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Guo P, Chen L, Yang D, Zhang L, Shu C, Li H, Zhu J, Zhou J, Li X. Predictive value of plasma ephrinB2 levels for amputation risk following endovascular revascularization in peripheral artery disease. PeerJ 2024; 12:e17531. [PMID: 38854794 PMCID: PMC11162178 DOI: 10.7717/peerj.17531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/17/2024] [Indexed: 06/11/2024] Open
Abstract
Background The aim of this study is to investigate the expression levels of ephrinB2 in patients with lower extremity peripheral arterial disease (PAD) and explore its association with the severity of the disease and the risk of amputation after endovascular revascularization. Methods During the period from March 2021 to March 2023, this study collected blood samples and clinical data from 133 patients diagnosed with lower extremity PAD and 51 healthy volunteer donors. The severity of lower extremity PAD patients was classified using the Rutherford categories. The expression of ephrin-B2 in plasma samples was detected using the Western Blotting. Results Compared to the control group, the levels of serum ephrinB2 in patients were significantly elevated (p < 0.001). Moreover, the plasma EphrinB2 levels were positively correlated with white blood cell counts (r = 0.204, p = 0.018), neutrophil counts (r = 0.174, p = 0.045), and neutrophil-to-lymphocyte ratio (NLR) (r = 0.223, p = 0.009). Furthermore, the AUCs of plasma ephrinB2 level, NLR, and their combination as predictors for amputation events within 30 months after lower extremity PAD endovascular revascularization were 0.659, 0.730 and 0.811. In the high-ephrinB2 group, the incidence of amputation events within 30 months after endovascular revascularization was higher. Conclusions Plasma EphrinB2 levels may be linked to lower extremity PAD development, inflammation, and postoperative amputation. Combining EphrinB2 and NLR can improve amputation prediction accuracy after endovascular revascularization in lower extremity PAD patients.
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Affiliation(s)
- Pengcheng Guo
- Vascular Surgery Department, the Secondary Xiangya Hospital, Central South University, Hunan, China
- Institute of Vascular Diseases, Central South University, Chang Sha, Hunan, China
| | - Lei Chen
- Pharmacy Department, the Secondary Xiangya Hospital, Central South University, Hunan, China
| | - Dafeng Yang
- Cardiology Surgery Department, the Secondary Xiangya Hospital, Central South University, Hunan, China
| | - Lei Zhang
- Vascular Surgery Department, the Secondary Xiangya Hospital, Central South University, Hunan, China
- Institute of Vascular Diseases, Central South University, Chang Sha, Hunan, China
| | - Chang Shu
- Vascular Surgery Department, the Secondary Xiangya Hospital, Central South University, Hunan, China
- Institute of Vascular Diseases, Central South University, Chang Sha, Hunan, China
- State Key Laboratory of Cardiovascular Diseases, Center of Vascular Surgery, Fuwai Hospital National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huande Li
- Pharmacy Department, the Secondary Xiangya Hospital, Central South University, Hunan, China
| | - Jieting Zhu
- Vascular Surgery Department, the Secondary Xiangya Hospital, Central South University, Hunan, China
- Institute of Vascular Diseases, Central South University, Chang Sha, Hunan, China
| | - Jienan Zhou
- Vascular Surgery Department, the Secondary Xiangya Hospital, Central South University, Hunan, China
- Institute of Vascular Diseases, Central South University, Chang Sha, Hunan, China
| | - Xin Li
- Vascular Surgery Department, the Secondary Xiangya Hospital, Central South University, Hunan, China
- Institute of Vascular Diseases, Central South University, Chang Sha, Hunan, China
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Bradley NA, Roxburgh CSD, McMillan DC, Guthrie GJK. A systematic review of the neutrophil to lymphocyte and platelet to lymphocyte ratios in patients with lower extremity arterial disease. VASA 2024; 53:155-171. [PMID: 38563057 DOI: 10.1024/0301-1526/a001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Lower extremity arterial disease (LEAD) is caused by atherosclerotic plaque in the arterial supply to the lower limbs. The neutrophil to lymphocyte and platelet to lymphocyte ratios (NLR, PLR) are established markers of systemic inflammation which are related to inferior outcomes in multiple clinical conditions, though remain poorly described in patients with LEAD. This review was carried out in accordance with PRISMA guidelines. The MEDLINE database was interrogated for relevant studies. Primary outcome was the prognostic effect of NLR and PLR on clinical outcomes following treatment, and secondary outcomes were the prognostic effect of NLR and PLR on disease severity and technical success following revascularisation. There were 34 studies included in the final review reporting outcomes on a total of 19870 patients. NLR was investigated in 21 studies, PLR was investigated in two studies, and both NLR & PLR were investigated in 11 studies. Relating to increased levels of systemic inflammation, 20 studies (100%) reported inferior clinical outcomes, 13 (92.9%) studies reported increased disease severity, and seven (87.5%) studies reported inferior technical results from revascularisation. The studies included in this review support the role of elevated NLR and PLR as key components influencing the clinical outcomes, severity, and success of treatment in patients with LEAD. The use of these easily accessible, cost effective and routinely available markers is supported by the present review.
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Popescu AI, Rata AL, Barac S, Popescu R, Onofrei RR, Vlad C, Vlad D. Narrative Review of Biological Markers in Chronic Limb-Threatening Ischemia. Biomedicines 2024; 12:798. [PMID: 38672153 PMCID: PMC11047884 DOI: 10.3390/biomedicines12040798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI), the advanced stage of peripheral arterial disease, is diagnosed in the presence of ischemic rest pain, non-healing ulcers, or gangrene. Several studies have demonstrated that inflammation and endothelial dysfunction are some of the main substrates of CLTI. METHODS A narrative review was conducted and reported according to PRISMA guidelines. Three databases were searched-Web of Science, Medline, and EMBASE-for the studies assessing CLTI and the biological markers related to it. RESULTS We included 22 studies, and all the markers identified (C-reactive protein, D-dimers, fibrinogen, cytokines, IL-6, TNF-α, ICAM-1 (Intracellular Adhesion Molecule-1), VCAM-1 (Vascular Cell Adhesion Molecule-1), neutrophile-to-lymphocytes ratio (NLR), IL-8, Pentraxin-3, neutrophil gelatinase-associated lipocalin (NGAL), calprotectin, E-selectin, P-selectin, neopterin, High-Mobility Group Box-1 protein (HGMB-1), Osteoprotegerin (OPG) and Sortilin) were positively associated with advanced CLTI, with major limb or major cardiovascular events in these patients. CONCLUSIONS All the studied markers had increased values in patients with CLTI, especially when associated with diabetes mellitus, proving a very important association between diabetes and major limb or cardiovascular events in these patients. There is a need for more studies to validate these markers in terms of diagnosis or prognosis in CLTI patients and in trying to find new medical strategies that target inflammation or endothelial dysfunction in these patients.
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Affiliation(s)
- Alexandra Ioana Popescu
- Pharmacology Department, Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Andreea Luciana Rata
- Surgical Emergencies Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Sorin Barac
- Vascular Surgery Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Roxana Popescu
- Cell and Molecular Biology Department, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Roxana Ramona Onofrei
- Department of Rehabilitation, Physical Medicine and Rheumatology, Research Center for Assessment of Human Motion, Functionality and Disability, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Cristian Vlad
- Pharmacology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (D.V.)
| | - Daliborca Vlad
- Pharmacology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (D.V.)
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Onofrei V, Crișan A, Adam CA, Marcu DTM, Haba MȘC, Tribus LC, Ceasovschih A, Eșanu IM, Petroaie AD, Crișan-Dabija R, Leon-Constantin MM, Cumpăt C, Mitu F. The Role Played by Novel Inflammatory Markers in Assessment of Peripheral Artery Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1557. [PMID: 37763676 PMCID: PMC10533060 DOI: 10.3390/medicina59091557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Atherosclerosis is a multifactorial process in which inflammatory markers have both therapeutic and prognostic roles. Recent studies bring into question the importance of assessing new inflammatory markers in relation to the severity of peripheral artery disease (PAD), such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-C-reactive protein ratio (LCR). Materials and Methods: We conducted a retrospective and descriptive study including 652 patients with PAD, who were divided into two groups according to the severity of the ankle-brachial index value: mild and moderate obstruction (257 patients) and severe obstruction (395 patients). We evaluated demographics, anthropometric data and clinical and paraclinical parameters in relation to the novel inflammatory biomarkers mentioned above. Results: Weight (p = 0.048), smoking (p = 0.033), the number of cardiovascular risk factors (p = 0.041), NLR (p = 0.037), LCR (p = 0.041) and PLR (p = 0.019), the presence of gangrene (p = 0.001) and the number of lesions detected via peripheral angiography (p < 0.001) were statistically significant parameters in our study. For the group of patients with severe obstruction, all three inflammatory biomarkers were statistically significantly correlated with a serum low-density lipoprotein-cholesterol level, the number of cardiovascular risk factors, rest pain, gangrene and a risk of amputation. In addition, directly proportional relationships were found between NLR, PLR and the number of stenotic lesions (p = 0.018, p = 0.016). Also, NLR (area under the curve = 0.682, p = 0.010) and PLR (AUC = 0.692, p = 0.006) were predictors associated with a high risk of amputation in patients with an ABI < 0.5. Conclusions: in our study, we demonstrated the importance of assessing inflammatory markers in relation to the presence of cardiovascular risk factors through the therapeutic and prognostic value demonstrated in PAD.
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Affiliation(s)
- Viviana Onofrei
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Adrian Crișan
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Dragos Traian Marius Marcu
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street no 30, 700115 Iasi, Romania
| | - Mihai Ștefan Cristian Haba
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Laura Carina Tribus
- Department of Internal Medicine, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine, Ilfov County Emergency Hospital, 022104 Bucharest, Romania
| | - Alexandr Ceasovschih
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Irina Mihaela Eșanu
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Antoneta Dacia Petroaie
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Department of Family Medicine, Preventive Medicine and Interdisciplinary, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Radu Crișan-Dabija
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street no 30, 700115 Iasi, Romania
| | - Maria-Magdalena Leon-Constantin
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Carmen Cumpăt
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Department of Management, “Alexandru Ioan Cuza” University, Blv. Carol I, 700506 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I and III, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Academy of Medical Sciences, 030167 Bucharest, Romania
- Academy of Romanian Scientists, 700050 Iasi, Romania
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Pasqui E, de Donato G, Molino C, Abu Leil M, Anzaldi MG, Galzerano G, Palasciano G. Residual Aneurysmal Sac Shrinkage Post-Endovascular Aneurysm Repair: The Role of Preoperative Inflammatory Markers. Biomedicines 2023; 11:1920. [PMID: 37509562 PMCID: PMC10377044 DOI: 10.3390/biomedicines11071920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION In this study, we evaluated the role of preoperative inflammatory markers as Neutrophil-to-Lymphocyte (NLR) and Platelet-to-Lymphocyte (PLR) ratios in relation to post-endovascular aneurysm repair (EVAR) sac shrinkage, which is known to be an important factor for abdominal aortic aneurysm (AAA) healing. METHODS This was a single-center retrospective observational study. All patients who underwent the EVAR procedure from January 2017 to December 2020 were eligible for this study. Pre-operative blood samples of all patients admitted were used to calculate NLR and PLR. Sac shrinkage was defined as a decrease of ≥5 mm in the maximal sac diameter. The optimal NLR and PLR cut-offs for aneurysmal sac shrinkage were obtained from ROC curves. Stepwise multivariate analysis was performed in order to identify independent risk and protective factors for the absence of AAA shrinkage. Kaplan-Meier curves were used to evaluate survival rates with respect to the AAA shrinkage. RESULTS A total of 184 patients were finally enrolled. The mean age was 75.8 ± 8.3 years, and 85.9% were male (158/184). At a mean follow-up of 43 ± 18 months, sac shrinkage was registered in 107 patients (58.1%). No-shrinking AAA patients were more likely to be older, to have a higher level of NLR and PLR, and be an active smoker. Kaplan-Meier curves highlighted a higher rate of survival for shrinking AAA patients with respect to their counterparts (p < 0.03). Multivariate analysis outlined active smoking and NLR as independent risk factors for no-shrinking AAA. CONCLUSIONS Inflammation emerged as a possible causative factor for no-shrinking AAA, playing a role in aneurysmal sac remodeling. This study revealed that inflammatory biomarkers, such as NLR and PLR, can be used as a preoperative index of AAA sac behavior after EVAR procedures.
