Diagnostic Value of the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in Various Respiratory Diseases: A Retrospective Analysis

Investigation of the Relationship Between Neutrophil/Lymphocyte, Platelet/Lymphocyte, IgA/C3, IgA/C4, and C3/C4 Ratios and Proteinuria in Patients With Immunoglobulin A (IgA) Nephropathy

Background Immunoglobulin A nephropathy (IgAN) is the most common primary glomerular disease, characterized by IgA-containing immune complexes in the mesangium and mesangial cell proliferation. Proteinuria is a strong indicator of the progression of chronic kidney disease. This study aimed to evaluate the relationship between systemic inflammation markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), IgA/complement (C)3, IgA/C4, and C3/C4 ratios, and proteinuria in IgAN patients. Methods This retrospective study involved 38 patients diagnosed with IgAN between 2002 and 2011. We assessed various serum markers such as leukocyte count, NLR, PLR, C-reactive protein (CRP), C3, C4, IgA, and IgM, as well as proteinuria. The correlation between these markers and proteinuria was examined. Results The mean age of the patients was 37.8 ± 2 years, with 68.42% male. No significant correlation was found between the NLR and proteinuria (p=0.3) or CRP (p=0.3). However, a moderate positive correlation was observed between the NLR and sedimentation rate (R=0.38, p=0.07). Significant negative correlations were found between proteinuria and both urine pH (R=-0.5, p=0.002) and IgA/C4 ratio (R=-0.5, p=0.013). There were positive correlations between the PLR and C4 (R=0.45, p=0.02) and negative correlations between the PLR and IgA/C4 ratio (R=-0.56, p=0.003) and IgA/C4 and C3 (R=-0.48, p=0.008). No significant differences in proteinuria and leukocyte count were observed between the two sexes. Conclusion Although no significant relationship was found between the NLR, PLR, and proteinuria in IgAN, correlation between the IgA/C4 ratio and C4 warrants further investigations in larger studies.

Association of pan-immune inflammation value and lung health in adults

BACKGROUND

Lung health is intricately linked with inflammation. The pan-immune-inflammation value (PIV) emerges as a promising biomarker, offering reflection into systemic inflammatory states and assisting in the prognosis of diverse diseases. This research aims to explore the associations between PIV and respiratory symptoms, respiratory diseases and lung function.

METHODS

The study was a cross-sectional population study from the National Health and Nutrition Examination Survey (NHANES). Restricted cubic spline (RCS) models were conducted to explore the relationships between PIV and respiratory health outcomes, while weighted linear regression models and weighted logistic regression models were the ones used for regression analysis. Trend tests probed the evolving relationship among PIV quartiles and outcomes. The study incorporated subgroup analysis and interaction tests to examine associations within specific subpopulations.

RESULTS

From the cohort of 6,263 participants, a distinct negative correlation was identified between PIV and lung health. Subsequent to confounding factors, a 100-unit increment in PIV was linked to a 2% increase in the incidence of cough and phlegm (OR, 95% CI: 1.02, 1.00 to 1.05; 1.02, 1.00 to 1.04). Additionally, higher PIV was associated with reductions in FEV1 (MD, 95% CI: -5.37, -9.10 to -1.64) and FVC (MD, 95% CI: -5.75, -10.34 to -1.15). Categorizing PIV into quartiles revealed an ascending trend: A significantly higher risk of cough/phlegm/wheeze was found in participants in the second/third/fourth PIV quartile compared to those in the first PIV quartile (all p for trend < 0.05). Moreover, lung function indicators (FEV1, FEV1%, FVC, FVC%, FEV1/FVC) declined significantly in the fourth quartile (all p for trend < 0.05). Besides, a nonlinear relationship between PIV and outcomes was evident. Subgroup analysis revealed variations in these associations stratified by gender, age, smoking and drinking status, as well as certain disease history.

CONCLUSIONS

The study highlighted the potential connections between PIV and respiratory symptoms, respiratory diseases and lung function. Monitoring PIV level could provide valuable insights into the inflammatory status and may inform clinical approaches for managing respiratory health.

