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

Characteristic Curve ◽

Allergic Diseases ◽

Youden Index ◽

Time Of Arrival ◽

Analysis Model ◽

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.

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 ◽

Estimated Glomerular Filtration Rate ◽

Characteristic Curve ◽

Linear Regression Analysis ◽

Significant Negative Correlation ◽

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.

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 ◽

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.

Predictive Value of Prognostic Nutritional Index on COVID-19 Severity

Frontiers in Nutrition ◽

10.3389/fnut.2020.582736 ◽

2021 ◽

Vol 7 ◽

Author(s):

Zhong-hua Wang ◽

Ying-Wen Lin ◽

Xue-biao Wei ◽

Fei Li ◽

Xiao-Long Liao ◽

...

Keyword(s):

Critically Ill ◽

Characteristic Curve ◽

Prognostic Nutritional Index ◽

Good Discrimination ◽

Nutritional Index ◽

Predictive Role

Background: The prognostic nutritional index (PNI) has been described as a simple risk-stratified tool for several diseases. We explored the predictive role of the PNI on coronavirus disease 2019 (COVID-19) severity.Methods: A total of 101 patients with COVID-19 were included in this retrospective study from January 2020 to March 2020. They were divided into two groups according to COVID-19 severity: non-critical (n = 56) and critical (n = 45). The PNI was calculated upon hospital admission: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (/mm3). Critical COVID-19 was defined as having one of the following features: respiratory failure necessitating mechanical ventilation; shock; organ dysfunction necessitating admission to the intensive care unit (ICU). The correlation between the PNI with COVID-19 severity was analyzed.Results: The PNI was significantly lower in critically ill than that in non-critically ill patients (P < 0.001). The receiver operating characteristic curve indicated that the PNI was a good discrimination factor for identifying COVID-19 severity (P < 0.001). Multivariate logistic regression analysis showed the PNI to be an independent risk factor for critical illness due to COVID-19 (P = 0.002).Conclusions: The PNI is a valuable biomarker that could be used to discriminate COVID-19 severity.

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

Canadian Respiratory Journal ◽

10.1155/2021/8492468 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Dandan Jiang ◽

Qu Chen ◽

Weiming Su ◽

Dinghui Wu

Keyword(s):

Roc Curves ◽

Type B ◽

Type B Aortic Dissection ◽

Lymphocyte Ratio ◽

Obstructive Sleep ◽

Sleep Parameters ◽

Higher Sensitivity

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.

The severity and risk factors for mortality in immunocompromised adult patients hospitalized with influenza-related pneumonia

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-021-00462-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Liang Chen ◽

Xiudi Han ◽

YanLi Li ◽

Chunxiao Zhang ◽

Xiqian Xing

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Characteristic Curve ◽

Neuraminidase Inhibitor ◽

Teaching Hospitals ◽

Multivariate Logistic Regression Model ◽

Optimal Cutoff

Abstract Objective To explore disease severity and risk factors for 30-day mortality of adult immunocompromised (IC) patients hospitalized with influenza-related pneumonia (Flu-p). Method A total of 122 IC and 1191 immunocompetent patients hospitalized with Flu-p from January 2012 to December 2018 were recruited retrospectively from five teaching hospitals in China. Results After controlling for confounders, multivariate logistic regression analysis showed that immunosuppression was associated with increased risks for invasive ventilation [odds ratio: (OR) 2.475, 95% confidence interval (CI): 1.511–4.053, p < 0.001], admittance to the intensive care unit (OR: 3.247, 95% CI 2.064–5.106, p < 0.001), and 30-day mortality (OR: 3.206, 95% CI 1.926–5.335, p < 0.001) in patients with Flu-p. Another multivariate logistic regression model revealed that baseline lymphocyte counts (OR: 0.993, 95% CI 0.990–0.996, p < 0.001), coinfection (OR: 5.450, 95% CI 1.638–18.167, p = 0.006), early neuraminidase inhibitor therapy (OR 0.401, 95% CI 0.127–0.878, p = 0.001), and systemic corticosteroid use at admission (OR: 6.414, 95% CI 1.348–30.512, p = 0.020) were independently related to 30-day mortality in IC patients with Flu-p. Based on analysis of the receiver operating characteristic curve (ROC), the optimal cutoff for lymphocyte counts was 0.6 × 109/L [area under the ROC (AUROC) = 0.824, 95% CI 0.744—0.887], sensitivity: 97.8%, specificity: 73.7%]. Conclusions IC conditions are associated with more severe outcomes in patients with Flu-p. The predictors for mortality that we identified may be valuable for the management of Flu-p among IC patients.

The severity and risk factors for mortality in immunocompromised adult patients hospitalized with influenza-related pneumonia

10.21203/rs.3.rs-238430/v1 ◽

2021 ◽

Author(s):

Liang Chen ◽

Xiudi Han ◽

YanLi Li ◽

Chunxiao Zhang ◽

Xiqian Xing

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Roc Analysis ◽

Characteristic Curve ◽

Neuraminidase Inhibitor ◽

Teaching Hospitals ◽

Multivariate Logistic Regression Model ◽

Multivariate Logistic Regression

Abstract Objective To explore disease severity and risk factors for 30-day mortality of adult immunocompromised (IC) patients hospitalized with influenza-related pneumonia (Flu-p).Method A total of 122 IC and 1,191 immunocompetent patients hospitalized with Flu-p from January 2012 to December 2018 were recruited retrospectively from five teaching hospitals in China. Results After controlling for confounders, multivariate logistic regression analysis showed that immunosuppression was associated with increased risks for invasive ventilation [odds ratio: (OR) 2.475, 95% confidence interval (CI): 1.511-4.053, p < 0.001], admittance to the intensive care unit (OR: 3.247, 95% CI: 2.064-5.106, p < 0.001), and 30-day mortality (OR: 3.206, 95% CI: 1.926-5.335, p < 0.001) in patients with Flu-p. Another multivariate logistic regression model revealed that baseline lymphocyte counts (OR: 0.993, 95% CI: 0.990-0.996, p < 0.001), coinfection (OR: 5.450, 95% C:I 1.638-18.167, p = 0.006), early neuraminidase inhibitor therapy (OR 0.401, 95% CI 0.127-0.878, p = 0.001), and systemic corticosteroid use at admission (OR: 6.414, 95% C:I 1.348-30.512, p = 0.020) were independently related to 30-day mortality in IC patients with Flu-p. Based on receiver operating characteristic curve (ROC) analysis, the optimal cutoff for lymphocyte counts was 0.6×109/L [area under the ROC (AUROC) = 0.824, 95% CI: 0.744 - 0.887], sensitivity: 97.8%, specificity: 73.7%].Conclusions IC conditions are associated with more severe outcomes in patients with Flu-p. The predictors for mortality that we identified may be valuable for the management of Flu-p among IC patients.

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 ◽

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.