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Affiliation(s)
- Edoardo Pasqui
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Gianmarco de Donato
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Cecilia Molino
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Mustafa Abu Leil
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Manfredi Giuseppe Anzaldi
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Giuseppe Galzerano
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Giancarlo Palasciano
- Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
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Topcu H, El Kılıc H. Association of neutrophil-to-lymphocyte ratio with thirty-day mortality in acute peripheral arterial ischemia. Vascular 2023; 31:402-406. [PMID: 35491879 DOI: 10.1177/17085381221094943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute peripheral arterial ischemia (APAI) is an acute ischemic condition that develops as a result of embolism or thrombosis, and its morbidity and mortality are still high today. The objective of this study is to determine the effect of preoperative Neutrophil-to-Lymphocyte ratio (NLR) on mortality in patients admitted with the diagnosis of APAI. METHODS 178 patients who were diagnosed with acute peripheral arterial occlusion and underwent emergency embolectomy were evaluated retrospectively over a 7-year period. Patient demographics, clinical history, risk factors, comorbidity, and hemogram sub-parameters were documented. The endpoint of the patients was determined as death. RESULTS A total of 178 patients were identified with a mean age 74.29±14.71 (range 28-111) years; among them, 105 (59%) were female. 18% patients (32/178) died within 30 days. Lower extremity involvement was present in 124 (69.7%) of the patients. A statistically significant difference was found between the mortality rates and blood parameters of the patients included in the study in terms of white blood count C-reactive protein (CRP), and age among those with normal distribution. Neutrophil, NLR, procalcitonin, lactate, aspartate aminotransferase, and urea; It was statistically significant in terms of mortality in our patients with APAI. NLR values of the deceased were determined as 7.98 ± 6.85. CONCLUSIONS APAI patients with high NLRs had significantly higher risks of 30-day mortality. The NLR can be used as a prognostic marker in these patients and warrants further investigation.
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Affiliation(s)
- Hatice Topcu
- Department of Emergency Medicine, Emergency Medicine Clinic, Health Science University, 64159Sisli Hamidiye Etfal Training and Education Hospital, Istanbul, Turkey
| | - Helin El Kılıc
- Department of Emergency Medicine, Emergency Medicine Clinic, Health Science University, 64159Sisli Hamidiye Etfal Training and Education Hospital, Istanbul, Turkey
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The Role of Neutrophils in Lower Limb Peripheral Artery Disease: State of the Art and Future Perspectives. Int J Mol Sci 2023; 24:ijms24021169. [PMID: 36674682 PMCID: PMC9866688 DOI: 10.3390/ijms24021169] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
In recent years, increasing attention has been paid to the role of neutrophils in cardiovascular (CV) disease (CVD) with evidence supporting their role in the initiation, progression, and rupture of atherosclerotic plaque. Although these cells have long been considered as terminally differentiated cells with a relatively limited spectrum of action, recent research has revealed intriguing novel cellular functions, including neutrophil extracellular trap (NET) generation and inflammasome activation, which have been linked to several human diseases, including CVD. While most research to date has focused on the role of neutrophils in coronary artery and cerebrovascular diseases, much less information is available on lower limb peripheral artery disease (PAD). PAD is a widespread condition associated with great morbidity and mortality, though physician and patient awareness of the disease remains low. To date, several studies have produced some evidence on the role of certain biomarkers of neutrophil activation in this clinical setting. However, the etiopathogenetic role of neutrophils, and in particular of some of the newly discovered mechanisms, has yet to be fully elucidated. In the future, complementary assessment of neutrophil activity should improve CV risk stratification and provide personalized treatments to patients with PAD. This review aims to summarize the basic principles and recent advances in the understanding of neutrophil biology, current knowledge about the role of neutrophils in atherosclerosis, as well as available evidence on their role of PAD.
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Muacevic A, Adler JR, Dulipala P. The Association of the Neutrophil-Lymphocyte Ratio With the Outcome of Diabetic Foot Ulcer. Cureus 2023; 15:e33891. [PMID: 36819314 PMCID: PMC9934850 DOI: 10.7759/cureus.33891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/18/2023] Open
Abstract
Introduction One of the most common lower-extremity impediments in people suffering from diabetes mellitus (DM) is foot ulceration. Neutrophil-lymphocyte ratio (NLR) is a useful measure in predicting disease-specific morbidity and mortality. Objectives The objective is to study the association between diabetic foot ulcer healing and the NLR. Methodology A prospective analytical study was conducted among 100 patients with diabetic foot ulcers admitted to a surgical ward in a teaching hospital between April and November 2022. Basic demographic details, ulcer examination, and NLR were evaluated on the day of admission, and the status of ulcers was assessed after six weeks and the outcome was compared with the NLR value. Data analysis was done using SPSS version 20 software (SPSS, Inc., Chicago, IL). Results The average neutrophils, lymphocytes, and neutrophil-lymphocyte ratio were, respectively, 94.73%, 14.97%, and 6.65%. 58% had healing ulcers, and 42% had non-healing ulcers. 44% of study subjects had NLR <6, which is normal, and 56% had NLR >6, which is abnormal. Among 58 subjects with healing ulcers, 75.9% had NLR < 6, and among 42 subjects with non-healing ulcers, 100% had NLR >6, which was statistically significant. The mean NLR in the healing group was 5.15 and in the non-healing group was 8.205; this was statistically significant. This shows an increased NLR has a predisposition towards non-healing chronic ulcers with a poor prognosis. Conclusion NLR can be used as a reliable indicator for determining the healing status of diabetic foot ulcers.
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Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio relation with outcomes in acute lower limb ischemia. ANGIOLOGIA 2023. [DOI: 10.20960/angiologia.00452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Neutrophil-to-Lymphocyte Ratio and Systemic Inflammation Index as Predictors of Poor Outcome in Patients with Critical Limb Ischemia Treated with Remote Endarterectomy. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Abstract
Introduction: Severe ischemia occurring in the lower limbs represents the advanced stage of peripheral artery disease (PAD). Atherosclerosis and inflammatory markers have been intensively studied to identify prognostic tools with a role in the evolution of patients with PAD. The aim of this study is to demonstrate the predictive value of systemic inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and the systemic inflammation index (SII) in the prognosis of patients diagnosed with critical leg ischemia (CLI) undergoing infrainguinal surgical revascularization with remote endarterectomy.
Materials and methods: This retrospective study included all patients admitted to the Vascular Surgery Clinic of the County Emergency Clinical Hospital of Târgu Mureș, Romania between January 2018 and December 2021, who had critical limb ischemia Leriche-Fontaine stage III and were treated with endarterectomy. Patients were divided into two groups based on the presence or absence of patency in the lower limbs at 12 months.
Results: There was a higher baseline value of neutrophil count (p <0.0001), platelet count (p = 0.006), NLR and SII value (p <0.0001), as well as a lower value of lymphocyte count (p = 0.001) in the group without patency at 12 months. The ROC curve analysis showed that the NLR and SII were associated with the risk of major amputation and primary patency failure at 12 months, while multivariate analysis has shown that arterial hypertension (OR 3.63, p = 0.04), history of myocardial infarction (OR 2.93, p = 0.009), diabetes mellitus (OR 2.20; p = 0.04) and smoking (OR 3.48, p <0.0001) were also predictors of primary patency failure.
Conclusions: The results of this study demonstrated the predictive role of NLR and SII regarding poor outcomes among patients with CLI Leriche-Fontaine stage III undergoing infrainguinal surgical revascularization with remote endarterectomy.
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Arbănași EM, Halmaciu I, Kaller R, Mureșan AV, Arbănași EM, Suciu BA, Coșarcă CM, Cojocaru II, Melinte RM, Russu E. Systemic Inflammatory Biomarkers and Chest CT Findings as Predictors of Acute Limb Ischemia Risk, Intensive Care Unit Admission, and Mortality in COVID-19 Patients. Diagnostics (Basel) 2022; 12:diagnostics12102379. [PMID: 36292068 PMCID: PMC9600434 DOI: 10.3390/diagnostics12102379] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/10/2022] [Accepted: 09/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Numerous tools, including inflammatory biomarkers and lung injury severity scores, have been evaluated as predictors of thromboembolic events and the requirement for intensive therapy in COVID-19 patients. This study aims to verify the predictive role of inflammatory biomarkers [monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)] and the CT Severity Score in acute limb ischemia (ALI) risk, intensive unit care (ICU) admission, and mortality in COVID-19 patients.; Methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients older than 18 years of age with a diagnosis of COVID-19 infection, confirmed through real time-polymerase chain reaction (RT-PCR), and admitted to the County Emergency Clinical Hospital of Targu-Mureș, Romania, and Modular Intensive Care Unit of UMFST “George Emil Palade” of Targu Mures, Romania between January 2020 and December 2021. Results: Non-Survivors and “ALI” patients were associated with higher incidence of cardiovascular disease [atrial fibrillation (AF) p = 0.0006 and p = 0.0001; peripheral arterial disease (PAD) p = 0.006 and p < 0.0001], and higher pulmonary parenchyma involvement (p < 0.0001). Multivariate analysis showed a high baseline value for MLR, NLR, PLR, SII, SIRI, AISI, and the CT Severity Score independent predictor of adverse outcomes for all recruited patients (all p < 0.0001). Moreover, the presence of AF and PAD was an independent predictor of ALI risk and mortality. Conclusions: According to our findings, higher MLR, NLR, PLR, SII, SIRI, AISI, and CT Severity Score values at admission strongly predict ALI risk, ICU admission, and mortality. Moreover, patients with AF and PAD had highly predicted ALI risk and mortality but no ICU admission.
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Affiliation(s)
- Emil Marian Arbănași
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Ioana Halmaciu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Réka Kaller
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Correspondence:
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Bogdan Andrei Suciu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- First Clinic of Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Cătălin Mircea Coșarcă
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Ioana Iulia Cojocaru
- First Clinic of Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Razvan Marian Melinte
- Department of Orthopedics, Regina Maria Health Network, 540098 Targu Mures, Romania
- Department of Orthopedics, Humanitas MedLife Hospital, 400664 Cluj Napoca, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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Chi PJ, Wu KT, Chen PJ, Chen CY, Su YC, Yang CY, Chen JH. The serial changes of Neutrophile-Lymphocyte Ratio and correlation to weight loss after Laparoscopic Sleeve Gastrectomy. Front Surg 2022; 9:939857. [PMID: 36147694 PMCID: PMC9485550 DOI: 10.3389/fsurg.2022.939857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aims to identify the pre- and postoperative changes in the neutrophil-lymphocyte ratio (NLR) and its correlations to clinical characteristics in obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Method Retrospectively, we included patients who has undergone LSG in our institution between January 2019 and April 2021. A total of 100 patients whose body mass index over 32.5 and received primary laparoscopic sleeve gastrectomy without infectious condition were included. Results There was a significant decline in NLR (T0 vs. POM3 2.21 vs. 1.78, p = 0.005), neutrophil (T0 vs. POM3 5369 vs. 4050, p < 0.001) and lymphocyte count (T0 vs. POM3 2440: 2100, p < 0.001, respectively) at postoperative 3 months (POM3) compared to preoperative (T0) levels, but similar between POM3 and POM6. The declined counts (Neutrophile vs. Lymphocyte 1445.5/µl vs. 323.5/µl, p < 0.001) and percentage (Neutrophile vs. Lymphocyte 25.11% vs. 13.07%, p < 0.001) of neutrophile are higher than lymphocyte from T0 to POM3, but similar in POM3 and POM6. Preoperative NLR has a significant correlation with the preoperative body weight, preoperative insulin level, and excessive body weight loss (EBWL) at POM3. Preoperative NLR <2.36 had a sensitivity of 67.6% and a specificity of 62.5% in predicting successful weight loss (EBWL > 37.7%) at POM3 (AUC = 0.635, p = 0.032). Conclusion There was a significant decline in NLR, neutrophil, and lymphocyte count from T0 to POM3, but similar between POM3 and POM6. The declined counts and percentage of neutrophile are higher than lymphocyte. Preoperative NLR shows the potential to be used as a prognostic biomarker for predicting successful weight loss at POM3 after LSG. Further studies could be designed to evaluate the value of prediction in successful outcome after LSG and figure out the relationship between the changes of neutrophil function and oncogenesis.
