Complete Blood Cell Count-Derived Inflammation Biomarkers in Men with Age-Related Macular Degeneration

Systemic inflammation indices as hematological biomarkers of inflammatory response in non-silicotic workers exposed to respirable silica dust

This cross-sectional study was performed to assess whether systemic inflammatory indices, including systemic inflammation response index (SIRI), systemic immune‑inflammation index (SII), and aggregate index of systemic inflammation (AISI), can be considered as possible inflammatory markers in silica-exposed workers with no diagnosis of silicosis. We studied 371 non-silicotic workers exposed to respirable silica dust (RSD) and 1422 reference workers. The workers' exposure to RSD were assessed and the inflammatory indices were compared between subgroups of the exposed workers based on the severity and duration of exposure. Correlations between inflammatory indices and the pulmonary function parameters were investigated. Also, the receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off values of the SII, SIRI, and AISI. Significant dose-response relationships were observed between duration of exposure and all indices except monocytes and LMR. No significant interaction was observed between duration of exposure to RSD and smoking. Borderline significant correlations were observed between AISI and SIRI with forced expiratory volume (FEV1) and FEV1 to forced vital capacity (FVC) ratio. Higher AUCs were obtained for SII and AISI, respectively. The cut-off values for these biomarkers to be considered abnormal were > 348.48 for SII, > 183.78 for AISI, and > 0.768 for SIRI. Overall, the present study showed for the first time, that SII, AISI, and SIRI might be considered as available, easy-to-obtain, and non-expensive markers of inflammation in non-silicotic workers with a long duration of exposure to RSD who are at risk of developing silicosis in subsequent years.

Evaluation of systemic immune-inflammatory index in patients with wet age-related macular degeneration

CLINICAL RELEVANCE

The systemic immune-inflammatory index is a relatively new parameter and has been shown to increase in inflammatory diseases.

BACKGROUND

The primary aim of this study was to investigate the systemic immune-inflammatory index in patients with wet-type age-related macular degeneration. The secondary aim was to determine the relationship between best-corrected visual acuity, central macular thickness, subfoveal choroidal thickness, systemic immune-inflammatory index, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio.

METHODS

This study retrospectively analysed patients with wet-type age-related macular degeneration between 2018 and 2022. Demographic data and peripheral complete blood count were obtained from the electronic medical record system. The most recent best-corrected visual acuity, central macular thickness, and subfoveal choroidal thickness values (within one month) for complete blood count were obtained from case sheets and the optical coherence tomography digital image database. The systemic immune-inflammatory index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were calculated. Age- and sex-matched controls were also generated.

RESULTS

Thirty-three patients (23 males, 10 females) with wet-type age-related macular degeneration and 43 controls (24 males, 19 females) were included. The groups were similar in terms of age and sex (78.0 ± 6.3 vs. 75.6 ± 6.6 years, p = 0.59; p = 0.38 for sex). The systemic immune-inflammatory index was higher in the wet-type age-related macular degeneration group (460.5 vs. 440.4); however, this difference was not statistically significant. When the correlations between the systemic immune-inflammatory index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, best-corrected visual acuity (logMAR), central macular thickness, and subfoveal choroidal thickness were examined, there was only a moderate positive correlation between best-corrected visual acuity and platelet-to-lymphocyte ratio (r = 0.46, p = 0.007).

CONCLUSION

There were no differences in the systemic immune-inflammatory index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio between the wet-type age-related macular degeneration and control groups. There was a positive correlation between the platelet-to-lymphocyte ratio and best-corrected visual acuity (logMAR). The systemic immune-inflammatory index was higher in patients with wet-type age-related macular degeneration than in the control group; however, this difference was not statistically significant.

Predictive values of systemic inflammation biomarkers in proliferative vitreoretinopathy associated with primary rhegmatogenous retinal detachment

CLINICAL RELEVANCE

Proliferative vitreoretinopathy (PVR) is still the leading cause of surgical failure after rhegmatogenous retinal detachment (RRD) repair. The factors that can predict the development of PVR remain to be elucidated.

BACKGROUND

This study evaluates the predictive values of the systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in patients with primary RRD with and without PVR.

