Neutrophil-to-Lymphocyte Ratio Facilitates Identification of Obstructive Sleep Apnea in Patients with Type B Aortic Dissection

Purpose. To determine whether the neutrophil-to-lymphocyte ratio (NLR) aids in the detection of obstructive sleep apnea (OSA) in patients with type B aortic dissection (TBAD). Methods. 324 patients with TBAD or type B aortic intramural hematoma (TB-AIMH) underwent an overnight sleep study. We divided the eligible 256 studied subjects into three groups: group A (n = 109, TBAD patients with OSA), group B (n = 68, TB-AIMH patients with OSA), and group C (n = 79, TBAD patients without OSA). Baseline characteristics, biochemical and sleep parameters, and STOP-Bang questionnaire scores were collected. To assess the predictive efficacy of potential variables, multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used. Results. The study found that about 58% of TBAD patients and 54% of TB-AIMH patients had OSA, a majority of whom had moderate to severe OSA (95.41% and 89.71%, respectively). In the comparison of sleep parameters between patients with TBAD and TB-AIMH, no other than apnea and hypopnea index (AHI) made a significant difference. The multivariate logistic regression analysis showed that neutrophil-to-lymphocyte ratio (NLR) (odds ratio (OR): 3.614, 95% confidence interval (CI): 2.273–5.748, and P < 0.05 ) and STOP-Bang scores (OR: 1.97, 95% CI: 1.34–2.90, and P < 0.05 ) were both independent predictors for OSA in patients with TBAD. ROC curves showed NLR had higher sensitivity (65% versus 59%) and specificity (86% versus 57%) for OSA than the STOP-Bang questionnaire. Furthermore, NLR was positively correlated with AHI through the Spearman test (r = 0.398 and P < 0.05 ). Conclusion. NLR was an independent predictor of OSA in TBAD patients with higher sensitivity and specificity than the STOP-Bang questionnaire, and it was positively associated with AHI. NLR may aid in the diagnosis and risk stratification of OSA in TBAD patients.

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Elevated preoperative neutrophil‐to‐lymphocyte ratio predicts early adverse outcomes in uncomplicated type B aortic dissection undergoing TEVAR

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01904-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hongqiao Zhu ◽

Lei Zhang ◽

Taiping Liang ◽

Yiming Li ◽

Jian Zhou ◽

...

Keyword(s):

Adverse Events ◽

Aortic Dissection ◽

Multivariable Analysis ◽

Adverse Outcomes ◽

Neutrophil To Lymphocyte Ratio ◽

Type B ◽

Type B Aortic Dissection ◽

Independent Predictive Factor ◽

Lymphocyte Ratio ◽

Clinical Events

Abstract Background Thoracic aortic endovascular repair (TEVAR) of uncomplicated type B aortic dissection (uTBAD) has favorable long-term outcomes but higher early adverse events compared with the optimal medical treatment. Recently, clinical evidence concerning vascular surgery indicates that elevated preoperative systemic inflammatory response predicts adverse clinical events. The aim of our study was to evaluate the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and early outcomes of uTBAD patients undergoing TEVAR. Results 216 patients diagnosed with uTBAD were included in this retrospective study between January 2015 and December 2018. The median (IQR) follow-up period was 21 (15–33) months. An early adverse event was defined as occurring within 2 years after the procedure. Median patient age was 60 (IQR, 48–68) years and 78.7 % were male. Early adverse events occurred in 24 patients (11.1 %). In the multivariable analysis, preoperative NLR (HR per SD, 1.98; 95 % CI, 1.14–3.44; P = 0.015) was associated with 2-year adverse events. Conclusions NLR is an independent predictive factor of early adverse events in uTBAD patients undergoing TEVAR.

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Neutrophil to lymphocyte ratio and fibrinogen values in predicting patients with type B aortic dissection

Scientific Reports ◽

10.1038/s41598-021-90811-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shuangshuang Li ◽

Jin Yang ◽

Jian Dong ◽

Renle Guo ◽

Sheng Chang ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Aortic Aneurysm ◽

