Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus

Inflammatory Markers in Thyroid Eye Disease: A Meta-Analysis

Thyroid Eye Disease (TED) is an inflammatory autoimmune condition affecting the eyes, often associated with Graves' disease. Inflammation is important in TED, involving immune cells and orbital tissues. While inflammatory markers have been studied in other diseases, their role in TED is unclear. We included 734 participants from 5 eligible studies investigated associations between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) and TED. Initial analysis found no significant differences in these markers between TED and control groups. However, sensitivity analysis excluding an outlier study revealed significant differences in NLR, PLR, and MLR between groups, suggesting the potential association between these inflammatory markers and TED. More research is needed, but these findings indicate complex TED pathogenesis and that inflammation may offer insights for TED diagnosis and management.

Significance of Neutrophil to Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) in Diabetic Foot Ulcer and Potential New Therapeutic Targets

Diabetic foot ulcer (DFU) is a well-known complication of diabetes and a significant burden on the national health systems. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio are inexpensive and easily accessible biomarkers that have proved to be useful in several inflammatory, infectious and cardiovascular diseases. We carried out a comprehensive review examining the association of NLR and PLR with the onset and progression of DFU. PLR and NLR were significantly increased in patients with DFU, compared with a control group of T2DM patients without DFU, and correlate well with DFU severity, evaluated by Wagner and IWGDF grading scales. In patients with diabetic foot infections (DFI), elevated NLR and PLR were correlated with osteomyelitis, increased risk of amputation, and septic complications. The significance of the elevated value of these biomarkers in DFU is related to chronic hyperglycemia and low-grade systemic inflammation, atherosclerotic and vascular complications, and also the associated septic factor. Serial, dynamic follow-up can provide useful information in planning and monitoring DFU treatment, as well as in risk stratification of these vulnerable patients. Further randomized studies are needed to set the cut-off values with clinical significance.

High remnant cholesterol as a risk factor for developing chronic kidney disease in patients with prediabetes and type 2 diabetes: a cross-sectional study of a US population

AIMS

To examine any potential links between remnant cholesterol (RC) and comorbid chronic kidney disease (CKD) in individuals with prediabetes and type 2 diabetes mellitus (T2DM).

METHODS

We used data from 2709 American people aged > 20 years from the National Health and Nutrition Examination Survey (NHANES) during 2011-2018. Subjects were categorized according to whether they had comorbid CKD. Logistic regression models and smoothed curve fitting methods were employed to assess the association of RC with comorbid CKD in patients with prediabetes and T2DM.

RESULTS

The 2709 participants included 1473 patients with T2DM and 1236 with prediabetes [impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)], of whom 744 (27.46%) had comorbid CKD. In multivariate-adjusted analysis, both RC and triglycerides (TG) were significantly associated with an increased risk of comorbid CKD, and a 1 mmol/L elevation of RC increased the risk by 38.1% [OR (95% CI) 1.636 (1.242, 2.156)], which was higher than the risk associated with a 1 mmol/L increase in TG [1.255 (1.106, 1.424)]. Additionally, those in the highest quartile of RC had a 43.6% higher risk of concomitant renal damage than those in the lowest quartile. RC was linearly and positively associated with the incidence of comorbid CKD in this population.

CONCLUSIONS

RC is an independent risk factor for comorbid CKD in patients with prediabetes and T2DM. This finding provides a novel insight into the management and early detection of renal disease in patients with impaired glucose metabolism.

Commonly Drawn Immunologic and Inflammatory Markers as Risk Predictors for Anal Cancer in Veterans Living With HIV

OBJECTIVES

This study aimed to determine if immune inflammatory markers (neutrophil lymphocyte ratio [NLR], platelet lymphocyte ratio [PLR], and prognostic nutritional index [PNI]) correlate with anal cancer risk in people living with HIV and to compare these markers with the CD4/CD8 ratio.

MATERIALS AND METHODS

This is a regional retrospective cohort study of veterans living with HIV who were screened for or diagnosed with anal neoplasia or cancer from 2001 to 2019. The NLR, PLR, PNI, and CD4/CD8 ratio within 1 year of anal pathology results were computed. Patients with anal cancer were compared to patients without anal cancer. Regression modeling was used to estimate the odds of developing anal cancer.

RESULTS

Three hundred thirty-four patients were included (37 with anal cancer, 297 without anal cancer). In patients with anal cancer, NLR and PLR were higher (2.17 vs 1.69, p = .04; 140 vs 110, p = .02, respectively), while PNI and CD4/CD8 ratio were lower (44.65 vs 50.01, p < .001; 0.35 vs 0.80, p < .001, respectively). On multivariate logistic regression modeling, only PNI (odds ratio, 0.90; p = .001) and CD4/CD8 ratio (odds ratio, 0.05; p < .001) were associated with increased anal cancer risk.

CONCLUSIONS

Although NLR and PLR independently correlate with anal cancer risk, when controlling for other risk predictors, only PNI and CD4/CD8 ratio were statistically significant biomarkers for anal cancer. The CD4/CD8 ratio is the strongest immune inflammatory marker that predicts risk of anal cancer among veterans living with HIV.

Correlation between insulin resistance and the rate of neutrophils-lymphocytes, monocytes-lymphocytes, platelets-lymphocytes in type 2 diabetic patients

BACKGROUND

Insulin resistance (IR) was a prominent feature commonly observed in individuals with type 2 diabetes mellitus (T2DM). T2DM Individuals often exhibited a concomitant presence of low-grade chronic inflammation. In this study conducted retrospectively, the aim was to investigate the connection between neutrophils-lymphocytes rate (NLR), monocytes-lymphocytes rate (MLR), platelets-lymphocytes rate (PLR) and IR, specifically among individuals with T2DM.

METHOD

This study encompassed a cohort of 405 individuals diagnosed with T2DM, comprising cases from January 2021 to November 2022. On the basis of whether there was IR or not, these sufferers were categorized into two cohorts, namely T2DM with IR group (292 cases) and T2DM without IR group (113 cases), as determined by a homeostasis model assessment-IR (HOMA-IR) value exceeding 2.0.

RESULTS

The findings of this study demonstrated compelling evidence of distinct biomarker profiles between individuals with T2DM who had IR and those without IR. Specifically, the IR individuals displayed notably raise NLR, MLR, PLR, C reactive protein (CRP) and serum amyloid A (SAA). Additionally, there was a noticeable decrease in superoxide dismutase (SOD) levels. Furthermore, IR was negatively correlated with SOD values, while positive associations were found between IR and NLR, CRP, and SAA levels (p < 0.05). Moreover, a rise in NLR and PLR levels demonstrated an identical relationship with the prevalence of IR (p = 0.007, p = 0.025, separately). The Receiver operating characteristic (ROC) curve demonstrated that the areas under the curve (AUC) for NLR, MLR, PLR, CRP, SAA and SOD in predicting occurrence of IR in T2DM patients were 0.603, 0.575, 0.581, 0.644, 0.594 and 0.632 respectively, with sensitivity of 79.5%, 95.2%, 46.9%,54.1% (or 51.4), 47.6% (or 45.7%) and 98.6% and specificity of 37.2%, 19.5%, 69.9%, 69% (or 71.7%), 71.6% (or 73.5%) and 23% respectively.

CONCLUSION

Our findings support the notion that higher magnitude of NLR, PLR, MLR, CRP, and SAA values, corresponded to lower SOD levels, indicating a more severe degree of IR in T2DM patients. Additionally, NLR, PLR, MLR, CRP, SAA, and SOD demonstrated predictive potential for assessing IR. Regrettably, due to the retrospective nature of this study, it was not feasible to take a measurement the majority of inflammatory factors and reactive oxygen species (ROS).

Cluster analysis of patient characteristics, treatment modalities, renal impairments, and inflammatory markers in diabetes mellitus

Type 2 diabetes mellitus (T2DM) is caused by an interplay of various factors where chronic hyperglycemia and inflammation have central role in its onset and progression. Identifying patient groups with increased inflammation in order to provide more personalized approach has become crucial. We hypothesized that grouping patients into clusters according to their clinical characteristics could identify distinct unique profiles that were previously invisible to the clinical eye. A cross-sectional record-based study was performed at the Primary Health Care Center Podgorica, Montenegro, on 424 T2DM patients aged between 30 and 85. Using hierarchical clustering patients were grouped into four distinct clusters based on 12 clinical variables, including glycemic and other relevant metabolic indicators. Inflammation was assessed through neutrophil-to-lymphocyte (NLR) and platelet to lymphocyte ratio (PLR). Cluster 3 which featured the oldest patients with the longest T2DM duration, highest hypertension rate, poor glycemic control and significant GFR impairment had the highest levels of inflammatory markers. Cluster 4 which featured the youngest patients, with the best glycemic control, the highest GFR had the lowest prevalence of coronary disease, but not the lowest levels of inflammatory markers. Identifying these clusters offers physicians opportunity for more personalized T2DM management, potentially mitigating its associated complications.

Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker to Managing Type 2 Diabetes Mellitus and Predicting Disease Progression

Introduction Diabetes is a chronic disease that causes dysregulation of blood glucose. Type 2 diabetes mellitus (T2DM) could result in long-term inflammatory conditions that affect different organs of the body. Despite the availability of diagnostic markers like glycated hemoglobin (HbA1c) for T2DM, it is essential to find an appropriate marker that could predict long-term complications. This study evaluates the potential role of neutrophil-to-lymphocyte ratio (NLR) in predicting disease progression and treatment responses.  Methods This case-control study was carried out among 160 T2DM patients and 132 non-diabetic persons. Blood samples were collected from each participant and were processed for hemoglobin, HbA1c, iron, ferritin, and complete blood picture (NLR).  Results The study showed that there was a significant variation in the serum levels of ferritin (264.8±611.6 ng/ml versus 168.3±364.7 ng/ml, p=0.392), iron (4.095±8.851 mcg/dl versus 55.20±37.62 mcg/dl, p=0.0111), and HbA1c (8.169±1.635% versus 5.668±0.5260% p<0.0001) among T2DM patients compared to non-diabetic persons. The NLR values (4.189±4.154 versus 4.095±8.851, p=0.009) among patients with T2DM significantly varied with that of non-diabetic persons. A significant negative correlation was noticed between the serum levels of iron and NLR (r=-0.17, p=0.014) and a positive correlation was noticed between HbA1c and NLR (r=0.19, p=0.014). The serum levels of iron revealed a significant positive correlation with the serum levels of ferritin (r=0.24, p=0.002) and hemoglobin percentage (r=0.41, p=0.008). HbA1c revealed a significant positive correlation with NLR (r=0.19, p=0.014). Additionally, a significant negative correlation was observed between iron with NLR (r=-0.17, p=0.029) and hemoglobin percentage with NLR (r=-0.30, p=0.005). However, no such correlation was demonstrated among non-diabetic persons. With an accuracy of 89.85% and high sensitivity and specificity, NLR showed diagnostic accuracy like HbA1c.  Conclusions NLR demonstrated equivalent efficacy to HbA1c in predicting glycemic control. Since diabetes affects different organs of the body, evaluating NLR probably predicts inflammation. Therefore, NLR could be useful in the management of T2DM and in predicting long-term complications.

Neutrophil: Lymphocyte and Platelet: Lymphocyte ratios measured before transplantation and their correlation with new-onset diabetes post-transplantation in renal transplant recipients

PURPOSE

Our goal was to evaluate the neutrophil:lymphocyte (NLR) and platelet:lymphocyte (PLR) ratios measured before transplantation and their correlation with new-onset diabetes after transplantation (NODAT) in renal transplant recipients.

PATIENTS AND METHODS

We conducted our study in 324 adult patients consecutively admitted to Military Hospital 103, Ha Noi, Viet Nam, who received kidney allografts from living donors. These patients were followed-up during the first 2 years post-transplantation for NODAT. We examined the association between NLR and PLR measured prior to transplantation in patients with NODAT: NLR and PLR were calculated based on the results of the complete blood count. The criteria for diagnosis of a fully symptomatic NODAT case were based on the guidelines established by the American Diabetes Association and included fasting venous blood glucose and glycosylated hemoglobin A1c (HbA1c) levels, with or without an oral glucose tolerance test.

RESULTS

The overall rate of NODAT during the two years after kidney transplantation was 13.6%. We found mean values of age and body mass index (BMI), and median values of NLR, PLR, high sensitivity C-reactive protein (hs-CRP) levels, and the arteriosclerosis ratio in the NODAT group to be significantly higher than those of the non-NODAT group (all p < 0.05). Furthermore, an adjusted multivariate regression analysis showed that age (area under the curve [AUC] = 0.727, p < 0.001), BMI (AUC = 0.846, p < 0.001), serum hs-CRP levels (AUC = 0.884, p < 0.001), NLR (AUC = 0.888; p < 0.001), and PLR (AUC = 0.818; p < 0.001) had predictive value for NODAT.

CONCLUSION

NLR and PLR measured before transplantation were good predictors for NODAT in the first 2 years post-renal transplantation.

Changes in Circulating Acylated Ghrelin and Neutrophil Elastase in Diabetic Retinopathy

Background and Objectives: The role and the levels of ghrelin in diabetes-induced retinal damage have not yet been explored. The present study aimed to measure the serum levels of total ghrelin (TG), and its acylated (AG) and des-acylated (DAG) forms in patients with the two stages of diabetic retinopathy (DR), non-proliferative (NPDR) and proliferative (PDR). Moreover, the correlation between serum ghrelin and neutrophil elastase (NE) levels was investigated. Materials and Methods: The serum markers were determined via enzyme-linked immunosorbent assays in 12 non-diabetic subjects (CTRL), 15 diabetic patients without DR (Diabetic), 15 patients with NPDR, and 15 patients with PDR. Results: TG and AG serum levels were significantly decreased in Diabetic (respectively, p < 0.05 and p < 0.01 vs. CTRL), NPDR (p < 0.01 vs. Diabetic), and in PDR patients (p < 0.01 vs. NPDR). AG serum levels were inversely associated with DR abnormalities (microhemorrhages, microaneurysms, and exudates) progression (r = -0.83, p < 0.01), serum neutrophil percentage (r = -0.74, p < 0.01), and serum NE levels (r = -0.73, p < 0.01). The latter were significantly increased in the Diabetic (p < 0.05 vs. CTRL), NPDR (p < 0.01 vs. Diabetic), and PDR (p < 0.01 vs. PDR) groups. Conclusions: The two DR stages were characterized by decreased AG and increased NE levels. In particular, serum AG levels were lower in PDR compared to NPDR patients, and serum NE levels were higher in the PDR vs. the NPDR group. Together with the greater presence of retinal abnormalities, this could underline a distinctive role of AG in PDR compared to NPDR.

Assessment of the Clinical Value of Platelet-to-Lymphocyte Ratio in Patients with Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is associated with higher mortality as a result of poor prognosis and unavailability of effective treatment options. This study retrospectively analyzed the clinical value of platelet-to-lymphocyte ratio (PLR) to aid in differentiating early hepatocellular carcinoma from liver cirrhosis patients. Three hundred and nine (309) patients including 155 patients with hepatocellular carcinoma (HCC) and 154 patients with liver cirrhosis were enrolled in this study. General clinical characteristics and blood parameters of each patient were collected, calculated, and retrospectively analyzed. Mann-Whitney U test was calculated to compare the two groups. Receiver operating characteristics (ROC) curve was performed to investigate the diagnostic potential of PLR in the prediction of HCC at a cut-off with high accuracy (area under the curve [AUC]) > 0.80. Hemoglobin (HB) concentration, red blood cell (RBC) count, neutrophil (NEU) count, platelet count, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the HCC patients than in the liver cirrhosis patients (p < 0.05). ROC curve analysis showed that the AUC, optimal cut-off value, sensitivity, and specificity of PLR to predict HCC patients were 0.912, 98.7, 81.2%, and 80.6% respectively. The results suggest that PLR is a potential biomarker that can be used to predict early HCC.

Serum resolvin D1 potentially predicts neurofunctional recovery, the risk of recurrence and death in patients with acute ischemic stroke

Resolvin D1 (RvD1) represses inflammation, oxidative damage and neural injury related to acute ischemic stroke (AIS) progression. The present study aimed to explore the association of serum RvD1 with disease features, neurological recovery and prognosis in patients with AIS. A total of 212 patients with newly diagnosed AIS, whose serum RvD1 was quantified at admission and at discharge using an ELISA were enrolled in the current study. The modified Rankin scale (mRS) score was noted at 3 months after patient enrolment (M3), and patients were followed up for a median duration of 11.4 (range, 1.1-21.0) months. The median RvD1 in patients with AIS at admission was 1.07 (range, 0.11-9.29) ng/ml and it was negatively correlated with the neutrophil/lymphocyte ratio (r=-0.160; P=0.009) and C-reactive protein level (r=-0.272; P<0.001), but it was not correlated with comorbidities or other biochemical indexes. RvD1 at admission was lower in patients with mRS >2 at M3 (P=0.001), recurrence (P=0.001) or death (P=0.032) compared with that in patients without the aforementioned characteristics, which had a general ability to estimate mRS >2 at M3 [area under curve (AUC), 0.633], as well as lower risk of recurrence (AUC, 0.745) and death (AUC, 0.757) according to receiver operator characteristic (ROC) curve analyses. The median RvD1 was raised to 1.70 (range, 0.30-16.62) ng/ml at discharge. RvD1 at discharge was able to forecast mRS >2 at M3 (AUC, 0.678) and was able to predict the risk of recurrence (AUC, 0.796) and death (AUC, 0.826) in the ROC curve analyses. Increased serum RvD1 was associated with an attenuated inflammation status, and predicted improved neurological recovery, and lower risk of recurrence and death in patients with AIS. More specifically, its level at discharge exhibits a better prognostic utility than that at admission.

Relationship between systemic immune inflammation index and mortality among US adults with different diabetic status: Evidence from NHANES 1999-2018

OBJECTIVE

To investigate the association between systemic immune inflammation index (SII) and all-cause or cardiovascular diseases (CVDs) mortality in US adults with different diabetic status based on the National Health and Nutrition Examination Survey (NHANES) database.

STUDY DESIGN AND SETTING

Adults with follow-up data in the NHANES 1999-2018 cycles were included in this study. The SII was calculated based on blood cells counts (including neutrophils, lymphocytes, and platelets) measured in the laboratory data. According to the quartiles of SII, population were divided into four groups (Q1-Q4). Mortality data was determined by linking NHANES survey participants to the National Death Index records, which collect mortality data and determine their vital status. Cox regression models were also performed to explore the hazard ratio (HR) and the corresponding 95 % confidence interval (95 % CI) of SII related with all-cause and CVDs mortality. In addition, restricted cubic spline was used to explore the nonlinear relationship between SII and mortality. Subgroup analysis and sensitivity analysis were performed to confirm the robustness of our results.

RESULTS

In this study, there were 45,454 participants were enrolled (50.43 % females), with a mean age of 47.35 ± 0.19 years. Among of which, 7971 were diabetes patients and 3281 were pre-diabetes. With the mean 9.89 ± 0.08 follow-up years, there were 6935 (15.26 %) deaths occurred. Of which, 1795 deaths were caused by CVDs. The age-adjusted death rates were higher in participants with high SII levels compared to those with low SII levels. Cox regression analysis, after adjusting for covariates, revealed that SII levels were associated with an increased risk of all-cause mortality (HR, 1.02; 95 % CI, 1.02-1.03, P < 0.0001) and CVDs mortality (HR, 1.05; 95 % CI, 1.02-1.08, P = 0.002) in the fully adjusted Model. Moreover, there was a slight increase in HR values with the progression of diabetes status. Restricted cubic spline analysis demonstrated a "U-shaped" relationship between SII and all-cause mortality in diabetic, pre-diabetic and non-diabetic populations (all the P for nonlinear < 0.001). In addition, the relationship between SII and CVDs mortality was also nonlinear in both the pre-diabetic and non-diabetic populations (both P < 0.001). However, there was a linear relationship between SII and cardiovascular mortality in individuals with diabetes (P = 0.528).

