these parameters at the suspected time for early PJI was evaluated by multivariate analysis and receiver operating characteristic (ROC) curve analysis. Results NLR, PLR, and LMR returned to preoperative levels within 2 weeks after surgery in the two groups. In the PJI group, NLR and PLR were significantly increased during the incubation period of infection or infection, and LMR was significantly reduced, although 61.5% (16/26) of the patients had normal white blood cells. Interestingly, ESR and CRP were still relatively high 2 weeks after surgery and were not different between the two groups before infection started (p = 0.12 and 0.4, respectively). NLR and PLR were significantly correlated with early PJI (Odds ratios for NLR and PLR = 88.36 and 1.12, respectively; p values for NLR and PLR = 0.005 and 0.01, respectively). NLR had great predictive ability for the diagnosis of early PJI, with a cut-off value of 2.77 (sensitivity = 84.6%, specificity = 89.7%, 95% CI = 0.86–0.97). Conclusions ESR and CRP seem not to be sensitive for the diagnosis of early PJI due to their persistently high levels after arthroplasty. The postoperative NLR at the suspected time may have a great ability to predict early PJI.

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Relationship Between Preoperative Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in the Probable Diagnosis of Malignant or Borderline Ovarian Tumors

10.21203/rs.3.rs-390552/v1 ◽

2021 ◽

Author(s):

Tae Hui Yoon ◽

Eun Byeol Cho ◽

Ki Ho Seol ◽

Jung Min Ryu ◽

Youn Seok Choi

Keyword(s):

Odds Ratio ◽

Blood Count ◽

Complete Blood Count ◽

Ovarian Tumors ◽

Imaging Diagnosis ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Borderline Ovarian Tumors ◽

Benign Ovarian Tumors ◽

Probable Diagnosis

Abstract Background: The purpose of this study was to investigate whether neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) can be supplementary tools to differentiate benign, borderline, and malignant ovarian tumors.Methods: This retrospective study reviewed the postoperative histopathology in patients with ovarian tumors (220 benign, 59 borderline, and 228 malignant). White blood cell, platelet, neutrophil and lymphocyte counts, percentage of neutrophils and lymphocytes, calculated NLR and PLR were analyzed between groups using complete blood count tests performed before surgery. Results: The platelet count and PLR in borderline ovarian tumors tended to be statistically close to benign ovarian tumors, while the neutrophil and lymphocyte count, NLR tended to be statistically close to malignancy. The diagnostic cut-off value of NLR for differentiating between benign and borderline was 2.42, PLR for differentiating between borderline and malignancy was 140.96. When the NLR was 2.4 or higher, the odds ratio of borderline or malignant risk was 3.264. In the case of PLR, 140 or higher, the odds ratio of malignancy was 1.916. When both PLR and NLR were above each cut-off, the sensitivity of malignancy diagnosis was 51.5%, specificity was 77.0%. Conclusions: In the case of borderline ovarian tumors, the NLR was higher than benign and similarly tend to malignancy, but the PLR was lower than malignancy and similarly tend to benign. We suggest that the NLR and PLR can be used as a supplementary tool for diagnosing benign, borderline, and malignant ovarian tumors in addition to imaging diagnosis and tumor markers such as CA125.

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Association of Neutrophil-Lymphocyte Ratio with Mild Cognitive Impairment in Elderly Chinese Adults: A Case-control Study

Current Alzheimer Research ◽

10.2174/1567205017666200103110521 ◽

2020 ◽

Vol 16 (14) ◽

pp. 1309-1315

Author(s):

Peilin An ◽

Xuan Zhou ◽

Yue Du ◽

Jiangang Zhao ◽

Aili Song ◽

...

Keyword(s):

Logistic Regression ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Predictive Values ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Elderly Chinese ◽