Aortic Dissection ◽

Physical Examination ◽

Multivariate Logistic Regression Analysis ◽

High Specificity ◽

Type B ◽

Type B Aortic Dissection ◽

Multivariate Logistic Regression

AbstractThe aim of this study is to detect the diagnosis value of neutrophil lymphocyte ratio (NLR) and fibrinogen (FIB) in type B aortic dissection (TBAD) patients. This retrospective observation study consisted patients with TBAD, aortic aneurysm and physical examination between January 1, 2016 and December 31, 2019. Demographic and clinical information after the first admission were collected. Multivariate logistic regression analysis was performed to explore the correlational relationship between NLR, FIB and TBAD. Receiver Operating Characteristic Curve (ROC) was performed to evaluate the diagnostic implication of NLR and FIB in TBAD patients. Six hundred and six patients who were first diagnosed with TBAD were included. Control groups were 202 aortic aneurysm and 140 physical examination subjects. The level of NLR and FIB in aortic dissection patients was significantly higher than aortic aneurysm patients and healthy group (P < 0.001). According to the results of multivariate logistic regression analysis, NLR and FIB were independent risk factors of aortic dissection, and the odds ratio (OR) and 95% confidence interval (CI) value of NLR and FIB were 1.499 (1.126–1.738) and 1.914 (1.475–2.485), respectively. The area under the curve (AUC) was 0.836 of NLR and 0.756 of FIB. NLR and FIB showed high specificity, 89% and 83% respectively. This is the first study provided information on the diagnosis performance of NLR and FIB in TBAD patients. NLR and FIB showed high specificity, which may be a valuable tool for the diagnosis of TBAD.

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The association between neutrophil-to-lymphocyte ratio and anaphylaxis refractory to epinephrine treatment

10.22514/sv.2021.034 ◽

2021 ◽

Keyword(s):

Operating Characteristic ◽

Characteristic Curve ◽

Multivariate Logistic Regression Analysis ◽

Allergic Diseases ◽

Neutrophil To Lymphocyte Ratio ◽

Youden Index ◽

Time Of Arrival ◽

Analysis Model ◽

Multivariate Logistic Regression ◽

Lymphocyte Ratio

Objectives: Anaphylaxis refractory to epinephrine treatment is a potentially fatal condition requiring additional medications. Neutrophil-to lymphocyte ratio (NLR) is commonly used to predict severity in allergic diseases. The aim of this study was to determine the association between NLR and refractory anaphylaxis. Methods: This was a retrospective, observational study of 126 adult anaphylaxis patients arriving at the emergency department between January 2015 and December 2019. Patients were placed into refractory anaphylaxis, if they required more than two 0.3 mg injections of intramuscular epinephrine for symptom resolution, and non-refractory anaphylaxis groups. NLRs were determined at the time of arrival at the hospital and were compared between groups. Results: Thirty-two (25.4%) patients were categorized as refractory anaphylaxis cases. NLR was significantly lower in the refractory anaphylaxis than in the non-refractory anaphylaxis group (P < 0.001). In the multivariate logistic regression analysis model, NLR was inversely associated with the occurrence of refractory anaphylaxis (adjusted odds ratio 0.33, 95% confidence interval 0.13-0.81, P = 0.016). The area under the receiver operating characteristic curve of NLR for prediction of refractory anaphylaxis was 0.717 (P < 0.001). The optimal cut-off value of NLR was < 0.68 using the Youden index, with 50.0% sensitivity and 80.9% specificity. Conclusions: NLR was independently and inversely associated with the occurrence of refractory anaphylaxis among anaphylactic patients. Therefore, NLR has the potential to be used as an easy and inexpensive test to predict refractory anaphylaxis in patients.

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Neutrophil to lymphocyte ratio and Fibrinogen Values in predicting patients with type B aortic dissection

10.21203/rs.3.rs-110633/v1 ◽

2020 ◽

Author(s):

Shuangshuang Li ◽

Jin Yang ◽

Renle Guo ◽

Jian Dong ◽

Sheng Chang ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Aortic Aneurysm ◽

Aortic Dissection ◽

Physical Examination ◽

Multivariate Logistic Regression Analysis ◽

High Specificity ◽

Type B ◽

Type B Aortic Dissection ◽

Multivariate Logistic Regression

Abstract The aim of this study is to detect the diagnosis value of neutrophil lymphocyte ratio (NLR) and fibrinogen (FIB) in type B aortic dissection (TBAD) patients. This retrospective observation study consisted patients with TBAD, aortic aneurysm and physical examination between January 1, 2016 and December 31, 2019. Demographic and clinical information after the first admission were collected. Multivariate logistic regression analysis was performed to explore the correlational relationship between NLR, FIB and TBAD. Receiver Operating Characteristic Curve (ROC) was performed to evaluate the diagnostic implication of NLR and FIB in TBAD patients. Six hundred and six patients who were first diagnosed with TBAD were included. Control groups were 202 aortic aneurysm and 140 physical examination subjects. The level of NLR and FIB in aortic dissection patients was significantly higher than aortic aneurysm patients and healthy group (P < 0.001). According to the results of multivariate logistic regression analysis, NLR and FIB were independent risk factors of aortic dissection, and the odds ratio (OR) and 95% confidence interval (CI) value of NLR and FIB were 1.499(1.126-1.738) and 1.914(1.475-2.485), respectively. The area under the curve (AUC) was 0.836 of NLR and 0.756 of FIB. NLR and FIB showed high specificity, 89% and 83% respectively. This is the first study provided information on the diagnosis performance of NLR and FIB in TBAD patients. NLR and FIB showed high specificity, which may be a valuable tool for the diagnosis of TBAD.