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Affiliation(s)
- Po-Jui Chi
- Division of Nephrology, Department of Medicine, E-DA Hospital, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kun-Ta Wu
- Division of General Surgery, Department of Surgery, E-Da Hospital, Taiwan
- Division of General Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Po-Jen Chen
- Department of Medical Research, E-Da Hospital, Taiwan
| | - Chung-Yen Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of General Surgery, Department of Surgery, E-Da Hospital, Taiwan
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu-Chieh Su
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Hematology-Oncology, E-Da Hospital, Kaohsiung, Taiwan
| | - Chung-Yi Yang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan
- Correspondence: Jian-Han Chen Chung-Yi Yang
| | - Jian-Han Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of General Surgery, Department of Surgery, E-Da Hospital, Taiwan
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
- Correspondence: Jian-Han Chen Chung-Yi Yang
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Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Impact on Predicting Outcomes in Patients with Acute Limb Ischemia. Life (Basel) 2022; 12:life12060822. [PMID: 35743853 PMCID: PMC9225565 DOI: 10.3390/life12060822] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/21/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Acute Limb Ischemia (ALI) of the lower limb is defined as a sudden drop in arterial limb perfusion, which is a medical emergency requiring prompt intervention with high amputation and mortality rates in the absence of revascularization. This observational, analytical, and retrospective cohort study with longitudinal follow-up aimed to confirm the relevance of the preoperative inflammatory biomarkers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting the 30-day poor prognosis of patients with Rutherford classification (RC) grades II and III ALI. The ROC analysis found a strong association of an NLR > 4.33 with all studied outcomes, while a PLR > 143.34 was associated with all studied outcomes, except the composite endpoint in all RC stages. Depending on the optimal cut-off value, the ROC analysis found a higher incidence of all adverse outcomes in all high NLR (>4.33) and high PLR (>143.34) groups. A multivariate analysis showed that a high baseline value for NLR and PLR was an independent predictor of amputation (OR:11.09; 95% CI: 5.48−22.42; p < 0.0001; and OR:8.97; 95% CI: 4.44−18.16; p < 0.0001), mortality (OR:22.24; 95% CI: 9.61−51.47; p < 0.0001; and OR:8.32; 95% CI: 3.90−17.73; p < 0.0001), and composite endpoint (OR:21.93; 95% CI: 7.91−60.79; p < 0.0001; and OR:9.98; 95% CI: 3.89−25.55; p < 0.0001), respectively. Furthermore, for all hospitalized patients, the RC grade III (OR:7.33; 95% CI: 3.73−14.26; p < 0.0001) was an independent predictor of amputation (OR:7.33; 95% CI: 3.73−14.26; p < 0.0001), mortality (OR:8.40; 95% CI: 4.08−17.31; p < 0.0001), and composite endpoint (OR: 10.70; 95% CI: 4.48−25.56; p < 0.0001), respectively. The NLR and PLR are excellent predictors of risks associated with ALI for primary and secondary prevention. Our study showed that increased pre-operative values for NLR and PLR are indicators of a poor outcome in patients with RC grades II and III ALI.
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Agarwal R, Aurora RG, Siswanto BB, Muliawan HS. The prognostic value of neutrophil-to-lymphocyte ratio across all stages of coronary artery disease. Coron Artery Dis 2022; 33:137-143. [PMID: 33826535 DOI: 10.1097/mca.0000000000001040] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor long-term outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.
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Affiliation(s)
- Raksheeth Agarwal
- Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Kenari, Kec. Senen, Jakarta Pusat, DKI Jakarta
| | - Ruth G Aurora
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jl. Let. Jend. S. Parman Kav 87, Jakarta Barat, DKI Jakarta
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jl. Let. Jend. S. Parman Kav 87, Jakarta Barat, DKI Jakarta
| | - Hary S Muliawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/Rumah Sakit Universitas Indonesia, Jl. Prof Bahder Djohan, Pondok Cina, Beji, Depok, Jawa Barat, Indonesia
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15
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Wadowski PP, Pultar J, Weikert C, Eichelberger B, Tscharre M, Koppensteiner R, Panzer S, Gremmel T. Platelet-to-Lymphocyte Ratio as Marker of Platelet Activation in Patients on Potent P2Y 12 Inhibitors. J Cardiovasc Pharmacol Ther 2022; 27:10742484221096524. [PMID: 35482903 DOI: 10.1177/10742484221096524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A high platelet-to-lymphocyte ratio (PLR) has recently been associated with ischemic outcomes in cardiovascular disease. Increased platelet reactivity and leukocyte-platelet aggregate formation are directly involved in the progress of atherosclerosis and have been linked to ischemic events following percutaneous coronary intervention (PCI). In order to understand the relation of PLR with platelet reactivity, we assessed PLR as well as agonist-inducible platelet aggregation and neutrophil-platelet aggregate (NPA) formation in 182 acute coronary syndrome (ACS) patients on dual antiplatelet therapy with aspirin and prasugrel (n = 96) or ticagrelor (n = 86) 3 days after PCI. PLR was calculated from the blood count. Platelet aggregation was measured by multiple electrode aggregometry and NPA formation was determined by flow cytometry, both in response to ADP and SFLLRN. A PLR ≥91 was considered as high PLR based on previous data showing an association of this threshold with adverse ischemic outcomes. In the overall cohort and in prasugrel-treated patients, high PLR was associated with higher SFLLRN-inducible platelet aggregation (67 AU [50-85 AU] vs 59.5 AU [44.3-71.3 AU], P = .01, and 73 AU [50-85 AU] vs 61.5 AU [46-69 AU], P = .02, respectively). Further, prasugrel-treated patients with high PLR exhibited higher ADP- (15% [11%-23%] vs 10.9% [7.6%-15.9%], P = .007) and SFLLRN-inducible NPA formation (64.3% [55.4%-73.8%] vs 53.8% [44.1%-70.1%], P = .01) as compared to patients with low PLR. These differences were not seen in ticagrelor-treated patients. In conclusion, high PLR is associated with increased on-treatment platelet reactivity in prasugrel-treated patients, but not in patients on ticagrelor.
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Affiliation(s)
- Patricia P Wadowski
- Department of Internal Medicine II, 27271Medical University of Vienna, Vienna, Austria
| | - Joseph Pultar
- Department of Internal Medicine II, 27271Medical University of Vienna, Vienna, Austria
| | - Constantin Weikert
- Department of Internal Medicine II, 27271Medical University of Vienna, Vienna, Austria
| | - Beate Eichelberger
- Department of Blood Group Serology and Transfusion Medicine, 27271Medical University of Vienna, Vienna, Austria
| | - Maximilian Tscharre
- Department of Internal Medicine II, 27271Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Renate Koppensteiner
- Department of Internal Medicine II, 27271Medical University of Vienna, Vienna, Austria
| | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, 27271Medical University of Vienna, Vienna, Austria
| | - Thomas Gremmel
- Department of Internal Medicine II, 27271Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine I, Cardiology and Intensive Care Medicine, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Institute of Antithrombotic Therapy in Cardiovascular Disease, Karl Landsteiner Society, St. Pölten, Austria
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de Rezende Ferreira Mendes AL, Sampaio HADC, Ferreira Carioca AA, Pinheiro LGP, Vasques PHD, Rocha DC, Cacau LT, Bezerra IN. Women with Abnormal Mammographic Findings and High Neutrophil-to-Lymphocyte Ratio have the Worst Dietary Carbohydrate Quality Index. Nutr Cancer 2021; 74:2436-2443. [PMID: 34854778 DOI: 10.1080/01635581.2021.2009885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There are gaps in knowledge in breast cancer prevention studies focusing on interactions among mammographic findings, inflammation, and diet, especially those related to carbohydrates. OBJECTIVE We aimed to verify the association among mammographic findings, inflammatory markers, and carbohydrate quality index (CQI) in women. METHODOLOGY This was a cross-sectional study of 532 women assisted in a healthcare service. The enrolled women were divided into two groups according to their mammographic findings: those without and those with abnormal mammographic findings. Two 24-hour dietary reminders were applied, and CQI was determined based on four components: fibers, glycemic index, ratio between whole and total grains, and ratio between solid and total carbohydrates. The neutrophil-to-lymphocyte ratio (NLR) was calculated as an inflammatory marker. RESULTS There were 178 (33.5%) women with abnormal mammographic findings, and 20 (3.8%) had NLR. There was no association between CQI and mammographic findings and NLR. Women with abnormal mammographic findings and high NLR had lower CQI (p = 0.039) and lower whole total ratio (p = 0.024). CONCLUSION Women with abnormal findings and high NLR had worse CQI and worse overall total grain ratio.
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Affiliation(s)
| | | | | | - Luiz Gonzaga Porto Pinheiro
- Education and Oncology Studies Group (Grupo de Educação e Estudos em Oncologia - GEEON), Federal University of Ceará, Fortaleza, Brazil
| | - Paulo Henrique Diógenes Vasques
- Education and Oncology Studies Group (Grupo de Educação e Estudos em Oncologia - GEEON), Federal University of Ceará, Fortaleza, Brazil
| | | | - Leandro Teixeira Cacau
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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García-Rivera E, San Norberto EM, Fidalgo-Domingos L, Revilla-Calavia Á, Estévez-Fernández I, Cenizo-Revuelta N, Martín-Pedrosa M, Vaquero-Puerta C. Impact of nutritional and inflammatory status in patients with critical limb-threatening ischemia. INT ANGIOL 2021; 40:504-511. [PMID: 34636508 DOI: 10.23736/s0392-9590.21.04739-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A pro-inflammatory state and a poor nutritional status have been associated with severity and prognosis of patients with peripheral arterial disease (PAD). The clinical applicability of the different pre-operative nutritional and inflammatory biomarkers in patients with critical limb-threatening ischemia (CLTI) was analyzed. METHODS A retrospective observational study was performed, that included all patients with CLTI revascularized from January 2016 to July 2019. The inflammatory state was calculated using neutrophil/lymphocyte (NLR), lymphocyte/monocyte (LMR) and platelet/lymphocyte ratios (PLR). For nutritional status, the Prognostic Nutritional Index (PNI) was calculated. Mortality and number of major amputations at 6 months and hospital length-of stay were studied. RESULTS 310 patients were included. Higher levels of NLR and lower levels of PNI were associated with mortality (6.61±5.6 vs. 3.98±3.27, P=0.034; 40.33±7.89 vs. 45.73±7.48, P=0.05, respectively). Lower levels of PNI and LMR (42.57±7.82 vs. 45.44±7.65, P=0.036; 2.77±1.61 vs. 3.22±1.75, P=0.013, respectively) and higher levels of NLR (6.91±7.85 vs. 3.94±2.57, P=0.023) were associated with major amputations. The mean hospital length-of-stay was higher in patients with lower levels of PNI and LMR (P=0.000 and P=0.003) and higher levels of NLR and PLR (P=0.001 and P=0.002). A PNI<42.87 predicted short-term mortality with a 66.7% of sensitivity and a 66.8% of specificity (P=0.000). CONCLUSIONS Our experience suggests that these inflammatory and nutritional biomarkers are independent predictors of short-term mortality and major amputations. In addition, our results suggest that PNI could be used to predict the short-term mortality with high sensitivity and specificity.
