Neutrophil-to-Lymphocyte Ratio and Covid-19 Symptom-based Severity at Admission

Background: Increased Neutrophil-to-Lymphocyte Ratio (NLR) is an independent risk factor for mortality in Covid-19 patients and is considered as an early warning sign of Covid-19 severity. This study aimed to observe the differences in NLR at admission between patients with mild, moderate, and severe symptoms of Covid-19 treated in a referral hospital in Banda Aceh, Indonesia.Methods: A total of 114 patients with Covid-19 admitted to a referral hospital in Banda Aceh, Indonesia, during March–September 2020 were included in this study. Demographic information and baseline laboratory data, including the NLR, were collected. Descriptive and inferential statistics were used to analyze the data. Results: The median NLR at admission was higher among patients with moderate to severe symptoms than those with mild symptoms [6.54 (2.80–97.00, IQR 4.81–9.44) vs 2.27 (0.79–5.07, IQR 1.43-2.98), p <0.001]. Covid-19 patients who died had a higher NLR than those who survived [10.88 (4.17–47.50, IQR 7.00–15.17) vs 6.15 (2.80–97.00, IQR 4.63–8.50), p 0.02]. Patients with moderate-severe symptoms had an initial NLR of 4.63–8.50 and decreased to 2.75–5.43 at the end of the treatment had a greater chance of survival. There was an increased probability of death in patients with moderate-severe symptoms whose initial NLR was 7.00–15.17, which was then elevated to 14.33–23.25.Conclusion: Different NLR at admission is seen among Covid-19 patients with mild and moderate-severe symptoms, leading to significantly different outcomes. The NLR can be used as a simple parameter to determine the severity of the disease and predict the outcome of Covid-19 patients.

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Prognostic Significance of Preoperative Neutrophil-to-Lymphocyte Ratio in Patients With Meningiomas

Frontiers in Oncology ◽

10.3389/fonc.2020.592470 ◽

2020 ◽

Vol 10 ◽

Author(s):

Yuki Kuranari ◽

Ryota Tamura ◽

Noboru Tsuda ◽

Kenzo Kosugi ◽

Yukina Morimoto ◽

...

Keyword(s):

Prognostic Significance ◽

Laboratory Data ◽

Progression Free Survival ◽

Cost Effective ◽

Tumor Location ◽

Neutrophil To Lymphocyte Ratio ◽

Ki 67 ◽

Who Grade ◽

Lymphocyte Ratio ◽

Subtotal Removal

BackgroundMeningiomas are the most common benign intracranial tumors. However, even WHO grade I meningiomas occasionally show local tumor recurrence. Prognostic factors for meningiomas have not been fully established. Neutrophil-to-lymphocyte ratio (NLR) has been reported as a prognostic factor for several solid tumors. The prognostic value of NLR in meningiomas has been analyzed in few studies.Materials and MethodsThis retrospective study included 160 patients who underwent surgery for meningiomas between October 2010 and September 2017. We analyzed the associations between patients’ clinical data (sex, age, primary/recurrent, WHO grade, extent of removal, tumor location, peritumoral brain edema, and preoperative laboratory data) and clinical outcomes, including recurrence and progression-free survival (PFS).ResultsForty-four meningiomas recurred within the follow-up period of 3.8 years. WHO grade II, III, subtotal removal, history of recurrence, Ki-67 labeling index ≥3.0, and preoperative NLR value ≥2.6 were significantly associated with shorter PFS (P < 0.001, < 0.001, 0.002, < 0.001, and 0.015, respectively). Furthermore, NLR ≥ 2.6 was also significantly associated with shorter PFS in a subgroup analysis of WHO grade I meningiomas (P = 0.003). In univariate and multivariate analyses, NLR ≥2.6 remained as a significant predictive factor for shorter PFS in patients with meningioma (P = 0.014).ConclusionsNLR may be a cost-effective and novel preoperatively usable biomarker in patients with meningiomas.