METHODS

A total of 150 patients with RRD and 51 age- and sex-matched healthy participants were included in the study. Patients who developed PVR within three months after surgery were enrolled as PVR cases (n = 75, Group 1), and those who did not develop PVR were enrolled in RRD without the PVR group (n = 75, Group 2). Ocular examination findings and medical records of all participants were analysed retrospectively. Peripheral blood samples were collected, and systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratios were calculated. The systemic immune-inflammation index calculation formula is: (Neutrophil/lymphocyte) × Platelet.

RESULTS

The median neutrophil-to-lymphocyte ratio and systemic immune-inflammation index levels were significantly higher in Group 1 patients compared to Group 2 and the control groups (p = 0.01, for both). However, the groups were similar regarding median platelet-to-lymphocyte ratio (p = 0.917). The optimal cut-off values of neutrophil-to-lymphocyte ratio and systemic immune-inflammation index were calculated as 1.72 (with 72% sensitivity and 48% specificity) and 407.9 (with 72% sensitivity and 49.3% specificity), respectively, for predicting PVR development in patients with RRD.

CONCLUSION

Neutrophil-to-lymphocyte ratio and systemic immune-inflammation index may be useful biomarkers for predicting the risk of PVR development in RRD patients.

Aggregate Index of Systemic Inflammation (AISI), Disease Severity, and Mortality in COVID-19: A Systematic Review and Meta-Analysis

Combined indices of different haematological cell types appear to be particularly promising for investigating the link between systemic inflammation and coronavirus disease 2019 (COVID-19). We conducted a systematic review and meta-analysis to assess the aggregate index of systemic inflammation (AISI), an emerging index derived from neutrophil, monocyte, platelet, and lymphocyte counts, in hospitalized COVID-19 patients with different disease severity and survival status. We searched electronic databases between the 1st of December 2019 and the 10th of June 2023 and assessed the risk of bias and the certainty of evidence. In 13 studies, severe disease/death was associated with significantly higher AISI values on admission vs. non-severe disease/survival (standard mean difference (SMD) = 0.68, 95% CI 0.38 to 0.97, p < 0.001). The AISI was also significantly associated with severe disease/death in five studies reporting odds ratios (4.39, 95% CI 2.12 to 9.06, p ˂ 0.001), but not in three studies reporting hazard ratios (HR = 1.000, 95% CI 0.999 to 1.002, p = 0.39). The pooled sensitivity, specificity, and area under the curve values for severe disease/death were 0.66 (95% CI 0.58 to 0.73), 0.78 (95% CI 0.73 to 0.83), and 0.79 (95% CI 0.76 to 0.83), respectively. Our study has shown that the AISI on admission can effectively discriminate between patients with different disease severity and survival outcome (PROSPERO registration number: CRD42023438025).

Assessment of aggregate index of systemic inflammation and systemic inflammatory response index in dry age-related macular degeneration: a retrospective study

Introduction

Inflammation is known to contribute to the development of age-related macular degeneration (AMD). Several inflammatory indices derived from routine complete blood counts have been proposed as biomarkers in multiple disorders.

Methods

In this study, clinical and laboratory data were retrospectively collected from medical records to assess the aggregate index of systemic inflammation (AISI) and the systemic inflammatory response index (SIRI) as potential biomarkers of systemic inflammation in patients with early diagnosis of dry AMD.

Results

The study included 90 patients with dry AMD and 270 age/sex-matched patients with cataracts as a control group. There were no significant differences in the AISI and SIRI results between the cases and controls (p = 0.16 and 0.19, respectively).

Conclusion

This suggests that AISI and SIRI may be inadequate metrics for AMD or lack sensitivity in detecting inflammatory changes. Exploring other routine blood markers may help to identify and prevent the early stages of AMD.

Blood Cells Count Derived Inflammation Indexes as Predictors of Early Treatment Response to Dupilumab in Patients with Moderate-to-Severe Atopic Dermatitis

Derived inflammatory indexes from routine hematological parameters might be useful for predicting early-response vs. late/non-response to dupilumab, the first biological agent approved for moderate-to-severe atopic dermatitis (AD). We tested this hypothesis by retrospectively investigating the association between pre-specified baseline inflammatory indexes and dupilumab response (≥50% reduction in the Eczema Area and Severity Index, EASI 50) at 4 and 16 weeks in a consecutive series of 66 AD patients (38 males and 28 females). Forty-six patients (69.7%) were early-responders at 4 weeks, whereas the remaining twenty (30.3%) were late/non-responders at 16 weeks. In logistic regression, the platelet-to-lymphocyte ratio (PLR) was independently associated with early-response (OR = 1.0159, 95% CI 1.0005 to 1.0315, p = 0.0426). The predictive performance of PLR and other derived indexes towards early-response was further improved by their combination with serum IgE concentrations, with a maximum AUC value for the combined systemic immune inflammation index (SII)-IgE of 0.797 (95% CI = 0.677 to 0.884, p < 0.0001). Derived inflammatory indexes, particularly SII-IgE, might be useful to identify early-responders to dupilumab and develop alternative treatment protocols for late/non-responders.

