A High Neutrophil-to-Lymphocyte Ratio Predicts Higher Risk of Poststroke Cognitive Impairment: Development and Validation of a Clinical Prediction Model

ObjectivePoststroke cognitive impairment (PSCI) is a serious complication of stroke. The neutrophil-to-lymphocyte ratio (NLR) is a marker of peripheral inflammation. The relationship between the NLR and PSCI is far from well studied, and the thesis of this study was to assess the predictive value of the NLR in patients with PSCI, and establish and verify the corresponding prediction model based on this relationship.MethodsA total of 367 stroke patients were included in this study. Neutrophils, lymphocytes, and NLRs were measured at baseline, and clinical and neuropsychological assessments were conducted 3 months after stroke. The National Institutes of Health Scale (NIHSS) was used to assess the severity of stroke. A Chinese version of the Mini Mental State Examination (MMSE) was used for the assessment of cognitive function.ResultsAfter three months of follow-up, 87 (23.7%) patients were diagnosed with PSCI. The NLR was significantly higher in PSCI patients than in non-PSCI patients (P < 0.001). Patient age, sex, body mass index, NIHSS scores, and high-density lipoprotein levels also differed in the univariate analysis. In the logistic regression analysis, the NLR was an independent risk factor associated with the patients with PSCI after adjustment for potential confounders (OR = 1.67, 95%CI: 1.21–2.29, P = 0.002). The nomogram based on patient sex, age, NIHSS score, and NLR had good predictive power with an AUC of 0.807. In the validation group, the AUC was 0.816.ConclusionAn increased NLR at admission is associated with PSCI, and the model built with NLR as one of the predictors can increase prognostic information for the early detection of PSCI.

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Association of Derived Neutrophil-To-Lymphocyte Ratio With Prognosis of Coronary Heart Disease After PCI

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.705862 ◽

2021 ◽

Vol 8 ◽

Author(s):

Gang-Qiong Liu ◽

Wen-Jing Zhang ◽

Jia-Hong Shangguan ◽

Xiao-Dan Zhu ◽

Wei Wang ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cox Regression ◽

Univariate Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Major Adverse Cardiovascular Events ◽

Lymphocyte Ratio ◽

Coronary Syndrome ◽

The Third

Aims: The present study aimed to investigate the prognostic role of derived neutrophil-to-lymphocyte ratio (dNLR) in patients with coronary heart disease (CHD) after PCI.Methods: A total of 3,561 post-PCI patients with CHD were retrospectively enrolled in the CORFCHD-ZZ study from January 2013 to December 2017. The patients (3,462) were divided into three groups according to dNLR tertiles: the first tertile (dNLR < 1.36; n = 1,139), second tertile (1.36 ≥ dNLR < 1.96; n = 1,166), and third tertile(dNLR ≥ 1.96; n = 1,157). The mean follow-up time was 37.59 ± 22.24 months. The primary endpoint was defined as mortality (including all-cause death and cardiac death), and the secondary endpoint was major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs).Results: There were 2,644 patients with acute coronary syndrome (ACS) and 838 patients with chronic coronary syndrome (CCS) in the present study. In the total population, the all-cause mortality (ACM) and cardiac mortality (CM) incidence was significantly higher in the third tertile than in the first tertile [hazard risk (HR) = 1.8 (95% CI: 1.2–2.8), p = 0.006 and HR = 2.1 (95% CI: 1.23–3.8), p = 0.009, respectively]. Multivariate Cox regression analyses suggested that compared with the patients in the first tertile than those in the third tertile, the risk of ACM was increased 1.763 times (HR = 1.763, 95% CI: 1.133–2.743, p = 0.012), and the risk of CM was increased 1.763 times (HR = 1.961, 95% CI: 1.083–3.550, p = 0.026) in the higher dNLR group during the long-term follow-up. In both ACS patients and CCS patients, there were significant differences among the three groups in the incidence of ACM in univariate analysis. We also found that the incidence of CM was significantly different among the three groups in CCS patients in both univariate analysis (HR = 3.541, 95% CI: 1.154–10.863, p = 0.027) and multivariate analysis (HR = 3.136, 95% CI: 1.015–9.690, p = 0.047).Conclusion: The present study suggested that dNLR is an independent and novel predictor of mortality in CHD patients who underwent PCI.

