scholarly journals The Neutrophil-to-Lymphocyte Ratio Is an Important Indicator Predicting In-Hospital Death in AMI Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhenjun Ji ◽  
Guiren Liu ◽  
Jiaqi Guo ◽  
Rui Zhang ◽  
Yamin Su ◽  
...  
Keyword(s):  
Predictive Ability ◽  
Electronic Medical Record System ◽  
Neutrophil To Lymphocyte Ratio ◽  
Smoking History ◽  
Youden Index ◽  
Hospital Death ◽  
Record System ◽  
Important Indicator ◽  
Lymphocyte Ratio ◽  
Risk Of Death

Objective: To explore the role of neutrophil-to-lymphocyte ratio (NLR) in predicting the short-term prognosis of NSTEMI and STEMI.Methods: This study was a single-center, retrospective and observational study. 2618 patients including 1289 NSTMI and 1329 STEMI patients were enrolled from June 2013 to February 2018 in Zhongda Hospital, Southeast University. The demographic information, clinical characteristics, medical history, laboratory examination, treatment, and outcome of individuals at admission and during hospitalization were extracted from the electronic medical record system. Outcome was defined as the all-cause death during hospitalization.Results: (1) In the NSTEMI group, the ability of NLR in predicting in-hospital death (AUC = 0.746) was higher than the neutrophil-monocyte ratio (NMR) (AUC = 0.654), the platelet-lymphocyte ratio (PLR) (AUC = 0.603) and the lymphocyte-monocyte ratio (LMR) (AUC = 0.685), and also higher than AST (AUC = 0.621), CK (AUC = 0.595), LDH (AUC = 0.653) and TnI (AUC = 0.594). The AUC of NLR in the STEMI group was only 0.621. (2) The optimal cut-off value of NLR in NSTEMI group was 5.509 (Youden index = 0.447, sensitivity = 77.01%, specificity = 67.72%). After adjusting variables including age, sex, diabetes history, smoking history, LDL-C and Cr, the logistic regression showed that the patients with NLR>5.509 had higher hazard risk of death (HR4.356; 95%CI 2.552–7.435; P < 0.001) than the patients with NLR ≤ 5.509. (3) Stratification analysis showed that the in-hospital mortality of patients with NLR > 5.509 was 14.611-fold higher than those with NLR ≤ 5.509 in patients aged <76, much higher than the ratio in patients aged ≥ 76. For patients with creatinine levels ≤ 71, the in-hospital death risk in high NLR group was 10.065-fold higher than in low NLR group (95%CI 1.761–57.514, P = 0.009), while the HR was only 4.117 in patients with creatinine levels > 71. The HR in patients with or without diabetes were 6.586 and 3.375, respectively. The HR in smoking or no smoking patients were 6.646 and 4.145, respectively. The HR in patients with LDL-C ≥ 2.06 or <2.06 were 5.526 and 2.967 respectively.Conclusion: Compared to NMR, PLR, and LMR, NLR had the best ability in predicting in-hospital death after NSTEMI. Age, creatinine, LDL-C, diabetes and smoking history were all important factors affecting the predictive efficiency in NSTEMI. NLR had the limited predictive ability in STEMI.

scholarly journals Hemogram as marker of in-hospital mortality in COVID-19

2021 ◽  
pp. jim-2021-001810
Author(s):  
Alejandro López-Escobar ◽  
Rodrigo Madurga ◽  
José María Castellano ◽  
Santiago Ruiz de Aguiar ◽  
Sara Velázquez ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Hospital Admission ◽  
White Blood Cells ◽  
Rate Of Change ◽  
Hospital Death ◽  
Direct Role ◽  
Lymphocyte Ratio ◽  
Risk Of Death ◽  
Rate Of Increase ◽  
Increased Risk