Bronchiectasis Exacerbation Increases the Risk of Adverse Renal Outcomes-Results From a Large Territory-Wide Cohort Study

INTRODUCTION

Bronchiectasis exacerbation (BE) is associated with unfavorable sequelae in other organs such as the cardiovascular system; data regarding its impact on adverse term renal outcomes, however, is lacking.

METHODS

A territory-wide retrospective cohort study was conducted in Hong Kong between 1/1/1993 and 31/12/2017. All patients with bronchiectasis followed in the public healthcare system in 2017 were classified as "Exacerbators" or "Non-Exacerbators," and their adverse renal outcomes (renal progression [decrease in eGFR by 30 mL/min lasted for more than 12 months during follow up], acute kidney injury [AKI], and annual rate of eGFR decline) in the ensuing 7 years were compared. Results were also analyzed in the 1:1 propensity score matched (PSM) cohort.

RESULTS

A total of 7929 patients (1074 "Exacerbators" group and 6855 "Non-exacerbators") were followed for 6.2 ± 1.6 years. A total of 1570 patients (19.8%) had renal progression, and 935 (11.8%) patients developed AKI. "Exacerbators" showed significantly increased risk of renal progression (adjusted odds ratio [aOR] 1. 27 [95% CI 1.08-1.50, p = 0.003]), more rapid eGFR decline (-3.67 [-1.74 to -6.54] vs. -3.03 [-1.56 to -5.12] mL/min/1.73 m2/year, p = 0.004) and AKI (aOR 1.99; 95% CI 1.44-2.73, p < 0.001) than the "Non-exacerbators." Annual number of BE was associated with renal progression (aOR 1.45; 95% CI 1.22-1.72, p < 0.001) and AKI (aOR 2.00; 95% CI 1.38-2.91, p < 0.001). Results were consistent in the analysis with the PSM cohort.

CONCLUSIONS

Renal progression and AKI are common among patients with bronchiectasis, and BE is an independent risk factor for adverse renal outcomes.

Impact of Natriuretic Peptide on the Evolution of Patients With Pulmonary Embolism and Neoplasm

This retrospective study investigated the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in 106 patients with pulmonary embolism (PE) and associated oncological pathology. The study aimed to evaluate the predictive accuracy of NT-proBNP for both the prognosis and complication risk, such as early mortality (≤ 30 days), late mortality (≥ 30 days), and PE recurrence, in relation to the neoplasm's location and stage. Additionally, it explored the relationship between NT-proBNP, hemodynamic status (stable/unstable), and the location of PE in the pulmonary arteries (main, lobar, segmental) for prognostic and complication risk assessment. The results showed that cancer patients with NT-proBNP levels above 600 ng/L had a significantly higher risk of acute PE recurrence compared to those with lower levels, especially in cases involving the main pulmonary arteries. Hemodynamic instability further elevated the risk of PE recurrence and death, underscoring the importance of NT-proBNP as a prognostic marker for this population. Patients with unstable hemodynamic status were more likely to have elevated NT-proBNP levels, and this was associated with a markedly increased risk of early as well as late demise. Furthermore, patients with multiple tumor locations demonstrated a heightened risk of mortality when NT-proBNP levels were elevated. These findings highlight the potential of NT-proBNP as a valuable tool for risk stratification and patient management in individuals with PE and associated oncological pathology.

External validation of the CARDOT score for predicting respiratory complications after thoracic surgery

BACKGROUND

The CARDOT scores have been developed for prediction of respiratory complications after thoracic surgery. This study aimed to externally validate the CARDOT score and assess the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) for postoperative respiratory complication.

METHODS

A retrospective cohort study of consecutive thoracic surgical patients at a single tertiary hospital in northern Thailand was conducted. The development and validation datasets were collected between 2006 and 2012 and from 2015 to 2021, respectively. Six prespecified predictive factors were identified, and formed a predictive score, the CARDOT score (chronic obstructive pulmonary disease, American Society of Anesthesiologists physical status, right-sided operation, duration of surgery, preoperative oxygen saturation on room air, thoracotomy), was calculated. The performance of the CARDOT score was evaluated in terms of discrimination by using the area under the receiver operating characteristic (AuROC) curve and calibration.