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Markers of Atherosclerosis in Hypertensive Patients with Less Advanced Chronic Kidney Disease

Acta Medica Marisiensis ◽

10.2478/amma-2019-0022 ◽

2019 ◽

Vol 65 (3) ◽

pp. 91-96

Author(s):

Claudia Floriana Suciu ◽

Andreea Varga ◽

Corneliu Florin Buicu ◽

Ioan Tilea

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Aortic Arch ◽

Laboratory Data ◽

Hypertensive Heart Disease ◽

Neutrophil To Lymphocyte Ratio ◽

Advanced Chronic Kidney Disease ◽

Hypertensive Patients ◽

Lymphocyte Ratio ◽

Aortic Arch Calcification

AbstractObjective: Our study aimed to validate the neutrophil-to-lymphocyte ratio (NLR) as a marker for aortic arch calcification in hypertensive patients with less advanced chronic kidney disease (CKD).Methods: A number of forty-four hypertensive patients with chronic kidney disease (categories G3a and G3b – 2012 KDIGO nomenclature) were included in the study. Considering the presence of aortic arch calcification (AAC) on chest X-ray, the study population was divided into two groups: 27 patients AAC present and seventeen without aortic arch calcification. Laboratory data were collected for each patient and NLR was computed. Comorbidities were also recorded: stable coronary artery disease, lower extremity arterial disease and hypertensive heart disease.Results: A positive correlation between neutrophil-to-lymphocyte ratio and aortic arch calcification in hypertensive CKD patients was identified. Furthermore, advanced age, increased alkaline phosphatase and increased erythrocyte sedimentation rate had a positive association with aortic arch calcification. We found no statistical correlation between neutrophil-to-lymphocyte ratio and other laboratory features in both groups of patients.Conclusions: Neutrophil-to-lymphocyte ratio may be viewed as a potential risk factor for vascular calcification in patients with moderate chronic kidney disease; nevertheless, future extensive studies are necessary. In the management of hypertensive patients, general medicine might particularly benefit of this simple, readily available inflammatory marker.

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Prognostic Role of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in the Survival of Patients with Esophageal Cancer

Basic & Clinical Cancer Research ◽

10.18502/bccr.v12i4.7981 ◽

2021 ◽

Author(s):

Maryam Tajik ◽

Mohammad Shirkhoda ◽

Maryam Hadji ◽

Monireh Sadat Seyyed- salehi ◽

Elnaz Saeidi ◽

...

Keyword(s):

Esophageal Cancer ◽

Medical Records ◽

Total Bilirubin ◽

Laboratory Data ◽

Neutrophil To Lymphocyte Ratio ◽

Poor Survival ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio

Background: Different factors can affect the future of a person with cancer. The patient’s systemic inflammatory response is an important factor. Several inflammatory markers have been evaluated for measuring the patient’s response to cancer. We evaluated neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as prognostic factors for survival in patients with pathologically proven esophageal cancer. Methods: In this retrospective cohort study, patients with pathologically approved esophageal cancer, who underwent surgical treatment in the cancer institute of Iran, were included. Demographic, pathological, and laboratory data of patients were obtained from the archive of medical records. Results: In this study, 135 patients with esophageal cancer with a mean age of 60 were studied. The median time of the follow-up period was 21 months. Mean NLR and PLR were 7.05 and 898, respectively. Patients’ survival had a significant relationship with their age, gender, tumor differentiation, receiving chemotherapy, absolute neutrophil count, total bilirubin, direct bilirubin, and NLR. Conclusion: According to the results, in a multivariable investigation, it was demonstrated that a high NLR has a direct effect on patients’ poor survival.

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Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients with Human Papillomavirus–Positive Oropharyngeal Cancer

Otolaryngology ◽

10.1177/0194599818764651 ◽

2018 ◽

Vol 159 (2) ◽

pp. 303-309 ◽

Cited By ~ 8

Author(s):

Yoon Kyoung So ◽

GilJoon Lee ◽

Dongryul Oh ◽

Sunju Byeon ◽

Woori Park ◽

...

Keyword(s):