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Affiliation(s)
- Elena García-Rivera
- Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| | - Enrique M San Norberto
- Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain -
| | - Liliana Fidalgo-Domingos
- Department of Angiology and Vascular Surgery, Centor Hospitalar Universitario do Algarve, Faro, Portugal
| | - Álvaro Revilla-Calavia
- Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| | | | - Noelia Cenizo-Revuelta
- Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| | - Miguel Martín-Pedrosa
- Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| | - Carlos Vaquero-Puerta
- Department of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
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Taurino M, Aloisi F, Del Porto F, Nespola M, Dezi T, Pranteda C, Rizzo L, Sirignano P. Neutrophil-to-Lymphocyte Ratio Could Predict Outcome in Patients Presenting with Acute Limb Ischemia. J Clin Med 2021; 10:jcm10194343. [PMID: 34640361 PMCID: PMC8509804 DOI: 10.3390/jcm10194343] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Acute limb ischemia (ALI), classified according to Rutherford’s classification (RC), is a vascular emergency burdened by high rates of mortality and morbidity. The need of new and different prognostic values for ALI has emerged, and, among all, the neutrophil-to-lymphocyte ratio (NLR) has been proven as a strong outcome predictor in vascular disease. The aim of this study is to investigate the role of preoperative NLR in predicting clinical outcomes in patients presenting acute limb ischemia. Material and Methods: A single-center retrospective study was conducted between January 2015 and December 2019. Demographic and clinical characteristics, procedural technical aspects, postoperative and early (up to 30-day) outcomes were recorded. All enrolled patients were categorized into low- and high-NLR at baseline, using a cut-off value of 5. Study outcomes were 30-day all-cause mortality and amputation rates. Results: A total of 177 ALI patients were included in the final analysis (6 RC I, 44 RC IIA, 108 RC IIB, and 19 RC III), 115 males (65%), mean age 78.9 ± 10.4 years. Mean NLR at hospital presentation was 6.65 ± 6.75 (range 0.5–35.4), 108 (61.1%) patients presented a low-NLR, 69 (38.9%) a high-NLR. Immediate technical success was achieved in 90.1% of cases. At 30 days, freedom from amputation and freedom from death rates were 87.1% and 83.6%, respectively. At the univariate analysis, amputation (p < 0.0001, OR: 9.65, 95%CI: 3.7–25.19), mortality (p = 0.0001, OR: 9.88, 95%CI: 3.19–30.57), and cumulative event rates (p < 0.001, OR: 14.45, 95%CI: 6.1–34.21), were significantly different between the two groups according to NLR value. Multivariate analysis showed that a high baseline NLR value was an independent predictor of unfavorable outcomes in all enrolled patients. Consistently, at ROC analysis, a preoperative NLR > 5 was strongly associated with all outcome occurrences. Conclusion: Preoperative NLR value seems to be strongly related to ALI outcomes in this unselected population. The largest series should be evaluated to confirm present results.
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Affiliation(s)
- Maurizio Taurino
- Vascular Surgery Unit, Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa, 1035/1039, 00189 Rome, Italy; (M.T.); (M.N.); (T.D.); (C.P.); (L.R.)
| | - Francesco Aloisi
- Vascular Surgery Unit, Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa, 1035/1039, 00189 Rome, Italy; (M.T.); (M.N.); (T.D.); (C.P.); (L.R.)
- Correspondence:
| | - Flavia Del Porto
- Internal Medicine Unit, Department of Surgery “Paride Stefanini”, Sant’Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa, 1035/1039, 00189 Rome, Italy;
| | - Martina Nespola
- Vascular Surgery Unit, Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa, 1035/1039, 00189 Rome, Italy; (M.T.); (M.N.); (T.D.); (C.P.); (L.R.)
| | - Tommaso Dezi
- Vascular Surgery Unit, Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa, 1035/1039, 00189 Rome, Italy; (M.T.); (M.N.); (T.D.); (C.P.); (L.R.)
| | - Chiara Pranteda
- Vascular Surgery Unit, Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa, 1035/1039, 00189 Rome, Italy; (M.T.); (M.N.); (T.D.); (C.P.); (L.R.)
| | - Luigi Rizzo
- Vascular Surgery Unit, Department of Molecular and Clinical Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa, 1035/1039, 00189 Rome, Italy; (M.T.); (M.N.); (T.D.); (C.P.); (L.R.)
| | - Pasqualino Sirignano
- Vascular Surgery Unit, Department of Surgery “Paride Stefanini”, Sant’Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa, 1035/1039, 00189 Rome, Italy;
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Bedel C, Korkut M, Armağan HH. Comment on ''Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)?''. ACTA ACUST UNITED AC 2021; 67Suppl 1:168-169. [PMID: 34259771 DOI: 10.1590/1806-9282.67.suppl1.20200812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Cihan Bedel
- Unıversıty of Health Scıences, Antalya Training and Research Hospital Physician, Department of Emergency Medicine - Antalya, Turkey
| | - Mustafa Korkut
- Unıversıty of Health Scıences, Antalya Training and Research Hospital Physician, Department of Emergency Medicine - Antalya, Turkey
| | - Hamit Hakan Armağan
- Suleyman Demirel University, Faculty of Medicine, Department of Emergency Medicine - Isparta, Turkey
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Yeh H, Gao SY, Lin CC. Wound Infections from Taiwan Cobra ( Naja atra) Bites: Determining Bacteriology, Antibiotic Susceptibility, and the Use of Antibiotics-A Cobra BITE Study. Toxins (Basel) 2021; 13:toxins13030183. [PMID: 33801318 PMCID: PMC7999477 DOI: 10.3390/toxins13030183] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 02/04/2023] Open
Abstract
Wound necrosis and secondary infection are common complications after Naja atra bites. Clinical tools to evaluate the infection risk after Taiwan cobra bites are lacking. In this Cobra BITE study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with Taiwan cobra snakebites. Patients with wound infection lacking tissue necrosis were included in developing Cobra BITE score utilizing univariate and multiple logistic regression, as patients with wound necrosis require antibiotics for infection treatment. 8,295,497 emergency department visits occurred in the span of this study, with 195 of those patients being diagnosed as having cobra bites. Of these patients, 23 had wound necrosis, and 30 had wound infection, resulting in a wound infection rate of 27.2% (53/195). Enterococcus faecalis and Morganella morganii were the main bacteria identified in the culture report regardless of whether patients’ wounds had necrosis. As per our Cobra BITE score, the three factors predicting secondary wound infection after cobra bites are hospital admission, a white blood cell count (in 103/µL) × by neu-trophil-lymphocyte ratio value of ≥114.23, and the use of antivenin medication. The area under the receiver operating characteristic curve for the Cobra BITE score system was 0.88; ideal sensitivity and specificity were 0.89 and 0.76. This scoring system enables the assessment of wound infections after N. atra bites, and it could be modified and improved in the future for other Naja spp. bites.
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Affiliation(s)
- Heng Yeh
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (H.Y.); (S.-Y.G.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shi-Ying Gao
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (H.Y.); (S.-Y.G.)
| | - Chih-Chuan Lin
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (H.Y.); (S.-Y.G.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence:
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21
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Engin M. Admission Time and Surgical Technique are Important in Aortic Dissection Treatment Results. Braz J Cardiovasc Surg 2020; 35:849-850. [PMID: 33118756 PMCID: PMC7598989 DOI: 10.21470/1678-9741-2020-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mesut Engin
- University of Health Sciences Mehmet Akif İnan Training and Research Hospital Department of Cardiovascular Surgery Şanlıurfa Turkey Department of Cardiovascular Surgery, University of Health Sciences, Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey.
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Kim MS, Oh DJ. Monocyte counts are negatively associated with ankle-brachial index values in non-dialysis-dependent chronic kidney disease patients. Ren Fail 2020; 42:740-747. [PMID: 32718214 PMCID: PMC7470144 DOI: 10.1080/0886022x.2020.1796704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Our aim was to determine which leukocyte subtypes are most relevant to ankle-brachial index (ABI) values in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). The study included 79 NDD-CKD patients aged 62.84 ± 12.09 years (63.33% men; 26.67% patients with diabetes) and 21 age-matched normal controls. According to the estimated glomerular filtration rate (eGFR) calculated by the CKD-Epidemiology Collaboration equation (CKD-EPI), we classified the study population into 2 groups (21 subjects with NDD-CKD with an eGFR 60–89 mL/min/1.73m2, 58 subjects with NDD-CKD with eGFR <60 mL/min/1.73 m2). ABI was calculated as the ratio of the ankle systolic BP divided by the arm systolic BP using an ABI-form device. An automated hematologic analyzer was used to measure total and differential leukocyte counts. Monocyte counts and monocyte-to-total leukocyte count ratios (MTR) in patients with an ABI value <1.10 were significantly higher than those in patients with an ABI value ≥1.10, respectively. Univariate analyses revealed that mean ABI values were negatively correlated with monocyte count (r= −0.341; p = 0.044), MTR (r= −0.346, p = 0.031). Multivariate linear regression analyses showed that monocyte count was negatively associated with ABI values (β ± SE = −1.825 ± 0.341, p = 0.013). The area under the curve of monocyte counts was 0.695 (95% confidence interval 0.586–0.804, p = 0.002) in predicting an ABI value <1.10. Monocyte counts are negatively associated with ABI values in patients with NDD-CKD without apparent peripheral arterial occlusive disorder (PAOD).
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Affiliation(s)
- Myung Sung Kim
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Dong-Jin Oh
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
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Platelet-to-lymphocyte and Neutrophil-to-lymphocyte Ratios Predict Target Vessel Restenosis after Infrainguinal Angioplasty with Stent Implantation. J Clin Med 2020; 9:jcm9061729. [PMID: 32503291 PMCID: PMC7355944 DOI: 10.3390/jcm9061729] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 01/03/2023] Open
Abstract
Platelet-to-lymphocyte (PLR), neutrophil-to-lymphocyte (NLR) and lymphocyte-to-monocyte (LMR) ratios are associated with the occurrence of critical limb ischemia in peripheral artery disease (PAD). We therefore investigated whether PLR, NLR or LMR are linked to target vessel restenosis (TVR) following infrainguinal angioplasty and stenting. Moreover, we studied on-treatment platelet reactivity and neutrophil-platelet aggregate (NPA) formation as potential underlying mechanisms. Platelet, neutrophil, lymphocyte and monocyte counts were determined one day after angioplasty and stenting in 95 stable PAD patients. Platelet reactivity and NPA formation in response to protease-activated receptor−1 stimulation were measured by light transmission aggregometry (LTA) and flow cytometry, respectively. PLR and NLR were significantly higher in patients who subsequently developed TVR (both p < 0.05). In contrast, LMR did not differ significantly between patients without and with TVR (p = 0.28). A PLR ≥ 91 and NLR ≥2.75 were identified as the best thresholds to predict TVR, providing sensitivities of 87.5% and 81.3%, and specificities of 34.9% and 50.8%, respectively, and were therefore defined as high PLR and high NLR. TVR occurred significantly more often in patients with high PLR and high NLR than in those with lower ratios (both p < 0.05). Patients with high PLR and high NLR exhibited significantly increased on-treatment platelet aggregation compared to those with lower ratios, and patients with high PLR had higher levels of NPA formation (all p < 0.01). In conclusion, PLR and NLR predict TVR after infrainguinal angioplasty with stent implantation. Platelet activation and neutrophil-platelet interaction may be involved in the underlying pathomechanisms
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Celebi S, Berkalp B, Amasyali B. The association between thrombotic and inflammatory biomarkers and lower-extremity peripheral artery disease. Int Wound J 2020; 17:1346-1355. [PMID: 32445291 DOI: 10.1111/iwj.13407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 12/26/2022] Open
Abstract
Lower-extremity peripheral artery disease (LEAD) is associated with increased rates of mortality and morbidity. The aim of this study was to evaluate the associations among inflammatory and thrombotic markers and lower-extremity peripheral disease. A total of 280 patients were enrolled in this study. Of these patients, 152 patients had LEAD on peripheral angiography that was performed because of suspected lower-extremity peripheral disease based on history, physical examination, and non-invasive tests. The control group consisted of 128 patients without LEAD on peripheral angiography. Patients with LEAD were classified according to trans-atlantic inter-society consensus (TASC) II classification. Subsequently, patients in TASC A to B were defined as having mild to moderate peripheral artery disease, and those in TASC C to D were defined as having advanced peripheral artery disease. Thrombotic and inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), the high-sensitivity C (hs-C) reactive protein level, the monocyte-to-high-density lipoprotein-cholesterol ratio, the fibrinogen to albumin ratio (FAR), and whole-blood viscosity at high shear rate (HSR) and low shear rate (LSR), were evaluated in this population. The NLR, the monocyte-to-high-density lipoprotein-cholesterol ratio, the FAR, and whole-blood viscosity, both at a LSR and a HSR, were significantly higher in patients with lower-extremity peripheral disease compared with patients without lower-extremity peripheral disease. We determined that lower-extremity peripheral disease severity was correlated with the NLR, monocyte-to-high-density lipoprotein-cholesterol ratio, FAR, whole-blood viscosity at LSR, and whole-blood viscosity at HSR (r = 0.719, P = .004; r = 0.25, P = .008; r = 0.691, P = .002; r = 0.546, P < .001; and r = 0.448, P = .001, respectively). However hs-C reactive protein levels were similar between patients with or without LEAD (2.47 ± 1.32 1.61 ± 0.91 P = .685). In addition, there was no correlation between the severity of LEAD and hs-C reactive levels. In this study, we determined that the levels of inflammatory and thrombotic biomarkers are elevated in peripheral artery disease, and these levels predict disease severity.
