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

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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Increased Neutrophil-To-Lymphocyte Ratio After Thrombolysis Improves Prediction of 3-Month Stroke Outcome

10.21203/rs.3.rs-156684/v1 ◽

2021 ◽

Author(s):

Duanlu Hou ◽

Chunjie Wang ◽

Xiaofei Ye ◽

Ping Zhong ◽

Danhong Wu

Keyword(s):

Functional Outcomes ◽

Clinical Laboratory ◽

Laboratory Data ◽

Blood Perfusion ◽

Multivariate Regression Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Before And After ◽

Patient Groups

Abstract Objectives-Thrombolysis is the effective therapy for acute ischemic stroke (AIS) within 4.5 hours of onset. It improves prognosis by increasing blood perfusion to the lesion. Though inflammation is a predictor of 3-month outcomes after thrombolysis, the temporal effect of thrombolysis on inflammation and the correlation between inflammation after thrombolysis and patients’ prognosis remain to be elucidated. Materials and Methods-Demographic, clinical, laboratory data before and after thrombolysis, and 3-month mRS scores were collected and compared. The neutrophil-to-lymphocyte ratio (NLR) was divided into low and high NLR subgroups and functional outcomes at 3 months were compared. Multivariate regression analysis was used to test independent predictors of 3-month prognosis. Results- 493 patients with AIS were prospectively enrolled between 1st August, 2017 and 1st September, 2019. 170 received thrombolysis and 323 patients did not. The NLR after thrombolysis was higher than that before thrombolysis among patients who received thrombolysis (p<0.001) and higher than that of patients who did not receive thrombolysis (p<0.001). The NLR after thrombolysis was an independent predictor of 3-month functional outcomes (OR =1.20, 95% CI: 1.01-1.42, p=0.03). The best discriminating value for the NLR is 4.51 (sensitivity 65.7%, specificity 73.1%, AUC: 0.85; 95% CI: 0.77-0.92). Significant difference (62% vs 88%, p<0.001) was observed in the patients with good 3-month outcome between patient groups with the NLR>4.51 and <4.51, respectively. Conclusions-NLR increase after thrombolysis was a predictor of poor 3-month functional outcome in AIS 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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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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Evaluation of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and C-Reactive Protein in Tension-Type Headache Patients

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1730124 ◽

2021 ◽

Author(s):

Hasan Hüseyin Özdemir ◽

Ahmet Dönder

Keyword(s):

Systemic Inflammation ◽

Tension Type Headache ◽

Neutrophil To Lymphocyte Ratio ◽

Control Group ◽

C Reactive Protein ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Significant Difference ◽

Type Headache

Abstract Objectives A tension headache is the most common type of headache, and its causes are multifactorial. A relationship has been shown between migraine headaches and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP). In this study, we investigated the NLR, PLR, and serum CRP levels in frequent episodic tension-type headache (FETTH) and chronic tension-type headache (CTTH) patients. Materials and Methods This retrospective study included 64 patients with FETTH, 80 patients with CTTH, and 60 healthy controls who were followed up in the neurology clinic. Hematological parameters were compared between the patient and control groups. Results In CTTH patients, platelets, NLR, PLR, and CRP values were statistically higher than in FETTH patients and patients in the control group. In FETTH patients, the PLR value was higher than in patients in the control group, but there was no statistically significant difference in NLR and CRP values between FETTH patients and patients in the control group. Also, there was no correlation between these values and age and gender. Conclusion Increase platelet count might have an effect on tension-type headache pathophysiology. Systemic inflammation parameters were shown to be significantly higher in CTTH patients. More comprehensive studies are needed to evaluate the effect of systemic inflammation on the chronicity of tension headaches.