Normal Cognitive Function ◽

The Absolute

Background: Inflammation plays a significant role in the pathophysiology of cognitive impairment in previous studies. Neutrophil-lymphocyte ratio (NLR) is a reliable measure of systemic inflammation. Objective: The aim of this study was to investigate the association between NLR and mild cognitive impairment (MCI), and further to explore the diagnostic potential of the inflammatory markers NLR for the diagnosis of MCI in elderly Chinese individuals. Methods: 186 MCI subjects and 153 subjects with normal cognitive function were evaluated consecutively in this study. Neutrophil (NEUT) count and Lymphocyte (LYM) count were measured in fasting blood samples. The NLR was calculated by dividing the absolute NEUT count by the absolute LYM count. Multivariable logistic regression was used to evaluate the potential association between NLR and MCI. NLR for predicting MCI was analyzed using Receiver Operating Characteristic (ROC) curve analysis. Results: The NLR of MCI group was significantly higher than that of subjects with normal cognitive function (2.39 ± 0.55 vs. 1.94 ± 0.51, P < 0.001). Logistic regression analysis showed that higher NLR was an independent risk factor for MCI (OR: 4.549, 95% CI: 2.623-7.889, P < 0.001). ROC analysis suggested that the optimum NLR cut-off point for MCI was 2.07 with 73.66% sensitivity, 69.28% specificity, 74.48% Positive Predictive Values (PPV) and 68.36% negative predictive values (NPV). Subjects with NLR ≥ 2.07 showed higher risk relative to NLR < 2.07 (OR: 5.933, 95% CI: 3.467-10.155, P < 0.001). Conclusion: The elevated NLR is significantly associated with increased risk of MCI. In particular, NLR level higher than the threshold of 2.07 was significantly associated with the probability of MCI.

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Predictive value of the neutrophil to lymphocyte ratio for disease deterioration and serious adverse outcomes in patients with COVID-19: a prospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-05796-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhi-Yong Zeng ◽

Shao-Dan Feng ◽

Gong-Ping Chen ◽

Jiang-Nan Wu

Keyword(s):

Cohort Study ◽

Hospital Admission ◽

Clinical Outcomes ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Characteristic Curve ◽

Adverse Outcomes ◽

Neutrophil To Lymphocyte Ratio ◽

Predictive Values ◽

Lymphocyte Ratio

Abstract Background Early identification of patients who are at high risk of poor clinical outcomes is of great importance in saving the lives of patients with novel coronavirus disease 2019 (COVID-19) in the context of limited medical resources. Objective To evaluate the value of the neutrophil to lymphocyte ratio (NLR), calculated at hospital admission and in isolation, for the prediction of the subsequent presence of disease progression and serious clinical outcomes (e.g., shock, death). Methods We designed a prospective cohort study of 352 hospitalized patients with COVID-19 between January 9 and February 26, 2020, in Yichang City, Hubei Province. Patients with an NLR equal to or higher than the cutoff value derived from the receiver operating characteristic curve method were classified as the exposed group. The primary outcome was disease deterioration, defined as an increase of the clinical disease severity classification during hospitalization (e.g., moderate to severe/critical; severe to critical). The secondary outcomes were shock and death during the treatment. Results During the follow-up period, 51 (14.5%) patients’ conditions deteriorated, 15 patients (4.3%) had complicated septic shock, and 15 patients (4.3%) died. The NLR was higher in patients with deterioration than in those without deterioration (median: 5.33 vs. 2.14, P < 0.001), and higher in patients with serious clinical outcomes than in those without serious clinical outcomes (shock vs. no shock: 6.19 vs. 2.25, P < 0.001; death vs. survival: 7.19 vs. 2.25, P < 0.001). The NLR measured at hospital admission had high value in predicting subsequent disease deterioration, shock and death (all the areas under the curve > 0.80). The sensitivity of an NLR ≥ 2.6937 for predicting subsequent disease deterioration, shock and death was 82.0% (95% confidence interval, 69.0 to 91.0), 93.3% (68.0 to 100), and 92.9% (66.0 to 100), and the corresponding negative predictive values were 95.7% (93.0 to 99.2), 99.5% (98.6 to 100) and 99.5% (98.6 to 100), respectively. Conclusions The NLR measured at admission and in isolation can be used to effectively predict the subsequent presence of disease deterioration and serious clinical outcomes in patients with COVID-19.

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Changes in Neutrophil–Lymphocyte or Platelet–Lymphocyte Ratios and Their Associations with Clinical Outcomes in Idiopathic Pulmonary Fibrosis

Journal of Clinical Medicine ◽

10.3390/jcm10071427 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1427

Author(s):

Steven D. Nathan ◽

Jayesh Mehta ◽

John Stauffer ◽

Elizabeth Morgenthien ◽

Ming Yang ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Clinical Outcomes ◽