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Neutrophil-to-Lymphocyte Ratio at Hospital Admission as a Novel Predictor of Early Growth of Intraparenchymal Haemorrhage in Patients With Traumatic Brain Injury

10.21203/rs.3.rs-100356/v1 ◽

2020 ◽

Author(s):

Dongzhou Zhuang ◽

Jiangtao Sheng ◽

Guoyi Peng ◽

Tian Li ◽

Shirong Cai ◽

...

Keyword(s):

Logistic Regression ◽

Multivariate Logistic Regression Analysis ◽

Final Analysis ◽

Early Growth ◽

Neutrophil To Lymphocyte Ratio ◽

Roc Curve Analysis ◽

Cerebral Contusion ◽

Lymphocyte Ratio ◽

Intraparenchymal Haemorrhage ◽

Development And Validation

Abstract BackgroundThis study aimed to explore the association between the neutrophil-to-lymphocyte ratio (NLR) and early growth of traumatic intraparenchymal haemorrhage (tICH) in patients with traumatic brain injury.MethodsA multicentre, observational cohort study was conducted at four hospitals and included patients with cerebral contusion undergoing baseline computed tomography (CT) for haematoma volume analysis within 6 hours after primary injury and who had follow-up visits within 48 hours. Routine blood tests were performed upon admission and analysed with early PIH. Logistic regression and receiver operating characteristic (ROC) analysis was used to explore the predictive value of the NLR for haematoma expansion. ResultsThe final analysis included 1003 patients in the retrospective development and validation cohorts. In the retrospective development cohort, the NLR were higher in the PIH group than in the non-PIH group (P<0.0001). Multivariate logistic regression analysis revealed that a higher NLR was independently associated with PIH (P<0.0001). ROC curve analysis showed that the NLR had a sensitive ability for predicting PIH (AUC, 0.91 [95% CI, 0.88-0.94]). In the validation study, the NLR had a similar ability to predict PIH. ConclusionThe NLR can be used to easily assess the growth of tICH and calculated using routine laboratory tests. A high NLR is independently predictive of early growth of tICH and may aid in risk stratification of patients with tICH on admission.

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The Predictive Role of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio on Intensive Care Unit Admission and Mortality of COVID-19 Patients in Iran

10.21203/rs.3.rs-334097/v1 ◽

2021 ◽

Author(s):

Peiman Foroughi ◽

Mojtaba Varshochi ◽

Mehdi Hassanpour ◽

Meisam Amini ◽

Behnam Amini ◽

...

Keyword(s):

Intensive Care Unit ◽

Risk Factor ◽

Intensive Care ◽

Independent Risk Factor ◽

Multivariate Logistic Regression Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Icu Admission ◽

Inflammatory Index

Abstract Since the outbreak of COVID-19 several studies conducted to identify predictive factors which are associated with prognosis of COVID-19. In this study we aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) could help the clinicians to predict intensive care unit (ICU) admission and mortality of COVID-19 patients. This retrospective cohort study involved examining the medical records of 311 Iranian COVID-19 patients from 22 July 2020 to 22 August 2020. All characteristic data and laboratory results were recorded. The receiver operating characteristic (ROC) curve was used to identify the predictive value of studied parameters for ICU admission and death. Comparison of data revealed that some factors were jointly higher in non-survivors and ICU admitted patients than survivors and non-ICU admitted patients, such as: age, hemoglobin (HB), NLR, derived neutrophil-to-lymphocyte ratio (dNLR), PLR, systemic inflammatory index (SII), lactate dehydrogenase (LDH), Respiratory diseases, ischemic heart disease (IHD). Multivariate logistic regression analysis showed that only hypertension (OR 3.18, P=0.02) is an independent risk factor of death in COVID-19 patients, and also PLR (OR 1.02, P=0.05), hypertension (OR 4.00, P=0.002) and IHD (OR 5.15, P=0.008) were independent risk factor of ICU admission in COVID-19 patients. This study revealed that the NLR, PLR, platelet-to-white blood Cell ratio (PWR), dNLR and SII are valuable factors for predicting ICU admission and mortality of COVID-19 patients.