The clinical impact of COVID-19 disease calls for the identification of routine variables to identify patients at increased risk of death. Current understanding of moderate-to-severe COVID-19 pathophysiology points toward an underlying cytokine release driving a hyperinflammatory and procoagulant state. In this scenario, white blood cells and platelets play a direct role as effectors of such inflammation and thrombotic response. We investigate whether hemogram-derived ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and the systemic immune-inflammation index may help to identify patients at risk of fatal outcomes. Activated platelets and neutrophils may be playing a decisive role during the thromboinflammatory phase of COVID-19 so, in addition, we introduce and validate a novel marker, the neutrophil-to-platelet ratio (NPR).Two thousand and eighty-eight hospitalized patients with COVID-19 admitted at any of the hospitals of HM Hospitales group in Spain, from March 1 to June 10, 2020, were categorized according to the primary outcome of in-hospital death.Baseline values, as well as the rate of increase of the four ratios analyzed were significantly higher at hospital admission in patients who died than in those who were discharged (p<0.0001). In multivariable logistic regression models, NLR (OR 1.05; 95% CI 1.02 to 1.08, p=0.00035) and NPR (OR 1.23; 95% CI 1.12 to 1.36, p<0.0001) were significantly and independently associated with in-hospital mortality.According to our results, hemogram-derived ratios obtained at hospital admission, as well as the rate of change during hospitalization, may easily detect, primarily using NLR and the novel NPR, patients with COVID-19 at high risk of in-hospital mortality.

scholarly journals Serologic and Histologic Predictors of Long-Term Renal Outcome in Biopsy-Confirmed IgA Nephropathy (Haas Classification): An Observational Study

2019 ◽  
Vol 8 (6) ◽  
pp. 848 ◽  
Author(s):  
Shang-Feng Tsai ◽  
Ming-Ju Wu ◽  
Mei-Chin Wen ◽  
Cheng-Hsu Chen
Keyword(s):  
Risk Factors ◽  
Iga Nephropathy ◽  
Neutrophil To Lymphocyte Ratio ◽  
Renal Outcome ◽  
Categorical Variables ◽  
Youden Index ◽  
Renal Survival ◽  
Platelet To Lymphocyte Ratio ◽  
Predictive Values ◽  
Lymphocyte Ratio

Background and objective: The Haas classification of IgA nephropathy should be validated for Asian populations. More detailed and newer predictions regarding renal outcome of IgA nephropathy remains mandatory. Materials: We conducted a retrospective cohort study between January 2003 and December 2013. Clinical, Pathological, and laboratory data were all collected via available medical records. A Mann–Whitney U test was used for continuous variables and the Chi-square test was implemented for categorical variables. A Kaplan–Meier curve was put in place in order to determine patient survival and renal survival. The Youden index and Cox proportional hazard regression were used to investigate the possible factors for renal survival and predictive power. Results: All 272 renal biopsy-confirmed IgAN patients were enrolled for further studies. The univariate analysis showed that risk factors for poor renal outcome included stage 4–5 of Haas classification (HR = 3.67, p < 0.001), a poor baseline renal function (HR = 1.02 and p < 0.001 for higher BUN; HR = 1.14 and p < 0.001 for higher serum creatinine; HR = 0.95, p < 0.001 for higher eGFR), IgG ≤ 907 (HR = 2.29, p = 0.003), C3 ≤ 79.7 (HR = 2.76, p = 0.002), a higher C4 (HR = 1.02, p = 0.026), neutrophil-to-lymphocyte ratio > 2.75 (HR = 2.92, p < 0.001), and a platelet-to-lymphocyte ratio ≥ 16.06 (HR = 2.02, p = 0.012). A routine-checked markers, such as neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, in order to predict the renal outcome, is recommended. Conclusions: This is the first study to demonstrate that Haas classification is also useful for establishing predictive values in Asian groups. A lower serum IgG (≤907 mg/dL) and serum C3 (≤79.7 mg/dL) were both risk factors for poor renal outcome. Additionally, this is the first study to reveal that serum C4 levels, an NLR > 2.75 and a PLR > 16.06, S could suggest poor renal outcome.

scholarly journals Clinical significance of neutrophil-to-lymphocyte ratio as a predictor of lymph node metastasis in gastric cancer

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
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.