Evaluation of Lymphocyte-to-Monocyte Ratio and Mean Platelet Volume-to-Platelet Ratio in Rhegmatogenous Retinal Detachment

Purpose

To assess the predictive value of inflammatory blood biomarkers in rhegmatogenous retinal detachment (RRD) patients and its correlation with proliferative retinopathy (PVR) grade.

Methods

82 RRD patients and 1 : 1 age- and gender-randomly matched cataract patients as the control group were included. The clinical features and laboratory parameters of all participants were collected and recorded, and the comprehensive index of inflammatory blood and its correlation with PVR were calculated.

Results

Monocytes and monocyte-to-high-density lipoprotein ratio (MHR) were significantly lower (P=0.005, P=0.044), while mean platelet volume (MPV), lymphocyte-to-monocyte ratio (LMR), and MPV-to-platelet ratio (MPR) were significantly higher in RRD patients as compared with the control group (P=0.013, P=0.019, P=0.037). LMR and MPR might be the predictors of RRD. The receiver operating characteristics analysis showed that the values of MPV, LMR, and MPR in RRD patients were 0.612, 0.606, and 0.594, respectively. PVR grade was not associated with inflammatory blood biomarkers.

Conclusion

The increase in MPV, LMR, and MPR were associated with increased odds of RRD. LMR and MPR may be useful as inexpensive and effortless biomarkers for assessing the occurrence of RRD.

Osteosarcopenic obesity and its components-osteoporosis, sarcopenia, and obesity-are associated with blood cell count-derived inflammation indices in older Chinese people

Background

The aim of this study was to investigate the associations of osteosarcopenic obesity (OSO) and its components with complete blood cell count-derived inflammation indices.

Methods

In this cross-sectional study, data of 648 participants aged ≥60 years (men/women: 232/416, mean age: 67.21 ± 6.40 years) were collected from January 2018 to December 2020. Areal bone mineral density and body fat percentage were used to define osteopenia/osteoporosis and obesity, respectively. The criteria of the 2019 Asian Working Group for Sarcopenia were used to diagnose sarcopenia. Based on the number of these conditions, participants were divided into four groups: OSO/0, OSO/1, OSO/2, and OSO/3. Logistic regression analysis was conducted to identify associations between blood cell count-derived inflammation indices and the number of disorders with abnormal body composition.

Results

Systemic inflammation response index (SIRI), white blood cells, neutrophil-to-lymphocyte ratio (NLR), aggregate inflammation systemic index (AISI), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) showed statistically significant differences among the four groups (P < 0.05). Unlike in the OSO/0 group, in all other groups, AISI, SIRI, PLR, and NLR were significantly associated with increased likelihood of having multiple disorders with abnormal body composition after adjustment for confounders (P < 0.0001 for all). However, LMR showed an inverse correlation with the number of these conditions (P < 0.05).

Conclusion

Higher SIRI, AISI, NLR, and PLR values and lower LMR values are closely associated with OSO and its individual components—osteoporosis, sarcopenia, and obesity—in older adults, suggesting that the value of these indices in the evaluation of OSO warrants further investigation.

The Aggregate Index of Systemic Inflammation (AISI): A Novel Prognostic Biomarker in Idiopathic Pulmonary Fibrosis

Variable patterns of disease progression are typically observed in patients with idiopathic pulmonary fibrosis (IPF). We sought to determine the prognostic capacity of blood cell count indexes, derived from routine complete blood cell (CBC) count, in a cohort of IPF patients. The neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) were calculated at baseline in a consecutive series of 82 IPF patients followed for four years. After adjusting for age, gender, body mass index, smoking status, and disease stage, only the AISI was significantly associated with mortality (HR 1.0013, 95% CI 1.0003–1.0023, p = 0.015). Patients with AISI <434 and ≥434 had a median survival from the diagnosis of 35.3 ± 15.2 and 26.6 ± 16.3 months (p = 0.015), and a four-year survival rate of 54% and 34%, respectively. The AISI, easily derivable from routine laboratory tests, is independently associated with mortality in patients with IPF. Prospective studies in larger cohorts are required to confirm this association.