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Affiliation(s)
- Savas Celebi
- Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey
| | - Berkten Berkalp
- Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey
| | - Basri Amasyali
- Department of Cardiology, TOBB Economics and Technology University Medical School, Ankara, Turkey
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Guetl K, Raggam RB, Muster V, Gressenberger P, Vujic J, Avian A, Hafner F, Wehrschuetz M, Brodmann M, Gary T. The White Blood Cell Count to Mean Platelet Volume Ratio for the Prediction of Chronic Limb-Threatening Ischemia in Lower Extremity Artery Disease. J Clin Med 2019; 8:jcm8101593. [PMID: 31581728 PMCID: PMC6832925 DOI: 10.3390/jcm8101593] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/19/2019] [Accepted: 09/27/2019] [Indexed: 01/22/2023] Open
Abstract
Background: The white blood cell count to mean platelet volume ratio (WMR) is increasingly gaining importance as a promising prognostic marker in atherosclerotic disease, but data on lower extremity artery disease (LEAD) are not yet available. The principle aim of this study was to assess the association of the WMR with the occurrence of CLTI (chronic limb-threatening ischemia) as the most advanced stage of disease. Methods: This study was performed as a retrospective analysis on 2121 patients with a diagnosis of LEAD. Patients were admitted to the hospital for the reason of LEAD and received conservative or endovascular treatment. Blood sampling, in order to obtain the required values for this analysis, was implemented at admission. Statistical analysis was conducted by univariate regression in a first step and, in case of significance, by multivariate regression additionally. Results: Multivariate regression revealed an increased WMR (p < 0.001, OR (95%CI) 2.258 (1.460–3.492)), but also advanced age (p < 0.001, OR (95%CI) 1.050 (1.040–1.061)), increased CRP (p < 0.001, OR (95%CI) 1.010 (1.007–1.014)), and diabetes (p < 0.001, OR (95%CI) 2.386 (1.933–2.946)) as independent predictors for CLTI. Conclusions: The WMR presents an easily obtainable and cost-effective parameter to identify LEAD patients at high risk for CLTI.
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Affiliation(s)
- Katharina Guetl
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Reinhard Bernd Raggam
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Viktoria Muster
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Paul Gressenberger
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Jovan Vujic
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria.
| | - Franz Hafner
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Martin Wehrschuetz
- Department of Radiology, Medical University of Graz, 8036 Graz, Austria.
| | - Marianne Brodmann
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Thomas Gary
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
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Mizobuchi K, Jujo K, Minami Y, Ishida I, Nakao M, Hagiwara N. The Baseline Nutritional Status Predicts Long-Term Mortality in Patients Undergoing Endovascular Therapy. Nutrients 2019; 11:nu11081745. [PMID: 31362417 PMCID: PMC6722841 DOI: 10.3390/nu11081745] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: Peripheral artery disease (PAD) occurs at an advanced stage of atherosclerosis and its comorbidities are associated with poor prognoses. Malnutrition is related to the severity of atherosclerosis in patients with cardiovascular disease and it predicts mortality. The Controlling Nutritional Status (CONUT) score is calculated from serum albumin concentration, peripheral lymphocyte count and total cholesterol concentration, and it robustly represents the nutritional status of hospitalized patients. This study aimed to determine the prognostic value of the CONUT score in patients with peripheral artery disease (PAD) who were undergoing endovascular therapy (EVT). METHODS and RESULTS: This study included 628 PAD patients who underwent EVT between 2013 and 2017 and were assigned to low (CONUT score 0: n = 81), mild (CONUT score 1–2: n = 250), moderate (CONUT score 3–4: n = 169), and high (CONUT score ≥ 5: n = 128) risk groups. The study’s primary endpoint was any death. Patients in the groups with higher CONUT scores were more likely to have chronic kidney disease (p < 0.001), impaired left ventricular ejection fractions (p < 0.001), and critical limb ischemia (p < 0.001) on admission. During follow-up, 95 patients (15%) died. Kaplan–Meier analyses revealed that the patients with higher CONUT scores had lower survival rates (p < 0.001; log-rank trend test). Multivariate Cox regression analyses showed that following adjustments for the confounding factors, a higher CONUT score was significantly associated with any death (hazard ratio, 1.15; 95% confidence interval, 1.03–1.30). CONCLUSION: The simple index CONUT score at the time of EVT may predict long-term mortality in PAD patients.
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Affiliation(s)
- Keiko Mizobuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University, Tokyo 162-8666, Japan.
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Issei Ishida
- Department of Cardiology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Masashi Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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Suárez-Cuenca JA, Ruíz-Hernández AS, Mendoza-Castañeda AA, Domínguez-Pérez GA, Hernández-Patricio A, Vera-Gómez E, De la Peña-Sosa G, Banderas-Lares DZ, Montoya-Ramírez J, Blas-Azotla R, Ortíz-Fernández M, Salamanca-García M, Melchor-López A, Mondragón-Terán P, Contreras-Ramos A, Alcaráz-Estrada SL. Neutrophil-to-lymphocyte ratio and its relation with pro-inflammatory mediators, visceral adiposity and carotid intima-media thickness in population with obesity. Eur J Clin Invest 2019; 49:e13085. [PMID: 30740673 DOI: 10.1111/eci.13085] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 02/03/2019] [Accepted: 02/07/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Atherosclerosis represents a cardiovascular risk. Chronic inflammation is a key factor for atherogenic progression. Neutrophil-to-lymphocyte ratio (NLR) has been proposed as a novel biomarker for cardiovascular risks. We aimed to explore whether NLR was related to surrogate pro-atherogenic promoters driving atherogenic progression, as measured by carotid intima-media thickness (CIMT). STUDY DESIGN Thirty-one patients with obesity candidates for bariatric surgery were recruited from Centro Médico Nacional "20 de Noviembre", ISSSTE, Mexico City. The results are part of the "CROP" study (NCT03561987). NLR was calculated from routine complete blood count, and its relation with plasma pro-inflammatory mediators (hsCRP, TNF-α and IL-1β), adipokines (adiponectin and leptin), adiposity markers (visceral adipose tissue [VAT] determined from CT scan image and VAT individual adipocyte area at histological sample) and CIMT were determined. RESULTS Neutrophil-to-lymphocyte ratio correlated with hsCRP (Spearman's r = 0.70 [95% CI 0.46 to 0.85], P < 0.01), TNF-α (r = 0.69 [0.44 to 0.84], P < 0.0001) and adiponectin (r = -0.69 [-0.84 to -0.45], P < 0.03), as well as with VAT individual adipocyte area (r = 0.64 [0.37 to 0.81], P < 0.0001) and with VAT area (r = 0.43; [0.07 to 0.68], P < 0.01). Leptin and adiponectin showed further independent association with higher NLR (multivariate regression analysis OR 7.9 [95% CI 1.1 to 56.2] P = 0.03 and 0.1 [0.01 to 1.0] P = 0.05, respectively). Moreover, NLR distribution significantly varied between subgroups divided according to progressive CIMT (P = 0.05); whereas adiponectin and VAT adipocyte area associated with CIMT > 0.9 mm (univariate analysis OR 0.1 [0.01 to 1.0] P = 0.05 and 13.1 [1.4 to 126.3] P = 0.03, respectively). CONCLUSION Neutrophil-to-lymphocyte ratio was related to pro-inflammatory, adiposity biomarkers and progressive subclinical atherogenesis.
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Affiliation(s)
- Juan Antonio Suárez-Cuenca
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico.,Internal Medicine Department, Hospital General de Xoco, SEDESA, Mexico City, Mexico.,Internal Medicine Department, Hospital General de Zona No. 58, IMSS, State of Mexico, Mexico
| | - Atzin S Ruíz-Hernández
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Ana A Mendoza-Castañeda
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Gabriela A Domínguez-Pérez
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Alejandro Hernández-Patricio
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Eduardo Vera-Gómez
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Gustavo De la Peña-Sosa
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Diana Z Banderas-Lares
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Jesus Montoya-Ramírez
- Bariatric Surgery Department, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Ricardo Blas-Azotla
- Bariatric Surgery Department, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Moises Ortíz-Fernández
- Bariatric Surgery Department, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Moises Salamanca-García
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Alberto Melchor-López
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico.,Internal Medicine Department, Hospital General de Xoco, SEDESA, Mexico City, Mexico.,Internal Medicine Department, Hospital General de Zona No. 58, IMSS, State of Mexico, Mexico
| | - Paul Mondragón-Terán
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
| | - Alejandra Contreras-Ramos
- Laboratorio de Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México "Federico Gómez", Mexico City, Mexico
| | - Sofia L Alcaráz-Estrada
- Division of Biomedical Research, Department of Experimental Metabolism and Clinical Research, Centro Médico Nacional "20 de Noviembre", Mexico City, Mexico
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Chen H, Luan X, Zhao K, Qiu H, Liu Y, Tu X, Tang W, He J. The association between neutrophil-to-lymphocyte ratio and post-stroke depression. Clin Chim Acta 2018; 486:298-302. [PMID: 30130533 DOI: 10.1016/j.cca.2018.08.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/12/2018] [Accepted: 08/14/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-stroke depression (PSD) is the most common complication occurring among stroke survivors. It has been shown that increased neutrophil-to-lymphocyte ratio (NLR) is associated with depression. We explored the relationship between NLR and PSD. METHODS In total, 299 ischemic stroke patients were consecutively enrolled in the study and received 1 month follow-up. The 17-Hamilton Rating Scale was used to measure depressive symptoms at 1 month after stroke. With the Hamilton Depression Scale score of >7, parents were given the DSM-IV criteria for diagnosis of PSD. NLR was computered from the admission blood work. Meanwhile, the control group consisted of 180 healthy volunteers was also recruited. RESULTS Seventy-eight patients (26.1%) were diagnosed with PSD at 1 month. PSD patients showed significantly higher levels of NLRs at admission as compared to non-PSD patients as well as normal controls (P < .001). In the logistic analysis, taking NLR values (<3.701) a reference and PSD presence as a dependent variable, NLR values (≥3.70 l) were independently associated with the development of PSD (OR 4.038, 95% CI 2.174-7.500, p < .001). CONCLUSIONS Increased NLRs at admission are found to be correlated with PSD and may add prognostic information for the early discovery of PSD.
