scholarly journals The prognostic value of neutrophil-lymphocyte ratio in acute pancreatitis

2016 ◽  
Vol 18 (3) ◽  
pp. 27
Author(s):  
Binit Katuwal ◽  
Sushil Kumar Shilpakar

Introduction and objective: Acute Pancreatitis (AP) is one of the leading causes of morbidity and mortality worldwide. In approximately a third of the patient with acute pancreatitis, severe pancreatitis may develop, producing progressive organ dysfunction caused by a systemic inflammatory response syndrome (SIRS). This study aimed to determine the correlation between Neutrophil Lymphocyte Ratio (NLR) and the severity of AP.Materials and Methods: All patients admitted in the Surgical Ward of Tribhuvan University Teaching Hospital with the diagnosis of AP were studied prospectively over a period of one year from January 2014 to January 2015. Total leucocyte count (TLC), neutrophil count, lymphocyte count and neutrophil lymphocyte ratio (NLR) at admission was recorded for each patient. Modified Marshall Score was determined at admission and at 48 hours. Severity of acute pancreatitis as defined by revised Atlanta Classification 2012 was taken into account.Results: A total of 79 patients of AP were included in the study. Among them, 38 % were categorized as having severe AP according to the revised Atlanta classification. There was a weak positive correlation of NLR to severity of AP which was statistically significant. The mean NLR was high in higher severity grades of AP (p-value < 0.05). The cutoff NLR of 8.02 showed sensitivity of 60 %, specificity of 60.4 %, PPV of 48.6 % and NPV of 70.7 %.Conclusion: NLR may be useful as an easy and reliable prognostic marker for the severity and complications of acute pancreatitis.

2020 ◽  
Vol 5 (1) ◽  
pp. 85-93
Author(s):  
Rendy Singgih ◽  
Yohanes Firmansyah

Abstract Introduction:  Hypertension in pregnancy is a common complication that affects maternal and fetal morbidity and mortality. Comprehensive handling is needed to overcome the incidence of hypertension in pregnancy so that it does not get worse. The use of inflammatory markers is widely used as a predictor of the incidence of hypertension in pregnancy, especially preeclampsia. Neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) values are believed to predict the incidence of hypertension in pregnancy. Aim of study: The purpose of this study was to determine the ability of both the NLR and MPV values to predict the incidence of hypertension in pregnancy. Methods: This research is an analytic observational study using secondary data from medical records. The data were taken from the Cimacan Regional Hospital from January to December 2019. The variables were then tested statistically to see the difference in the mean. If there are significant results, the predictor's ability will be tested again with the ROC curve test. Results: The results of statistical tests between the normotensive pregnancy group and pregnancy with hypertension showed that the mean difference was significant in the NLR variable with P-value of 0.004 and MPV with a P-value of 0.005. Then the NLR and MPV values were tested again by the ROC Curve method. The AUC results on the NLR variable (AUC: 0.562 / p-value: 0.022) and MPV (AUC: 0.560 / p-value: 0.022). Conclusion: Although NLR and MPV had differences mean between the two groups, their ability to predict pregnancy with hypertension was very low.   Keywords: Pregnancy; Hypertension; Preeclampsia; NLR; MPV.