scholarly journals Significance of The Neutrophil-To-Lymphocyte Ratio in Predicting the Response of Neoadjuvant Chemotherapy in Osteosarcoma: A Multicenter Retrospective Study

2021 ◽  
Author(s):  
Tang Haijun ◽  
Liu Dehuai ◽  
Lu Jili ◽  
He Juliang ◽  
Ji Shuyu ◽  
...  
Keyword(s):  
Multivariate Analyses ◽  
Univariate Analysis ◽  
Complete Response ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lower Percentage ◽  
Youden Index ◽  
Factors Affecting ◽  
Lymphocyte Ratio ◽  
Lower Stage ◽  
Index Sensitivity

Abstract Background At present, there is no validated predictive factor for early efficacy of neoadjuvant hemotherapy (NACT) in osteosarcoma. The purpose of this study was to investigate the significance of the neutrophil-to-lymphocyte ratio (NLR) in predicting the response of NACT in osteosarcoma. Methods Pathological complete response (pCR) was used to assess the efficacy of NACT. Receiver Operating Characteristic (ROC) curve and Youden index (sensitivity + specificity-1) were used to determine the optimal cut-off values of NLR. Univariate and multivariate analyses by logistic regression model were conducted to confirm the independent factors affecting the efficacy of NACT. Results The optimal cutoff value of NLR was 2.36 (sensitivity, 80.0%; specificity, 71.3%). Univariate analysis revealed that the smaller tumor volum, lower stage, lower NLR and lower PLR were more likely to achieve pCR. Multivariate analyses confirmed that NLR before treatment was an independent risk factor for pCR. Compared to patients with a high NLR, those with a low NLR showed more than 2-fold higher chance to achieve pCR (OR 2.82, 95% CI 1.36–5.17, p = 0.02). Conclusion NLR is a novel and effective factor predicting the response to NACT in osteosarcoma patients. Patients with higher NLR showed a lower percentage of pCR after NACT.

Elevated preoperative peripheral blood neutrophil-to-lymphocyte ratio to predict clinical outcome in patients with localized soft tissue sarcoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 11049-11049
Author(s):  
Jason Yongsheng Chan ◽  
Zewen Zhang ◽  
Winston Chew ◽  
Grace Fangmin Tan ◽  
Chloe Liwen Lim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Tumor Grade ◽  
Neutrophil To Lymphocyte Ratio ◽  
Age At Diagnosis ◽  
Receiver Operating Curve ◽  
Blood Neutrophil ◽  
Curative Surgery ◽  
Lymphocyte Ratio ◽  
Risk Of Death

11049 Background: Recent studies suggest that markers of systemic inflammation such as blood neutrophil-to-lymphocyte ratio (NLR) may be prognostic for various cancers, though its clinical utility has not been widely accepted. This study aims to investigate its clinical relevance in patients (pts) with soft tissue sarcoma (STS). Methods: Five hundred and twenty-nine pts with localized STS who had available pre-operative blood counts at the time of diagnosis were retrospectively examined. An optimal cutoff for high NLR ( > 2.5) in predicting overall survival (OS) and relapse-free survival (RFS) in pts who underwent curative surgery (n = 473) was determined using receiver operating curve analyses. Cutoffs for platelet-lymphocyte ratios (PLR, > 180) and lymphocyte-monocyte ratios (LMR, < 3.6) were similarly obtained. Survival analysis was performed using the Kaplan-Meier method and multivariate Cox proportional models. Median follow-up was 40 months. Results: A high NLR was present in 311 (58.8%) pts, which was significantly associated with tumor grade ( p< 0.0001), depth ( p= 0.003) and size > 5 cm ( p= 0.0242), but not with age at diagnosis, sex or ethnicity. High NLR was associated with both worse OS (HR 1.78; 95%CI 1.28-2.47; p= 0.0005) and RFS (HR 1.54; 95%CI 1.17-2.03; p= 0.0019), as were age at diagnosis, tumor grade, size, PLR and LMR. In multivariate models adjusted for clinicopathological predictors of survival, only NLR, in addition to tumor grade and size, were independently associated with worse OS (HR 1.52; 95%CI 1.09-2.11; p= 0.0131) and RFS (HR 1.42; 95%CI 1.08-1.85; p= 0.0114). Analysis of survival according to American Joint Committee on Cancer (AJCC) stages subdivided as NLR-high and NLR-low revealed a significant worse prognosis for NLR-high subgroups ( p< 0.0001), with a 2.2-fold and 1.5-fold higher risk of death within stages II (HR 2.20; 95%CI 1.20-4.01; p= 0.0103) and III (HR 1.55; 95%CI 1.01-2.37; p= 0.0459), respectively. Conclusions: High NLR is an independent marker of poor prognosis among pts with localized STS. Inclusion of NLR as a classifier into the AJCC staging of STS may improve estimation of survival.

