scholarly journals The Neutrophil-to-lymphocyte Ratio at the Time of Admission: A New Prognostic Indicator for Hospital Mortality of Trauma Patients

2021 ◽  
Author(s):  
Hamed Fouladseresht ◽  
Shahram Bolandparvaz ◽  
Hamid Reza Abbasi ◽  
Hossein Abdolrahimzadeh Fard ◽  
Shahram Paydar
Keyword(s):  
Survival Analysis ◽  
Hospital Mortality ◽  
Regression Models ◽  
Cox Regression ◽  
Prognostic Indicator ◽  
Neutrophil To Lymphocyte Ratio ◽  
Trauma Patients ◽  
Lymphocyte Ratio ◽  
Kaplan Meier ◽  
Time Of Admission

The elevated neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical outcomes, especially in pro-inflammatory states such as surgical injuries and severe hemorrhages. Therefore, it was hypothesized whether NLR value at the time of admission could be a prognostic indicator of hospital mortality in trauma patients. This retrospective cohort study was conducted on 865 trauma patients referred to Rajaee Hospital between April 2016 and July 2019. The NLR value was calculated at the time of admission, and receiver operating characteristics (ROC) curve analysis was used to determine the cut-off point value of admission NLR related to hospital mortality of trauma patients. Furthermore, Kaplan-Meier survival analysis and Cox regression models have been applied to determine the effectiveness and prognostic potential of the admission NLR in the hospital mortality of trauma patients. The median age of the trauma patients was 32 years with an interquartile range (IQR) of 23 to 48 years, and most of them were male (83.9%). Also, trauma patients had a median injury severity score (ISS) of 9 (IQR=4-16) and a median Glasgow coma scale (GCS) of 14 (IQR=9-15). The cut-off value for admission NLR was 5.27 (area under the curve: 0.642, 95%CI: 0.559-0.726, p=0.001). In Kaplan-Meier survival analysis, the admission NLR>5.27 was an indicator of hospital mortality in trauma patients (p=0.001). Multivariate Cox regression models demonstrated that trauma patients with an admission NLR>5.27 had a 2.33-fold risk of hospital mortality (hazard ratio=2.33, 95%CI: 1.02-5.38, p=0.041). Furthermore, the admission NLR>5.27 was associated with a higher risk of hospital mortality in trauma patients with age≥65 years, systolic blood pressure≤90 mmHg, blood potassium>4.5 mmol/L, blood sodium>144 mEq/L, blood potential hydrogen (pH)≤7.28, GCS≤8, ISS>24 and blood base excess≤-6.1 mEq/L. The NLR value greater than 5.27 at the time of admission was associated with poorer outcomes, and it can be considered an independent prognostic indicator of hospital mortality in trauma patients.

scholarly journals The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients

Molecules ◽  
2020 ◽  
Vol 25 (23) ◽  
pp. 5725 ◽  
Author(s):  
Alessandro G. Fois ◽  
Panagiotis Paliogiannis ◽  
Valentina Scano ◽  
Stefania Cau ◽  
Sergio Babudieri ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Systemic Inflammation ◽  
Cox Regression ◽  
Rapid Onset ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Kaplan Meier ◽  
Group Methods ◽  
Aggregate Index ◽  
Inflammatory State

Background. The rapid onset of a systemic pro-inflammatory state followed by acute respiratory distress syndrome is the leading cause of mortality in patients with COVID-19. We performed a retrospective observational study to explore the capacity of different complete blood cell count (CBC)-derived inflammation indexes to predict in-hospital mortality in this group. Methods. The neutrophil to lymphocyte ratio (NLR), derived NLR (dNLR), platelet to lymphocyte ratio (PLR), mean platelet volume to platelet ratio (MPR), neutrophil to lymphocyte × platelet ratio (NLPR), monocyte to lymphocyte ratio (MLR), systemic inflammation response index (SIRI), systemic inflammation index (SII), and the aggregate index of systemic inflammation (AISI) were calculated on hospital admission in 119 patients with laboratory confirmed COVID-19. Results. Non-survivors had significantly higher AISI, dNLR, NLPR, NLR, SII, and SIRI values when compared to survivors. Similarly, Kaplan–Meier survival curves showed significantly lower survival in patients with higher AISI, dNLR, MLR, NLPR, NLR, SII, and SIRI. However, after adjusting for confounders, only the SII remained significantly associated with survival (HR = 1.0001; 95% CI, 1.0000–1.0001, p = 0.029) in multivariate Cox regression analysis. Conclusions. The SII on admission independently predicts in-hospital mortality in COVID-19 patients and may assist with early risk stratification in this group.

