Evaluation of Prognosis and Risk of Death by Neutrophil/Lymphocyte Ratio, C-Reactive Protein/Albumin Ratio and Plasma D-Dimer in Patients with Pulmonary Thromboembolism

Background:C-reactive protein to albumin ratio (CAR) has emerged as a significant biomarker to evaluate and predict systemic inflammation[1]. However, the role of CAR in patients with axial spondyloarthritis (axSpA) remains unknown.Objectives:The aim of this study was to investigate the relationship between CAR and disease activity of axSpA.Methods:A total of 241 patients and 61 healthy controls from Guangdong Second Provincial General Hospital from December 2015 to August 2019 were retrospectively recruited in this study. Patients were divided into two groups, with 176 patients in remission group (BASDAI<4) and 65 patients in active group (BASDAI≥4). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin (ALB), CAR, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) were detected. The correlations between CAR, NLR, PLR, MLR and disease activity were analyzed by the Spearman’s correlations analysis. Receiver operation characteristic (ROC) curves were performed to evaluate the discriminative utility of these parameters for disease activity of axSpA. Furthermore, the evaluation of the risk factors of axSpA was conducted using binary logistic regression analysis.Results:CAR, ESR, CRP, NLR, PLR and MLR in axSpA patients were significantly higher than those in the control group (p<0.05 for each), while ALB was significantly lower (p<0.001). Similarly, CAR in remission group was higher than that in control group (p<0.001) and was lower than that in active group (p<0.001). Besides, there were significantly positive correlations between CAR and ESR (r=0.702, P<0.001), CRP (r=0.996, P<0.001), BASDAI (r=0.329, p<0.001) and BASFI (r=0.328, P<0.001). Furthermore, ROC suggested that the area under the curve (AUC) of CAR was 0.701, which was the highest. The optimal cutoff point of CAR was 0.3644, with sensitivity and specificity of 58.5% and 79.0%. Logistic analysis results revealed that elevated CAR and MLR were independent risk factors for axSpA (EXP (B) =15.546, 95%CI: 5.898-40.979, P<0.001; EXP (B) =2.206, 95%CI: 1.077-4.519, P=0.031, respectively).Conclusion:CAR was increased in axSpA patients especially in active group, and significantly correlated with disease activity. CAR may serve as a novel inflammatory marker of monitoring disease activity in patients with axSpA.References:[1]He, Y., et al., Correlation between albumin to fibrinogen ratio, C-reactive protein to albumin ratio and Th17 cells in patients with rheumatoid arthritis. Clin Chim Acta, 2020. 500: p. 149-154.Fig 1.ROC curve analysis of the discriminative values of the parameters for disease activity of axSpATable 1.Discriminative values of the parameters for disease activity of axSpAAUC95% CIOptimal cutoff pointSpecificitySensitivityCAR0.7010.623-0.7780.364479.0%58.5%NLR0.4500.365-0.5343.16584.1%18.5%PLR0.5280.448-0.608127.38542.6%69.2%MLR0.4680.384-0.5530.38592.6%16.9%ESR0.6850.612-0.75815.552.3%76.9%CRP0.6910.614-0.76910.8571.6%63.1%CAR, C-reactive protein to albumin ratio; NLR, neutrophil-lymphocyte ratio; PLR, platelet-lymphocyte ratio; MLR, monocyte-lymphocyte ratio; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; AUC, areas under the ROC curveDisclosure of Interests:None declared

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C-REACTIVE PROTEIN/ALBUMIN RATIO AND NEUTROPHIL-LYMPHOCYTE RATIO AS PREDICTORS OF COVID-19 SEVERITY

International Journal of Advanced Research ◽

10.21474/ijar01/13919 ◽

2021 ◽

Vol 9 (12) ◽

pp. 374-378

Author(s):

M.V. Madhav ◽

◽

Y. Sirisha ◽

V. Anjaneya Prasad ◽

◽

...

Keyword(s):

Inflammatory Markers ◽

World Health ◽

Common Finding ◽

C Reactive Protein ◽

Albumin Ratio ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

First Case ◽

Severity Prediction

Coronavirus disease 2019 (COVID-19) was announced in early December 2019. By genome sequencing, the virus was recognised. From Wuhan City, the virus spread globally. The pandemic situation was declared by the World Health Organization.The first case of COVID-19 in Indiawas reported in Kerala on January 27, 2020.The clinical features varied with disease severity. Most COVID-19 patients have non-severe manifestations and show a good prognosis. However, patients with severe disease may progress to pulmonary dysfunction, multiple organ dysfunction, and death. COVID-19 related to a considerable mortality rate in older patients and cases had other morbidities. Studies suggested that the inflammatory storm is a common finding in other coronaviruses.Similarly, increases in the inflammatory markers like C-reactive protein (CRP),ferritin,interleukin-6 (IL-6) and were described in COVID-19 (1). Albumin levels decreased in the inflammatory conditions reduced levels were confirmed in severe COVID-19 patients. Hypoalbuminemia and high CRP/albumin ratio were previously linked to the mortality of various clinical conditions as critically ill patients.To avoid the unnecessary or inappropriate utilisation of the healthcare resources, early prediction of the severity of COVID-19 will be helpful. Severity prediction will also improve the prognosis by reducing the mortality rate.Thus, this study aimed to evaluate the role of inflammatory markers in estimating the severity and predicting the prognosis of COVID-19. This study hypothesised that elevated values of CRP/ albumin ratio and the neutrophil-lymphocyte ratio at the time of COVID-19 diagnosis are associated with COVID-19 severity and mortality.