CONCLUSION

The SII is closely associated with the risk of all-cause and cardiovascular mortality. These associations vary among individuals with different diabetic states. Therefore, monitoring systemic inflammation and SII values is crucial in mitigating the risk of mortality.

Assessment of Hematological Profiles and Prognostic Role of Hemogram-Derived Novel Markers for Diabetes Mellitus and Its Complications Among Type 2 Diabetes Mellitus Adult Patients Attending Bishoftu General Hospital, Central, Ethiopia: A Comparative Cross-Sectional Study

Background

Diabetes is a chronic metabolic syndrome that is a global public health problem. Studies have used hematological parameters and hemogram-derived markers as predictors of poor glycemic and microvascular complications status in diabetics. However, the tendency to use these parameters is not fully evaluated in our context, and the evidence is inadequate. This study aimed to assess the hematological profiles and prognostic role of hemogram-derived novel markers in diabetes mellitus and its complications among DM patients at Bishoftu General Hospital, Ethiopia.

Methods

A comparative cross-sectional study was conducted among 261 participants from June 15 to August 12, 2022. A systematic random sampling technique was used to select participants. Data were collected using structured questionnaires, physical measurements, checklists, and laboratory tests. Hematological parameters and fasting blood glucose levels were determined from blood using Sysmex-XN550 and Cobas C311 analyzers, respectively. Blood smear was used to check Hematology analyzer output, and to screen participants for malaria parasites. Collected data were entered into Epi-data 3.1 and exported to SPSS-25. Data were analyzed by Chi-square, Mann-Whitney U-test, Kruskal-Wallis test, Post hoc test, and ROC curve. A P-value <0.05 was considered statistically significant.

Results

Total WBC, neutrophils, Monocyte, NLR, MLR, MPVLR, and PLR were significantly higher in poor glycemic and complicated T2DM; meanwhile, measured RBC parameters, RBC indices values were significantly lower in poor glycemic and complicated T2DM. The NLR, MLR, MPVLR, PLR, and NLR, MLR, MPVLR, RPR values were identified as predictors of poor glycemic and complication status in diabetic patients, respectively.

Conclusion

Significant increment of some hematological parameters and hemogram-derived markers, and their role in predicting poor glycemic and microvascular complications were identified in diabetic patients. Routine screening of hematological parameters and use of hemogram-derived markers for monitoring of altered health status in DM is very important in the improvement of patient quality of life.

Finnish diabetes risk score outperformed triglyceride-glucose index in diabetes risk prediction

Purpose

Triglyceride-Glucose (TyG) index is a surrogate marker of insulin resistance. This study compared the performance of TyG index and the Finnish diabetes risk score (FINDRISC) in diabetes risk prediction.

Methods

This cross-sectional study involved 122 young adults (aged 15-35 years) in Asaba, Delta State, Nigeria. Anthropometric measurements and biochemical analysis were done following standard protocols. Diabetes risk scoring was done using the FINDRISC questionnaire. TyG index was calculated logarithmically. Discrimination between TyG index and FINDRISC was done by plotting receiver operating characteristic (ROC) curves.

Results

High risk participants had significantly (p < 0.001) higher mean values of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) relative to the lower risk categories. Participants in TyG index Quartile 4 had significantly higher mean values of triglyceride (p < 0.001) and fasting plasma glucose (p < 0.05). BMI and triglyceride had the most significant (p < 0.001) positive correlation with FINDRISC and TyG index, respectively. A moderately elevated to high risk (FINDRISC ≥ 12) of developing diabetes was found in 14.8% of the participants; with a female preponderance (20.6%) relative to males (7.4%). More than half of the participants (52.5%) had slightly elevated risk and differences in diabetes risk susceptibility were significant (p < 0.001) across gender. FINDRISC had an AUC value of 0.826 while TyG index had an AUC value of 0.628 for diabetes risk prediction.

Conclusion

FINDRISC had a better performance than TyG index in the prediction of diabetes risk in this population. The use of other TyG-related parameters rather than TyG index is recommended in future studies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01252-y.

Diagnostic value of the neutrophil lymphocyte ratio in discrimination between tuberculosis and bacterial community acquired pneumonia: A meta-analysis

Background

We conducted a systematic review and meta-analysis, based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, to evaluate current literature on diagnostic value of neutrophil to lymphocyte ratio (NLR) in discrimination between tuberculosis (TB) and bacterial community acquired pneumonia (B-CAP).

Methods

Literature search was conducted from July 20, 2023 using Scopus, PubMed, and Web of Science databases. STATA software (version 12.0; Stata Corporation) was used for all analyses.

Results

We found that patients with TB had significantly lower levels of NLR compared to those with B-CAP (SMD = -1.09, 95 %CI = -1.78- -0.40, P = 0.002). In the quality subgroup analysis, we found that patients with TB had significantly lower level of NLR compared to those with B-CAP consistent in moderate (SMD = -0.86, 95 %CI = -2.30, 0.57, P = 0.23) and high-quality studies (SMD = -1.25, 95 %CI = -2.07, -0.42). In the subgroup analysis based on continent, we found that patients with TB had significantly lower level of NLR compared to those with B-CAP in studies performed in Asian populations (SMD = -1.37, 95 %CI = -2.13, -0.61, P < 0.001), but not on African population (SMD = -0.02, 95 %CI = -1.06, 1.02, P = 0.97). The result of this study did not change after execution of sensitivity analysis. The pooled sensitivity of NLR was 0.86 (95% CI = 0.80, 0.91), and the pooled specificity was0.88 (95% CI = 0.69, 0.95).

Conclusion

Patients with TB had a significantly lower NLR levels compared to those with B-CAP, so we utilized this biomarker for distinguishing between the disorders.

Is the neutrophil-to-lymphocyte ratio a marker for differentiating between benign and malignant submandibular gland masses?

OBJECTIVE

This study aimed to evaluate the effect of the neutrophil-to-lymphocyte ratio on the differentiation of benign and malignant masses in the submandibular triangle.

METHODS

We retrospectively evaluated 48 patients who underwent surgery for submandibular gland masses between January 2013 and February 2023. The patient's age, gender, preoperative complete blood count and imaging findings, postoperative histopathological diagnosis, and hemogram data were analysed. Patients were evaluated according to their postoperative histopathological diagnoses and categorised into four main groups: sialolithiasis, sialadenitis, benign tumours, and malignant tumours. Benign submandibular gland disease formations were evaluated under group B and malignant tumour formations under group M.

RESULTS

A preoperative fine needle aspiration biopsy was performed on 19 patients due to sialadenitis, pleomorphic adenoma, and malignant diseases other than sialolithiasis. One patient died among the patients with malignant disease and the remaining 7 patients were compared with the benign group of 40 patients regarding preoperative and postoperative neutrophil-to-lymphocyte ratio. In the benign group, the neutrophil-to-lymphocyte ratio was 2.64 preoperatively and decreased to 2.34 in the first postoperative year. The preoperative neutrophil-to-lymphocyte ratio decreased from 4.79 to 1.77 postoperatively in the malignant group. A statistically significant difference was observed (p<0.05).

CONCLUSION

This is the first study to demonstrate that the neutrophil-to-lymphocyte ratio can be used as a biomarker in submandibular gland masses and has prognostic significance in malignant masses. In addition to fine needle aspiration biopsy results, neutrophil-to-lymphocyte ratio can be used as a biomarker.

Comparative Analysis of Red Blood Cells, White Blood Cells, Platelet Count, and Indices in Type 2 Diabetes Mellitus Patients and Normal Controls: Association and Clinical Implications

Background

Diabetes mellitus (DM) is a major health burden affecting 537 million adults worldwide, characterized by chronic metabolic disorder and various complications. This case control study aimed to assess the impact of type 2 diabetes mellitus (T2DM), including hyperglycemia levels, on hematological parameters and complete blood count (CBC) derived parameters.

Methods

A total of 250 known diabetic patients from the Jazan Diabetic Center, Saudi Arabia, between January 2021 and December 2022, along with 175 healthy adult controls were recruited from Jazan Hospital's blood donation center. Demographic characteristics, medical histories, and relevant factors such as gender, age, BMI, treatment, disease duration, and comorbidities were collected with informed consent.

Results

The results of the red blood cell (RBC) count, RBC indices, and mean platelet volume showed significant differences between patients and controls, while the white cell (WBC) and platelet count were comparable between the two groups. CBC-derived parameters, especially neutrophil/lymphocyte ratio (NLR), and platelet/neutrophil ratio (PNR) exhibited significant differences.

Conclusion

CBC and derived parameters serve as inexpensive tools for T2DM patients monitoring, indicating early blood cell alterations and potential development of anemia. Further studies are needed to explore their role in predicting T2DM pathogenesis and progression, aiming to reduce severe complications, mortality and morbidity.

Can the Combination of Magnetic Resonance Imaging, Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict the Mass Origin in Ovarian Masses?

Objective

Evaluate the effectiveness of magnetic resonance imaging (MRI), blood parameters, and tumor markers to determine the role of objective criteria in distinguishing malignant, borderline, and benign masses and to minimize unnecessary surgical interventions by reducing interpretation differences.

Methods

The histopathological and clinical-laboratory results of the patients who underwent surgery for the initial diagnosis and whose ovarian masses were confirmed were retrospectively reviewed. Between groups, age, cancer antigen 125, mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), the presence of ascites, the ovarian-adnexal reporting and data system MRI scores, mass characteristics, and lymphocyte count were compared.