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The association between neutrophil-to-lymphocyte ratio and contrast-induced acute kidney injury in patients with carotid artery stenting

Vascular ◽

10.1177/17085381211012562 ◽

2021 ◽

pp. 170853812110125

Author(s):

Altuğ Ösken ◽

Ahmet Öz ◽

Muhammed Keskin ◽

Evliya Akdeniz ◽

Hasan Şahan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Kidney Injury ◽

Fold Increase ◽

Multivariate Regression Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Life Threatening ◽

Prolonged Hospital

Objectives Contrast-induced acute kidney injury (CI-AKI) is a life-threatening complication that leads to comorbidities and prolonged hospital stay lengths in the setting of peripheral interventions. The presence of some CI-AKI risk factors has already been investigated. In this study, we evaluated the predictors of CI-AKI after carotid artery stenting. Methods A total of 389 patients with 50% to 99% carotid artery stenosis who underwent carotid artery stenting were included in this study. Patients were grouped according to CI-AKI status. Results CI-AKI developed in 26 (6.6%) patients. Age, baseline creatinine level, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were higher and estimated glomerular filtration rate, haemoglobin and lymphocyte count were lower in CI-AKI patients. In the multivariate regression analysis, the neutrophil-to-lymphocyte ratio triggered a 1.39- to 2.63-fold increase in the risk of CI-AKI onset ( p < 0.001). Conclusions The neutrophil-to-lymphocyte ratio may be a significant predictor of CI-AKI in patients with carotid artery stenting and higher neutrophil-to-lymphocyte ratio values may be independently associated with CI-AKI.

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The value of neutrophil-to-lymphocyte ratio as a marker of renal damage in patients with H-type hypertension

Biomarkers in Medicine ◽

10.2217/bmm-2020-0638 ◽

2021 ◽

Author(s):

Zhen-Ni Chen ◽

Yi-Ran Huang ◽

Xing Chen ◽

Kun Liu ◽

Si-Jin Li ◽

...

Keyword(s):

Regression Analysis ◽

Renal Damage ◽

Operating Characteristic ◽

Estimated Glomerular Filtration Rate ◽

Characteristic Curve ◽

Linear Regression Analysis ◽

Significant Negative Correlation ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

The Relationship

Aim: To explore the relationship between the neutrophil-to-lymphocyte ratio (NLR) and renal damage in patients with H-type hypertension. Materials & methods: A total of 618 patients between 2017 and 2019 were analyzed retrospectively. Results: NLR was significantly correlated with renal damage in hypertension patients. Appropriate cut-off value for NLR (2.247) was determined by receiver operating characteristic curve; linear regression analysis showed that NLR and estimated glomerular filtration rate, blood urea nitrogen/creatinine has a significant negative correlation in H-type hypertension group (p < 0.05); logistic regression analysis showed that the risk of renal damage increased by 10% for each 1 umol/l increase of homocysteine, and 51% for each 1.0 increase of NLR in H-type hypertension patients. Conclusion: NLR worth popularizing in prediction of renal damage in patients with H-type hypertension.

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Predictive value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for primary patency of percutaneous transluminal angioplasty in hemodialysis arteriovenous fistula stenosis

Vascular ◽

10.1177/17085381211039672 ◽

2021 ◽

pp. 170853812110396

Author(s):

Feng Zhu ◽

Yao Yao ◽

Hongbo Ci ◽

Alimujiang Shawuti

Keyword(s):

Arteriovenous Fistula ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Primary Patency ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Percutaneous Transluminal ◽

Hemodialysis Arteriovenous Fistula

Objective The aim of this study is to investigate the potential association of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with the primary patency of percutaneous transluminal angioplasty (PTA) in hemodialysis arteriovenous fistula (AVF) stenosis. Methods This study conducted a retrospective review of patients with end-stage renal disease referred for hemodialysis AVF stenosis in one center. The study consisted of 114 patients with significant (significant stenosis was defined as a reduction in the caliber of the fistula vein of > 50% with respect to the non-aneurysmal venous segment). AVF stenosis patients were treated with PTA, with conventional balloon angioplasty. The NLR and PLR were calculated from the pre-interventional blood samples. The patients were classified into two groups: group A, primary patency < 12 months ( n = 35) and group B, and primary patency ≥ 12 months ( n = 79). Comparisons between the groups were performed using the Mann–Whitney U test. Kaplan–Meier analysis was performed to compare the factors, NLR and PLR, for association with primary patency AVFs. A receiver-operating characteristic curve analysis was performed to identify the sensitivity and specificity of the NLR and PLR cut-off values in the prediction of primary patency time. Results There was no difference in gender; age; side of AVF; AVF type; comorbid diseases such as diabetes mellitus and hypertension; or blood parameters such as white cell count, erythrocytes, hemoglobin, neutrophils, lymphocytes, monocytes, eosinophils, basophils, C-reactive protein, NLR, or PLR between the two groups ( p > 0.05). There was also no significant difference in the patency rate between the NLR < 4.13 and NLR ≥ 4.13 groups at 12 months (NLR cut-off point = 4.13, p = 0.273). There were statistically significant differences between the primary patency rates of the PLR < 187.86 and PLR ≥ 187.86 groups at 12 months (PLR cut-off point = 187.86, p = 0.023). The cut-off value for PLR for the determination of primary patency was 187.86, with a sensitivity of 57.0% and specificity of 34.4%. Conclusion An increased level of PLR may be a risk factor for the development of early AVF restenosis after successful PTA. However, more studies are needed to validate this finding.