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Neutrophil-to-Lymphocyte Ratio at Hospital Admission as a Novel Predictor of Early Growth of Intraparenchymal Haemorrhage in Patients With Traumatic Brain Injury

10.21203/rs.3.rs-100356/v1 ◽

2020 ◽

Author(s):

Dongzhou Zhuang ◽

Jiangtao Sheng ◽

Guoyi Peng ◽

Tian Li ◽

Shirong Cai ◽

...

Keyword(s):

Logistic Regression ◽

Multivariate Logistic Regression Analysis ◽

Final Analysis ◽

Early Growth ◽

Neutrophil To Lymphocyte Ratio ◽

Roc Curve Analysis ◽

Cerebral Contusion ◽

Lymphocyte Ratio ◽

Intraparenchymal Haemorrhage ◽

Development And Validation

Abstract BackgroundThis study aimed to explore the association between the neutrophil-to-lymphocyte ratio (NLR) and early growth of traumatic intraparenchymal haemorrhage (tICH) in patients with traumatic brain injury.MethodsA multicentre, observational cohort study was conducted at four hospitals and included patients with cerebral contusion undergoing baseline computed tomography (CT) for haematoma volume analysis within 6 hours after primary injury and who had follow-up visits within 48 hours. Routine blood tests were performed upon admission and analysed with early PIH. Logistic regression and receiver operating characteristic (ROC) analysis was used to explore the predictive value of the NLR for haematoma expansion. ResultsThe final analysis included 1003 patients in the retrospective development and validation cohorts. In the retrospective development cohort, the NLR were higher in the PIH group than in the non-PIH group (P<0.0001). Multivariate logistic regression analysis revealed that a higher NLR was independently associated with PIH (P<0.0001). ROC curve analysis showed that the NLR had a sensitive ability for predicting PIH (AUC, 0.91 [95% CI, 0.88-0.94]). In the validation study, the NLR had a similar ability to predict PIH. ConclusionThe NLR can be used to easily assess the growth of tICH and calculated using routine laboratory tests. A high NLR is independently predictive of early growth of tICH and may aid in risk stratification of patients with tICH on admission.

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Compared with Monocyte to High-Density Lipoprotein Ratio (MHR) and Neutrophil to Lymphocyte Ratio (NLR),Neutrophil to High-Density Lipoprotein Ratio (NHR) is more Valuable in the Inflammatory Process of Parkinson's Disease

10.21203/rs.3.rs-185056/v1 ◽

2021 ◽

Author(s):

Qingli Fan ◽

Zhu Liu ◽

Shizheng Wu ◽

Yancheng Lei

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

High Density Lipoprotein ◽

Early Stage ◽

Density Lipoprotein ◽

High Density ◽

Neutrophil To Lymphocyte Ratio ◽

Control Group ◽

Course Of Disease ◽

Lymphocyte Ratio

Abstract Background: Inflammatory response plays an important role in the pathologic process and prognosis of Parkinson's disease (PD).We investigated the relationship between the neutrophil to high-density lipoprotein ratio (NHR),neutrophil to lymphocyte ratio (NLR),and monocyte to high-density lipoprotein ratio (MHR) on the prediction of PD and its course and severity.Methods: Patients with Parkinson's disease were selected (n=101) and divided into three groups according to the onset cycle:<6 years (n=64),6-10 years (n=23) and > 10 years(n=14).And according to Hoehn and Yahr classification: 1~2.5 is the early stage (n=55);Grades 3~5 are divided into two groups (n=46).In addition, healthy subjects (n=97) matched with the above pd patients in the same period were selected as the control group.In this way, the influence of NHR, NLR, MHR and other indicators on corresponding groups is evaluated.Results: Neutrophils, NHR and NLR in PD group were significantly higher than those in control group. nevertheless, lymphocyte, total cholesterol, low density lipoprotein and hemoglobin were significantly lower than those in the control group. Multi-factor logistic regression analysis indicated that NHR (odds ratio (OR)=1.456,95%CI:1.007~2.104,P=0.046) and NLR(OR=1.663,95%CI:1.101~2.513,P=0.016) were risk factors for Parkinson's disease, while MHR had no significant correlation with Parkinson's disease. The AUC(area under the ROC curve) of PD predicted by NHR and NLR were 0.648(95%CI:0.572~0.724,P=0.0003) and 0.718 (95%CI:0.646~0.790,P<0.0001),respectively, and the critical values for optimal diagnosis were3.104×109/mmol and 1.939×109/mmol. Spearman analysis showed that NHR was significantly negatively correlated with the course of disease.Conclusions: In summary, NHR not only has strong predictive value for PD disease, but also is closely related to the course of disease. NHR levels may be better predictors of long-term clinical outcomes in PD patients than MHR and NLR.