Results

The study comprised a total of 191 patients. These patients were categorized into three groups: Benign (n=113), borderline (n=26), and malignant (n=52). No noteworthy correlation was detected between the unilocular or multilocular nature of solid, cystic, or mixed masses and the rates of NLR, PLR, or MPV. However, a notable correlation was identified between NLR and the presence of acidity (p=0.003). In ovarian cancer patients, there was no significant difference in NLR and MPV between malignant epithelial and malignant sex cord-stromal types (p>0.05), whereas a significant difference emerged in the PLR ratio (p=0.013).

Conclusion

In ovarian masses with malignant potential, laboratory parameters such as NLR and PLR can guide the diagnosis process. In the future, various studies such as the development of different tests, markers, and imaging methods, the use of blood tests such as NLR, PLR, and MPV in cancer diagnosis will be possible. The results of these studies may contribute to the development of new methods for the diagnosis of ovarian cancer and the improvement of treatment protocols.

Hematological Indices Are Useful in Predicting Complications of Liver Cirrhosis

BACKGROUND

Liver cirrhosis is the final stage of chronic liver disease. We aimed to evaluate non-invasive scores as predictors of complications and outcome in cirrhotic patients.

METHODS

A total of 150 cirrhotic patients were included. Models for end-stage liver disease (MELD), albumin-bilirubin (ALBI) score, neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MoLR), and neutrophil-lymphocyte-albumin ratio (NLA) scores were tested in relation to the development of complications and mortality using receiver operating characteristic (ROC) curves.

RESULTS

The ROC curve analysis showed (area under the curve) AUC values of NLR, NLA, ALBI, and MELD of 0.711, 0.730, 0.627, and 0.684, respectively, for short-term mortality. MELD, ALBI, and NLA scores showed a statistically significant correlation with hepatic encephalopathy (p = 0.000 vs. 0.014 vs. 0.040, respectively), and the MELD cut-off value of 16 had a sensitivity of 70% and a specificity of 52% (AUC: 0.671, 95% CI (0.577-0.765)). For the assessment of the presence of ascites, the AUC values for NLA and MoLR were 0.583 and 0.658, respectively, with cut-offs of 11.38 and 0.44.

CONCLUSIONS

MELD, ALBI, and NLA are reliable predictors of hepatic encephalopathy. NLA and MoLR showed a significant correlation with the presence of ascites, and MELD, ALBI, NLR, and NLA have prognostic value to predict 30-day mortality in cirrhotic patients.

Serum Isthmin-1 Was Increased in Type 2 Diabetic Patients but Not in Diabetic Sensorimotor Peripheral Neuropathy

Purpose

This study aimed to investigate the relationship between serum isthmin-1 (ISM1) and type 2 diabetes mellitus (T2DM), and the alteration of serum ISM1 level in both diabetic sensorimotor peripheral neuropathy (DSPN) and diabetic adults with obesity.

Patients and Methods

We recruited 180 participants (120 T2DM and 60 controls) in the cross-sectional study. First, we compared the serum ISM1 concentration in diabetic patients and non-diabetic controls. Secondly, according to DSPN, patients were divided into DSPN and non-DSPN groups. Last, patients were categorized as lean T2DM (15 males, 15 females), overweight T2DM (35 males, 19 females), and obese T2DM groups (23 males, 13 females) according to gender and body mass index (BMI). All participants were collected with clinical characteristics and biochemical profiles. Serum ISM1 was detected in all subjects by ELISA.

Results

Higher serum ISM1 [7.78 ng/mL (IQR: 6.33-9.06) vs 5.22 (3.86-6.04), P <0.001] was observed in diabetic patients compared to non-diabetic controls. Binary logistic regression analysis showed that serum ISM1 was a risk factor for type 2 diabetes after adjustment (OR=4.218, 95% CI: 1.843-9.653, P=0.001). Compared to the non-DSPN group, serum ISM1 level was not changed significantly in patients who suffered from DSPN. Diabetic females with obesity had lower level of serum ISM1 (7.10±1.29 ng/mL) when compared to the lean T2DM (8.42±1.36 ng/mL, P <0.05) and the overweight T2DM (8.33±1.27 ng/mL, P <0.05). However, serum ISM1 was not changed significantly in male groups or all patients together.

Conclusion

Serum ISM1 was a risk factor for type 2 diabetes, and it was associated with diabetic adults with obesity while there was sexual dimorphism. However, serum ISM1 levels were not correlated with DSPN.

Hematocytological, biochemical, and hemostasis parameters' role in predicting the possibility of the various forms of the COVID-19 course in hospitalized Ukrainian patients: A cross-sectional study

Background and Aims

The main objective of this study is to establish the characteristics of blood laboratory parameters in hospitalized coronavirus disease 2019 (COVID-19) Ukrainian patients and the significance of the above-mentioned parameters for predicting the course of the disease.

Methods

Hematocytological, biochemical, and hemostasis methods of research have been used. Groups of patients with different forms of the coronavirus disease course have been analyzed (lethality - recovery, recovery with a severe and mild course).

Results and Conclusion

Age is one of the risk factors for COVID-19 mortality. Absolute values of neutrophils, neutrophil-lymphocyte ratio (NLR), systemic inflammation index, d-dimer, C-reactive protein, and soluble fibrin complex can be used by clinicians to effectively differentiate between two possible outcomes (lethality vs. recovery). A higher number of stab leukocytes, d-NLR, and platelets concentration have been recorded in patients with severe COVID-19 cases, compared to mild ones. The risk of adverse COVID-19 outcome (lethality) is significantly linked with d-dimer and NLR (odds ratio 1.42). The risk of a severe course of the disease was significantly associated with the count of leukocytes (odds ratio 4.96).

Combined evaluation of Geriatric nutritional risk index and Neutrophil to lymphocyte ratio for predicting all-cause and cardiovascular mortality in hemodialysis patients

OBJECTIVE

Malnutrition, accompanied by an inflammatory profile, is a risk factor for poor prognosis in hemodialysis patients. The purpose of this study was to investigate the predictive value of NLR combined with GNRI for all-cause and cardiovascular mortality in hemodialysis patients.

METHODS

A total of 240 maintenance hemodialysis (MHD) patients in hemodialysis centers were enrolled in this retrospective study. The influencing factors of all-cause death in hemodialysis patients were analyzed by COX regression. The cut-off values of GNRI and NLR for predicting mortality in enrolled MHD patients were 89.01 and 4, respectively. Based on these cut-off values, the patients were divided into four groups: G1: high GNRI (≥ 89.01) + high NLR (≥ 4) group; G2: high GNRI (≥ 89.01) + low NLR (<4) group, G3: low GNRI (< 89.01) + high NLR (≥4) group; G4: low GNRI (< 89.01) + low NLR (<4).

RESULTS

During the follow-up period (average: 58 months), the all-cause mortality was 20.83%(50/240) and the cardiovascular mortality was 12.08%(29/240). Both NLR and GNRI were independent risk factors for the prognosis of MHD patients (P<0.05). Survival analysis showed that patients with low GNRI had a lower survival rate than those with high GNRI, whereas patients with high NLR had a lower survival rate than those with low NLR. Kaplan-Meier curve for all-cause mortality revealed that compared to G1, G2, and G4, G3 had the lowest survival rate, while G2 had the highest survival rate among all groups (P < 0.05). Kaplan-Meier curve for cardiovascular mortality showed that G3 had lower survival than G1, G2, and G4 (P < 0.001).

CONCLUSIONS

Our study demonstrates that bothGNRI and NLR are associated with all-cause mortality and cardiovascular mortality in MHD patients. Combining these two factorsmay contribute to a prognostic evaluation for MHD patients.

Glycemic Dysregulation, Inflammation and Disease Outcomes in Patients Hospitalized with COVID-19: Beyond Diabetes and Obesity

INTRODUCTION

During the COVID-19 pandemic, diabetes mellitus (DM) and obesity were associated with high rates of morbidity and mortality. The aim of this study was to investigate the relationship between markers of inflammation, disease severity, insulin resistance, hyperglycemia, and outcomes in COVID-19 patients with and without diabetes and obesity.

MATERIALS AND METHODS

Epidemiological, clinical, and laboratory data were collected from the University Hospital of Ioannina COVID-19 Registry and included hospitalized patients from March 2020 to December 2022. The study cohort was divided into three subgroups based on the presence of DM, obesity, or the absence of both.

RESULTS

In diabetic patients, elevated CRP, IL-6, TRG/HDL-C ratio, and TyG index, severe pneumonia, and hyperglycemia were associated with extended hospitalization. Increased IL-6, NLR, and decreased PFR were associated with a higher risk of death. In the obese subgroup, lower levels of PFR were associated with longer hospitalization and a higher risk of death, while severe lung disease and hyperglycemia were associated with extended hospitalization. In patients without DM or obesity severe pneumonia, NLR, CRP, IL-6, insulin resistance indices, and hyperglycemia during hospitalization were associated with longer hospitalization.

CONCLUSION

Inflammatory markers and disease severity indices were strongly associated with disease outcomes and hyperglycemia across all subgroups.

Could Systemic Inflammatory Index Predict Diabetic Kidney Injury in Type 2 Diabetes Mellitus?

BACKGROUND

The systemic inflammatory index (SII) is a new inflammatory marker that has been the subject of various studies in diseases with chronic inflammation. Diabetic nephropathy is a disease associated with chronic inflammation. We aimed to evaluate the relationship between SII and diabetic nephropathy.

METHODS

Patients with diabetes who applied to our outpatient clinic were included in the study. Diabetic patients were divided into two groups: those with diabetic nephropathy and those without. In addition, healthy individuals who applied to our clinic for general check-ups during these dates were included as the control group. The SII values and other characteristics of the three study groups were compared.

RESULTS

The median SII value for those with DKI was 584 (178-4819); for those without DKI, it was 282 (64-618); and for the control group, it was 236 (77.5-617) (p < 0.001). SII was significantly and positively correlated with BMI, weight, blood glucose, HbA1c, CRP, and creatinine, and negatively correlated with the glomerular filtration rate (GFR) value. SII values higher than 336 have 75% sensitivity and 70% specificity in detecting DKI.