TAMI-03. PROGNOSTIC SIGNIFICANCE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO (NLR) IN PATIENTS WITH BRAIN METASTASES FROM DIFFERENT TUMOR ORIGINS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi198-vi198
Author(s):  
Guanhua Deng ◽  
Lei Wen ◽  
zhaoming Zhou ◽  
Changguo Shan ◽  
Mingyao Lai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Brain Metastases ◽  
Median Overall Survival ◽  
Cox Regression ◽  
Independent Prognostic Factor ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Risk Of Death ◽  
Metastatic Sites

Abstract PURPOSE Brain metastases (BMs) represent the most common adult intracranial malignancy. The prognosis of BMs is subject to many factors, i.e., the number, size and locations of the metastatic sites, tumor origins, pathologic types, gene mutation status, metastatic sites, and KPS etc. This study aimed to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in brain metastases. METHODS A total of 480 patients diagnosed with brain metastases from a wide range of tumor origins, i.e., NSCLC, SCLC, breast cancer, melanoma, prostate, kidney, gastrointestinal cancer, cervical carcinoma, ovarian cancer, choriocarcinoma of uterus were retrospectively analyzed. Pre-radiotherapy NLR, PLR, and LMR were calculated as total neutrophil/lymphocyte, platelet/Lymphocyte, lymphocyte/monocyte, respectively. Survival rates were estimated using the Kaplan-Meier survival analysis. Cox regression models were used to identify independent prognostic factors. RESULTS The median overall survival (OS) was 14.4 months [95%CI: 13.4-15.5]. The median overall survival after radiotherapy was significantly different between patients with NLR&lt; 4 and those with NLR≥4 (OS 16.3 mo. vs. 12.2 mo., P&lt; 0.0001). No significant difference was observed between PLR vs. OS, and LMR vs. OS (PLR&lt; 180: HR=1.221, P=0.240; LMR&lt; 4: HR=0.753, P=0.141). The Cox regression model for the continuous metric values revealed that the NLR increased every 1.0 was associated with additional 5.9% of fatal risk (HR: 1.059; 95%CI = 1.033–1.087, P&lt; 0.0001). NLR was validated as an independent prognostic factor for risk of death after adjusting for sex, age, and KPS. CONCLUSIONS We revealed pre-treatment NLR is an independent prognostic factor in patients with brain metastases for poor OS, independent of different tumor origins. The NLR warrants further studies using sub-group analysis and validation in external cohorts. Future studies in this parameter have a potential to facilitate more precise risk-stratifications to guide personalized treatment for BM.

scholarly journals Predictive values of the postoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio for the diagnosis of early periprosthetic joint infections: a preliminary study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Guanglei Zhao ◽  
Jie Chen ◽  
Jin Wang ◽  
Siqun Wang ◽  
Jun Xia ◽  
...  
Keyword(s):  
Predictive Ability ◽  
Neutrophil To Lymphocyte Ratio ◽  
Platelet To Lymphocyte Ratio ◽  
Predictive Values ◽  
Great Ability ◽  
Laboratory Parameters ◽  
Lymphocyte Ratio ◽  
Lymphocyte To Monocyte Ratio ◽  
Joint Infections ◽  
Age Range