RESULTS

There were 1086 and 1645 patients included in the development and validation datasets. The incidence of respiratory complications was 15.7% (171 of 1086) and 22.5% (370 of 1645) in the development and validation datasets, respectively. The CARDOT score had good discriminative ability for both the development and validation datasets (AuROC 0.789 (95% CI 0.753-0.827) and 0.758 (95% CI 0.730-0.787), respectively). The CARDOT score showed good calibration in both datasets. A high NLR (≥ 4.5) significantly increased the risk of respiratory complications after thoracic surgery (P < 0.001). The AuROC curve of the validation cohort increased to 0.775 (95% CI 0.750-0.800) when the score was combined with a high NLR. The AuROC of the CARDOT score with the NLR showed significantly greater discrimination power than that of the CARDOT score alone (P = 0.008).

CONCLUSIONS

The CARDOT score showed a good discriminative performance in the external validation dataset. An addition of a high NLR significantly increases the predictive performance of CARDOT score. The utility of this score is valuable in settings with limited access to preoperative pulmonary function testing.

Blood-Count-Derived Inflammatory Markers as Predictors of Response to Biologics and Small-Molecule Inhibitors in Psoriasis: A Multicenter Study

Background: Psoriasis is an immune-mediated chronic disorder associated with various comorbidities. Even though biologics and small-molecule inhibitors are the mainstay treatment for moderate-to-severe psoriasis, there is no current consensus regarding which agent should be used for a specific type of patient. This paper aims to test the reliability of blood-count-derived inflammatory markers in assessing treatment response to biologics and small-molecule inhibitors in psoriasis. Material and Methods: Bio-naïve adult patients diagnosed with chronic plaque psoriasis fulfilling the inclusion criteria were enrolled. They were divided into study subgroups based on treatment of choice, and blood-count-derived inflammatory markers were analyzed at baseline, three-month, six-month, and at twelve-month visits. Results: A total of 240 patients were included. The highest number of patients underwent treatment with ixekizumab. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-monocyte ratio (PMR), monocyte-to-lymphocyte ratio (MLR), derived neutrophil-to-lymphocyte ratio (d-NLR), systemic inflammation response index (SIRI), systemic immune inflammation index (SII), and aggregate index of systemic inflammation (AISI) all varied significantly (p < 0.005) between the four visits. The psoriasis area severity index (PASI) score correlated with PLR, d-NLR, and SII, while the psoriasis scalp severity index (PSSI) score correlated with AISI and SIRI. More than half of patients reached the target goal of PASI90 at the six-month visit. A total of 77 patients were super-responders, with the highest number undergoing treatment with ixekizumab. Higher baseline values of d-NLR and SIRI are independent predictors of the super-responder status. Conclusions: Blood-count-derived inflammatory markers can serve as indicators of treatment response to biologics in psoriasis, while d-NLR and SIRI were independent predictors of super-responders in our study.

The Value of White Cell Inflammatory Biomarkers as Potential Predictors for Diabetic Retinopathy in Type 2 Diabetes Mellitus (T2DM)

The pathogenesis of diabetic retinopathy is still challenging, with recent evidence proving the key role of inflammation in the damage of the retinal neurovascular unit. This study aims to investigate the predictive value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic inflammation index (SII) for diabetic retinopathy (DR) and its severity. We performed a retrospective study on 129 T2DM patients, divided into three groups: without retinopathy (NDR), non-proliferative DR (NPDR), and proliferative DR (PDR). NLR, MLR, and SII were significantly higher in the PDR group when compared to NDR and NPDR (3.2 ± 1.6 vs. 2.4 ± 0.9 and 2.4 ± 1.1; p = 0.005; 0.376 ± 0.216 vs. 0.269 ± 0.083 and 0.275 ± 0.111, p = 0.001; 754.4 ± 514.4 vs. 551.5 ± 215.1 and 560.3 ± 248.6, p = 0.013, respectively). PDR was correlated with serum creatinine (OR: 2.551), NLR (OR: 1.645), MPV (OR: 1.41), and duration of diabetes (OR: 1.301). Logistic regression analysis identified three predictive models with very good discrimination power for PDR (AUC ROC of 0.803, 0.809, and 0.830, respectively): combining duration of diabetes with NLR, MLR, and, respectively, PLR, MPV, and serum creatinine. NLR, MPV, SII, and LMR were associated with PDR and could be useful when integrated into comprehensive risk prediction models.