CONCLUSION

The SII value can predict diabetic kidney injury in diabetics, and it can be used as an adjunctive diagnostic tool.

The Association between Neutrophil-to-Lymphocyte Ratio and Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Background

Glycated hemoglobin (HbA1c) is a commonly used clinical marker to monitor the control of type 2 diabetes mellitus patients (T2DM). However, it is unable to identify the ongoing inflammatory changes in the body. These factors could be easily identified and monitored by the neutrophil-to-lymphocyte ratio (NLR). Therefore, this study is aimed at investigating the relationship between NLR and glycemic control in T2DM.

Method

A comprehensive search of eligible studies was performed in various databases published until July 2021. A random effect model was used to estimate the standardized mean difference (SMD). A metaregression, subgroup, and sensitivity analysis were conducted to search for potential sources of heterogeneity.

Result

A total of 13 studies were included in this study. Accordingly, the SMD of the NLR values between the poor and good glycemic control groups was 0.79 (95% CI, 0.46-1.12). Our study also showed that high NLR was significantly associated with poor glycemic control in T2DM patients (OR = 1.50, 95% CI: 1.30-1.93).

Conclusion

The results of this study suggest an association between high NLR values and an elevated HbA1C in T2DM patients. Therefore, NLR should be considered a marker of glycemic control in addition to HbA1c in T2DM patients.

Impact of Uncontrolled Diabetes Mellitus on Blood Cells Indices and Plasma Components in Patients Without Nephropathy

<b>Background and Objective:</b> Diabetes mellitus (DM) the most prevalent consequences are diabetic retinopathy, neuropathy, cardiovascular illnesses, erectile dysfunctions, stroke and cardiovascular difficulties. The main goal of this study was to evaluate the impact of uncontrolled diabetes mellitus on blood cells' indices and plasma components. <b>Materials and Methods:</b> This is a prospective cross-sectional study. The research was carried out at the King Fahad Medical Center in Riyadh, in duration from February, 2023 to May, 2023, in the interest of healthcare consumers attending the hematology laboratory for routine investigations. Sixty samples were collected and complete blood count, lipid profile, HbA1c and blood glucose for blood samples. <b>Results:</b> In this study, females accounted for 53.3% of the participants, while males accounted for 46.7%. In terms of age distribution, more than 55 years old accounted for 50% of the study's participants. A significant correlation has been found between HbA1c and red blood cell Mean Cell Volume (MCV) and there was a significant association between the high level of HbA1c and the red blood count. However, there was no significant correlation between plasma components and HbA1c. <b>Conclusion:</b> There is a remarkable effect of uncontrolled diabetes mellitus and RBCs count and erythrocyte MCV.

A novel clinical prediction model of severity based on red cell distribution width, neutrophil-lymphocyte ratio and intra-abdominal pressure in acute pancreatitis in pregnancy

BACKGROUND

Acute pancreatitis in pregnancy (APIP) with a high risk of death is extremely harmful to mother and fetus. There are few models specifically designed to assess the severity of APIP. Our study aimed to establish a clinical model for early prediction of severity of APIP.

METHODS

A retrospective study in a total of 188 patients with APIP was enrolled. The hematological indicators, IAP (intra-abdominal pressure) and clinical data were obtained for statistical analysis and prediction model construction.

RESULTS

According to univariate and multivariate logistic regression analysis, we found that red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR) and Intra-abdominal pressure (IAP) are prediction indexes of the severity in APIP (p-value < 0.05). Our novel clinical prediction model was created by based on the above three risk factors and showed superior predictive power in primary cohort (AUC = 0.895) and validation cohort (AUC = 0.863). A nomogram for severe acute pancreatitis in pregnancy (SAPIP) was created based on the three indicators. The nomogram was well-calibrated.

CONCLUSION

RDW, NLR and IAP were the independent risk factors of APIP. Our clinical prediction model of severity in APIP based on RDW, NLR and IAP with predictive evaluation is accurate and effective.

Effects of Semaglutide and Empagliflozin on Inflammatory Markers in Patients with Type 2 Diabetes

Low-grade inflammation is associated with complications of type 2 diabetes. Glucagon-like peptide-1 receptor agonists and sodium-glucose transporter-2 inhibitors have shown cardioprotective effects that are independent of their glucose-lowering effects. Cardio-protection could be mediated by the anti-inflammatory effects of these medications, but there is currently limited evidence to support this hypothesis. We conducted a prospective clinical study in patients with type 2 diabetes requiring treatment intensification. Ten patients were assigned to receive empagliflozin 10 mg and 10 patients to receive s/c semaglutide (titrated to 1 mg once a week) in a non-randomised manner. All parameters were measured at baseline and after 3 months. Fasting plasma glucose and glycated haemoglobin improved significantly in both treatment groups, with no between-group differences. Body weight and body mass index reduced significantly more in the semaglutide group, whereas waist circumference decreased only in the empagliflozin group. There was a trend for high-sensitivity CRP reduction in both treatment groups that did not reach statistical significance. Interleukin-6 and the neutrophil-to-lymphocyte ratio did not change in either group. Ferritin and uric acid decreased significantly only in the empagliflozin group, and ceruloplasmin decreased significantly only in the semaglutide group. Though there were clinically meaningful improvements in diabetes control in both treatment arms, we could detect only minor changes in some inflammatory markers.

Neutrophil–lymphocyte ratio as a reliable marker to predict pre-clinical retinopathy among type 2 diabetic patients

Background

Diabetic retinopathy is now recognized as a neurovascular in lieu of a microvascular complication. Visual evoked potentials (VEPs) are greatly valuable in detecting early diabetic retinal functional changes before the occurrence of structural damage. Low-grade inflammation plays a fundamental part in the development and progression of retinopathy in diabetics. Detecting diabetic patients with early retinopathy before the occurrence of clinical symptoms provides a window of opportunity to ensure the best prognosis for these eyes. Neutrophil–lymphocyte ratio (NLR) has recently been introduced as a novel marker of inflammation in various diseases. Indeed, the presence of a cheap, available, and reliable marker of inflammation that is capable to detect pre-clinical diabetic retinopathy (P-DR) is crucial for early intervention to retard the progression of ocular damage. As far as we know no previous studies investigated the role of NLR in the detection of P-DR. The aim of this study was to investigate the quality of prediction of NLR in detecting pre-clinical retinopathy in type 2 diabetic patients.

Results

In this case–control study, VEPs results showed a significant delay in P100 latencies of the patients’ group compared to the control group. According to the VEPs results, the patient group was further subdivided into two: diabetic with VEPs changes (a group with P-DR) and diabetic without VEPs changes. NLR was significantly elevated in patients with P-DR (p < 0.001). NLR cut-off point ≥ 1.97 is able to predict P-DR with 89.29% sensitivity and 84.37% specificity. Linear regression model revealed that NLR is the only independent factor that predicts P-DR. (odds ratio 3.312; 95% confidence interval 1.262–8.696, p = 0.015*.

Conclusions

Visual evoked potentials have an important role to evaluate the visual pathway in diabetics and to diagnose pre-clinical diabetic retinopathy before the occurrence of structural damage. Neutrophil–lymphocyte ratio is a reliable marker for the detection of pre-clinical diabetic retinopathy with good sensitivity (89.29%) and specificity (84.37%). Finding a reliable available laboratory test to predict P-DR could be of help to save diabetic patients from serious ocular complications.

Logistic Regression Analysis of Clinical Characteristics for Differentiation of Chronic Obstructive Pulmonary Disease Severity

Background

This study aimed to investigate the predictive value of general clinical data, blood test indexes, and ventilation function test indexes on the severity of chronic obstructive pulmonary disease (COPD).

Methods

A total of 141 clinical characteristics of COPD patients admitted to our hospital were collected. A mild-to-moderate group and a severe group were classified depending on the severity of COPD, and their baseline data were compared. The predictive factors of severe COPD were analyzed by univariate and multivariate logistic regression, and the nomogram model of severe COPD was constructed. The clinical variables, including gender, height, weight, body mass index (BMI), age, course, diabetes, hypertension, smoking history, WBC, NEUT, lymphocyte count (LY), MONO, eosinophil count (EOS), PLT, mean platelet volume (MPV), platelet distribution width (PDW), partial pressure of oxygen (PaO₂), and PaCO₂, were collected.

Results

There were 67 mild-to-moderate COPD patients and 74 severe COPD patients in this study cohort. Severe COPD had a higher white blood cell count (WBC), neutrophil count (NEUT), monocyte count (MONO), platelet count (PLT), neutrophil to lymphocyte ratio (NLR), and a lower partial pressure of carbon dioxide (PaCO₂). Univariate logistic regression analysis showed that WBC, NEUT, MONO, PLT, and NLR were contributing factors of severe COPD, while PaCO₂ was an unfavorable factor of severe COPD. Enter, forward, backward, and stepwise multivariate logistic regression analyses all showed that NEUT and PLT were independent contributing factors to severe COPD. Moreover, the nomogram model had good predictive ability, with an area under the curve (AUC) of the receiver operating characteristic (ROC) curve being 0.881. Good calibration and clinical utility were validated through the calibration plot and the decision curve analysis (DCA) plot, respectively.

Conclusion

The severity of COPD was correlated with NEUT and PLT, and the nomogram model based on these factors had good predictive performance.

Evaluation of Inflammatory Blood Markers in Sinonasal Inverted Papilloma

OBJECTIVE

Sinonasal inverted papillomas are benign neoplasms of the nasal cavity and paranasal sinuses. They have characteristic features such as a high risk of recurrence and possible malignant transformation. This study was conducted to investigate the relationship between sinonasal inverted papilloma and inflammatory blood markers.