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Neutrophil-to-Lymphocyte Ratio is a Prognostic Predictive Factor for Local Advanced Lower Rectal Cancer Treated with Curative Surgical Treatment after Neoadjuvant Chemoradiotherapy: A Single-Center Retrospective Cohort Study

10.21203/rs.3.rs-386980/v1 ◽

2021 ◽

Author(s):

Ryosuke Nakagawa ◽

Shimpei Ogawa ◽

Yuji Inoue ◽

Takeshi Ohki ◽

Yoshiko Bamba ◽

...

Keyword(s):

Rectal Cancer ◽

Univariate Analysis ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Operation Time ◽

Neutrophil To Lymphocyte Ratio ◽

Lower Rectal Cancer ◽

Curative Surgery ◽

Lymphocyte Ratio ◽

Significant Difference

Abstract Background: The neutrophil-to-lymphocyte ratio (NLR) correlates with relapse-free survival (RFS) and may be a predictor of recurrence in patients after curative surgery for colorectal cancer. This study aimed to analyze the long-term oncological outcomes of locally advanced lower rectal cancer treated with curative surgery after neoadjuvant chemoradiotherapy (nCRT) to examine the prognostic value of the NLR and to evaluate the fluctuation of pre- and post-CRT NLR as recurrence risk factors.Methods: Fifty-two patients who underwent curative surgery were enrolled between 2009 and 2016. A cut-off pre-CRT NLR of 3.20 was used based on receiver-operating characteristic curve analysis. The primary outcome was RFS. Factors influencing recurrence after treatment according to fluctuations between the pre- and post-CRT NLR were also analyzed.Results: Univariate analysis was performed using 17 clinicopathological factors thought to affect RFS. A significant difference was found in the pre-CRT NLR (hazard ratio [HR]: 7.626, 95% confidence interval [CI]: 2.760-21.06, p<0.0001), operation time (HR: 2.949, 95% CI: 1.137-7.646, p=0.0261), and pathological T stage (HR: 8.342, 95% CI: 2.458-28.306 p=0.0007). RFS according to the pre-CRT NLR using Kaplan–Meier analysis showed that the group with pre-CRT ≥3.20 had a lower 5-year RFS (p=0.001). A lower pre-CRT NLR resulted in a significantly higher recurrence rate, regardless of the increase or decrease in the pre- and post-CRT NLR.Conclusions: The pre-CRT NLR may be a predictor of prognosis in patients with locally advanced lower rectal cancer after nCRT.

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Neutrophil-to-lymphocyte ratio and chemotherapy response score as prognostic markers in ovarian cancer patients treated with neoadjuvant chemotherapy

Journal of Ovarian Research ◽

10.1186/s13048-021-00902-0 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

M. Liontos ◽

A. Andrikopoulou ◽

K. Koutsoukos ◽

C. Markellos ◽

E. Skafida ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Statistical Significance ◽

Univariate Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Platinum Resistance ◽

