The prognostic value of lymphocyte-to-monocyte ratio in retinopathy of prematurity

Predictive role of systemic immune-inflammation index and neutrophil/lymphocyte ratio values in infants with retinopathy of prematurity

PURPOSE

To search the relationship between serum neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) values with the development of retinopathy of prematurity (ROP) and the requirement for laser treatment.

METHODS

This retrospective cohort study was carried out with 195 preterm infants between 2012 and 2023. The NLR, PLR, LMR, and SII values were calculated on both the first day and at the end of the first month after birth. The association between development of ROP and other risk factors were analyzed using univariate analysis and multivariate logistic regression analysis.

RESULTS

Of patients, 92 infants were diagnosed with ROP. Laser treatment was administered to 36 infants. The postnatal first-day NLR and SII values were higher in infants with ROP than in infants without ROP (p < 0.001 for both). Postnatal first-month NLR, LMR, and SII values were higher in infants with ROP (p < 0.001, p = 0.007, and p < 0.001, respectively). In multivariate analyses, postnatal first-day NLR and first-month LMR values were regarded as independent risk factors for the development of ROP (OR:8.867 and 1.286, p = 0.002 and p = 0.009, respectively). In multivariate analyses performed for laser treatment requirement, postnatal first-month PLR and SII values were determined as independent risk factors (OR:0.951 and 1.011, respectively, p = 0.004 for both).

CONCLUSIONS

Postnatal first-day NLR and first-month LMR values were determined as independent risk factors for the development of ROP. For the requirement of laser treatment, the postnatal first-month PLR and SII values were determined as independent risk factors.

The effect of leucocytosis on retinopathy of prematurity

Postnatal leukocytosis reflects the general condition of inflammatory. Infection and inflammatory reaction have been proven to affect the occurrence of ROP and other visual dysfunction. Infants with a gestational age of < 28 weeks who were less than three days of age and admitted to the hospital between September 2015 and March 2021 were included in the study. Infants with a white blood cell (WBC) count ≥ 30 × 109/L were assigned to the leucocytosis group (n = 82). Gestational age- and weight-matched infants without leucocytosis were included as a control group (n = 85). The incidence and prognosis of ROP in preterm infants were compared between the groups. Receiver operating characteristic (ROC) curves were used to analyse the correlation between the WBC count and severe ROP. Compared to the infants in the control group, those in the leucocytosis group had lower 1-min Apgar scores (p < 0.001); higher C-reactive protein (p < 0.001) and procalcitonin (p < 0.001); and higher incidences of intracranial haemorrhage (p = 0.007), leukomalacia (p = 0.045), sepsis (p = 0.006), bronchopulmonary dysplasia (p = 0.017). The maternal age was higher in the leucocytosis group (p < 0.001). After adjusting for gestational age at 45 weeks, the incidence of severe ROP (p = 0.001) and the requirement for ranibizumab injections (p = 0.004) were higher in the leucocytosis group. The cut-off WBC count was determined to be 19.1 × 109/L, with a sensitivity of 88.6%, a specificity of 77.3%, and an area under the curve of 0.941 (95% confidence interval: 0.904-0.978) for the detection of severe ROP. Leucocytosis may be associated with severe ROP in premature infants.

Complete blood count parameters as biomarkers of retinopathy of prematurity: a Portuguese multicenter study

PURPOSE

To evaluate complete blood count (CBC) parameters in the first week of life as predictive biomarkers for the development of retinopathy of prematurity (ROP).

METHODS

Multicenter, prospective, observational study of a cohort of preterm infants born with gestational age (GA) < 32 weeks or birth weight < 1500 g in eight Portuguese neonatal intensive care units. All demographic, clinical, and laboratory data from the first week of life were collected. Univariate logistic regression was used to assess risk factors for ROP and then multivariate regression was performed.

RESULTS

A total of 455 infants were included in the study. The median GA was 29.6 weeks, and the median birth weight was 1295 g. One hundred and seventy-two infants (37.8%) developed ROP. Median values of erythrocytes (p < 0.001), hemoglobin (p < 0.001), hematocrit (p < 0.001), mean corpuscular hemoglobin concentration (p < 0.001), lymphocytes (p = 0.035), and platelets (p = 0.003) of the group of infants diagnosed with ROP any stage were lower than those without ROP. Mean corpuscular volume (MCV) (p = 0.044), red blood cell distribution width (RDW) (p < 0.001), erythroblasts (p < 0.001), neutrophils (p = 0.030), neutrophils-lymphocytes ratio (p = 0.028), and basophils (p = 0.003) were higher in the ROP group. Higher values of MCV, erythroblasts, and basophils remained significantly associated with ROP after multivariate regression.