PATIENTS AND METHODS

Sixty-five patients who were diagnosed histologically as having sinonasal inverted papilloma and 65 age- and sex-matched healthy controls were included in the study. Inflammatory blood markers such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), red cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) of the patient and control groups were compared.

RESULTS

There were no statistically significant differences between the patients and controls for white blood cell, platelet, hemoglobin, neutrophil, and lymphocyte counts (P > .05). No statistically significant difference was found between the patients and controls for NLR, PLR, RDW, MPV, and PDW (P > .05). In the logistic regression analysis model, which was created to investigate the effects of inflammatory blood markers in determining the patient group, the increase in the NLR and decrease in the PLR were found to be statistically significant factors (P = .008, P = .039).

CONCLUSION

This is the first study in the literature to investigate the relationship between sinonasal inverted papilloma and inflammatory blood markers, and the results suggest that NLR and PLR may be used to distinguish patients with sinonasal inverted papilloma from controls.

Investigating Neutrophil-to-Lymphocyte and C-Reactive Protein-to-Albumin Ratios in Type 2 Diabetic Patients with Dry Eye Disease

BACKGROUND

Patients with Diabetes mellitus (DM) are at risk of developing dry eye disease (DED). We investigated routine laboratory parameters in patients with type 2 DM (T2D) and T2D-DED to identify potential inflammatory markers.

METHODS

A retrospective study of 241 randomly selected patients (30 DED non-diabetic, 120 T2D, and 91 with T2D-DED). The neutrophil-to-lymphocyte ratios (NLR), CRP-to-albumin ratios (CAR), and the glycosylated haemoglobin A1c (HbA1c) results were correlated between groups.

RESULTS

The NLR and HbA1c were significantly higher in the T2D-DED group (p≤0.001 and 0.0001, respectively) when compared with T2D and DED non-diabetic groups. CAR was insignificantly high in the three groups (p=0.192). A positive correlation was identified between CAR and NLR in T2D-DED patients (p= 0.008).

CONCLUSION

In T2D-DED patients, NLR was significantly high and positively correlate with CAR. These results predicate diabetes with dry eye complications, and biomarker-mediated inflammation may have important roles in DED pathogenesis.

The Value of Peripheral Blood Cell Ratios in Primary Membranous Nephropathy: A Single Center Retrospective Study

Background

Primary membranous nephropathy (PMN) is a common cause of nephrotic syndrome in adults. Forty percent of the patients continue to progress and eventually develop into chronic renal failure. Although phospholipase A2 receptor (PLA2R) is the major antigen of PMN, the clinical features do not often parallel with the antibody titers. Therefore, it is significant to find relative credible markers to predict the treatment response.

Methods

One hundred and eighteen PMN patients were recruited. The response to treatment was defined as ALB≥30g/L at 6 months and complete remission (CR) or not at the end of the follow-up. Renal outcome endpoint was defined as 50% or more Cr increase at the end.

Results

The patients with poor treatment effects had numerically higher platelet-lymphocytes ratio (PLR). For patients with CR or not, the difference was near to statistic significant (P=0.095). When analyzing CR or not, the fitting of the binary logistic regression model including both PLA2R Ab titer and PLR (Hosmer-Lemeshow test: χ ²=8.328, P = 0.402; OR (PLA2R Ab titer) = 1.002 (95% CI 1.000-1.004, P = 0.042); OR (PLR) = 1.006 (95% CI 0.999-1.013, P = 0.098)) was markedly better than that with only PLA2R Ab titer (Hosmer-Lemeshow test: χ ²=13.885, P = 0.016). The patients with renal function deterioration showed significantly higher monocyte-lymphocyte ratio (MLR) (0.26 (0.22-0.31) vs 0.18 (0.13-0.22), P = 0.012).

Conclusion

PMN patients with poor treatment response tended to have higher PLR at the time of renal biopsy, and a higher MLR was associated with poor renal outcomes. Our findings suggested that PLR and MLR might be used to predict treatment efficacy and prognosis for PMN patients, respectively.

Evaluation of descriptive performances of platelet indices, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio in aortic dissections

OBJECTIVE

Mechanical damage resulting from aortic dissection creates a thrombus in the false lumen, in which platelets are involved. Platelet index is useful for the function and activation of platelets. The aim of this study was to show the clinical relevance of the platelet index of aortic dissection.

METHODS

A total of 88 patients diagnosed with aortic dissection were included in this retrospective study. Demographic data and hemogram and biochemistry results of the patients were determined. Patients were divided into two groups: deceased and surviving patients. The data obtained were compared with 30-day mortality. The primary outcome was the relationship of platelet index with mortality.

RESULTS

A total of 88 patients, 22 of whom were female (25.0%), diagnosed with aortic dissection, were included in the study. It was determined that 27 (30.7%) of the patients were mortal. The mean age of the entire patient group was 58±13 years. According to the DeBakey classification of aortic dissection of the patients, the percentages of the 1-2-3 type were determined as 61.4, 8.0, and 30.7%, respectively. Platelet index was not found to be directly related to mortality. Increase in age, decrease in bicarbonate value, and presence of diabetes mellitus were associated with mortality.

CONCLUSION

Although there were no significant changes in platelet index in aortic dissection, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were found to be high in line with the literature. In particular, the presence of advanced age diabetes mellitus and decrease in bicarbonate are associated with mortality.

The Pathogenic Role of Oxidative Stress, Cytokine Expression, and Impaired Hematological Indices in Diabetic Cardiovascular Diseases

A simultaneous increase in the prevalence of diabetes mellitus (DM), a risk factor for cardiovascular diseases (CVDs), has contributed to the escalation of CVD related mortalities. To date, oxidative stress and inflammation are increasingly recognized as significant drivers of cardiovascular complications in patients with diabetes. Therefore, this study aims to explore the correlation between oxidative stress, inflammation, and hematological indices in diabetic patients with CVDs. Patients were allocated into five groups: healthy controls; nondiabetic patients with myocardial infarction; diabetic patients with myocardial infarction; nondiabetic patients with heart failure; and diabetic patients with heart failure. The results revealed that the malondialdehyde levels were increased; whereas superoxide dismutase enzyme activities were markedly reduced in all CVD groups compared with those of healthy controls. Although the mRNA expression levels of interleukin (IL)-6, IL-18, and IL-38 were significantly increased, those of the anti-inflammatory cytokine, IL-35, have been reduced in all CVD groups compared with healthy controls. Regarding hematological indices, hematocrit, red blood cell distribution width, mean platelet (PLT) volume, plateletcrit, PLT distribution width, leukocyte count, and PLT-to-lymphocyte and neutrophil-to-lymphocyte ratios were markedly increased in the diabetic and nondiabetic CVD groups compared with those of the healthy controls. Oxidative stress and cytokine biomarkers may play a significant role in the complications of diabetic cardiomyopathy. Moreover, hematological indices are particularly sensitive to systemic inflammatory changes and are novel markers for the early detection of diabetic cardiomyopathy.

Preoperative Neutrophil Lymphocyte Ratio in Prediction of Adnexal Mass Torsion

Aims

Adnexal torsion commonly affects reproductive age group females. Prompt diagnosis and early management help in the preservation of fertility. However, its diagnosis is challenging. Preoperative diagnosis can be suspected in only 23-66% of the cases and half of the patients operated for adnexal torsion have different diagnosis. This article thus aims to identify the diagnostic value of preoperative neutrophil lymphocyte ratio in adnexal torsion in comparison with other untwisted unruptured ovarian cysts.

Methods

This was a retrospective study conducted in the duration of five years from 1st January 2016 to 1st January 2020. The data about demographic parameters, hematological parameters, operative approach, operative technique, and histopathological reports were derived from an electronic database and documented on proforma. SPSS was used for statistical analysis. Logistic regression analysis and influence of each factor on preoperative diagnosis of Adnexal torsion was evaluated.

Results

A total of 125 patients were included in the article (adnexal torsion group n = 25, untwisted unruptured ovarian cyst group n = 100). There was no statistically significant difference in comparison to age, parity, and abortion between both groups. Most patients had undergone laparoscopic surgery which was based on surgeon's skill and preference. Nineteen (78%) patients in the adnexal torsion group underwent oophorectomy while infarcted ovary was seen in only 4 cases. Among the blood parameters, only neutrophil-lymphocyte ratio (NLR) >3 was found to be statistically significant under logistic regression analysis. Most common adnexal pathology to undergo torsion was serous cyst.

Conclusion

Preoperative neutrophil-lymphocyte ratio can be a predictive marker for diagnosis of adnexal torsion and can differentiate it from untwisted unruptured ovarian cysts.

Oxidative Stress and Inflammatory Biomarkers in Patients with Diabetic Foot

Background and Objectives: Diabetic foot (DF) development is driven by complex interactions of hyperglycemia, inflammation, and oxidative stress (OS). We aimed to investigate OS and inflammatory biomarkers in patients with DF and their potential to improve early diagnosis and management of DF. Materials and Methods: The prooxidant−antioxidant balance (PAB), superoxide dismutase (SOD), total oxidative status (TOS), total sulfhydryl groups (SHG), routine biochemical parameters, and complete blood count were determined in 42 patients with type-2 DM, of which 23 patients had DF, while 19 patients were without DF complications. The neutrophils-to-lymphocyte ratio (NLR) was evaluated as a biomarker of inflammation. Results: Patients with DF had significantly higher (p < 0.05) PAB levels (170 ± 33.9 U/L) compared to those without DF complications (142 ± 31.3 U/L). In addition, patients with DF had significantly reduced SOD activities (p < 0.01). NLR values were significantly higher in the DF group (median: 2.8; interquartile range: 2.0−4.3) than in the group without DF (median: 1.4; interquartile range: 1.4−2.1; p < 0.01). A positive correlation was found between the PAB and NLR index (r = 0.449; p < 0.05). The diagnostic accuracy of both PAB (AUC = 0.741; p < 0.01) and NLR (AUC = 0.760; p < 0.01) was estimated as acceptable. Conclusions: In conclusion, the development of DF is associated with enhanced OS and inflammation processes. PAB and NLR could be useful non-invasive biomarkers of DF development.