Human Papillomavirus ◽

Oropharyngeal Cancer ◽

Medical Center ◽

Laboratory Data ◽

Disease Free Survival ◽

Neutrophil To Lymphocyte Ratio ◽

Prognostic Impact ◽

Prognostic Role ◽

Lymphocyte Ratio ◽

N Classification

Objective To investigate the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) for human papillomavirus–positive oropharyngeal cancer (HPV+ OPC). Study Design Retrospective institutional database analysis. Setting Tertiary referral medical center. Material and Methods In total, 104 patients with HPV+ OPC were enrolled. From the blood laboratory data checked within 4 weeks before initiation of primary treatment, NLR was calculated. The association between clinicopathological characteristics and NLR was analyzed, and the prognostic role was evaluated based on overall survival (OS) and disease-free survival (DFS). Results According to the cutoff value (2.42) for NLR, the patients were classified into the low NLR group (n = 61) or the high NLR group (n = 43). High NLR was associated with a higher rate of advanced T classification ( P = .007) and diabetes mellitus ( P = .01). The proportion of surgery-based treatment was lower in the high NLR group (20.9% vs 42.6%, P = .02). The high NLR group showed a lower 5-year OS rate (85.3% vs 96.3%, P = .09) and a lower 5-year DFS rate (68.1% vs 94.7%, P = .01) than those in the low NLR group. Multivariate analysis showed that advanced N classification was a significant predictor for worse 5-year OS (hazard ratio [HR], 17.40; 95% confidence interval [CI], 2.36-128.29) and that both advanced N classification (HR, 7.78; 95% CI, 2.33-25.93) and high NLR (HR, 4.16; 95% CI, 1.24-13.95) were important prognosticators for worse 5-year DFS. Conclusion Elevated pretreatment NLR was associated with poor DFS in patients with HPV+ OPC.

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Role of neutrophil-to-lymphocyte ratio as a prognostic indicator for hemodialysis arteriovenous fistula failure

The Journal of Vascular Access ◽

10.1177/1129729819826037 ◽

2019 ◽

Vol 20 (6) ◽

pp. 608-614 ◽

Cited By ~ 2

Author(s):

Yuthapong Wongmahisorn

Keyword(s):

Confidence Interval ◽

Arteriovenous Fistula ◽

Multivariate Analyses ◽

Laboratory Data ◽

Neutrophil To Lymphocyte Ratio ◽

Optimal Cutoff ◽

Lymphocyte Ratio ◽

Cutoff Values ◽

The Impact

Objective: To evaluate the role of preoperative peripheral blood neutrophil-to-lymphocyte ratio in predicting early arteriovenous fistula failure. The impact of postoperative neutrophil-to-lymphocyte ratio on arteriovenous fistula failure was also investigated. Methods: Medical records from 470 patients who underwent first-time arteriovenous fistula creation were studied. Demographic, clinical, and laboratory data were obtained. Receiver operating characteristic curves were constructed to determine the optimal cutoff values of preoperative and postoperative neutrophil-to-lymphocyte ratios for predicting early arteriovenous fistula failure. Univariate and multivariate analyses were performed to evaluate whether the neutrophil-to-lymphocyte ratio parameters were prognostic indicators for arteriovenous fistula failure. Results: Complete data from 396 patients were studied. The prevalence of early arteriovenous fistula failure was 30.6%. The optimal cutoff values of preoperative and postoperative neutrophil-to-lymphocyte ratios for predicting early arteriovenous fistula failure were 2.7 (82.6% sensitivity and 52.0% specificity) and 2.9 (78.5% sensitivity and 73.1% specificity), respectively. By univariate and multivariate analyses, high preoperative and postoperative neutrophil-to-lymphocyte ratios were significantly associated with early arteriovenous fistula failure. The adjusted odds ratios were 5.46 (95% confidence interval: 3.15–9.48) and 7.19 (95% confidence interval: 4.12–12.55), respectively. Conclusions: High preoperative and postoperative neutrophil-to-lymphocyte ratios significantly predict early arteriovenous fistula failure.

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Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Sepsis

10.21203/rs.3.rs-706210/v1 ◽

2021 ◽

Author(s):

Xinyu Liao ◽

Fuxing Li ◽

Fuke Wang ◽

Guoliang Wang ◽

Yaxing Zheng ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Sofa Score ◽

Prognostic Value ◽

Laboratory Data ◽

Neutrophil To Lymphocyte Ratio ◽

Univariate Logistic Regression Analysis ◽

Lymphocyte Ratio ◽

Reactive Protein

Abstract Objective: We attempt to evaluate the role of neutrophil-to-lymphocyte ratio (NLR) in predicting 28-day mortality in patients with sepsis to investigate its prognostic value.Method: Relevant clinical and laboratory data of 91 healthy controls, 87 non-septic patients admitted to intensive care unit (ICU) and 127 septic patients on admission were collected, and septic patients were divided into survival (n=79) and death groups (n=48) according to their prognoses. NLR levels among different groups were compared and analyzed for associations with C-reactive protein (CRP), procalcitonin (PCT) and SOFA score. Univariate logistic regression analysis was used to assess the prognostic value of the NLR in patients with sepsis. Result: The NLR level was significantly higher in the septic patients compared to the case controls and healthy individuals (P < 0.05), and was much higher in septic patients who died (P < 0.05). ROC analysis indicated that the NLR had the best prognostic value for sepsis, with an AUC of 0.77 (95% CI: 0.69-0.84). Univariate logistic regression analysis suggested that NLR >8.25 was an independent risk factor for sepsis (odds ratio [OR] 6.39, P = 0.001). Correlation analysis suggested that the NLR was positively correlated with CRP, PCT and SOFA score.Conclusion: Peripheral serum NLR appeares to have a predictive value for 28-day mortality in patients with sepsis.