Author(s):  
Vinay Bharat ◽  
Mitali Singhal ◽  
Ankita Varma ◽  
Sonal Jindal

Introduction: Corona virus 2019 was first isolated in 1960. Middle East Respiratory Syndrome virus (MERS) and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) also belongs to Corona viridae family. Human Coronavirus causes fever, cough, fatigue, respiratory infection and abdominal symptoms. This virus has a strong affinity to human respiratory receptors and transmits rapidly. Since the virus has spread around the world and has acquired features of emergency, WHO declared it as a pandemic in March 2020. Aim: To study the clinical, haematological, biochemical findings and significance of co-morbidities amongst COVID-19 positive survivors and nonsurvivors. Materials and Methods: A retrospective cohort study was done at Chattrapati Shivaji Subharti Hospital (CSSH), Meerut, Uttar Pradesh, a level 3 COVID-19 Hospital from mid-June to end of August 2020 including 140 COVID-19 positive patients selected randomly. Patients were categorised into asymptomatic and symptomatic. Symptomatic were further divided into survivors and nonsurvivors. Haematological and biochemical parameters were analysed amongst survivors and nonsurvivors, with calculation of significant p-value. Results: Out of total 140 patients, 37/140 patients (26%) were asymptomatic and 103/140 (74%) symptomatic. Amongst symptomatic, survivors were 78/140 (56%) and nonsurvivors were 25/140 (18%) of total positive patients. Out of 37/140 (26%) asymptomatic patients, majority were in the age group 21-30 years 14/140 (10%) with female preponderance 10/140 (7.1%). Out of 78/140 (56%) survivors, majority were in 51 to 60 years age group, with male predominance17/140 (18.6%). Amongst 25/140 (18%) nonsurvivors most common affected age group was 51 to 60 years 10/140 (7.1%). Most common symptoms in survivors was cough (51/78 patients; 65%) and fever (35/78 patients; 45%). In Nonsurvivors, pneumonia was seen in 100% (25/25) patients. Out of 23/25 (92%) patients presented with fever, 19/25 (76%) had breathlessness, 16/25 (64%) had myalgia, 9/25 (36%) had cough, 5/25 (20%) presented with vomiting or pain in abdomen. Amongst nonsurvivors, Total Leucocyte Count (TLC), Absolute Neutrophil Count (ANC), Neutrophil Lymphocyte Ratio (NLR), urea, serum creatinine, serum bilirubin, Aspartate Amino Transferase (AST) and Alanine Amino Transferase (ALT) were significantly raised as compared to survivors (p<0.01); meanwhile platelet count and Platelet Lymphocyte Ratio (PLR) in nonsurvivors was significantly lower than survivors (p<0.01). Most common comorbidity was diabetes in 12/25 (48%) and hypertension in 6/25 (24%) among nonsurvivors. Conclusion: COVID-19 infection more likely affects older men with co-morbidities like diabetes mellitus and hypertension and can rapidly progress to pneumonia, Acute Respiratory Distress Syndrome (ARDS) and septic shock. Certain haematological and biological parameters have been found to be in concordance with increased mortality which can be reduced by early identification of these parameters.


Author(s):  
Dessy Iriana ◽  
Ani Kartini ◽  
Yuyun Widaningsih ◽  
Agus Alim Abdullah

The Neutrophil-Lymphocyte Ratio (NLR) and procalcitonin are used to indicate systemic inflammation in variousmedical disorders. Both parameters were determined in this study to predict the severity of acute pancreatitis. This studywas a cross-sectional study using a retrospective approach to patients diagnosed with acute pancreatitis by using medicalrecord data from patients at Dr. Wahidin Sudirohusoso Hospital, Makassar, from January 2014 to May 2019. This studycomprised 35 patients hospitalized with acute pancreatitis, with a similar proportion of males and females. This studydiscovered that the mean age in this study was 44.17±12.9 years. The most prevalent cause was Gallstones (77.1%), themost severe degree was mild (54.2%), and the highest outcome was survival (77.1%). The NLR (9.93±11.19, p=0.011)increased in proportion to severity. However, additional analysis based on classification of disease severity revealed thatonly mild-severe NLR was significant (p=0.005). Procalcitonin (8.13±11.25, p=0.001) increased along with the increaseddisease severity, and the subsequent analysis showed that the distribution of severity was similar. The NLR can predict theseverity of acute pancreatitis but is less effective than procalcitonin. This study required a more proportional subjectpopulation and consideration of other factors.


2019 ◽  
Vol 10 (04) ◽  
pp. 648-652
Author(s):  
K. G. Ashwath ◽  
Ashish Aggarwal ◽  
Kokkula Praneeth ◽  
Navneet Singla ◽  
Kirti Gupta

Abstract Background Since histopathology is available only after surgery, clinical condition and radiological characters of the tumor are important factors on which a clinician counsels the patient of brain tumor to take a decision regarding the management. Neutrophil lymphocyte ratio (NLR), a marker of inflammation can be used as a prognostic marker to predict the survival in high-grade gliomas and metastases. We evaluated the utility of NLR as an adjunct tool in predicting the histopathological grade of brain tumors. Materials and Methods One hundred sixteen patients with a diagnosis of brain tumors planned for surgical excision or biopsy were enrolled in the study. NLR was estimated in the preoperative blood sample. Patients were grouped into low- and highgrade brain tumors and their mean NLRs were analyzed. Similar evaluation was carried out between the intra- and extra-axial tumors. Results Mean age of the study group was 40.14 years with 61 males. Seventy-eight patients had low-grade tumor and 38 patients had high-grade tumor. Sixty patients had extra-axial tumors and 56 patients had intra-axial tumors. The mean NLR of low-grade tumors was 1.68 ± 0.53 and that of high-grade tumors was 3.12 ± 0.74. NLR > 2.4 can be used to identify high-grade brain tumors with a sensitivity of 80%, specificity of 92%, positive predictive value of 82.1%, negative predictive value of 91%, an excellent impact with likelihood ratio (+) of 10.1, and an odds ratio of 54.1. The mean NLR of extra-axial tumors was 1.68 + 0.62 and that of intra-axial tumors was 2.64 ± 0.91. These observations were statistically significant with p-value < 0.05. Conclusions NLR is an easily available and inexpensive marker of systemic inflammation, which varies across different histopathological grades of brain tumors. Mean NLR is higher in high-grade tumors and also intra-axial tumors with a cutoff value of NLR > 2.4 and > 2.0, respectively.