Chemotherapy Response ◽

Lymphocyte Ratio ◽

Response Score

Abstract Background Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is the recommended approach in patients with advanced epithelial ovarian cancer (EOC). However, most patients eventually relapse despite the initial high response rate to chemotherapy. Neutrophil-to-lymphocyte ratio is a well-known biomarker that reflects severe inflammation, critical illness, and mortality in various diseases. Chemotherapy response score (CRS) and neutrophil-to-lymphocyte ratio (NLR) have been identified as potential biomarkers of platinum resistance and disease prognosis. We retrospectively evaluated 132 patients with stage IIIc or IV ovarian/fallopian tube/primary peritoneal cancer who had received NACT followed by IDS from 01/01/2003 to 31/12/2018. CRS was assessed on omental specimens collected from IDS according to ICCR guidelines. Results Median age was 64.57 years (SD: 9.72; range 39.2–87.1). Most ovarian tumors were serous epithelial (90.9%; 120/132). An elevated NLR (defined as > 3) was observed in 72% (95/132) of patients in contrast with 28% (37/132) of patients characterized by low NLR status. Median PFS (mPFS) and median overall survival (mOS) were 13.05 months (95% CI: 11.42–14.67)) and 34.69 months (95% CI: 23.26–46.12) respectively. In univariate analysis, CRS3 score was significantly associated with prolonged mPFS (CRS1/2: 12.79 months vs CRS3: 17.7 months; P = 0.008). CRS score was not associated with mOS (P = 0.876). High NLR was not significantly associated with mPFS (P = 0.128), however it was significantly associated with poor mOS (P = 0.012). In multivariate analysis, only performance of surgery maintained its statistical significance with both PFS (P = 0.001) and OS (P = 0.008). Conclusion NLR could serve as a useful predictor of OS but not PFS in ovarian cancer patients receiving NACT. In accordance with our previous study, CRS score at omentum was found to be associated with PFS but not OS in ovarian cancer patients treated with NACT and IDS.

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

10.21203/rs.3.rs-707519/v1 ◽

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.

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Neutrophil-to-Lymphocyte Ratio (NLR) Predicts PD-1 Inhibitor Survival in Patients with Metastatic Gastric Cancer

Journal of Immunology Research ◽

10.1155/2021/2549295 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Miaomiao Gou ◽

Tongtong Qu ◽

Zhikuan Wang ◽

Huan Yan ◽

Yanhai Si ◽

...

Keyword(s):

Gastric Cancer ◽

Response Rate ◽

Univariate Analysis ◽

Objective Response ◽

Progression Free Survival ◽

Metastatic Gastric Cancer ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Formula Group

Background and Aims. Biomarkers for systemic inflammation have been introduced into clinical practice for risk-rating in cancer patients’ treatment. This study is aimed at confirming the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) as an effective biomarker for patients with metastatic gastric cancer (MGC) receiving anti-PD-1 agents. Method. Patients with MGC who received anti-PD-1 treatment at the Chinese PLA General Hospital between January 2016 and November 2020 were reviewed. The study analyzed the association of NLR and overall survival (OS) or progression-free survival (PFS) and antitumor response rate with PD-1 inhibitors. Results. 137 patients were included in the final analysis. The area under the curve value of NLR for 6-month OS was 0.71. The best cut-off value for NLR was 3.23. NLR < 3.23 was associated with longer OS ( HR = 0.38 , 95% CI, 0.26-0.57, p < 0.001 ) and PFS ( HR = 0.42 , 95% CI, 0.29-0.62, p < 0.001 ) in patients with MGC. No significant difference was observed in the objective response rate (ORR) (35.8% vs. 28.6%, p = 0.377 ) and disease control rate (DCR) (86.4% vs. 78.6%, p = 0.229 ) in the NLR < 3.23 group and in the NLR ≥ 3.23 group, respectively. Univariate analysis and multivariate analysis found that NLR was an independent prognosis biomarker for PFS and OS. Conclusions. Pretreatment elevated NLR was significantly associated with inferior PFS and OS in patients with MGC who received anti-PD-1 inhibitors. Clinicians need to consider patients with elevated NLR for decisions on immunotherapy strategy.

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Compared with the monocyte to high-density lipoprotein ratio (MHR) and the neutrophil to lymphocyte ratio (NLR), the neutrophil to high-density lipoprotein ratio (NHR) is more valuable for assessing the inflammatory process in Parkinson’s disease

Lipids in Health and Disease ◽

10.1186/s12944-021-01462-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Zhu Liu ◽