Predictive Biomarkers ◽

Phase Iii ◽

Response To Treatment ◽

Reference Ranges ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

The Relationship

Identification of prognostic and predictive biomarkers in idiopathic pulmonary fibrosis (IPF) could aid assessment of disease severity and prediction of progression and response to treatment. This analysis examined reference ranges for neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) in IPF, and the relationship between NLR or PLR changes and clinical outcomes over 12 months. This post hoc analysis included patients with IPF from the Phase III, double-blind trials of pirfenidone, ASCEND (NCT01366209) and CAPACITY (NCT00287716 and NCT00287729). The relationship between change from baseline to Month 12 in NLR or PLR (divided into quartiles (Q1–Q4)) and outcomes (mortality, respiratory hospitalization, declines in lung function, exercise capacity and quality of life) was assessed. Estimated reference ranges at baseline for all patients analyzed (n = 1334) were 1.1–6.4 for NLR and 56.8–250.5 for PLR. Significant trends were observed across NLR and PLR quartiles for all outcomes in placebo-treated patients, with patients manifesting the greatest NLR or PLR changes experiencing the worst outcomes. These results suggest that the greatest NLR or PLR changes over 12 months were associated with worse clinical outcomes. Further research is needed to determine the utility of NLR and PLR as prognostic biomarkers in IPF.

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Fetal CHD and perinatal outcomes

Cardiology in the Young ◽

10.1017/s1047951120000785 ◽

2020 ◽

Vol 30 (5) ◽

pp. 686-691

Author(s):

Christina J. Ge ◽

Amanda C. Mahle ◽

Irina Burd ◽

Eric B. Jelin ◽

Priya Sekar ◽

...

Keyword(s):

Cohort Study ◽

Preterm Delivery ◽

Odds Ratio ◽

Retrospective Cohort ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Fold Increase ◽

Cesarean Sections ◽

Increased Risk ◽

Gestational Age At Delivery

AbstractObjective:To evaluate delivery management and outcomes in fetuses prenatally diagnosed with CHD.Study design:A retrospective cohort study was conducted on 6194 fetuses (born between 2013 and 2016), comparing prenatally diagnosed with CHD (170) to those with non-cardiac (234) and no anomalies (5790). Primary outcomes included the incidence of preterm delivery and mode of delivery.Results:Gestational age at delivery was significantly lower between the CHD and non-anomalous cohorts (38.6 and 39.1 weeks, respectively). Neonates with CHD had a significantly lower birth weights (p < 0.001). There was an approximately 1.5-fold increase in the rate of primary cesarean sections associated with prenatally diagnosed CHD with an odds ratio of 1.49 (95% CI 1.06–2.10).Conclusions:Our study provides additional evidence that the prenatal diagnosis of CHD is associated with a lower birth weight, preterm delivery, and with an increased risk of delivery by primary cesarean section.

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Detectability on Plain CT is an Effective Discriminator between Carcinoma and Benign Disorder for a Polyp >10 mm in the Gallbladder

Diagnostics ◽

10.3390/diagnostics11030388 ◽

2021 ◽

Vol 11 (3) ◽

pp. 388

Author(s):

Tatsunori Satoh ◽

Masataka Kikuyama ◽

Keiko Sasaki ◽

Hirotoshi Ishiwatari ◽

Shinya Kawaguchi ◽

...

Keyword(s):

Computed Tomography ◽

Multivariate Analysis ◽

Odds Ratio ◽

Patient Characteristics ◽

Polyp Size ◽

Predictive Values ◽

Lesion Detectability ◽

Contrast Enhanced ◽

Cell Densities ◽

Sensitivity Specificity

An appropriate diagnosis is required to avoid unnecessary surgery for gallbladder cholesterol polyps (GChPs) and to appropriately treat pedunculated gallbladder carcinomas (GCs). Generally, polyps >10 mm are regarded as surgical candidates. We retrospectively evaluated plain and contrast-enhanced (CE) computed tomography (CT) findings and histopathological features of 11 early GCs and 10 GChPs sized 10–30 mm to differentiate between GC and GChP >10 mm and determine their histopathological background. Patient characteristics, including polyp size, did not significantly differ between groups. All GCs and GChPs were detected on CE-CT; GCs were detected more often than GChPs on plain CT (73% vs 9%; p < 0.01). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for GCs were 73%, 90%, 89%, 75%, and 81%, respectively. On multivariate analysis, lesion detectability on plain CT was independently associated with GCs (odds ratio, 27.1; p = 0.044). Histopathologically, GChPs consisted of adipose tissue. Although larger vessel areas in GCs than in GChPs was not significant (52,737 μm2 vs 31,906 μm2; p = 0.51), cell densities were significantly greater in GCs (0.015/μm2 vs 0.0080/μm2; p < 0.01). Among GPs larger than 10 mm, plain CT could contribute to differentiating GCs from GChPs.