2021 ◽  
Vol 4 (1) ◽  
pp. 410-413
Author(s):  
Surendra Shah ◽  
Sanjaya Paudyal ◽  
Shanta Bir Maharjan ◽  
Shailendra Shah ◽  
Jay Narayan Shah

Introduction: Acute severe pancreatitis is associated with increased mortality. Several scoring systems have been used to predict severe acute pancreatitis which are either time-consuming or calculated 48 hours after admission. This study was aimed to assess the utility of neutrophils to lymphocyte ratio and platelet to lymphocyte ratio as an early predictor of severe acute biliary pancreatitis.Materials and Methods: This was a retrospective cohort study conducted from January 2017 to January 2020. Patients with non-biliary pancreatitis, referred after initial treatment, missed data, and acute pancreatitis with acute cholecystitis or cholangitis were excluded from the study. Data were collected from case sheets. Patients were divided into two groups according to the development of severe acute biliary pancreatitis based on the revised Atlanta Classification. Association of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with severe acute biliary pancreatitis was assessed using Mann Whitney U-test. p-value < 0.05 was considered as statistically significant.Results: Total 73 cases included in the study (males/females= 0.55). Sixty-six patients (90.4%) had mild/moderate acute biliary pancreatitis, and 7 (9.6%) patients had severe acute biliary pancreatitis. There was a development of complications in 7 (9.6%) patients who had severe acute biliary pancreatitis including one mortality. The mean neutrophil to lymphocyte ratio and mean platelet to lymphocyte ratio were high in the severe acute biliary pancreatitis group compared to the nonsevere acute biliary pancreatitis group, however, these differences were not statistically significant.Conclusions:  Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio cannot predict severe acute biliary pancreatitis.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sarah Mohamed Mahmoud ◽  
Bassam Sobhy ◽  
Ramy Raymond

Abstract Background The neutrophil–lymphocyte ratio (NLR) is considered an independent predictor of mortality and myocardial infarction (MI) in stable coronary artery disease (SCAD). Also NLR have prognostic value in patients with acute coronary syndromes (ACSs). However the diagnostic power of NLR in patients suspected of ACS is still under study Objective is to determine the ability of neutrophil-lymphocyte ratio to predict troponin elevation in patients presenting to emergency department with acute coronary syndrome Material and Methods From June 2018 to March 2019, 100 patients were enrolled who presented to the ER with NST-ACS. Patients were divided into 2 groups based upon the troponin positivity in the 12- to 24-hour follow-up. Baseline Complete blood count with calculation of NLR is done Results The study population was divided into 2 groups: troponin- negative group (n = 50) and troponin-positive group (n = 50). Mean age was 55.8 ± 11.3. 77% of the patients were male. No significance difference in the level of hemoglobin, WBCs and platelets between the 2 groups. The neutrophil count was significantly higher in the troponin-positive group (p &lt; 0.001). The median admission. NLR was significantly higher in the troponin-positive group (2 vs. 3.9, P &lt; 0.001). A cutoff point of 3.4 for NLR measured on admission had 84% sensitivity and 84% specificity in predicting follow-up troponin positivity. A highly significant correlation was found between NLR and level of troponin change (p value &lt;0.01) Conclusion NLR can be used as a diagnostic tool in the differentiation of patients with acute coronary syndrome. NLR is a non-expensive, simple and available parameter that can be used in diagnosis of NSTEMI.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nadia abdelaty Abdelkader ◽  
Moustafa Hamed Abdelaleem ◽  
Mohammed El-Gharib Abo El- maaty ◽  
Heba Ismail Aly ◽  
Sayed Ahmed Sayed