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The association between neutrophil to lymphocyte ratio and overall survival in patients with triple-negative breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12591 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12591-e12591

Author(s):

Dilan Anil Patel ◽

Bilal Hassan ◽

Jingqin Luo ◽

Cynthia X. Ma ◽

Jian Li Campian

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Prediction Models ◽

Immune Surveillance ◽

Laboratory Data ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Poor Outcomes

e12591 Background: Recent reports have suggested that an elevated neutrophil to lymphocyte ratio (NLR) is associated with poor outcomes in various malignancies. Furthermore, radiation therapy (RT) alone or in combination with chemotherapy often results in reduced absolute lymphocyte counts (ALC), which has been postulated to impair host immune surveillance and anti-tumor responses. We sought to better understand whether an elevated NLR results in impaired OS in patients with triple-negative breast cancer. Methods: Our retrospective analysis was performed on a database of patients with biopsy proven triple-negative breast cancer treated at Washington University in St. Louis between 2002 and 2010. Patients who received radiation therapy and had adequate follow up in terms of clinical documentations and laboratory data were included. NLR and ALC were collected at baseline, post-adjuvant chemotherapy, prior to RT, end of RT, 2 months post RT, 1 year post RT, and completion of all planned treatments. Results: Total of 155 patients were included. We used a cutoff value of 3.0 to classify high NLR. Wilcoxon rank-sum test was used to compare NLR at each time point between deceased and alive patients. High NLR post chemotherapy is associated with worse OS (HR 1.127, 95% CI = 1.016-1.249; p<0.05). In addition, NLRs from end of RT, 2 months post and 1 year post RT are associated with worse OS: (HR 1.109, 95% CI = 1.059–1.161; p < 0.001); (HR 1.074, 95% CI = 1.041–1.109; p < 0.001); (HR 1.069, 95% CI = 1.048–1.091; p < 0.001) respectively. Conclusions: High NLR post-chemotherapy and RT are associated with worse OS in patients with triple-negative breast cancer.Further studies are warranted to establish NLR as a prognostic marker and an addition to risk prediction models. [Table: see text]

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Increased neutrophil-to-lymphocyte ratio after thrombolysis better predicts 3-month stroke outcome

10.21203/rs.3.rs-50722/v1 ◽

2020 ◽

Author(s):

Duanlu Hou ◽

Chunjie Wang ◽

Xiaofei Ye ◽

Ping Zhong ◽

Danhong Wu

Keyword(s):

Cerebral Infarction ◽

Functional Outcome ◽

Characteristic Curve ◽

Laboratory Data ◽

Multivariate Regression Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Unique Identifier ◽

Clinical Trial Registration ◽

Lymphocyte Ratio ◽

Significant Difference

Abstract Background-Thrombolysis has become an effective therapy for acute cerebral infarction (AIS) within 4.5 hours. Thrombolysis improves prognosis by increasing perfusion of the ischemic penumbra. Inflammation as one of the mechanisms of cerebral infarction, the role of thrombolysis is the topic of our exploration. Methods-From August 1, 2017 and September 1, 2019, 493 consecutive patients with AIS were prospectively enrolled in this cohort. 170 patients received thrombolytic therapy and 323 patients did not have thrombolysis. Clinical evaluation, laboratory data before and after thrombolysis and 3-month modified Rankin scale (mRS) scores were compared. Neutrophil-to-lymphocyte ratio (NLR), which represents inflammatory response, was divided into quartiles for comparison. Multivariate regression analysis was used to determine independent factors of 3-month prognosis. The receiver operating characteristic curve was used to evaluate the predictability of NLR for good prognosis that was defined as 3-month mRS scores < 3. Results-The NLR after thrombolysis was higher than that before thrombolysis (p < 0.001) and in non-thrombolytic patients (p < 0.001). NLR after thrombolysis is an independent predictor of 3-month functional outcome (odds ratio (OR) = 1.20, 95% confidence interval (CI), 1.01–1.42, p = 0.03). Also, a cutoff value of 4.51 for NLR was detected in predicting post-thrombolysis 3-month functional outcome with a sensitivity of 65.7% and a specificity of 73.1% (area under curve [AUC], 0.85; 95% CI, 0.77–0.92). We also found a significant difference (62% vs 88%, p < 0.001) in the proportion of good 3 months prognosis between the higher and lower group. Conclusions-This study showed that NLR increase after thrombolysis better predict post-thrombolytic unfavorable functional outcome in AIS patients. Clinical Trial Registration-URL: http://www.chictr.org.cn/index.aspx, Unique identifier: ChiCTR1800018315. URL: http://www.chictr.org.cn/index.aspx, Unique identifier: ChiCTR1800019615.