Complete blood cell count measures in retinal artey occlusions

PURPOSE

To investigate the role of complete blood cell count (CBC) measures in retinal artery occlusion (RAO).

METHODS

This was a case-control study, including 73 newly diagnosed RAO patients and 73 sex- and age-matched subjects without RAO. On the same day of RAO diagnosis, a blood sample was collected and CBC was determined using an automatic blood counter. Dimensional CBC indices, such as mean platelet volume (MPV) and red cell distribution width (RDW), and some CBC-combined indices, including neutrophil/lymphocyte ratio (NLR), derived NLR [dNLR = neutrophils/(white blood cells - neutrophils)] and platelet/lymphocyte ratio (PLR), were evaluated. Erythrocyte sedimentation rate (ESR) was also measured.

RESULTS

Median neutrophils, red cell distribution width (RDW), NLR and dNLR were 4.5x10⁹ /L (IQR = 3.8-5.8), 13.4% (IQR = 12.7-14.75), 2.47 (IQR = 1.85-3.13) and 1.70 (IQR = 1.26-2.18) in RAO patients and 4x10⁹ /L (IQR = 3.18-4.93), 12.9% (IQR = 12-14), 1.86 (IQR = 1.42-2.44) and 1.32 (IQR = 1.02-1.64) in controls. RAO patients had significantly higher values of neutrophils (p = 0.003), RDW (p = 0.0011), NLR (p = 0.0001) and dNLR (p = 0.0001). There were no significant differences between the values of white blood cells, lymphocytes, platelet count, MPV and PLR. Multivariate logistic regression models revealed a statistically significant correlation between RAO and increased RDW (OR = 1.36, 95% CI = 1.06-1.73, p = 0.015), NLR (OR = 2.02, 95% CI = 1.34-3.06, p = 0.0009) and dNLR (OR = 3.4, 95% CI = 1.71-6.75, p = 0.0005).

CONCLUSION

Results suggest that RDW, NLR and dNLR may be involved in the pathogenesis of RAO and predict its occurrence. However, high-quality epidemiologic studies, preferably of cohort design, are warranted to confirm whether, or not, an RDW, NLR and dNLR may be considered potential biomarkers of RAO.

Blood Cell Count Indexes of Systemic Inflammation in Carotid Artery Disease: Current Evidence and Future Perspectives

Carotid artery disease is commonly encountered in clinical practice and accounts for approximately 30% of ischemic strokes in the general population. Numerous biomarkers have been investigated as predictors of the onset and progression of carotid disease, the occurrence of cerebrovascular complications, and overall prognosis. Among them, blood cell count (BCC) indexes of systemic inflammation might be particularly useful, from a pathophysiological and clinical point of view, given the inflammatory nature of the atherosclerotic process. The aim of this review is to discuss the available evidence regarding the role of common BCC indexes, such as the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW), in the diagnosis and risk stratification of carotid artery disease, and their potential clinical applications.

Is there a relationship between hematological inflammatory parameters and age-related macular degeneration?

Purpose

We aimed to analyze blood inflammation parameters in patients with age-related macular degeneration (AMD).

Methods

In this retrospective study, patients were divided into three groups: wet-type AMD (n = 60), dry-type AMD (n = 60), and healthy controls (n = 71). The laboratory and demographic data of the patients were analyzed. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated manually.

Results

The mean NLR was 2.26 ± 1.42 in the dry-type AMD group, 3.90 ± 1.65 in the wet-type AMD group, and 1.84 ± 0.61 in the control group (p < 0.001). The mean MLR was 0.30 ± 0.20 in the dry-type AMD group, 0.47 ± 0.31 in the wet-type AMD group, and 0.28 ± 0.14 in the control group (p < 0.001). The mean PLR was 129.31 ± 79.82 in the dry-type AMD group, 156.67 ± 83.99 in the wet-type AMD group, and 135.59 ± 58.68 in the control group (p = 0.101). Receiver operating characteristic (ROC) curve analyses revealed that the area under the curve (AUC) for NLR and MLR was 0.920 and 0.717, respectively, for wet-type AMD. The sensitivity and specificity of NLR for wet-type AMD were 64% and 93%, respectively, whereas MLR was 63% and 75%, respectively.