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Combination of C-Reactive Protein and Neutrophil-to-Lymphocyte Ratio as a Novel Prognostic Index in Patients With Bladder Cancer After Radical Cystectomy

Frontiers in Oncology ◽

10.3389/fonc.2021.762470 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yidi Wang ◽

Keyi Wang ◽

Jinliang Ni ◽

Houliang Zhang ◽

Lei Yin ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Cox Regression ◽

Roc Curves ◽

Neutrophil To Lymphocyte Ratio ◽

Postoperative Survival ◽

C Reactive Protein ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

T Stage

BackgroundInflammation is widely considered an important hallmark of cancer and associated with poor postoperative survival. The objective of this study is to assess the significance of preoperative C-NLR, a new inflammation-based index that includes preoperative C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), on therapeutic outcomes for bladder cancer (BC) patients after radical cystectomy (RC).Materials and MethodsBC patients who underwent RC between 2010 and 2019 were retrospectively analyzed from our medical center. The predictive effect of CRP, NLR, and C-NLR on the survival of BC patients were analyzed by the receiver operating characteristic (ROC) curves. The relationship between C-NLR and postoperative survival was investigated by Cox regression. The corresponding nomograms were built based on the Cox regression results of overall survival (OS) and disease-free survival (DFS), which were further validated by ROC curves, decision curve analysis (DCA) curves, and calibration curves.ResultsOf the 199 eligible patients, 83 (41.70%) were classified as high C-NLR group and the remaining 116 (58.30%) were classified as low C-NLR group. ROC analysis showed that C-NLR had the largest area under curve (AUC) compared to CRP and NLR. Multivariate analysis revealed that T-stage and C-NLR [high C-NLR vs. low C-NLR, hazard ratio (HR) = 2.478, 95% confidence interval (CI), 1.538–3.993, p < 0.001] were independent predictors of OS, whereas T-stage, M-stage, and C-NLR (high C-NLR vs. low C-NLR, HR = 2.817, 95% CI, 1.667–4.762, p < 0.001) were independent predictors of DFS. ROC and DCA analysis demonstrated better accuracy and discrimination of 3- and 5-year OS and DFS with C-NLR-based nomogram compared to TNM stage. The calibration curve reconfirmed the accurate predicting performance of nomograms.ConclusionC-NLR is a reliable predictor of long-term prognosis of BC patients after RC and will contribute to the optimization of individual therapy for BC patients.

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Clinical significance of neutrophil-to-lymphocyte ratio as a predictor of lymph node metastasis in gastric cancer

BMC Cancer ◽

10.1186/s12885-019-6404-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Toshiyuki Kosuga ◽

Tomoki Konishi ◽

Takeshi Kubota ◽

Katsutoshi Shoda ◽

Hirotaka Konishi ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Clinical Significance ◽

Characteristic Curve ◽

Neutrophil To Lymphocyte Ratio ◽

Youden Index ◽

Lymphocyte Ratio ◽

Node Metastasis ◽

Higher Sensitivity

Abstract Background Precise staging is indispensable to select the appropriate treatment strategy for gastric cancer (GC); however, the diagnostic accuracy of conventional modalities needs to be improved. This study investigated the clinical significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) for the prediction of pathological lymph node metastasis (pN+) in GC. Methods This was a retrospective study of 429 patients with GC who underwent curative gastrectomy. The predictive ability of NLR for pN+ was examined in comparison with that of computed tomography. Results The preoperative NLR ranged from 0.6 to 10.8 (median, 2.0), and the optimal cut-off value for predicting pN+ was 1.6 according to the receiver operating characteristic curve with the maximal Youden index. Multivariate analysis identified a NLR ≥ 1.6 (odds ratio (OR) 3.171; 95% confidence interval (CI) 1.448–7.235, p = 0.004) and cN+ (OR 2.426; 95% CI 1.221–4.958, p = 0.011) to be independent factors associated with pN+ in advanced GC (cT2-T4). On the other hand, a NLR ≥ 1.6 was not useful for predicting pN+ in early GC (cT1). In advanced GC, a NLR ≥ 1.6 detected pN+ with a higher sensitivity (84.9%) and negative predictive value (NPV) (63.9%) than conventional modalities (50.0 and 51.7%, respectively). When the subjects were limited to those with advanced GC with cN0, the sensitivity and NPV of a NLR ≥ 1.6 for pN+ increased further (90.7 and 81.0%, respectively). Conclusion The preoperative NLR may be a useful complementary diagnostic tool for predicting pN+ in advanced GC because of its higher sensitivity and NPV than conventional modalities.

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