scholarly journals Neutrophil to Lymphocyte Ratio as Prognostic Indicator for Patients with Esophageal Squamous Cell Cancer

2017 ◽  
Vol 32 (4) ◽  
pp. 409-414 ◽  
Author(s):  
Guo-Dong Gao ◽  
Bo Sun ◽  
Xian-Bin Wang ◽  
Shi-Meng Wang
Keyword(s):  
Overall Survival ◽  
Squamous Cell ◽  
Cox Regression ◽  
Cell Cancer ◽  
Prognostic Indicator ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Leukocyte Counts ◽  
Clinical Records

Background This study aimed to evaluate the correlation between neutrophil to lymphocyte ratio (NLR) with overall survival (OS) of esophageal squamous cell carcinoma (ESCC) patients. Method Records of patients with diagnosed ESCC were reviewed. Leukocyte counts and patients' characteristics were extracted from their clinical records to calculate NLR. Correlation between NLR and baseline characteristics with overall survival (OS) was then analyzed using Cox regression. The patients were then separated into higher and lower NLR groups according to median NLR. OS was further compared between the 2 groups. Results A total of 1281 patients were included in the study. Cox regression analysis showed a significant correlation of NLR with OS of ESCC patients. The median pretreatment NLR was identified as 2.86. Higher NLR was associated with worse prognosis in terms of OS. Conclusions Pretreatment NLR is independently associated with OS of ESCC patients. Therefore, NLR may be used as a predictive indicator for pretreatment evaluation and adjustment of treatment regimen.

scholarly journals High Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Associated with Poor Survival in Patients with Hemodialysis

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jialing Zhang ◽  
Xiangxue Lu ◽  
Shixiang Wang ◽  
Han Li
Keyword(s):  
Cox Regression ◽  
Pearson Correlation ◽  
Neutrophil To Lymphocyte Ratio ◽  
Poor Survival ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Kaplan Meier ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Relationship

Background. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers for systemic inflammation condition. Although NLR has emerged as a risk factor for poor survival in end-stage renal disease (ESRD) patients, the relationship between PLR and mortality is still unknown. We aimed to explore the interaction of NLR and PLR in predicting mortality in hemodialysis (HD) patients. Method. We enrolled 360 HD patients for a 71-month follow-up. The endpoint was all-cause and cardiovascular (CV) mortality. Pearson correlation analysis was conducted to evaluate the relationship between factors and NLR or PLR. Kaplan-Meier curves and Cox proportional analysis were used to assess the prognostic value of NLR and PLR. Results. NLR was positively correlated with neutrophil and negatively correlated with lymphocyte, hemoglobin, and serum albumin. PLR was positively correlated with neutrophil and platelet and negatively correlated with lymphocyte and hemoglobin. In multivariate Cox regression, a higher NLR level was independently associated with all-cause mortality (OR 2.011, 95% CI 1.082-3.74, p = 0.027 ), while a higher PLR level might predict CV mortality (OR 2.768, 95% CI 1.147-6.677, p = 0.023 ) in HD patients. Conclusion. NLR and PLR are cheap and reliable biomarkers for all-cause and CV mortality to predict survival in HD patients.

Prognostic value of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 551-551 ◽  
Author(s):  
Jae Hyun Kim ◽  
Seun Ja Park
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Value ◽  
Cox Regression ◽  
Neutrophil To Lymphocyte Ratio ◽  
Platelet To Lymphocyte Ratio ◽  
Poor Overall Survival ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Kaplan Meier ◽  
Independent Risk Factors

551 Background: Inflammatory response plays an important role in the pathogenesis of cancer. Some evidence has suggested that elevations in the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with decreased survival in various types of cancer. In this study, we aimed to evaluate the prognostic value of the NLR and PLR in patients with colorectal cancer (CRC). Methods: Between August 1995 and December 2010, medical records from a total of 2,004 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 multivariate Cox regression models. Results: The median follow-up duration was 42 months (interquartile range, 19 – 69). The estimation of NLR and PLR was based on the time of diagnosis. In multivariate Cox regression analysis, high NLR ( ≥ 2.6) [hazard ratio (HR) 2.251, 95% confidence interval (CI) 1.570-3.228, p < 0.001] and high PLR ( ≥ 155) [HR 1.473, 95% CI 1.019 – 2.128, p = 0.039] were independent risk factors predicting poor overall survival (OS) in CRC patients. Combined high NLR and PLR was also an independent risk factor predicting poor OS in patients with CRC [HR 2.316, 95% CI 1.529 – 3.508, p < 0.001]. Conclusions: In this study, we identified that high NLR ( ≥ 2.6), high PLR ( ≥ 155), and combined high NLR and PLR are useful prognostic factors to predict OS in CRC patients.