CONCLUSION

In our cohort, the increase in erythroblasts, MCV, and basophils in the first week of life was significantly and independently associated with the development of ROP. These CBC parameters may be early predictive biomarkers for ROP.

Association between treatment for retinopathy of prematurity and blood monocyte counts

PURPOSE

To investigate blood monocyte counts as a risk factor for retinopathy of prematurity (ROP) treatment.

DESIGN

Retrospective cohort study.

METHODS

Infants who underwent ROP screening at Shiga University of Medical Science Hospital between January, 2011 and July, 2021 were included in this study. Screening criteria were a gestational age (GA) < 32 weeks or birth weight (BW) < 1500 g. The week with the largest difference in monocyte counts between the infants with and without type 1 ROP determined based on the effect size. Multivariate logistic regression analysis was applied to investigate whether the monocyte counts constituted an independent risk factor for type 1 ROP. The objective variable was type 1 ROP, and the explanatory variables were GA, BW, infants' infection, and Apgar score at 1 min and monocyte counts in the week with the largest monocyte-counts difference between the with- and without type 1 ROP groups.

RESULTS

In total, 231 infants met the inclusion criteria. The monocyte counts in the fourth week after birth (4w MONO) exhibited the largest difference between infants with and without type 1 ROP. The analysis was performed on 198 infants, excluding 33 infants without 4w MONO data. Thirty-one infants had type 1 ROP, whereas 167 infants did not. BW and 4w MONO were significantly associated with type 1 ROP (odds ratio: 0.52 and 3.9, P < .001 and 0.004, respectively).

CONCLUSIONS

The 4w MONO was an independent risk factor for type 1 ROP and may be useful in follow-up of infants with ROP.

Blood neutrophil-to-lymphocyte ratio as a risk factor in treatment for retinopathy of prematurity

PURPOSE

To investigate the blood neutrophil-to-lymphocyte ratio (NLR) as a risk factor for retinopathy of prematurity (ROP) development or treatment.

METHODS

Retrospective cohort study. Infants who underwent ROP screening at Shiga University of Medical Science Hospital and Omihachiman Community Medical Center between April 2010 and December 2021 were included in this study. Screening criteria were gestational age (GA) < 32 weeks or birth weight (BW) < 1500 g. Multivariate logistic regression analysis was applied to investigate whether the NLR constituted an independent risk factor for ROP development or treatment. The objective variable was ROP development or treatment, and the explanatory variables were GA, BW, NLR, maternal infection or clinical chorioamnionitis and corticosteroid use by the mother. Maternal infection or clinical chorioamnionitis and corticosteroid use by the mother was included in the explanatory variables to adjust for factors affecting the NLR.

RESULTS

In total, 220 infants met the inclusion criteria, of whom 125 developed ROP, whereas 95 infants did not display ROP. GA was significantly associated with ROP development (odds ratio (OR): 0.41, p < 0.001); however, the NLR was not significantly associated with ROP development (OR: 1.0, p = 0.74). Thirty-eight infants received treatment for ROP, whereas 182 infants had no such treatment. BW and the NLR were significantly associated with ROP treatment (OR: 1.6 and 0.66, p < 0.001 and 0.003, respectively).

CONCLUSION

The NLR was not a risk factor for ROP development but was a risk factor for ROP treatment.

Abnormal percent amplitude of fluctuation changes in patients with monocular blindness: A resting-state functional magnetic resonance imaging study

PURPOSE

Previous studies on monocular blindness (MB) have mainly focused on concept and impact. The present study measured spontaneous brain activity in MB patients using the percentage of amplitude fluctuation (PerAF) method.

METHODS

Twenty-nine patients with MB (21 male and 8 female) and 29 age-, gender-, and weight-matched healthy controls (HCs) were recruited. All participants underwent resting state functional magnetic resonance imaging (rs-fMRI). The PerAF method was used to analyze the data and evaluate the spontaneous regional brain activity. The ability of PerAF values to distinguish patients with MB from HCs was analyzed using receiver operating characteristic (ROC) curves, and correlation analysis was used to assess the relationship between PerAF values of brain regions and the Hospital Anxiety and Depression Scale (HADS) scores.