Qingli Fan ◽

Shizheng Wu ◽

Yaqi Wan ◽

Yancheng Lei

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

High Density Lipoprotein ◽

Predictive Value ◽

Disease Duration ◽

Density Lipoprotein ◽

High Density ◽

Neutrophil To Lymphocyte Ratio ◽

Control Group ◽

Lymphocyte Ratio

Abstract Background The inflammatory response plays essential roles in the pathological process and prognosis of Parkinson’s disease (PD). This research investigated the predictive value of the neutrophil to high-density lipoprotein ratio (NHR), neutrophil to lymphocyte ratio (NLR), and monocyte to high-density lipoprotein ratio (MHR) for PD. Methods Patients with PD (n = 98) were divided into three groups according to disease duration: < 6 years (n = 55), 6–10 years (n = 29) and > 10 years (n = 14). Based on the classification system of Hoehn and Yahr, grades 1 ~ 2.5 were considered early-stage PD (n = 44), and grades 3 ~ 5 were considered advanced-stage PD (n = 54). In addition, healthy subjects (n = 98) matched to the above PD patients in the same period were selected as the control group. Differences in the NHR, NLR, MHR and other indicators among the groups were evaluated. Results Smoking, drinking, the neutrophil count and the NHR and NLR were remarkably greater and hypertension, index of body mass, the lymphocyte count, and the levels of cholesterol in total, triglycerides, lipoprotein cholesterol with low density and uric acid were sharply lower in the PD group compared with in the control group. Analysis of multifactor logistic regression indicated that the NHR (odds ratio (adjusted OR) = 1.576, 95% CI: 1.053 ~ 2.358, P = 0.027) and NLR (adjusted OR = 1.734, 95% CI: 1.046 ~ 2.876, P = 0.033) were factors of risk for PD, while the MHR was not significantly correlated with PD. The areas under the receiver operating characteristic (ROC) curve (AUCs) for the prediction of PD by the NHR and NLR were 0.654 (95% CI: 0.583 ~ 0.721, P = 0.0001) and 0.69 (95% CI: 0.62 ~ 0.754, P < 0.0001), respectively, and the optimal cutoff values were 1.848 × 109/mmol and 2.62 × 109/mmol. Spearman’s correlation analysis indicated that the NHR was correlated with the disease duration significantly negatively and that the MHR was positively correlated with disease severity. Conclusions In summary, the NHR not only has strong predictive value for PD but is also closely related to disease duration. The NHR may be a better prediction for the long-period clinical results in PD patients than the MHR and NLR. Trial registration Clinical medical reserach center project of Qinghai Province (2017-SF-L1).

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Dynamic changes of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predicts breast cancer prognosis

BMC Cancer ◽

10.1186/s12885-020-07700-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ju-Yeon Kim ◽

Eun Jung Jung ◽

Jae-Myung Kim ◽

Han Shin Lee ◽

Seung-Jin Kwag ◽

...

Keyword(s):

Initial Treatment ◽

Univariate Analysis ◽

Axillary Lymph Node Metastasis ◽

Post Treatment ◽

Neutrophil To Lymphocyte Ratio ◽

Cancer Prognosis ◽

Axillary Lymph ◽

Platelet To Lymphocyte Ratio ◽

Free Survival ◽

Lymphocyte Ratio

Abstract Background We aimed to identify whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are more useful predictors after initial intention to treat than at the time of diagnosis. Methods We collected the medical data of 533 patients. The results of the peripheral blood sampling before the primary treatments were labeled as initial cohort, and those obtained between 24 and 36 months after initial treatment were defined as the 2nd cohort. Delayed metastasis has been defined as distant metastasis 2 years after treatment, and survival outcome was estimated and compared across groups. Results Median follow-up duration was 74 months (24–162 months), and 53 patients experienced delayed metastasis. In univariate analysis, metastasis-free survival, patient age at diagnosis, tumor size, axillary lymph node metastasis, HER-2 status, initial NLR and PLR, and 2nd NLR and PLR were found to be significantly associated with delayed metastasis. However, in multivariate analysis, only the 2nd NLR and PLR were found to be significantly associated with delayed metastasis, excluding initial NLR and PLR. Metastasis-free survival was analyzed through the pattern changes of NLR or PLR. The results revealed that patients with continued low NLR and PLR values at pre- and post-treatment (low initial values and 2nd values) showed a significantly better prognosis than those with a change in value or continued high NLR and PLR. Conclusions We identified that patients with persistent high NLR and PLR after initial treatment have significant worse prognosis in terms of late metastasis. Therefore, these results suggest that NLR and PLR are more useful in predicting prognosis post-treatment.

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