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Affiliation(s)
- Huijun Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Kai Zhao
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; First School of Clinical Medicine, Wenzhou Medical University, Wenzhou 325000, China
| | - Huihua Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yuntao Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xinjie Tu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Wenjie Tang
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou 325000, China.
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis. Oncotarget 2018; 8:32171-32189. [PMID: 28418870 PMCID: PMC5458276 DOI: 10.18632/oncotarget.16291] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
Abstract
An accurate, time efficient, and inexpensive prognostic indicator is needed to reduce cost and assist with clinical decision making for cancer management. The neutrophil-to-lymphocyte ratio (NLR), which is derived from common serum testing, has been explored in a variety of cancers. We sought to determine its prognostic value in gastrointestinal cancers and performed a meta-analysis of published studies using the Meta-analysis Of Observational Studies in Epidemiology guidelines. Included were randomized control trials and observational studies that analyzed humans with gastrointestinal cancers that included NLR and hazard ratios (HR) with overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and/or cancer-specific survival (CSS). We analyzed 144 studies comprising 45,905 patients, two-thirds of which were published after 2014. The mean, median, and mode cutoffs for NLR reporting OS from multivariate models were 3.4, 3.0, 5.0 (±IQR 2.5-5.0), respectively. Overall, NLR greater than the cutoff was associated with a HR for OS of 1.63 (95% CI, 1.53-1.73; P < 0.001). This association was observed in all subgroups based on tumor site, stage, and geographic region. HR for elevated NLR for DFS, PFS, and CSS were 1.70 (95% CI, 1.52-1.91, P < 0.001), 1.64 (95% CI, 1.36-1.97, P < 0.001), and 1.83 (95% CI, 1.50-2.23, P < 0.001), respectively. Available evidence suggests that NLR greater than the cutoff reduces OS, independent of geographic location, gastrointestinal cancer type, or stage of cancer. Furthermore, DFS, PFS, and CSS also have worse outcomes with elevated NLR.
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30
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Nam KW, Kwon HM, Jeong HY, Park JH, Kim SH, Jeong SM. High neutrophil to lymphocyte ratios predict intracranial atherosclerosis in a healthy population. Atherosclerosis 2018; 269:117-121. [PMID: 29353226 DOI: 10.1016/j.atherosclerosis.2017.12.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/06/2017] [Accepted: 12/20/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Although atherosclerosis has been shown to be an inflammatory disease, intracranial atherosclerosis (ICAS) has not been well addressed. The purpose of this study was to evaluate the relationship between the neutrophil to lymphocyte ratio (NLR) and the presence of ICAS lesions in a generally healthy population. METHODS A consecutive series of subjects, who voluntarily visited for health check-ups between January 2006 and December 2013, were selected. Brain magnetic resonance imaging, brain magnetic angiography (MRA), and blood cell count data were assessed. ICAS was defined as an occlusion or more than 50% stenosis of intracranial vessels, as observed on brain MRA images. NLR was calculated based on absolute neutrophil and lymphocyte counts. RESULTS A total of 2842 subjects were evaluated, and 76 ICAS cases were found. The median NLR was 1.52 [1.17-2.01]. In multivariate analysis, NLR remained an independent predictor of ICAS [adjusted OR (aOR) = 1.72, 95% confidence interval (CI) = 1.01-2.95, p = 0.048]. Age (aOR = 1.08, 95% CI = 1.05-1.11, p < 0.001) and hypertension (aOR = 1.81, 95% CI = 1.11-2.94, p = 0.017) were also significant factors for ICAS independent of NLR. Regarding ICAS burdens, NLR was significantly higher when the number of ICAS lesions (p = 0.017) or occlusive ICAS lesions (p = 0.005) was increased in a dose-response manner. CONCLUSIONS A high NLR was associated with both prevalence and burdens of ICAS in a healthy population.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
| | - Han-Yeong Jeong
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea.
| | - Sang Hyuck Kim
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
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31
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High neutrophil to lymphocyte ratio is associated with white matter hyperintensity in a healthy population. J Neurol Sci 2017; 380:128-131. [DOI: 10.1016/j.jns.2017.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/22/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022]
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32
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Neutrophil-To-Lymphocyte Ratio Predicts 3-Month Outcome of Acute Ischemic Stroke. Neurotox Res 2017; 31:444-452. [PMID: 28181171 DOI: 10.1007/s12640-017-9707-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
Increasing evidences have demonstrated that inflammation is involved in the mechanisms of acute ischemic stroke (AIS). As an important and easy-to-measure inflammatory marker, neutrophil-to-lymphocyte ratio (NLR) shows a high association with mortality in patients with stroke in recent studies. In this study, we evaluated the prognostic role of NLR in patients with AIS. One hundred forty-three patients with AIS were enrolled. Clinical data were collected and the NLR was calculated from the admission blood work. The patients were followed up for 3 months after stroke onset. The occurrence of death and the major disability at 3 months after onset were end points in this study. Modified Rankin Scale score ≥3 was considered as poor outcome. In this study, 75 patients (52%) had poor outcome. We used binary logistic regression model to evaluate risk factor for poor outcome of AIS and found that the NLR was independently associated with the poor outcome of 3 months (P < 0.001). The optimal cutoff value for NLR as a predictor for 3-month outcome was 2.995. Therefore, in our study, high NLRs inversely predicted 3-month outcome in patients with AIS.
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Vatankhah N, Jahangiri Y, Landry GJ, McLafferty RB, Alkayed NJ, Moneta GL, Azarbal AF. Predictive value of neutrophil-to-lymphocyte ratio in diabetic wound healing. J Vasc Surg 2016; 65:478-483. [PMID: 27887858 DOI: 10.1016/j.jvs.2016.08.108] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The neutrophil-to-lymphocyte ratio (NLR) has been used as a surrogate marker of systemic inflammation. We sought to investigate the association between NLR and wound healing in diabetic wounds. METHODS The outcomes of 120 diabetic foot ulcers in 101 patients referred from August 2011 to December 2014 were examined retrospectively. Demographic, patient-specific, and wound-specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing, minor amputation, major amputation, and chronic ulcer. RESULTS The subjects' mean age was 59.4 ± 13.0 years, and 67 (66%) were male. Final outcome was complete healing in 24 ulcers (20%), minor amputation in 58 (48%) and major amputation in 16 (13%), and 22 chronic ulcers (18%) at the last follow-up (median follow-up time, 6.8 months). In multivariate analysis, higher NLR (odds ratio, 13.61; P = .01) was associated with higher odds of nonhealing. CONCLUSIONS NLR can predict odds of complete healing in diabetic foot ulcers independent of wound infection and other factors.
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Affiliation(s)
- Nasibeh Vatankhah
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore.
| | - Younes Jahangiri
- Dotter Interventional Institute, Oregon Health & Science University, Portland, Ore
| | - Gregory J Landry
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Robert B McLafferty
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Nabil J Alkayed
- Department of Anesthesiology and Perioperative Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Gregory L Moneta
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Amir F Azarbal
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
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Teperman J, Carruthers D, Guo Y, Barnett MP, Harris AA, Sedlis SP, Pillinger M, Babaev A, Staniloae C, Attubato M, Shah B. Relationship between neutrophil-lymphocyte ratio and severity of lower extremity peripheral artery disease. Int J Cardiol 2016; 228:201-204. [PMID: 27865186 DOI: 10.1016/j.ijcard.2016.11.097] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/06/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of this study was to determine the association between neutrophil-lymphocyte ratio (NLR) and severity of lower extremity peripheral artery disease (PAD). METHODS A retrospective chart review identified 928 patients referred for peripheral angiography. NLR was assessed from routine pre-procedural hemograms with automated differentials and available in 733 patients. Outcomes of interest were extent of disease on peripheral angiography and target vessel revascularization. Median follow-up was 10.4months. Odds ratio (OR) [95% confidence intervals] was assessed using a logistic regression model. RESULTS There was a significant association between elevated NLR and presence of severe multi-level PAD versus isolated suprapopliteal or isolated infrapopliteal disease (OR 1.11 [1.03-1.19], p=0.007). This association remained significant even after adjustment for age (OR 1.09 [1.01-1.17], p=0.02); age, sex, race, and body mass index (OR 1.08 [1.00-1.16], p=0.046); and age, sex, race, body mass index, hypertension, diabetes mellitus, coronary artery disease, and creatinine (OR 1.07 [1.00-1.15], p=0.049). After additional adjustment for clinical presentation, there was a trend towards association between NLR and severe multi-level PAD (OR 1.07 [1.00-1.15], p=0.056), likely limited by sample size. In patients who underwent endovascular intervention (n=523), there was no significant difference in rate of target vessel revascularization across tertiles of NLR (1st tertile 14.8%, 2nd tertile 14.1%, 3rd tertile 20.1%; p=0.32). CONCLUSION In a contemporary cohort of patients undergoing peripheral angiography with possible endovascular intervention, elevated NLR was independently associated with severe multi-level PAD. Larger studies evaluating the association between this inexpensive biomarker and clinical outcomes are warranted.
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Affiliation(s)
- Jacob Teperman
- Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - David Carruthers
- Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Yu Guo
- Department of Population Health, Division of Biostatistics, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Mallory P Barnett
- Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Adam A Harris
- Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Steven P Sedlis
- Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA; Department of Medicine, Section of Cardiology, VA New York Harbor Health Care Center, 423 E 23rd St, New York, NY 10010, USA
| | - Michael Pillinger
- Department of Medicine, Section of Rheumatology, VA New York Harbor Health Care Center, 423 E 23rd St, New York, NY 10010, USA; Department of Medicine, Division of Rheumatology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Anvar Babaev
- Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Cezar Staniloae
- Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Michael Attubato
- Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Binita Shah
- Department of Medicine, Division of Cardiology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA; Department of Medicine, Section of Cardiology, VA New York Harbor Health Care Center, 423 E 23rd St, New York, NY 10010, USA.
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Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, Iyisoy A. The Relation Between Atherosclerosis and the Neutrophil–Lymphocyte Ratio. Clin Appl Thromb Hemost 2016; 22:405-411. [DOI: 10.1177/1076029615569568] [Citation(s) in RCA: 229] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Inflammation plays an important role in the pathophysiology of vascular disease. In this review, we consider the associations between the neutrophil–lymphocyte ratio (NLR; an indicator of inflammation) and vascular disease and its associated risk factors. The NLR has received attention due to its role as an independent prognostic factor for coronary artery disease. The NLR can also be affected by atherosclerotic risk factors, such as hypercholesterolemia, metabolic syndrome, diabetes, and hypertension. Importantly, it can predict mortality in cardiovascular diseases. There are also reports of a positive correlation between the NLR and commonly used inflammatory markers. Inflammation is important not only in pathophysiology but also clinical outcomes of many diseases. The NLR is a widely available, easily derived, and reproducible marker of inflammation. Unlike many other inflammatory markers, the NLR is inexpensive and readily available and it provides additional risk stratification beyond conventional risk scores.