Abstract Background Several studies have been conducted to report diagnostic values of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in the many diseases, such as oncological, inflammatory, and some infectious diseases. However, the predictive value of these laboratory parameters for early periprosthetic joint infections (PJIs) has not yet been reported. The aim of this study was to determine predictive values of the postoperative NLR, PLR, and LMR for the diagnosis of PJIs. Methods In this retrospective study, 104 patients (26 early PJI cases and 78 non-PJI cases) who underwent total joint arthroplasty were enrolled in this study. All the patients were then categorized into two groups: PJI group, patients with the diagnosis of PJI (26 patients; 14 males, 12 females; mean age = 65.47 ± 10.23 age range = 51–81 ) and non-PJI group, patients without PJI (78 patients; 40 males, 38 females; mean age = 62.15 ± 9.33, age range = 41–92). We defined “suspected time” as the time that any abnormal symptoms or signs occurred, including fever, local swelling, or redness around the surgical site between 2 and 4 weeks after surgery and before the diagnosis. Suspected time and laboratory parameters, including NLR, PLR, LMR, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), were compared between both groups. The trends of postoperative NLR, LMR, PLR, CRP, and ESR were also reviewed. The predictive ability of these parameters at the suspected time for early PJI was evaluated by multivariate analysis and receiver operating characteristic (ROC) curve analysis. Results NLR, PLR, and LMR returned to preoperative levels within 2 weeks after surgery in the two groups. In the PJI group, NLR and PLR were significantly increased during the incubation period of infection or infection, and LMR was significantly reduced, although 61.5% (16/26) of the patients had normal white blood cells. Interestingly, ESR and CRP were still relatively high 2 weeks after surgery and were not different between the two groups before infection started (p = 0.12 and 0.4, respectively). NLR and PLR were significantly correlated with early PJI (Odds ratios for NLR and PLR = 88.36 and 1.12, respectively; p values for NLR and PLR = 0.005 and 0.01, respectively). NLR had great predictive ability for the diagnosis of early PJI, with a cut-off value of 2.77 (sensitivity = 84.6%, specificity = 89.7%, 95% CI = 0.86–0.97). Conclusions ESR and CRP seem not to be sensitive for the diagnosis of early PJI due to their persistently high levels after arthroplasty. The postoperative NLR at the suspected time may have a great ability to predict early PJI.

scholarly journals Establishment of Routine Clinical Indicators-Based Nomograms for Predicting the Mortality in Patients With COVID-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Jialin He ◽  
Caiping Song ◽  
En Liu ◽  
Xi Liu ◽  
Hao Wu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Manifestations ◽  
Vital Signs ◽  
Multivariate Logistic Regression Analysis ◽  
Smoking History ◽  
Hospital Death ◽  
Multivariate Logistic Regression ◽  
Clinical Indicators ◽  
Risk Of Death ◽  
Patients At Risk

This study aimed to establish and validate the nomograms to predict the mortality risk of patients with coronavirus disease 2019 (COVID-19) using routine clinical indicators. This retrospective study included a development cohort enrolled 2,119 hospitalized patients with COVID-19 and a validation cohort included 1,504 patients with COVID-19. The demographics, clinical manifestations, vital signs, and laboratory tests of the patients at admission and outcome of in-hospital death were recorded. The independent factors associated with death were identified by a forward stepwise multivariate logistic regression analysis and used to construct the two prognostic nomograms. The nomogram 1 was a full model to include nine factors identified in the multivariate logistic regression and nomogram 2 was built by selecting four factors from nine to perform as a reduced model. The nomogram 1 and nomogram 2 showed better performance in discrimination and calibration than the Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension and Age (MuLBSTA) score in training. In validation, nomogram 1 performed better than nomogram 2 for calibration. We recommend the application of nomogram 1 in general hospitals which provide robust prognostic performance though more cumbersome; nomogram 2 in the out-patient, emergency department, and mobile cabin hospitals, which depend on less laboratory examinations to make the assessment more convenient. Both the nomograms can help the clinicians to identify the patients at risk of death with routine clinical indicators at admission, which may reduce the overall mortality of COVID-19.

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