Neutrophil-to-lymphocyte ratio as a prognostic biomarker for overall survival in men with advanced prostate cancer treated with platinum chemotherapy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 266-266
Author(s):  
Panagiotis J. Vlachostergios ◽  
Aileen Lee ◽  
Charlene Thomas ◽  
Amy Hackett ◽  
Ana M. Molina ◽  
...  
Keyword(s):  
Cox Regression ◽  
Group Versus ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Kaplan Meier ◽  
Platinum Based Chemotherapy ◽  
Significant Difference ◽  
Ecog Ps ◽  
Available Information ◽  
Platinum Chemotherapy

266 Background: Platinum compounds are active in pts with metNEPC/CRPC. The neutrophil-to-lymphocyte ratio (NLR) is a simple clinical metric of systemic inflammation with prognostic and predictive value in advanced PC treated with FDA-approved therapies (doc, abi, enza, cabaz, mitox). We hypothesized that pretreatment NLR may be associated with clinical outcomes of platinum-treated pts. Methods: Records were reviewed from NEPC/CRPC platinum-treated pts with available information to enable pretreatment NLR calculation. Kaplan Meier curves, Cox regression analyses were used to predict PSA-PFS, radiographic PFS and OS after platinum initiation. For NLR, a cutoff of ≤5 was used as previously described (Leibowitz-Amit et al. 2014). Results: 108 men, median age 64 yrs (range 46-80), were studied. 28 pts (26%) were NEPC based on histological features. 54 had visceral mets (39 liver, 31 lung, 8 brain). 100 received carboplatin, 17 received cisplatin (9 received both sequentially, with initial platinum used for this analysis). Most received platinum in combination with other drugs, most commonly paclitaxel (N = 71) and etoposide (N = 20). 51 (47.2%) had low NLR ≤5 and 57 (52.7%) had high NLR > 5. Median PSA-PFS was 5 months in the low NLR group versus 3 months in the high NLR group (log-rank P = 0.07). Median rPFS did not differ between the two NLR groups (log-rank P = 0.36). Median OS of pts with NLR ≤5 was 15 months vs only 9 months in the high NLR ( > 5) subgroup (log-rank P = 0.06). There was no significant difference in NLR or OS status between NEPC and CRPC pts. On multivariate analysis (adjusted for age at platinum, Gleason, PSA, ALP, LDH, Hb, measurable disease, visceral mets, ECOG PS, use of opioids), NLR emerged as an independent prognostic factor for OS (HR 5.39, 95% CI 1.25-23.33, P = 0.02), together with PSA (P = 0.03) and visceral mets (P = 0.02). Conclusions: NLR is associated with shorter OS in men with advanced PC who receive platinum-based chemotherapy. It may serve as a useful clinical indicator of systemic inflammatory response and is more prognostic than standard NEPC vs adenocarcinoma histology. Prospective validation studies in such pts are needed to confirm these findings.

scholarly journals The Neutrophil to Lymphocyte Ratio May Predict Benefit from Chemotherapy in Lung Cancer

2018 ◽  
Vol 46 (4) ◽  
pp. 1595-1605 ◽  
Author(s):  
Dan Liu ◽  
Jing Jin ◽  
Li Zhang ◽  
Lei Li ◽  
Juan Song ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cox Regression ◽  
Poor Response ◽  
Disease Status ◽  
Complete Response ◽  
Prognostic Indicator ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Response To Chemotherapy ◽  
The Impact