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Disease activation and laboratory parameters in Fibromyalgia Syndrome: Relationship with C-reactive protein/albumin ratio, neutrophil/lymphocyte ratio, mean platelet volume

Medicine Science | International Medical Journal ◽

10.5455/medscience.2021.07.235 ◽

2021 ◽

Vol 10 (4) ◽

pp. 1464

Author(s):

Melih Pamukcu ◽

Rabia Baykara ◽

Tugba Duran

Keyword(s):

Mean Platelet Volume ◽

Fibromyalgia Syndrome ◽

C Reactive Protein ◽

Platelet Volume ◽

Albumin Ratio ◽

Laboratory Parameters ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein

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The role of coinfection with influenza viruses in the pathogenesis of severe infection in patients with COVID-19

Medical academic journal ◽

10.17816/maj78155 ◽

2021 ◽

Vol 21 (3) ◽

pp. 159-164

Author(s):

Tamara N. Shvedova ◽

Olga S. Kopteva ◽

Polina A. Kudar ◽

Anna A. Lerner ◽

Yuliya A. Desheva

Keyword(s):

Influenza A ◽

Fold Increase ◽

Igg Antibodies ◽

C Reactive Protein ◽

S Protein ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Coronavirus Infection

BACKGROUND: Despite the continuing global spread of the coronavirus infection COVID-19 caused by the SARS-CoV-2 coronavirus, the mechanisms of the pathogenesis of severe infections remain poorly understood. The role of comorbidity with other seasonal viral infections, including influenza, in the pathogenesis of the severe course of COVID-19 remains unclear. MATERIALS AND METHODS: The present study used sera left over from ongoing laboratory studies of patients with varying degrees of severity of COVID-19. The study was approved by the Local Ethics Committee of the Federal State Budgetary Scientific Institution IEM (protocol 3/20 from 06/05/2020). We studied 28 paired samples obtained upon admission of patients to the hospital and after 57 days of hospital stay. Paired sera of patients with COVID-19 were tested for antibodies to influenza A and B viruses. The presence of IgG antibodies specific to the SARS-CoV-2 spike (S) protein was studied using an enzyme-linked immunosorbent assay (ELISA). The serum concentration of C-reactive protein and the neutrophil-lymphocyte ratio on the day of hospitalization were also assessed. RESULTS: At least a 4-fold increase in serum IgG antibodies to SARS-CoV-2 S protein was found both in patients with PCR-confirmed SARS-CoV-2 infection and without PCR confirmation. It was shown that out of 18 patients with moderate and severe forms of COVID-19 infection, six of them showed at least a 4-fold increase in antibodies to influenza A/H1N1, in one to influenza A/H3N2 and in two cases to the influenza B. Laboratory data in these two groups were characterized by significant increases in serum C-reactive protein and neutrophil-lymphocyte ratio concentrations compared with the moderate COVID-19 group. CONCLUSIONS: Serological diagnostics can additionally detect cases of coronavirus infection when the virus was not detected by PCR. In moderate and severe cases of COVID-19, coinfections with influenza A and B viruses have been identified. The results obtained confirm the need for anti-influenza immunization during the SARS-CoV-2 pandemic. Influenza virus screening can significantly improve patient management because recommended antiviral drugs (neuraminidase inhibitors) are available.

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Comparison of the Neutrophil/Lymphocyte Ratio and C-Reactive Protein Levels in Patients With Amputation for Diabetic Foot Ulcers

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734617696729 ◽

2017 ◽

Vol 16 (1) ◽

pp. 23-28 ◽

Cited By ~ 4

Author(s):

Hasan Metineren ◽

Turan Cihan Dülgeroğlu

Keyword(s):

Diabetic Foot ◽

Inflammatory Marker ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

C Reactive Protein ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Protein Levels ◽

Reactive Protein ◽

Before And After

This study compared the effectiveness of the neutrophil/lymphocyte ratio (NLR) versus C-reactive protein (CRP) for evaluating the prognosis and degree of inflammation in patients with amputation for a diabetic foot ulcer (DFU). This study enrolled 56 patients with amputations for DFU with gangrene and compared the CRP levels and NLR measured before and after surgery. Overall, 24 patients (42%) died within 2 weeks postoperatively. Mortality increased with a preoperative/postoperative CRP difference ≤1.5 ( P < .001) and age 73 years or older ( P < .001). The postoperative NLR was lower than the preoperative value but was not significant as a prognostic or inflammatory marker ( P = .945). An increasing serum CRP level is a significant predictor of mortality. CRP and old age are reliable prognostic factors in patients with DFU.

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