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Affiliation(s)
- Sevket Balta
- Department of Cardiology, Eskisehir Military Hospital, Eskişehir, Turkey
| | - Turgay Celik
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, University College London Medical School London, University College London (UCL), London, England
| | - Cengiz Ozturk
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Mustafa Aparci
- Department of Cardiology, Etimesgut Military Hospital, Ankara, Turkey
| | - Atila Iyisoy
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
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Rief P, Pichler M, Raggam R, Hafner F, Gerger A, Eller P, Brodmann M, Gary T. The AST/ALT (De-Ritis) ratio: A novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. Medicine (Baltimore) 2016; 95:e3843. [PMID: 27310963 PMCID: PMC4998449 DOI: 10.1097/md.0000000000003843] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The aspartat aminotransferase (AST)/alanin aminotransferase (ALT) (De-Ritis) ratio (AAR) is an easily applicable blood test. An elevated AAR on the one hand has been associated with an increase in nonalcoholic fatty liver disease (NAFLD). NAFLD on the other hand is associated with an increase in cardiovascular disease, all-cause mortality, and diabetes. As the AAR is also elevated in case of muscular damage, we investigated AAR and its association with critical limb ischemia (CLI) in peripheral arterial occlusive disease (PAOD) patients.In our cross-sectional study, we included 1782 PAOD patients treated at our institution from 2005 to 2010. Patients with chronic alcohol consumption (>20 g/day) were excluded. AAR was calculated and the cohort was categorized into tertiles according to the AAR. An optimal cut-off value for the continuous AAR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI.In our cohort, occurrence of CLI significantly increased with an elevation in AAR. As an optimal cut-off value, an AAR of 1.67 (sensitivity 34.1%, specificity 81.0%) was identified. Two groups were categorized, 1st group containing 1385 patients (AAR < 1.67) and a 2nd group with 397 patients (AAR > 1.67). CLI was more frequent in AAR > 1.67 patients (166 [41.9%]) compared to AAR < 1.67 patients (329 [23.8%]) (P < 0.001), as was prior myocardial infarction (28 [7.1%] vs 54 [3.9%], P = 0.01). Regarding inflammatory parameters, C-reactive protein (median 8.1 mg/L [2.9-28.23] vs median 4.3 mg/L [2.0-11.5]) and fibrinogen (median 427.5 mg/dL [344.25-530.0] vs 388.0 mg/dL [327.0-493.0]) also significantly differed in the 2 patient groups (both P < 0.001). Finally, an AAR > 1.67 was associated with an odds ratio (OR) of 2.0 (95% confidence interval [CI] 1.7-2.3) for CLI even after adjustment for other well-established vascular risk factors.An increased AAR is significantly associated with patients at high risk for CLI and other cardiovascular endpoints. The AAR is a broadly available and cheap marker, which might be useful to highlight patients at high risk for vascular endpoints.
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Affiliation(s)
| | | | | | | | | | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University Graz, Graz, Austria
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Paquissi FC. The role of inflammation in cardiovascular diseases: the predictive value of neutrophil-lymphocyte ratio as a marker in peripheral arterial disease. Ther Clin Risk Manag 2016; 12:851-60. [PMID: 27313459 PMCID: PMC4892833 DOI: 10.2147/tcrm.s107635] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peripheral arterial disease (PAD) is an important manifestation of atherosclerosis, with increasing prevalence worldwide. A growing body of evidence shows that the systemic inflammatory response is closely related to the development, progression, and prognosis of atherosclerosis. In the last decade, several studies have suggested the role of measured inflammatory biomarkers as predictors of severity and prognosis in PAD in an effort to stratify the risk of these patients, to improve treatment selection, and to predict the results after interventions. A simple inflammatory marker, more available than any other, is the neutrophil-lymphocyte ratio (NLR), which can be easily obtained in clinical practice, based on the absolute count of neutrophils and lymphocytes from the differential leukocytes count. Many researchers evaluated vigorously the NLR as a potential prognostic biomarker predicting pathological and survival outcomes in patients with atherosclerosis. In this work, we aim to present the role of NLR as a prognostic marker in patients with PAD through a thorough review of the literature.
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Bhat TM, Afari ME, Garcia LA. Neutrophil lymphocyte ratio in peripheral vascular disease: a review. Expert Rev Cardiovasc Ther 2016; 14:871-5. [DOI: 10.1586/14779072.2016.1165091] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chen SC, Lee MY, Huang JC, Tsai YC, Mai HC, Su HM, Chang JM, Chen HC. Platelet to Lymphocyte Percentage Ratio Is Associated With Brachial-Ankle Pulse Wave Velocity in Hemodialysis. Medicine (Baltimore) 2016; 95:e2727. [PMID: 26871812 PMCID: PMC4753908 DOI: 10.1097/md.0000000000002727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Increased arterial stiffness in patients receiving hemodialysis (HD) is highly prevalent and is associated with cardiovascular morbidity and mortality. In HD, inflammation is one of the major causes of increased arterial stiffness. Activation of platelets and decreased lymphocyte percentage (LYMPH%) may exhibit inflammation. The aim of this study is to examine the relationship between platelet to LYMPH% ratio and arterial stiffness in HD patients.A total of 220 patients receiving HD were enrolled in this study. The brachial-ankle pulse wave velocity (baPWV) was measured using an ankle-brachial index form device. Multivariate linear regression analysis was performed to investigate the relations of the platelet to LYMPH% ratio and baPWV. The value of the platelet to LYMPH% ratio was 59.2 ± 33.3 (10 cells/L/%). After multivariate stepwise analysis, diabetes (β: 163.973, P = 0.02), high systolic blood pressure (per 1 mm Hg, β: 9.010, P < 0.001), high platelet to LYMPH% ratio (per 10 cells/L/%, β: 3.334, P < 0.01), and low albumin (per 0.1 mg/dL, β: -55.912, P < 0.001) were independently associated with an increased baPWV. Furthermore, high white blood cells (per 10 cells/L, β: 3.941, P < 0.001), high neutrophil percentage (per 1%, β: 1.144, P < 0.001), and high CRP (per 1 mg/L, β: 9.161, P = 0.03) were independently associated with an increased platelet to LYMPH% ratio.An increased platelet to LYMPH% ratio is associated with an increased baPWV in HD patients. An easy and inexpensive laboratory measure of platelet to LYMPH% ratio may provide an important information regarding arterial stiffness in patients with HD.
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Affiliation(s)
- Szu-Chia Chen
- From the Graduate Institute of Clinical Medicine, College of Medicine (S-CC, M-YL, J-CH, Y-CT); Division of Nephrology (S-CC, J-CH, Y-CT, J-MC, H-CC); Division of Cardiology (H-MS); Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital (M-YL); Department of Internal Medicine (S-CC, M-YL, J-CH, H-MS); Department of Nursing, Kaohsiung Municipal Hsiao-Kang Hospital (H-CM); and Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (S-CC, Y-CT, H-MS, J-MC, H-CC)
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Aykan AÇ, Hatem E, Kalaycıoğlu E, Karabay CY, Zehir R, Gökdeniz T, Altıntaş Aykan D, Çelik Ş. Neutrophil-to-lymphocyte ratio may be a marker of peripheral artery disease complexity. Anatol J Cardiol 2015; 16:497-503. [PMID: 27004700 PMCID: PMC5331397 DOI: 10.5152/anatoljcardiol.2015.6240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between peripheral artery disease (PAD) severity and complexity, as evaluated by TransAtlantic Inter-Society Consensus-II (TASC-II) classification, and neutrophil-to-lymphocyte (N/L) ratio. METHODS A total of 407 patients underwent peripheral angiography due to signs and symptoms of PAD; of these, 64 patients were excluded and the remaining 343 patients were WARFARIN in this cross-sectional study. Patients with previous peripheral revascularizations, acute coronary syndrome, vasculitis, non-atherosclerotic stenosis, and malignancy were excluded. Patients were divided into 4 groups according to TASC-II classification, and clinical and laboratory data were compared. The chi-square test, Student's t-test, Mann-Whitney U test, analysis of variance, Kruskal-Wallis test, Spearman's correlation analysis, multiple logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. RESULTS Lymphocyte count was weakly correlated (r=-0.169, p=0.002) whereas neutrophil count and N/L ratio were moderately correlated with the TASC score (r=0.432, p<0.001 and r=0.470, p<0.001, respectively). Low-density lipoprotein cholesterol [odds ratio (OR)=1.010, 95% confidence interval (CI) 95%=1.003-1.017, p=0.004], high-density lipoprotein cholesterol (OR=0.940, 95% CI=0.894-0.987, p=0.013), and N/L ratio (OR=1.914, 95% CI=1.515-2.418, p<0.001) were the independent factors for predicting a higher TASC class in multiple logistic regression analysis. The cut-off value of the N/L ratio for predicting TASC C&D class was >3.05 (sensitivity=75.0%, specificity=62.9%, area under the curve=0.678, 95% CI=0.688-0.784, p<0.001) in ROC curve analysis. CONCLUSION The N/L ratio, a marker of inflammation, may be an important predictor of PAD complexity. Therefore, a simple blood count test may provide an important clue about the severity of PAD and risk stratification in patients presenting with intermittent claudication. Additional studies are required to confirm our findings.
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Affiliation(s)
- Ahmet Çağrı Aykan
- Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey.
| | - Engin Hatem
- Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey
| | - Ezgi Kalaycıoğlu
- Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey
| | - Can Yücel Karabay
- Department of Cardiology, Kartal Koşuyolu Heart Education and Research Hospital, İstanbul-Turkey
| | - Regayip Zehir
- Department of Cardiology, Siyami Ersek Education and Research Hospital, İstanbul-Turkey
| | - Tayyar Gökdeniz
- Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey
| | - Duygun Altıntaş Aykan
- Department of Pharmacology, Karadeniz Technical University Faculty of Medicine, Trabzon-Turkey
| | - Şükrü Çelik
- Department of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon-Turkey
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Wang F, Hu S, Ding Y, Ju X, Wang L, Lu Q, Wu X. Neutrophil-to-Lymphocyte Ratio and 30-Day Mortality in Patients with Acute Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2015; 25:182-7. [PMID: 26500171 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/22/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although a highly significant association has been described between neutrophil-to-lymphocyte ratio (NLR) and mortality in patients with various types of stroke, the association between NLR and mortality in intracerebral hemorrhage (ICH) patients remains unclear. METHODS In this observational study, we enrolled 224 ICH patients. They were divided into 2 groups based on their 30-day outcomes. Multivariate logistic regression was performed to identify independent risk factors of 30-day mortality. An optimal cutoff value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between the survival and death groups. RESULTS Among 224 patients, 26 died. No significant difference in NLR at admission was observed between the 2 groups (surviving: 2.39 ± 1.75 versus nonsurviving: 3.09 ± 2.16, P= .065), whereas NLR on the next morning following admission was significantly higher in the patients who died (12.53 ± 9.33) than in those who survived (5.53 ± 4.68) (P <.001). On multivariate logistic analysis, Glasgow Coma Scale score (odds ratio [OR] .805, 95% confidence interval [CI] .661-.979, P = .030), age (≥80 years; OR .203, CI .055-.750, P = .017), ICH volume (≥30 cm(3); OR .112, CI .108-.699, P = .019), and NLR on the next morning (OR 1.091, CI 1.002-1.188, P = .044) were independent risk factors of 30-day mortality. An NLR of 7.35 was identified as the optimal cutoff value. The area under the curve of NLR for 30-day mortality was .762 (P < .001). The mortality was significantly higher in patients with an NLR of 7.35 or higher than in those with an NLR less than 7.35 (31.6% versus 4.8%, P <.001). CONCLUSIONS Higher NLR exhibited an increased mortality in ICH patients. NLR could be used to predict 30-day outcome in ICH patients.
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Affiliation(s)
- Fei Wang
- Emergency Department, Jiading District Center Hospital, Shanghai, China
| | - Shanyou Hu
- Emergency Department, Jiading District Center Hospital, Shanghai, China
| | - Yong Ding
- Community Health Center, Shanghai, China
| | - Xuefeng Ju
- Emergency Department, Jiading District Center Hospital, Shanghai, China
| | - Li Wang
- Emergency Department, Jiading District Center Hospital, Shanghai, China
| | - Qiuxia Lu
- Community Health Center, Shanghai, China
| | - Xiao Wu
- Emergency Department, Jiading District Center Hospital, Shanghai, China.