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Prognostic role of the preoperative neutrophil-to-lymphocyte ratio and albumin for 30-day mortality in patients with postoperative acute pulmonary embolism

10.21203/rs.2.20738/v2 ◽

2020 ◽

Author(s):

Chuan Liu ◽

Hui-lu Zhan ◽

Zhang-Heng Huang ◽

Chuan Hu ◽

Yue-Xin Tong ◽

...

Keyword(s):

Pulmonary Embolism ◽

Medical Records ◽

Acute Pulmonary Embolism ◽

Area Under The Curve ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Unit Increase ◽

Probability Of Death

Abstract Background: This retrospective study aimed to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and albumin for 30-day mortality in patients with postoperative acute pulmonary embolism (PAPE).Methods: We retrospectively reviewed the medical records of 101 patients with PAPE admitted from September 1, 2012, to March 31, 2019. The characteristics, surgical information, admission examination data and mortality within 30 days after PAPE were obtained from our electronic medical recording system and follow-up. The associations between the NLR, PLR, and other predictors and 30-day mortality were analyzed with univariate and multivariate analyses. Then, the nomogram including the independent predictors was established and evaluated.Results: Twenty-four patients died within 30 days, corresponding to a 30-day mortality rate of 23.8%. The results of the multivariate analysis indicated that both the NLR and albumin were independent predictors for 30-day mortality in patients with PAPE. The probability of death increased by approximately 17.1% (OR=1.171, 95% CI: 1.073–1.277, P=0.000) with a one-unit increase in the NLR, and the probability of death decreased by approximately 15.4% (OR=0.846, 95% CI: 0.762c–0.939, P=0.002) with a one-unit increase in albumin. The area under the curve of the nomogram was 0.888 (95% CI: 0.812-0.964).Conclusion: Our findings showed that an elevated NLR and decreased albumin were related to poor prognosis in patients with PAPE. The NLR and albumin were independent prognostic factors for PAPE.

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Platelet-Based Biomarkers for Diagnosis and Prognosis in COVID-19 Patients

Life ◽

10.3390/life11101005 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1005

Author(s):

Ricardo Wesley Alberca ◽

Rosa Liliana Solis-Castro ◽

Maria Edith Solis-Castro ◽

Fernanda Cardoso ◽

Alberto Jose da Silva Duarte ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Predictive Value ◽

Laboratory Data ◽

Clinical Manifestations ◽

Multiple Organ ◽

Neutrophil To Lymphocyte Ratio ◽

Nasopharyngeal Swab ◽

Predictive Values ◽

Lymphocyte Ratio ◽

New Biomarkers

Coronavirus disease 2019 (COVID-19) caused millions of deaths worldwide. COVID-19's clinical manifestations range from no symptoms to a severe acute respiratory syndrome, which can result in multiple organ failure, sepsis, and death. Severe COVID-19 patients develop pulmonary and extrapulmonary infections, with a hypercoagulable state. Several inflammatory or coagulatory biomarkers are currently used with predictive values for COVID-19 severity and prognosis. In this manuscript, we investigate if a combination of coagulatory and inflammatory biomarkers could provide a better biomarker with predictive value for COVID-19 patients, being able to distinguish between patients that would develop a moderate or severe COVID-19 and predict the disease outcome. We investigated 306 patients with COVID-19, confirmed by severe acute respiratory syndrome coronavirus 2 RNA detected in the nasopharyngeal swab, and retrospectively analyzed the laboratory data from the first day of hospitalization. In our cohort, biomarkers such as neutrophil count and neutrophil-to-lymphocyte ratio from the day of hospitalization could predict if the patient would need to be transferred to the intensive care unit but failed to identify the patients´ outcomes. The ratio between platelets and inflammatory markers such as creatinine, C-reactive protein, and urea levels is associated with patient outcomes. Finally, the platelet/neutrophil-to-lymphocyte ratio on the first day of hospitalization can be used with predictive value as a novel severity and lethality biomarker in COVID-19. These new biomarkers with predictive value could be used routinely to stratify the risk in COVID-19 patients since the first day of hospitalization.

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