Abstract Background Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and it is also a common cause of death in patients with chronic liver disease. The curative treatment options for HCC that are currently available are surgical resection, liver transplantation and radiofrequency ablation .Despite progressive improvements in the efficacy of RFA, the survival of patients with HCC who undergo RFA remains disappointing, mainly due to frequent intrahepatic recurrence of HCC after RFA. Aim of the work To evaluate the role of transient elastography (as an indirect indicator to degree of liver fibrosis) in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation in hepatitis C related hepatocellular carcinoma .And to compare between transient elastography and other non invasive fibrosis indices in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation hepatitis C related hepatocellular carcinoma Patients and methods This prospective cohrt study was conducted on hepatocellular carcinoma patient, who underwent radiofrequency ablation in Tropical Medicine Department in Eldemerdash and Ain Shams Specialized Hospital, HCC clinic Ain Shams University Hospitals, Cairo, Egypt between march, 2017 and May, 2019. Data of the patient, who underwent radiofrequency ablation during the study period, were reviewed and the patients who fulfilled the inclusion criteria were enrolled into this study. The patients who fulfilled the inclusion criteria and underwent radiofrequency ablation were followed up for 12 months. Results TE revealed 28 patients with F4 and only 2 patients with F3, the mean measurement of liver stiffness was (22.45 ± 10.36) KPa. There was a significant negative correlation between LS and denovo recurrence of HCC (mean of LS in patients with complete response was 17.19 ± 3.32 and the mean of LS in patient with denovo recurrence was 36,94 ± 5.93,with the The best cut off value ≥24.65 (p value &lt; 0.001)). There was no significant correlation between CDC, FIB4, API scores and denovo recurrence of HCC. Also it was found that the LS was significantly associated with prediction of manifestation of hepatic decompensation after RFA (means of LS in patient without manifestation decompensation after RFA (p value &lt;0.001) .Regarding prediction of mortality, LS at cut off value &gt; 42 .75 (p value = 0,031) was significantly associated with prediction of mortality after one year of RFA. As regard serum non invasive fibrosis indices our results showed correlation between FIB4 score and hepatic decompensation after one year of intervention (the mean of FIB4 score in patients ascites and jaundice was 6.05 ± 4.71 (p value = 0.05) ).Therewas no statistically significant correlation between CDS and API with hepatic decompensation after RFA .As regard role of serum non invasive fibrosis indices in prediction of mortality after RFA, FIB4 score, CDS and API were statistically non significant. Conclusion Our data suggest that LS measurement is a useful predictor of HCC de novorecurrence overall survival and possibility of hepatic decompensation after RFA


2021 ◽  
pp. 19-26
Author(s):  
Jeremiah Adeyemi Akinwumi ◽  
Fabian Victory Edem ◽  
Ganiyu Olatunbosun Arinola

The pandemicity of coronavirus disease 2019 (COVID-19) necessitated its novel biomarkers in prognosis and monitoring in low resource settings. Changes in total white blood cell counts have been associated with the progression of diseases. This study determined the prognostic value of some cellular inflammatory cells and their indices in relation to duration of hospital admission, gender, and age of COVID-19 patients. This longitudinal and case–control study determined blood cell components (total white blood cells (TWBC), neutrophil, lymphocyte, monocyte, and platelet) and inflammatory indices (neutrophil lymphocyte ratio [NLR], lymphocyte monocyte ratio [LMR], platelet lymphocyte ratio [PLR], derived NLR [DNLR], and systemic immune inflammatory index [SII]) in 95 symptomatic hospitalized COVID-19 patients and 45 COVID-19 free controls. These parameters were related to age, sex, and days of admission of the patients. Blood samples obtained were analyzed using hematological autoanalyzer (Sysmex XN-450) and indices calculated. Data were analyzed using the Statistical Package for the Social Sciences (SPSS Inc., USA) version 20.0. The mean platelet count (P = 0.016) and PLR (P = 0.000) were significantly lower while TWBC counts (P = 0.013) were significantly increased in COVID-19 patients compared with control. The mean TWBC count (P = 0.030) and SII (P = 0.029) were significantly increased while lymphocyte count (P = 0.015) and LMR (P = 0.026) were significantly decreased in COVID-19 patients at discharge compared with COVID-19 patients at admission. The mean neutrophil count (P = 0.048), PLR (P = 0.015), and SII (P = 0.022) were significantly lower while mean lymphocyte count (P = 0.026) was significantly higher in COVID-19 patients aged <40 years compared with patients aged ?40 years. This study concluded that inflammatory response is a phenomenon in COVID-19 patients especially in patients ?40 years of age and that this inflammation persist till discharge, though gender has no influence on cellular inflammatory indices of COVID-19 patients.