Investigation of the value of hematological biomarkers in the clinical differential diagnosis of IgG4-RD

BACKGROUND

IgG4- related disease (IgG4- RD) is a systemic fibroinflammatory disease whose pathogenesis has not been completely elucidated. Due to the novelty and complexity of the diagnostic criteria, it is difficult to distinguish from the diseases included in the differential diagnosis without tissue biopsy. This study aimed to discover new biomarkers that can help for disease diagnosis and its differential diagnosis by reviewing the relationships between neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI).

METHODS

Thirty IgG4- RD, 38 granulomatous polyangiitis (GPA), and 46 sarcoidosis patients presenting to the Rheumatology Clinic meeting the criteria of 2019 American College of Rheumatology, 2012 International Chapel Hill and 1999 American Thoracic Society meeting, respectively, and 27 healthy control subjects were included. We collected data on complete blood count with automated differential values including NLR, PLR, SII, and SIRI.

RESULTS

The SII and PLR values were significantly higher in patients with IgG4-RD compared to healthy controls, (SII median (minmax) 572 (102-5583) vs. 434 (172-897), PLR median (min-max) 130 (56.8-546) vs. 104 (57.5- 253) p < 0.001). SII value was found to have a significant positive correlation with CRP in IgG4-RD disease (r = 0.371; p = 0.043). While SII, SIRI, NLR, PLR parameters were not significant between the IgG4-RD and sarcoidosis groups, SII, SIRI, NLR, PLR were significantly higher in patients with GPA than in IgG4-RD patients (p < 0.001).

DISCUSSION

This is the first study to review the SII, SIRI, NLR, and PLR in IgG4-RD. The obtained results suggest that the SII could beused as a new tool, for differential diagnosis and activity of the IgG4-RD.

Red Blood Cell Distribution Width as a Novel Parameter in Canine Disorders: Literature Review and Future Prospective

Red blood cell distribution width (RDW) is a quantitative laboratory parameter applied for the measurement of anisocytosis and is a reliable and inexpensive method for clinical classification of anemia. An increased RDW reflects a great heterogeneity in the size of red blood cells typical of regenerative and iron-deficiency anemia. In humans, numerous and recent studies have shown a relationship between increased RDW and the risk of morbidity and mortality in patients with various disorders. In particular, a strong association has been established between changes in RDW and the risk of adverse outcome in humans with diseases affecting different organs or systems. Following the human literature, some studies have recently been conducted trying to clarify the clinical role of RDW in various animal disorders, particularly in dogs. In this review, we summarize and critically evaluate the results of the studies based on the measurement of RDW in dogs. We also emphasize the need for further and more extensive studies on the use of this simple and inexpensive parameter in animals.

CPAP Influence on Readily Available Inflammatory Markers in OSA-A Pilot Study

Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse, chronic hypoxia and a proinflammatory phenotype. The purpose of our study was to evaluate readily available inflammatory biomarkers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), WBC-to-MPV ratio (WMR) and lymphocyte-to-C-reactive protein ratio (LCR)) before and after CPAP in patients with moderate-severe OSA. We performed a prospective study that included patients with newly-diagnosed moderate-severe OSA. The control groups (patients without OSA and with mild OSA) were selected from the hospital polygraphy database. All subjects underwent routine blood panel, which was repeated in moderate-severe OSA patients after 8 weeks of CPAP. Our final study group included 31 controls, 33 patients with mild, 22 patients with moderate and 37 patients with severe OSA. CRP, ESR, NLR and WMR were correlated with OSA severity. After 8-week CPAP therapy, we documented a decrease in weight status, which remained statistically significant in both CPAP-adherent and non-adherent subgroups. Readily available, inexpensive inflammatory parameters can predict the presence of moderate-severe OSA, but are not influenced by short-term CPAP.