Background/Aims: The objectives of this study were to evaluate the impact of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) on overall survival (OS) and to explore the value of changes in the NLR and PLR with treatment as a response indicator. Methods: A total of 934 patients were eligible for retrospective analysis between 2008 and 2014. The pretreatment and post-treatment PLR and NLR in all patients were calculated based on complete blood counts. Univariate and multivariate Cox regression analyses were performed to determine the associations of the PLR and NLR with OS. Results: The pretreatment NLR and PLR were correlated with different disease status and response to chemotherapy. Patients with lower NLR and PLR had a significantly better complete response (CR) rate to chemotherapy versus those with a higher NLR and PLR (p< 0.001). The NLR and PLR were sustained in patients who obtained a CR compared with moderate or poor response patients. The lower NLR of pretreatment was independently associated with a favourable prognosis in whole patients with lung cancer (HR: 0.69, 95% CI, 0.55-0.85, p< 0.001). In the patients under control after chemotherapy, the NLR of post-chemotherapy had a greater impact on survival, and the low NLR level maintained during chemotherapy was identified a predictor for favourable survival. PLR was not an independent prognostic indicator in the whole cohort or any subgroups. Conclusion: Our results suggested that NLR was well-connected with outcomes and response to chemotherapy in patients with lung cancer. As a response indicator, NLR may predict benefit from chemotherapy and improve patient selection.

scholarly journals Prognostic Value of Preoperative Neutrophil-to -Lymphocyte Ratio in Adenoid Cystic Carcinoma of the Head and Neck

2021 ◽  
Author(s):  
XIN-RAN LI ◽  
LIN ZHOU ◽  
YU-XIN CHEN ◽  
NA LI ◽  
JIAN MENG
Keyword(s):  
Adenoid Cystic Carcinoma ◽  
Head And Neck ◽  
Prognostic Value ◽  
Cox Regression ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cutoff Value ◽  
Lymphocyte Ratio ◽  
Adenoid Cystic ◽  
Kaplan Meier ◽  
Chi Squared

Abstract BackgroundStudies in recent years have shown that the neutrophil-to-lymphocyte ratio (NLR) is associated with the survival and prognosis of patients with malignant tumors.However, the utility of the NLR in predicting outcomes in patients with adenoid cystic carcinoma (ACC) of the head and neck remains unclear. Here, we examined the prognostic value of the preoperative NLR in patients with ACC of the head and neck.MethodsThis study retrospectively analyzed 71 patients with a histopathological diagnosis of ACC from August 2005 to November 2020.The optimal cutoff value was obtained by receiver operating characteristic (ROC) analysis. The characteristics of the patients were evaluated using chi-squared tests.The value of the NLR used in predicting the outcomes of these patients was analyzed using Kaplan-Meier curves and Cox regression models.ResultsThe cutoff value of the NLR was 2.071. The chi-squared tests showed that a high NLR(>2.071)was associated with tumor stage and lymph node metastasis(LNM). Kaplan-Meier survival analysis showed that the NLR>2.071 group was correlated with a shorter Overall survival(P<0.05). In multivariate Cox regression analysis, high NLR (>2.071) and high age (>54 years) were independent risk factors predicting poorer outcomes in patients with ACC.ConclusionsWe suggest that the preoperative NLR is a useful biomarker for the prognosis of patients with ACC.

scholarly journals Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio and Their Role as Predictors of Disease Severity of Coronavirus Disease 2019 (COVID-19)

2021 ◽  
Author(s):  
Rohit Jain ◽  
Arun Gopal ◽  
Basant Kumar Pathak ◽  
Sourya Sourabh Mohakuda ◽  
TVSVGK Tilak ◽  
...  
Keyword(s):  
Disease Severity ◽  
Complete Blood Count ◽  
Wide Spectrum ◽  
Statistical Significance ◽  
Severe Disease ◽  
Neutrophil To Lymphocyte Ratio ◽  
Screening Tools ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Time Of Admission

Abstract Context Due to the wide spectrum of clinical illness in coronavirus disease 2019 (COVID-19) patients, it is important to stratify patients into severe and nonsevere categories. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been evaluated rapidly by a few studies worldwide for its association with severe disease, but practically none have been conducted in the Indian population. This study was undertaken to examine the role of NLR and PLR in predicting severe disease in Indian patients. Objectives The objective was to study the association of NLR and PLR observed at the time of admission with maximum disease severity during hospitalization and to study their role in predicting disease severity. Material and Methods A total of 229 COVID-19 patients were admitted at the center during the study period. After applying inclusion and exclusion criteria, 191 patients were included in the study. The demographic, clinical, and laboratory (complete blood count, NLR, and PLR) data of all patients were obtained at the time of admission. Maximum disease severity of all patients was assessed during hospitalization. Statistical Analysis Chi-square and Mann–Whitney U tests were used to assess statistical significance. Receiver operating characteristic curve (ROC) was plotted for NLR and PLR to estimate the cutoff values and sensitivity and specificity using Youden’s index for predicting severe disease. Logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals. Results Mean NLR and PLR were significantly higher in severe patients (NLR = 7.41; PLR = 204) compared with nonsevere patients (NLR = 3.30; PLR = 121). ROC analysis showed that NLR, in comparison to PLR, had a higher area under the curve (AUC) of 0.779, with a larger OR of 1.237 and cutoff of 4.1, and showed 69% sensitivity and 78% specificity in predicting severe disease. Cut off for PLR was 115.3, which showed 79% sensitivity and 62% specificity in predicting severe disease. Conclusion NLR and PLR, both showing acceptable AUCs, can be used as screening tools to predict disease severity. However, NLR was a better predictor of disease severity.