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Racial differences in the neutrophil-to-lymphocyte ratio in patients with non-ST-segment elevation myocardial infarction. Coron Artery Dis 2015; 26:381-5. [DOI: 10.1097/mca.0000000000000237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Belaj K, Pichler M, Hackl G, Rief P, Eller P, Hafner F, Brodmann M, Gary T. Association of the Derived Neutrophil-Lymphocyte Ratio With Critical Limb Ischemia. Angiology 2015; 67:350-4. [PMID: 26058674 DOI: 10.1177/0003319715590701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neutrophil and leukocyte counts are laboratory parameters that reflect the systemic inflammatory response in patients with atherosclerotic diseases. Based on the means of these parameters, the derived neutrophil-lymphocyte ratio (dNLR) can be calculated. We investigated a possible association of critical limb ischemia (CLI) and the dNLR in patients with peripheral arterial disease (PAD). We performed a retrospective data analysis including 1995 patients with PAD treated at our department in the years 2005 to 2010. The cohort was divided into tertiles according to dNLR. Higher dNLR values were associated with an increased CLI rate. In the tertile with lowest dNLR, the CLI rate was 20.4%, in the second tertile the CLI rate was 26.1%, and in the third tertile the CLI rate was 36.1%. Statistical significance was shown using a Jonckheere-Terpstra test (P < .001). A high dNLR is associated with an increased rate of CLI in patients with PAD. This might be a useful parameter to highlight patients at increased risk of CLI.
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Affiliation(s)
- Klara Belaj
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Gerald Hackl
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Peter Rief
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Philipp Eller
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
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Men M, Zhang L, Li T, Mi B, Wang T, Fan Y, Chen Y, Shen G, Liang L, Ma A. Prognostic Value of the Percentage of Neutrophils on Admission in Patients with ST-elevated Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Arch Med Res 2015; 46:274-9. [PMID: 25989351 DOI: 10.1016/j.arcmed.2015.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS An elevated neutrophil count or neutrophil/lymphocyte ratio on admission has been reported to be an independent predictor of adverse cardiac events in patients with acute coronary syndrome (ACS). The relationship between the percentage of neutrophils (N%) at the time of admission and the long-term outcomes in patients with ST-segment elevated myocardial infarction (STEMI) who have undergone primary percutaneous coronary intervention (PCI) remains unclear. The aim of this study was to investigate the usefulness of the admission N% in predicting long-term mortality in patients with STEMI who were undergoing primary PCI. METHODS We evaluated 701 consecutive patients admitted to nine medical institutions in northwest China within 24 h after symptom onset from January 1, 2009-December 31, 2011. Using a receiver-operating characteristic analysis, N% ≥82.1% was the best predictor of long-term mortality. Patients were divided into two groups according to this criterion. Mean follow-up time was 39.03 months. RESULTS The long-term all-cause mortality rate was significantly higher in patients with a high N% level (7.17 vs. 3.11%, p = 0.015) as was the rate of cardiac mortality (6.48 vs. 2.59%, p = 0.013). In a multivariate logistic analysis, a high N% level was an independent predictor of long-term all-cause mortality (odds ratio 2.59, 95% confidence interval 1.21-5.53, p = 0.002) and long-term cardiac mortality (odds ratio 2.79, 95% confidence interval 1.24-6.28, p = 0.013). CONCLUSIONS A high N% level on admission is an independent predictor of long-term mortality in STEMI patients undergoing primary PCI.
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Affiliation(s)
- Min Men
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Cardiovascular Medicine, Xi'an Central Hospital, Xi'an, China
| | - Li Zhang
- Department of Geriatrics, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Tao Li
- Department of Cardiovascular Medicine, Xi'an Central Hospital, Xi'an, China
| | - Baibing Mi
- Department of Statistics and Epidemiology, Xi'an Jiaotong University, Health Science Center, Xi'an, China
| | - Tingzhong Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology, Shaanxi Province, China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Xi'an, China
| | - Yan Fan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuewu Chen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guidong Shen
- Department of Cardiovascular Medicine, Ankang Central Hospital, Ankang, China
| | - Lei Liang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Aiqun Ma
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Key Laboratory of Molecular Cardiology, Shaanxi Province, China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Xi'an, China.
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Tan TP, Arekapudi A, Metha J, Prasad A, Venkatraghavan L. Neutrophil-lymphocyte ratio as predictor of mortality and morbidity in cardiovascular surgery: a systematic review. ANZ J Surg 2015; 85:414-9. [PMID: 25781147 DOI: 10.1111/ans.13036] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR) is an emerging biomarker of inflammation and predicts poorer outcome in cancer surgery. The prognostic value of NLR in cardiovascular surgery is unclear. METHODS Systematic review and meta-analysis of studies of in cardiovascular surgical patients were conducted to assess the role of perioperative NLR in predicting post-operative mortality and morbidity. Electronic searches were conducted on Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Database of Systemic Reviews for all prospective clinical studies reporting on NLR and post-operative morbidity and mortality in cardiovascular surgical patient population. Our primary end point was all-cause post-operative mortality and the secondary end point was post-operative morbidity. Mortality outcome from prospective studies were pooled for a meta-analysis using a random-effect model. RESULTS Of the 999 citations identified, five studies with 3487 patients met the inclusion criteria. In a pooled analysis of three prospective studies of 3108 patients, a preoperative increase in NLR (>3.3 in cardiac surgery, >5 in vascular surgery) was associated with increased mortality at a mean follow-up of 34.8 months (hazard ratio 1.85, 95% confidence interval 1.46-2.36; P < 0.00001). Raised NLR value was also associated with increased cardiac mortality, amputation in vascular operations and raised risk of post-operative re-intubation. CONCLUSIONS Elevated NLR were associated with increased long-term mortality and morbidity after major cardiac and vascular surgery. NLR may guide perioperative management and risk-stratification of patients.
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Affiliation(s)
- Tze Ping Tan
- Department of Anaesthesia, Shepparton Hospital, Shepparton, Victoria, Australia
| | - Anil Arekapudi
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jigesh Metha
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Arun Prasad
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lashmi Venkatraghavan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Gary T, Pichler M, Belaj K, Eller P, Hafner F, Gerger A, Brodmann M. Lymphocyte-to-monocyte ratio: a novel marker for critical limb ischemia in PAOD patients. Int J Clin Pract 2014; 68:1483-7. [PMID: 25359092 DOI: 10.1111/ijcp.12495] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The lymphocyte-to-monocyte ratio (LMR) is easily determined from the white blood cell count. Lymphocytes were previously investigated as a part of the neutrophil-to-lymphocyte ratio (NLR) in patients with atherosclerotic disease and an elevated NLR was negatively associated with cardiovascular endpoints. As monocytes play a leading role in the progression of atherosclerosis, especially in peripheral arterial occlusive disease (PAOD), we investigated LMR and its association with critical limb ischemia and other vascular endpoints in PAOD patients. METHODS AND FINDINGS We evaluated 2121 PAOD patients treated at our institution from 2005 to 2010. LMR was calculated and the cohort was divided into tertiles according to the LMR. An optimal cut-off value for the continuous LMR was calculated by applying a receiver operating curve analysis to discriminate between CLI and non-CLI. In our cohort occurrence of CLI decreased significantly with an increase in LMR. An LMR of 3.1 was identified as an optimal cut-off. Two groups were categorized, one with 1021 patients (LMR < 3.1) and a second one with 1100 patients (LMR ≥ 3.1). CLI was more frequent in LMR < 3.1 patients [426 (41.7%)] than in LMR ≥ 3.1 patients [254 (23.1%)] (p < 0.001), as was also the case with prior myocardial infarction [60 (9.5%) vs. 35 (3.2%), p = 0.003] and congestive heart failure [136 (13.3%) vs. 66 (6.0%), p < 0.001). As to inflammatory parameters, C-reactive protein [median 9.0 mg/l (4.0-30.0) vs. median 4.0 mg/l (2.0-8.0)] and fibrinogen (median 438 mg/dl (350-563) vs. 372 mg/dl (316-459.5)] also differed significantly in the two patient groups (both p < 0.001). A LMR < 3.1 was associated with an odds ratio (OR) of 2.0 (95% CI 1.8-2.2, p < 0.001) for CLI, even after adjustment for other vascular risk factors. CONCLUSIONS A decreased LMR is significantly associated with a high risk for CLI and other vascular endpoints. The LMR is an easily determinable, broadly available and inexpensive marker that could be used to identify patients at high risk for vascular endpoints.
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Affiliation(s)
- T Gary
- Division of Vascular Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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47
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Neutrophil/lymphocyte ratio as a predictor of cardiovascular events in incident dialysis patients: a Japanese prospective cohort study. Clin Exp Nephrol 2014; 19:718-24. [DOI: 10.1007/s10157-014-1046-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/17/2014] [Indexed: 12/24/2022]
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48
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The Relationship Between Inflammatory Marker Levels and Pulmonary Tuberculosis Severity. Inflammation 2014; 38:691-6. [DOI: 10.1007/s10753-014-9978-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Kounis NG, Soufras GD, Tsigkas G, Hahalis G. White blood cell counts, leukocyte ratios, and eosinophils as inflammatory markers in patients with coronary artery disease. Clin Appl Thromb Hemost 2014; 21:139-43. [PMID: 24770327 DOI: 10.1177/1076029614531449] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Inflammation is a key feature of atherosclerosis and its clinical manifestations. The leukocyte count has emerged as a marker of inflammation that is widely available in clinical practice. Since inflammation plays a key role in atherosclerosis and its end results, discovering new biomarkers of inflammation becomes important in order to help diagnostic accuracy and provide prognostic information about coronary cardiac disease. In acute coronary syndromes and percutaneous coronary intervention, elevated levels of almost all subtypes of white blood cell counts, including eosinophils, monocytes, neutrophils, and lymphocytes, and neutrophil-lymphocyte ratio and eosinophil-leukocyte ratio constitute independent predictors of adverse outcomes. Eosinophil count and eosinophil-leukocyte ratio, in particular, emerge as novel biomarkers for risk stratification in patients with coronary artery disease. Since the presence of eosinophils denotes hypersensitivity inflammation and hypersensitivity associated with Kounis syndrome, this reality is essential for elucidating the etiology of inflammation in order to consider predictive and preventive measures and to apply the appropriate therapeutic methods.
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Affiliation(s)
- Nicholas G Kounis
- Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Greece
| | - George D Soufras
- Departments of Cardiology, University of Patras Medical School, Patras, Greece
| | - Grigorios Tsigkas
- Departments of Cardiology, University of Patras Medical School, Patras, Greece
| | - George Hahalis
- Departments of Cardiology, University of Patras Medical School, Patras, Greece
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Açar G, Fidan S, Uslu ZA, Turkday S, Avci A, Alizade E, Kalkan ME, Tabakci ON, Tanboğa IH, Esen AM. Relationship of neutrophil-lymphocyte ratio with the presence, severity, and extent of coronary atherosclerosis detected by coronary computed tomography angiography. Angiology 2014; 66:174-9. [PMID: 24554426 DOI: 10.1177/0003319714520954] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated whether the neutrophil-lymphocyte ratio (NLR) was associated with the presence, severity, and extent of coronary atherosclerotic plaques detected by computed tomography angiography (CTA). We studied 238 patients who underwent dual-source 64-slice CTA for the assessment of coronary artery disease. Coronary arteries were evaluated on 16-segment basis and critical plaque was described as luminal narrowing >50%. In regression analysis, being in the third NLR tertile increased the risk of coronary atherosclerosis (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.15-4.43; P = .023). When the severity of coronary atherosclerosis was assessed, being in the third NLR tertile increased the risk of critical luminal stenosis (OR, 2.60; 95% CI, 1.19-5.69; P = .017). Although plaque morphology was not associated with NLR, the extent of coronary atherosclerosis was increased with higher NLR tertiles (P = .001). Our results suggest that a higher NLR may be a useful additional measure to assess cardiovascular risk in clinical practice.
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Affiliation(s)
- Göksel Açar
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Serdar Fidan
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Zulal Alnur Uslu
- Department of Radiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Sevim Turkday
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Anıl Avci
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Elnur Alizade
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Kalkan
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
| | - Omer Naci Tabakci
- Department of Radiology, Sisli Etfal Educational and Research Hospital, Istanbul, Turkey
| | | | - Ali Metin Esen
- Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey
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