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Efficacy and Safety of Nivolumab and Ipilimumab for Advanced or Metastatic Renal Cell Carcinoma: A Multicenter Retrospective Cohort Study

Current Oncology ◽

10.3390/curroncol28020133 ◽

2021 ◽

Vol 28 (2) ◽

pp. 1402-1411

Author(s):

Koji Iinuma ◽

Koji Kameyama ◽

Kei Kawada ◽

Shota Fujimoto ◽

Kimiaki Takagi ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Objective Response ◽

Predictive Biomarkers ◽

Progression Free Survival ◽

Predictive Marker ◽

Efficacy And Safety ◽

Lymphocyte Ratio

We conducted a multicenter, retrospective study to evaluate the efficacy and safety of combination nivolumab plus ipilimumab (NIVO+IPI) in 35 patients with advanced or metastatic renal cell carcinoma (mRCC). In this study, we focused on patients who received NIVO+IPI and were stratified into intermediate- or poor-risk disease according to the International Metastatic Renal Cell Carcinoma Database Consortium model at five institutions in Japan. The primary endpoint was overall survival (OS). Secondary endpoints were disease control rate (DCR), best overall response (BOR), objective response rate (ORR), and progression-free survival (PFS). In addition, we evaluated the role of inflammatory cell ratios, namely neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as predictive biomarkers in patients with mRCC. The median follow-up period was 1 year, and the 1-year OS rate was 95.8%. The ORR and DCR were 34.3% and 80.0%, respectively. According to BOR, four patients (11.4%) achieved complete response. According to NLR stratification, the 1-year PFS rates were 82.6% and 23.7% when the NLR was ≤4.6 and >4.6, respectively (p = 0.04). Based on PLR stratification, the 1-year PFS rates were 81.7% and 34.3% when the PLR was ≤188.1 and >188.1, respectively (p = 0.033). Although 71.4% of the patients experienced treatment-related adverse events (TRAEs) with NIVO+IPI, only four patients discontinued NIVO+IPI due to grade 3/4 TRAEs. Patients treated with NIVO+IPI as a first-line therapy for advanced or mRCC achieved relatively better oncological outcomes. Therefore, NIVO+IPI may have potential advantages and may lead to a treatment effect compared to those receiving targeted therapies. In addition, PLR >188.1 may be a useful predictive marker for mRCC patients who received NIVO+IPI.

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Can Hematological Parameters Play a Role in the Differential Diagnosis of Adrenal Tumors?

Uro ◽

10.3390/uro1020006 ◽

2021 ◽

Vol 1 (2) ◽

pp. 39-44

Author(s):

Mehmet Gürkan Arıkan ◽

Göktan Altuğ Öz ◽

Nur Gülce İşkan ◽

Necdet Süt ◽

İlkan Yüksel ◽

...

Keyword(s):

Differential Diagnosis ◽

Inflammatory Markers ◽

Blood Count ◽

Complete Blood Count ◽

Low Cost ◽

Easy Access ◽

Adrenal Tumors ◽

Tumor Diameter ◽

Lymphocyte Ratio ◽

Significant Difference

There have been few studies reported with conflicting results in the use of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), redcell-distribution-width (RDW), etc. for predicting prognosis and differential diagnosis of adrenal tumors. The aim of this study is to investigate the role of inflammatory markers through a complete blood count, which is an easy access low-cost method, for the differential diagnosis of adrenocortical adenoma (ACA), adrenocortical carcinoma (ACC), and pheochromocytoma. The data of patients who underwent adrenalectomy between the years of 2010–2020 were retrospectively analyzed. Systemic hematologic inflammatory markers based on a complete blood count such as neutrophil ratio (NR), lymphocyte ratio (LR), NLR, PLR, RDW, mean platelet volume (MPV), and maximum tumor diameter (MTD) were compared between the groups. A statistically significant difference was found between the three groups in terms of PLR, RDW, and MTD. With post-hoc tests, a statistically significant difference was found in PLR and MTD between the ACA and ACC groups. A statistically significant difference was found between the ACA and pheochromocytoma groups in PLR and RDW values. In conclusion, it could be possible to plan a more accurate medical and surgical approach using PLR and RDW, which are easily calculated through an easy access low-cost method such as a complete blood count, together with MTD in the differential diagnosis of ACC, ACA, and pheochromocytoma.

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