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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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Lack of an Association between Neutrophil-to-Lymphocyte Ratio and PSA Failure of Prostate Cancer Patients Who Underwent Radical Prostatectomy

BioMed Research International ◽

10.1155/2016/6197353 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Yoko Maeda ◽

Takashi Kawahara ◽

Mitsuyuki Koizumi ◽

Hiroki Ito ◽

Yohei Kumano ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Characteristic Curve ◽

Tumor Grade ◽

Receiver Operator Characteristic Curve ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Resection Margin Status ◽

Complete Blood Counts

Introduction. The neutrophil-to-lymphocyte ratio (NLR), which can be easily calculated from routine complete blood counts of the peripheral blood, has been suggested to serve as a prognostic factor for some solid malignancies. In the present study, we aimed to determine the relationship between NLR in prostate cancer patients undergoing radical prostatectomy (RP) and their prognosis.Materials and Methods. We assessed NLR in 73 men (patients) who received RP for their prostate cancer. We also performed immunohistochemistry for CD8 and CD66b in a separate set of RP specimens.Results. The median NLR in the 73 patients was 1.85. There were no significant correlations of NLR with tumor grade (p=0.834), pathological T stage (p=0.082), lymph node metastasis (p=0.062), or resection margin status (p=0.772). Based on the area under the receiver operator characteristic curve (AUROC) to predict biochemical recurrence after RP, potential NLR cut-off point was determined to be 2.88 or 3.88. However, both of these cut-off points did not precisely predict the prognosis. There were no statistically significant differences in the number of CD66b-positive neutrophils or CD8-positive lymphocytes between stromal tissues adjacent to cancer glands and stromal tissues away from cancer glands and between different grades or stages of tumors.Conclusions. There was no association between NLR and biochemical failure after prostatectomy.

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Predictive value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Vaginitis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.1.2774 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Eren Pek ◽

Fatma Beyazit ◽

Nilay Sen Korkmaz

Keyword(s):

Bacterial Vaginosis ◽

Predictive Value ◽

Inflammatory Marker ◽

Diagnostic Value ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet To Lymphocyte Ratio ◽

Cross Sectional ◽

Distribution Width ◽

Lymphocyte Ratio ◽

Significant Difference

Objectives: This study was conducted to evaluate the diagnostic value of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in vaginitis patients. Methods: This cross-sectional retrospective study was performed in Afyon Dinar State Hospital between July 2016 to August 2017. A total of 64 bacterial vaginosis (BV) patients, 66 vulvovaginal candidiasis (VVC) patients and 65 age-matched control subjects were enrolled. NLR, PLR, mean platelet volume (MPV), red cell distribution width (RDW) and other conventional inflammatory marker values were recorded for all patients before and after treatment. Results: In the BV group, NLR values were found to be elevated compared to VVC and healthy controls [2.9 (1.2-14.7), 2.1 (1.1-11.7) and 2.1 (0.8-7.0), respectively] (p=0.008). Although not found to be statistically significant, the median NLR levels of BV patients decreased from 2.9 (1.2-14.7) to 2.4 (1.2-7.0) after treatment. PLR levels did not show a statistically significant difference between the three groups (p=0.970). The cut-off value of the NLR for BV was 2.19, with 67.2% sensitivity and 63.8% specificity. Conclusions: The present study demonstrated that NLR levels are elevated in bacterial vaginosis and NLR levels can be used as a reflection of systemic inflammatory response in vaginosis patients. doi: https://doi.org/10.12669/pjms.37.1.2774 How to cite this:Pek E, Beyazit F, Korkmaz NS. Predictive value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Vaginitis. Pak J Med Sci. 2021;37(1):250-255. doi: https://doi.org/10.12669/pjms.37.1.2774 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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