Hematological characteristics of COVID-19 patients with fever infected by the Omicron variant in Shanghai: A retrospective cohort study in China

BACKGROUND

A wave of the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has rapidly spread in Shanghai, China. Hematological abnormalities have been reported in coronavirus disease 2019 (COVID-19) patients; however, the difference in hematological parameters between COVID-19 patients with fever and patients who are febrile from other causes remains unexplored.

METHODS

This retrospective cohort study enrolled 663 SARS-CoV-2 positive patients identified by RT-PCR. Clinical parameters, including age, sex, and threshold cycle values of all COVID-19 patients, and hematological parameters of COVID-19 patients in the fever clinic were abstracted for analysis.

RESULTS

Overall, 60.8% of COVID-19 patients were male, and the median age was 45 years. Most of COVID-19 patients were asymptomatic, while 25.8% of patients showed fever and 10.9% of patients had other emergencies. COVID-19 patients with fever had significantly lower white blood cells (WBCs), neutrophils, lymphocytes, platelets and C-reactive protein (CRP), and significantly higher monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and mean platelet volume-to-platelet ratio (MPR) levels, compared with those in SARS-CoV-2 negative patients with fever from other causes (p < 0.05). Neutrophil-to-lymphocyte ratio (NLR), PLR, and systemic inflammatory index (SII) levels were significantly higher in COVID-19 patients with emergencies (p < 0.05). WBCs showed the best performance with an area under the curve (0.756), followed by neutrophils (0.730) and lymphocytes (0.694) in the diagnosis of COVID-19 in the fever clinic.

CONCLUSION

WBCs, neutrophils, lymphocytes, platelets, CRP and MLR, PLR, and MPR may be useful in early diagnosis of COVID-19 in the fever clinic.

Neutrophil-lymphocyte ratio as a risk factor for osteoporotic vertebrae fractures and femoral neck fractures

Fracture is associated with osteopenia after osteoporosis. Neutrophil-lymphocyte ratio (NLR) is common in inflammatory diseases. NLR can be used as an effective clinical tool to assess postmenopausal osteoporosis. The aim of this study is to further explore the relationship between elevated NLR and the severity of osteoporotic vertebrae fractures and femoral neck fracture based on magnetic resonance imaging (MRI). A total of 80 patients with osteoporotic vertebrae fractures, osteoporotic femoral neck fracture in Baoding Second Central Hospital from 2017 to 2020 were selected as the research objects. This study included a series of pretreatment factors, mainly including white blood cell count, red blood cell count, hemoglobin, and the general condition of the patients. Statistical methods included Pearson chi-square test, Spearman correlation test, logistic regression analysis and receiver operator characteristic (ROC) curve. According to Pearson chi-square test, Spearman correlation test, univariate/multivariate logistic regression analysis, the severity of osteoporotic vertebrae fractures, osteoporotic femoral neck fracture was significantly correlated with NLR (P < .001). NLR (odds ratio [OR] = 13.229, 95% CI: 4.167-41.998, P < .001) was a significant independent risk factor for osteoporotic vertebrae fractures, osteoporotic femoral neck fracture. receiver operator characteristic (ROC) curve was used to detect the specificity and sensitivity. The level of NLR has an important influence on the severity of osteoporotic vertebrae fractures and femoral neck fracture. The higher the level of NLR, the more serious the osteoporotic vertebrae fractures and femoral neck fracture.

The Diagnostic Value of Neutrophil to Lymphocyte Ratio as an Effective Biomarker for Eye Disorders: A Meta-Analysis

The neutrophil to lymphocyte ratio (NLR) reflects a dynamic relationship between the innate (neutrophils) and adaptive (lymphocytes) cellular immune response. This systematic review and meta-analysis was conducted to critically evaluate the literature regarding the use of the NLR as a reliable means to detect several ocular disorders. Our study was registered with the PROSPERO (ID: CRD42022314850). Three databases, including PubMed, Embase, Scopus, and the Web of Science, were searched on September 9, 2022, with no restrictions on the article's language. Finally, 32 articles were recognized as eligible for our meta-analysis. We found that patients with eye diseases had significantly elevated levels of NLR in comparison to healthy controls (SMD =0.53, 95% CI =0.35-0.71, P < 0.001). In subgroup analysis, patients with keratoconus (SMD =0.69; 95% CI =0.33-1.05, P < 0.001), glaucoma (SMD =0.56, 95% CI =0.25-0.87, P < 0.001), pterygium (SMD =0.14; 95% CI =0.01-0.26, P < 0.001), and idiopathic epiretinal membrane (SMD =0.14; 95% CI =0.01-0.26, P < 0.001) had higher levels of NLR compared to healthy controls. However, NLR levels of patients with dry eye disease were similar to healthy controls (SMD =0.32, 95% CI = -0.49-1.13, P = 0.435). It can be said that NLR is a valuable marker of systemic inflammation, which is significantly increased in many eye disorders, suggesting that inflammation plays a key role in the pathophysiology of these diseases.

High Pretreatment Level of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio and Other Factors Associated with Delayed Sputum Conversion in Patients with Pulmonary Tuberculosis

Introduction

Patients with delayed intensive phase sputum conversion have a higher risk of multidrug resistant-tuberculosis (MDR-TB) and poorer treatment outcomes. Both, host (immune response and comorbidity) and pathogen factors play important roles in determining sputum conversion after treatment initiation. Impaired host immune response, especially the cellular components, as defined by the increased pre-treatment level of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and other additional factors, were associated with severe active TB.

Purpose

To evaluate whether impaired immune responses (high pre-treatment level of NLR and MLR) and other factors associate with delayed sputum conversion at the end of the intensive phase treatment.

Patients and Methods

This was a case–control study from 2016 to 2020, which retrospectively analyzed the pre-treatment level of NLR, MLR and other factors among patients with new cases of pulmonary tuberculosis (PTB).

Results

A total of 62 patients (31 cases and 31 control). The cut-off value of high pretreatment level of NLR and MLR was 5.065 and 0.585, respectively. Bivariate analysis showed that pretreatment NLR ≥5.065 (OR 8.23, CI 95% 2.48–27.32, p < 0.001), MLR ≥0.585 (OR 10.18, 95% CI 3.13–33.18, p < 0.001) and BMI <18.5 (OR 2.91, 95% CI 1.03–8.20, p = 0.041) were associated with an increased risk of delayed sputum conversion. Multivariate analysis, however, showed that pretreatment NLR ≥5.065 was not significantly associated with delayed sputum conversion (AOR 3.370, 95% CI 0.71–15.91, p value 0.125). A high pretreatment of MLR (AOR 30.802, 95% CI 3.22–287.55, p value 0.003) and lower BMI (AOR 10.942, 95% CI 1.121–98.563, p value 0.033) were significantly associated with an increased risk of delayed intensive phase sputum conversion.

Conclusion

High MLR pretreatment and a low BMI were significantly associated with an increased risk of delayed sputum conversion at the end of the PTB intensive phase treatment. High NLR pretreatment, smoking, diabetes, and HIV were not associated with sputum conversion.

Association between neutrophil-to-lymphocyte ratio and polycystic ovary syndrome: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

The neutrophil-to-lymphocyte ratio (NLR) has been suggested to be a potential biomarker for assessing the systemic inflammatory response in polycystic ovary syndrome (PCOS). This meta-analysis is aimed at evaluating whether PCOS patients present with a higher NLR and whether obesity, metabolic, and hormonal indices have effects on the states.

METHODS

We performed a literature search on PubMed, Embase and Web of Science (last update: August 2, 2022). Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated by applying random-effects models. Meta-regression analyses were used to explore the sources of heterogeneity and assess the relationship between NLR and several clinical parameters. Sensitivity analysis and publication bias were also assessed.

RESULTS

Thirteen studies involving 826 PCOS patients and 780 healthy controls were eligible for the present meta-analysis. Generally, NLR significantly increased in PCOS women versus healthy women (SMD = 0.81, 95% CI = 0.30-1.33, P = .002). NLR disparity was subsequently investigated in obese and non-obese cohorts. Obese PCOS women exhibited a higher NLR than obese controls (SMD = 0.56, 95% CI = 0.24-0.87, P = .001), and a similar difference was shown between non-obese PCOS and non-obese controls (SMD = 0.36, 95% CI = 0.02-0.71, P = .038). No significant NLR disparity was observed between obese versus non-obese PCOS women (SMD = 0.50, 95% CI = -0.37 to 1.38, P = .259). Meta-regression analysis revealed that NLR was significantly positively associated with fasting blood glucose (P = .006) and total cholesterol levels (P = .021), but not correlated with body mass index and other parameters in PCOS patients. Sensitivity analysis indicated that no individual study significantly affected the overall pooled result, and no publishing bias was observed.

CONCLUSION

PCOS women typically present with an increased NLR. Such an increase is independent of obesity and may be associated with glycolipid metabolic disorders.

Elevated levels of monocyte-lymphocyte ratio and platelet-lymphocyte ratio in adolescents with non-suicidal self-injury

BACKGROUND

Neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) are blood indicators of systemic inflammation. This study aims to compare the levels of inflammatory indicators derived from blood routine tests between adolescents with non-suicidal self-injury (NSSI) and those with non-NSSI.

METHODS

A total of 201 adolescents with mood or emotional disorders were enrolled in this study, among which 106 had engaged in NSSI and 95 had never engaged in NSSI. NLR, MLR, and PLR were calculated based on the complete blood cell count.