2019 ◽  
Vol 35 (6) ◽  
Author(s):  
Erhan Onalan ◽  
Nevzat Gozel ◽  
Emir Donder

Objective: To examine potential associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, mean platelet volume (MPV), HbA1c and microvascular complications in diabetic patients from a cost-effectiveness perspective. Methods: One hundred patients with type 2 diabetes attending our outpatient unit between May 2018 and October 2018 were included, and 100 healthy individuals served as the control group. A retrospective file search was performed to collect information on hemoglobin, mean platelet volume (MPV), glycosylated haemoglobin (HbA1c), hematocrit (Hct), neutrophil and lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelets (Plt), platelet/lymphocyte ratio (PLR), and microvascular complications (neuropathy, retinopathy, nephropathy). Results: Demographic and laboratory data were retrospectively controlled between diabetes (n=100) and healthy control (n=100) groups. The mean age in diabetic patients and healthy controls was 56.34 and 36.68 years, respectively. The mean NLR in diabetics and healthy controls was 2.48 and 2.11, the difference in NLR being significant (p=0.002). MPV in diabetics and controls was 8.54 and 8.53, respectively, and the difference was not significant (p=0.93). PLR was also similar, i.e. 149.7 and 145.3 in diabetics and healthy controls (p=0.067). With respect to microvascular complications, retinopathy was found to be significantly associated with MPV and NLR (p=0.015, and p=0.051), and nephropathy showed a significant association with NLR (p=0.027) among diabetics. In contrast with the two other microvascular complications, no significant association between neuropathy and NLR could be detected, while PLR and neuropathy was significantly associated (p=0.003). Conclusion: Microvascular complications may be associated with certain hematologic parameters, as suggested by comparisons both between diabetics and healthy individuals and within the group of diabetic individuals. We believe that hematologic parameters such as hematocrit, MPV, NLR, and PLR, which can be obtained through a simple complete blood count, may be utilized as cost-effective predictors of diabetic microvascular complications. Further prospective studies with larger sample size are required to better delineate these associations. doi: https://doi.org/10.12669/pjms.35.6.1150 How to cite this:Onalan E, Gozel N, Donder E. Can hematological parameters in type 2 diabetes predict microvascular complication development? Pak J Med Sci. 2019;35(6):1511-1515. doi: https://doi.org/10.12669/pjms.35.6.1150 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.


Author(s):  
P. A. Awoyesuku ◽  
D. A. Macpepple ◽  
B. O. Altraide ◽  
D. H. John

Background: Infection with hepatitis B (HBV) and human immunodeficiency virus (HIV) are global public health problems. These infections during pregnancy increase the risk of maternal morbidity and mortality, and also pose a risk to the fetus due to mother to child transmission. Objective: To determine the prevalence of seropositive HIV and HBsAg cases amongst pregnant women at the Rivers State University Teaching Hospital (RSUTH). Methodology: A retrospective review of hospital and laboratory records of all pregnant women booked at RSUTH in two years, from May 2017 to April 2019, was carried out. Data on patients’ age, parity and educational level and reactivity of HIV and HBsAg test at booking were retrieved using structured proforma and analyzed using Epi Info Version 7. Test for significance using Chi-square was set at a significant level of P<0.05. Results: 3560 patients had HIV and HBsAg screening out of which 148 (4.2%) and 9 (0.3%) respectively were positive. The comorbidity rate in this study was 0.06%. The mean age was 31.5±4.7 years and the mean gestational age at booking was 22.1±6.8 weeks. There was no significant relationship between their age (χ2 = 2.690, p-value=0.442) and parity (χ2 = 3.759, p-value = 0.145) with HIV seropositivity, but these were significant for HBsAg (χ2 = 13.691, p-value = 0.003) (χ2 = 13.121, p-value=0.001).  Educational status was significant for HIV (χ2 = 16.188, p-value=0.000) but not for HBsAg (χ2 = 0.229, p-value=0.892). Conclusion: The seroprevalence rate of HIV and HBsAg in this study were low. HIV seroprevalence was significantly affected by lower education, while HBsAg seroprevalence was significantly affected by younger maternal age and nulliparity. Continued screening of pregnant women for these infections remains valuable and further community-based studies to identify risk factors are recommended.


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