RESULTS

PerAF values in Occipital_Mid_L/Occipital_Mid_R/Cingulum_ Mid_L were significantly lower in patients with MB than in controls. Conversely, values in the Frontal_Sup_Orb_L/Frontal_Inf_Orb_L/Temporal _Inf_L/Frontal_Inf_Oper_L were significantly higher in MB patients than in HCs. And the AUC of ROC curves were follows: 0.904, (p < 0.0001; 95%CI: 0.830-0.978) for Frontal_Sup_Orb_L/Frontal_Inf_Orb_L; Temporal_Inf_L 0.883, (p < 0.0001; 95% CI: 0.794-0.972); Frontal_Inf_Oper_L 0.964, (p < 0.0001; 95% CI: 0.924-1.000), and 0.893 (p < 0.0001; 95% CI: 0.812-0.973) for Occipital_Mid_L; Occipital_Mid_R 0.887, (p < 0.0001; 95% CI: 0.802-0.971); Cingulum_Mid_L 0.855, (p < 0.0001; 95% CI: 0.750-0.960).

CONCLUSION

The results of our study show abnormal activity in some brain regions in patients with MB, indicating that these patients may be at risk of disorder related to these brain regions. These results may reflect the neuropathological mechanisms of MB and facilitate early MB diagnoses.

Complete blood count parameters to predict retinopathy of prematurity: when to evaluate and what do they tell us?

PURPOSE

To evaluate the relationship of novel inflammatory markers neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with retinopathy of prematurity (ROP) development and requirement for laser photocoagulation (LP) treatment.

METHODS

The charts of infants screened for ROP were reviewed retrospectively, and 120 newborns who had complete blood count (CBC) data in the first 24 hours after delivery (early period) and between 35 and 37th gestational weeks (late period) were included. Study population consisted of 34 infants who required LP for ROP treatment, 52 newborns with ROP that regressed without treatment, and 34 controls who did not developed any ROP stages. Demographics, etiological factors and CBC data including NLR and PLR values were noted. Risk factors for ROP development and treatment requirement were investigated using logistic regression analyses.

RESULTS

Significantly lower NLR was found in ROP cases compared to non-ROP group during late period (p = 0.003), while there was no difference in NLR during early period (p = 0.298). No significant difference was observed in PLR during both early and late periods (p = 0.230 and p = 0.349, respectively). Multivariate analysis revealed daily weight gain as major risk factor for ROP development (p = 0.001; OR: 0.870, 95% CI: 0.799-0.947), and hyperbilirubinemia as an independent risk factor for LP requirement (p = 0.045; OR: 0.204, 95% CI: 0.043-0.966).

CONCLUSION

NLR or PLR does not appear to be predictive risk factors for treatment requirement in cases with ROP. CBC values during first 24 h of life may be misleading; therefore, a late period CBC is recommended to evaluate prognostic factors for ROP development.

Neutrophil-to-lymphocyte ratio in ocular diseases: a systematic review

AIM

To summarize the results of studies investigating neutrophil-to-lymphocyte ratio (NLR) and to identify the role of NLR in ocular diseases.

METHODS

With the aim of identifying the studies related to NLR, a search was conducted on http://www.ncbi.nlm.nih.gov/pubmed by utilizing the key words "neutrophil lymphocyte ratio, ocular diseases, and eye diseases" up to February 2018. All of the original articles were assessed according to date of publications, countries, clinics and topics. Studies about ocular inflammatory diseases were evaluated according to their qualifications, review methods and results.

RESULTS

A total of 4473 publications, including original research articles and reviews were screened. The number of publications was shown a regular logarithmic increase over the years. The majority of studies were performed by clinics in Turkey and many of these publications were performed by oncology and cardiology clinics. A total of 75 publications were identified to be about ocular diseases.

CONCLUSION

Elevated NLR as a cheap, reproducible, and readily available marker could be used as a diagnostic and/or prognostic marker in ocular diseases.

Pretreatment neutrophil-to-lymphocyte ratio predicts prognosis in patients with diabetic macular edema treated with ranibizumab

Background

To investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with diabetic macular edema (DME) treated monthly with ranibizumab.

Methods

We retrospectively analyzed the medical records of all patients who received intravitreal ranibizumab (IVR) treatment for DME at the First Affiliated Hospital of Nanchang University between December 2015 and December 2017. Clinicopathological parameters, including NLR, were evaluated to identify predictors of better outcomes of IVR monotherapy.

Results

Ninety-one treatment-naïve eyes treated with IVR for DME were retrospectively analyzed in this study. Baseline best-corrected visual acuity (BCVA), neutrophils, NLR, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were negatively correlated with the changes in BCVA at 24 weeks compared with the baseline, while baseline central retinal thickness and lymphocytes were positively correlated with the changes in BCVA at 24 weeks compared with the baseline. Multiple linear regression analysis revealed that NLR was independently associated with the mean change of BCVA between baseline and week 24. In addition, patients with NLR < 2.27 showed a better improvement in letter score than those with NLR > 2.27.

Conclusion

Pretreatment NLR is independently associated with the BCVA in DME patients treated with IVR, and higher pretreatment NLR may contribute to inferior BCVA outcomes.