RESULTS

There was no significant difference in demographic data between the two groups. The NSSI group exhibited significantly higher MLR (P = 0.001) and PLR (P = 0.007) than the non-NSSI group. Multivariate logistic regression analysis revealed that MLR (OR 1.545, 95%CI [1.087-2.281], P = 0.021) and PLR (OR 1.327, 95%CI [1.215-1.450], P < 0.001) were independently associated with NSSI. Receiver operating characteristic (ROC) curve analyses demonstrated that for differentiating NSSI from non-NSSI, the optimal cut-off value of MLR was 0.135 and the area under curve was 0.638 ([0.561- 0.715], P < 0.001), with a sensitivity of 90.60% and a specificity of 33.70%; the optimal cut-off value of PLR was 127.505 and the area under curve was of 0.611 ([0.533-0.689], P < 0.001), with a sensitivity of 39.60% and a specificity of 81.10%.

CONCLUSIONS

Systemic inflammation, as indicated by elevated MLR and PLR, was found to be strongly associated with NSSI among adolescents.

Tip 2 diabetes mellituslu hastalarda nötrofil lenfosit oranı ile diyabet kontrolü arasındaki ilişki

Aim: The current study was purposed to examine the association between NLR and the control of glucose in patients with T2DM. We also aimed to reveal correlations between microalbuminuria, Mean Platelet Volume (MPV), Red Blood Cell Distribution (RDW), and glycosylated hemoglobin (HbA1c). Materials and Methods: It was a retrospective study arranged in Ege University, in Endocrinology Department. We collected the fields of 198 patients having type 2 diabetes mellitus (T2DM), and they were categorized into two groups, patients with controlled T2DM (Hba1c≤7%) (n=82) and uncontrolled T2DM (Hba1c>7%) (n=116). Results: There were no statistically significant differences between NLR, RDW and MPV in two groups (p=0.123, p=0.298, p=0.595 respectively). Duration of T2DM 5 years and below and after 5 years between two groups was statistically important (p=0.002). NLR was found higher in uncontrolled T2DM than controlled T2DM, but not statistically significant. Receiver operating characteristic curve of NLR, RDW, MPV, WBC were not found significant (p>0.05). Conclusion: Our study revealed that duration of T2DM may predict microalbuminuria, and evaluated the relationship between RDW, MPV, NLR and Hba1c, microalbuminuria levels together in the patients with T2DM. According to NLR, RDW and MPV levels, we did not detect any statistically differences between uncontrolled T2DM than controlled T2DM.

Neutrophil to Lymphocyte Ratio in Epilepsy: A Systematic Review

This study was conducted to summarize the results of studies investigating the role of neutrophil to lymphocyte ratio (NLR) in epilepsy. The search was conducted on PubMed, Scopus, and Web of Science up to December 25, 2021. Finally, a total of seven studies were included in the review. The NLR in patients who were in the acute phase was higher than that of healthy. NLR in the patients who were in either acute or subacute phase was higher than in healthy controls. A significant difference in NLR levels between the acute and subacute phases was also noted. Epilepsy is one of the most important neurological diseases in the world, and millions of people around the world suffer from it, and a cheap and fast biomarker is needed for it. The interesting thing is that inflammation plays a role in epilepsy, and elevated NLR value can be a good biomarker of inflammation and, as a result, for epilepsy.

The mechanistic role of neutrophil lymphocyte ratio perturbations in the leading non communicable lifestyle diseases

Inflammation plays a critical role in the development and progression of chronic diseases like type 2 diabetes mellitus, coronary artery disease, and chronic obstructive pulmonary disease. Inflammatory responses are indispensable for pathogen control and tissue repair, but they also cause collateral damage. A chronically activated immune system and the resultant immune dysregulation mediated inflammatory surge may cause multiple negative effects, requiring tight regulation and dampening of the immune response to minimize host injury.  While chronic diseases are characterized by systemic inflammation, the mechanistic relationship of neutrophils and lymphocytes to inflammation and its correlation with the clinical outcomes is yet to be elucidated. The neutrophil to lymphocyte ratio (NLR) is an easy-to-measure laboratory marker used to assess systemic inflammation. Understanding the mechanisms of NLR perturbations in chronic diseases is crucial for risk stratification, early intervention, and finding novel therapeutic targets. We investigated the correlation between NLR and prevalent chronic conditions as a measure of systemic inflammation. In addition to predicting the risk of impending chronic conditions, NLR may also provide insight into their progression. This review summarizes the mechanisms of NLR perturbations at cellular and molecular levels, and the key inflammatory signaling pathways involved in the progression of chronic diseases. We have also explored preclinical studies investigating these pathways and the effect of quelling inflammation in chronic disease as reported by a few in vitro, in vivo studies, and clinical trials.

Isolated and Combined Effect of Age and Gender on Neutrophil-Lymphocyte Ratio in the Hyperglycemic Saudi Population

Inflammation is pivotal to the pathogenesis of diabetes mellitus (DM), but pathological alterations of the neutrophil−lymphocyte ratio (NLR), an emerging inflammatory index in DM management, remains understudied. The aim of this study is to examine the relationship between NLR and glycemic control in the Saudi population. Gender, age, WBC count, and fasting blood glucose (FBG) were obtained from Al-Borg Medical Laboratories for 14,205 subjects. Means, prevalence, risk measures, and the diagnostic accuracy of elevated NLR and hyperglycemia (HG) were evaluated. Subjects with elevated NLR (>3) had significantly higher FBG (105.10 ± 0.33 vs. 114.0 ± 2.81) and NLR was significantly elevated in impaired fasting glycemia (IFG; 1.21 ± 0.01 vs. 1.25 ± 0.01) and HG (1.21 ± 0.01 vs. 1.39 ± 0.02). Elevations of NLR in HG but not in IFG persisted across all age groups except young males and elderly females. The prevalence of elevated NLR in hyperglycemic subjects was 4.12% compared to 2.16% in subjects with normal FBG. HG was more prevalent in subjects with elevated NLR (17.33% vs. 12.46%) who had a relative risk (RR) of 1.68 (95% CI = 1.38−2.06, p < 0.0001) and an odds ratio (OR) of 1.94 (95% CI = 1.48−2.56, p < 0.0001) to be hyperglycemic. Nevertheless, NLR failed to discriminate individuals with normal FBG from those with HG based on ROC curve analysis. Pathological fluctuations in NLR may serve as supportive evidence in DM management.

Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer

BACKGROUND

Platelet count or complete blood count (CBC)-based ratios including lymphocyte-to-monocyte (LMR), neutrophil-to-lymphocyte (NLR), hemoglobin-to-platelet (HPR), red blood cell count distribution width-to-platelet (RPR), and platelet-to-lymphocyte (PLR) ratio are good predictors of colorectal cancer (CRC) survival. Their change in time is not well documented, however.

AIM

To investigate the effect of longitudinal CBC ratio changes on CRC survival and their possible associations with clinicopathological properties, comorbidities, and anamnestic data.

METHODS

A retrospective longitudinal observational study was conducted with the inclusion of 835 CRC patients, who attended at Semmelweis University, Budapest. CBC ratios and two additional newly defined personalized platelet count metrics (pPLT_D and pPLT_S, the platelet counts relative to the measurement at the time of CRC diagnosis and to the one 4-6 wk after tumor removal surgery, respectively) were recorded.

RESULTS

The 835 CRC patients had a total of 4608 measurements (5.52 visits/patient, in average). Longitudinal survival models revealed that the increases/decreases in LMR [hazard ratio (HR): 0.4989, P < 0.0001], NLR (HR: 1.0819, P < 0.0001), HPR (HR: 0.0533, P = 0.0038), pPLT_D (HR: 4.9229, P < 0.0001), and pPLT_S (HR: 4.7568, P < 0.0001) values were poor prognostic signs of disease-specific survival. The same was obtained for all-cause mortality. Most abnormal changes occurred within the first 3 years after the diagnosis of CRC. RPR and PLR had an only marginal effect on disease-specific (P = 0.0675) and all-cause mortality (Bayesian 95% credible interval: 0.90–186.05), respectively.

CONCLUSION

LMR, NLR, and HPR are good metrics to follow the prognosis of the disease. pPLT_D and pPLT_S perform just as well as the former, while the use of RPR and PLR with the course of the disease is not recommended. Early detection of the abnormal changes in pPLT_D, pPLT_S, LMR, NLR, or HPR may alert the practicing oncologist for further therapy decisions in a timely manner.

Tanshinone IIA prevents acute lung injury by regulating macrophage polarization

OBJECTIVE

Acute lung injury (ALI) is a serious respiratory dysfunction caused by pathogen or physical invasion. The strong induced inflammation often causes death. Tanshinone IIA (Tan-IIA) is the major constituent of Salvia miltiorrhiza Bunge and has been shown to display anti-inflammatory effects. The aim of the current study was to investigate the effects of Tan-IIA on ALI.

METHODS

A murine model of lipopolysaccharide (LPS)-induced ALI was used. The lungs and serum samples of mice were extracted at 3 days after treatment. ALI-induced inflammatory damages were confirmed from cytokine detections and histomorphology observations. Effects of Tan-IIA were investigated using in vivo and in vitro ALI models. Tan-IIA mechanisms were investigated by performing Western blot and flow cytometry experiments. A wound-healing assay was performed to confirm the Tan-IIA function.

RESULTS

The cytokine storm induced by LPS treatment was detected at 3 days after LPS treatment, and alveolar epithelial damage and lymphocyte aggregation were observed. Tan-IIA treatment attenuated the LPS-induced inflammation and reduced the levels of inflammatory cytokines released not only by inhibiting neutrophils, but also by macrophage. Moreover, we found that macrophage activation and polarization after LPS treatment were abrogated after applying the Tan-IIA treatment. An in vitro assay also confirmed that including the Tan-IIA supplement increased the relative amount of the M2 subtype and decreased that of M1. Rebalanced macrophages and Tan-IIA inhibited activations of the nuclear factor-κB and hypoxia-inducible factor pathways. Including Tan-IIA and macrophages also improved alveolar epithelial repair by regulating macrophage polarization.

CONCLUSION

This study found that while an LPS-induced cytokine storm exacerbated ALI, including Tan-IIA could prevent ALI-induced inflammation and improve the alveolar epithelial repair, and do so by regulating macrophage polarization.