scholarly journals Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning

2021 ◽  
Vol 16 (1) ◽  
pp. 703-710
Author(s):  
Yuhang Mu ◽  
Boqi Hu ◽  
Nan Gao ◽  
Li Pang
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Poor Prognosis ◽  
Prognostic Value ◽  
Organophosphorus Pesticide ◽  
Neutrophil To Lymphocyte Ratio ◽  
Pesticide Poisoning ◽  
Lymphocyte Ratio

Abstract This study investigates the ability of blood neutrophil-to-lymphocyte ratio (NLR) to predict acute organophosphorus pesticide poisoning (AOPP). Clinical data of 385 patients with AOPP were obtained within 24 h of admission, and NLR values were calculated based on neutrophil and lymphocyte counts. The patients were divided into two groups – good and poor – based on prognosis. Poor prognosis included in-hospital death and severe poisoning. The factors affecting prognosis were analyzed by logistic regression analysis, and the prognostic value of NLR was evaluated using the area under the receiver operating characteristic curve (AUC). Univariate logistic regression analysis showed that NLR levels, serum cholinesterase, and creatinine levels were good predictors of AOPP. Multivariate logistic regression analysis showed that high NLR was an independent risk factor for severe poisoning (adjusted odds ratio [AOR], 1.13; 95% CI, 1.10–1.17; p < 0.05) and in-hospital mortality (AOR, 1.07; 95% CI, 1.03–1.11; p < 0.05). NLR values >13 and >17 had a moderate ability to predict severe poisoning and in-hospital mortality, respectively (AUC of 0.782 [95% CI, 0.74–0.824] and 0.714 [95% CI, 0.626–0.803], respectively). Our results show that high NLR at admission is an independent indicator of poor prognosis in AOPP and can be used to optimize treatment and manage patients.

scholarly journals Outcomes of major trauma among patients with chronic kidney disease and receiving dialysis in Nova Scotia: a retrospective analysis

2021 ◽  
Vol 6 (1) ◽  
pp. e000672
Author(s):  
Ryan Pratt ◽  
Mete Erdogan ◽  
Robert Green ◽  
David Clark ◽  
Amanda Vinson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Nova Scotia ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Major Trauma ◽  
Injury Severity ◽  
Cox Regression ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Increased Risk

BackgroundThe risk of death and complications after major trauma in patients with chronic kidney disease (CKD) is higher than in the general population, but whether this association holds true among Canadian trauma patients is unknown.ObjectivesTo characterize patients with CKD/receiving dialysis within a regional major trauma cohort and compare their outcomes with patients without CKD.MethodsAll major traumas requiring hospitalization between 2006 and 2017 were identified from a provincial trauma registry in Nova Scotia, Canada. Trauma patients with stage ≥3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) or receiving dialysis were identified by cross-referencing two regional databases for nephrology clinics and dialysis treatments. The primary outcome was in-hospital mortality; secondary outcomes included hospital/intensive care unit (ICU) length of stay (LOS) and ventilator-days. Cox regression was used to adjust for the effects of patient characteristics on in-hospital mortality.ResultsIn total, 6237 trauma patients were identified, of whom 4997 lived within the regional nephrology catchment area. CKD/dialysis trauma patients (n=101; 28 on dialysis) were older than patients without CKD (n=4896), with higher rates of hypertension, diabetes, and cardiovascular disease, and had increased risk of in-hospital mortality (31% vs 11%, p<0.001). No differences were observed in injury severity, ICU LOS, or ventilator-days. After adjustment for age, sex, and injury severity, the HR for in-hospital mortality was 1.90 (95% CI 1.33 to 2.70) for CKD/dialysis compared with patients without CKD.ConclusionIndependent of injury severity, patients without CKD/dialysis have significantly increased risk of in-hospital mortality after major trauma.

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