Chitosan-Coated Solid Lipid Nano-Encapsulation Improves the Therapeutic Antiairway Inflammation Effect of Berberine against COPD in Cigarette Smoke-Exposed Rats

Berberine (Ber) is an isoquinoline alkaloid that has shown therapeutic potential in mice with chronic obstructive pulmonary disease (COPD). However, the therapeutic efficiency of Ber is restricted by its low aqueous solubility and bioavailability. Chitosan and solid lipid nanoparticles (SLNs) have demonstrated great abilities as delivery systems in enhancing the bioavailability of therapeutic compounds. The present study aimed to get together the biological features of SLNs with the advantages of chitosan to formulate an efficient nano-carrier platform for the oral delivery of Ber and evaluate the therapeutic effect of the prepared Ber-encapsulated nanoparticles on airway inflammation in cigarette smoke (CS)-induced COPD rats. The Ber-encapsulated SLE-chitosan formulation was manufactured using a modified solvent-injection method followed by a homogenization process. Physicochemical properties, encapsulation efficiency, in vitro stability and Ber release, and pharmacokinetics of the manufactured formulation were evaluated. The COPD rat model was developed by exposing animals to CS. To study the therapeutic efficiency of Ber-encapsulated SLE-chitosan nanoparticles and pure berberine, the histopathological changes of the lung tissues, levels of inflammatory cells and cytokines, and activities of myeloperoxidase (MPO) and superoxide dismutase (SOD) enzymes were evaluated in bronchoalveolar lavage fluid (BALF). Ber-encapsulated SLE-chitosan showed the particle size in nano-range with high stability and controlled slow-release profile in vitro in simulated gastric (pH 1.5) and intestinal (pH 6.8) fluids. Administration of Ber-loaded SLE-chitosan nanoparticles could significantly ameliorate inflammation scores in lung tissues and reduce levels of inflammatory cells (neutrophils and macrophages) and inflammatory cytokines (IL-1β, Il-6, Il-17, and TNFα) in BALF when compared with the pure Ber. SLE-chitosan-based nanoparticles can strongly improve the therapeutic anti-inflammatory impact of Ber against CS-induced airway inflammation in COPD rats, suggesting the promising application of Ber-encapsulated SLN-chitosan nanoparticles for treating COPD and other inflammation-mediated diseases.

Research on the correlation of immunity in patients with chronic insomnia

PURPOSE

To investigate the changes in immunity and clinical infection events among patients with chronic insomnia.

MATERIALS AND METHODS

Forty-two patients with chronic insomnia (age = 64.44 ± 10.53) and 47 normal controls (age = 67.08 ± 7.822) were selected to determine differences in data, such as complete blood counts (CBCs), biochemical indices, lymphocyte subsets, immunoglobulin (Ig), complement C3 and C4 and interleukin-6 (IL-6), as well as to compare the incidence of clinical infection between the two groups.

RESULTS

There were significant differences in erythrocyte, hemoglobin, hematocrit, albumin, globulin, creatinine, IgG, IgG/IgM ratio, CD4⁺ T-lymphocytes, CD19-lymphocytes, CD4⁺/CD8⁺ ratio, platelet/lymphocyte ratio, CD19/CD3 ratio, and clinical infection events between the chronic insomnia group and the control group (p < 0.05). There was no significant difference in neutrophil, lymphocyte, monocyte, and platelet counts; lymphocyte subsets CD8⁺ T and CD56⁺; platelet-to-lymphocyte ratio (PLR); neutrophil-to-lymphocyte ratio (NLR); complement C3; complement C4; IgM; IgA; and IL-6 between the experimental group and their controls (p > 0.05). The systolic and diastolic blood pressures of the chronic insomnia group did not vary widely from those of the controls (p > 0.05).

CONCLUSION

Patients with chronic insomnia have immunological abnormalities, characterized by a higher incidence of clinical infection.