Conclusion

Simple blood tests revealed that NLR and MLR were significantly higher in patients with wet-type AMD than in patients with dry-type AMD and healthy controls, which implies low-grade inflammation.

Red Cell Distribution Width (RDW) and Complete Blood Cell Count-Derived Measures in Non-Arteritic Anterior Ischemic Optic Neuropathy

Purpose: To assess the role of complete blood cell count (CBC) dimensional indices and CBC-derived measures in non-arteritic anterior ischemic optic neuropathy (NA-AION). Methods: In this retrospective case-control survey, 37 newly diagnosed NA-AION patients and 37 sex- and age-matched cataract controls were enrolled in 2017-2018. On the same day of NA-AION diagnosis, a blood sample was collected and CBC was determined using an automatic blood counter. CBC dimensional indices, such as mean platelet volume (MPV) and red cell distribution width (RDW), and CBC-combined indices, including neutrophil/lymphocyte ratio (NLR), derived NLR [dNLR = neutrophils/(white blood cells - neutrophils)], and platelet/lymphocyte ratio (PLR), were evaluated. Erythrocyte sedimentation rate (ESR) was also measured. Results: Mean platelet count, median MPV, RDW, NLR, and dNLR were 221±48 x 10⁹/L, 8.2 fL (IQR=7.6-8.9), 13% (IQR=12-14.5), 2.50 (IQR=1.77-3.06), and 1.73 (IQR=1.31-2.07) in NA-AION patients and 248±56 x 10⁹/L, 7.60 fL (IQR=7.05-8.25), 12% (IQR=11.6-13), 1.95 (IQR=1.43-2.49) and 1.36 (IQR=1.07-1.69) in controls. NA-AION patients showed significantly lower platelet count (p=0.03) and significantly higher median values of MPV (p=0.01), RDW (p=0.015), NLR (p=0.03), and dNLR (p=0.01). Multivariate logistic regression models disclosed a significant correlation only between higher levels of RDW and NA-AION (p≤0.05). The attributable risk of the association between NA-AION and RDW was 33%. Conclusions: Results suggest that RDW may be somehow involved in the pathogenesis of NA-AION. However, high-quality cohort studies are warranted to confirm whether, or not, an altered RDW may be considered a potential biomarker of this vascular disorder affecting the optic nerve.

Combined oral contraceptives modify the effect of smoking on inflammatory cellular indexes and endothelial function in healthy subjects

Little information is available on the influence of sex in combination with smoking habits and combined oral contraceptives (COC) use on cellular inflammatory indexes such as neutrophil/lymphocyte ratio (NLR), derived NRL (dNLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), mean platelet volume/platelet count (MPV/PLT), aggregate inflammation systemic index (AISI), and systemic inflammation response index (SIRI), which are cost-effective biomarkers to assessing inflammation. Therefore, the effect of COC was studied alone or in association with smoking and compared with results from healthy COC-free women and men. Furthermore, the association of cellular inflammatory indexes with endothelial function (arginine (Arg), asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and lipid peroxidation (malondialdehyde MDA) biomarkers was evaluated. Blood was collected for hematological and biochemical analysis, which were used to calculate PLR, NLR, dNLR, MLR, MPV/PLT, AISI, and SIRI. Serum samples were assayed for Arg, ADMA, SDMA, and MDA. Monocytes, MLR, SIRI, and MPV/PLT were higher in men, while PLT count was higher in women. COC use increased lymphocytes and lowered PLR and MLR. Smoking reduced sexually divergent parameters, especially in COC users: smoking and non-smoking COC-free women displayed six divergent parameters, while COC users displayed only two (monocytes and MPV). In addition, COC affected endothelial function, reducing ADMA and Arg. Moreover, COC-free women had lower Arg levels than men. In conclusion, COC use strongly influence the effects of tobacco smoking, which are sex and parameter specific. Further, these data stress that COC use and smoking attitude select different cohorts indicating that sex and gender studies need intersectionality.

Blood Cell Count Biomarkers, Risk, and Outcomes of Ischemia-Related Lower Limb Amputations: Systematic Review

Lower limb amputations due to ischemia represent an important health care and social issue. However, there are currently no specific biomarkers able to predict the risk of amputation and postamputation complications and prognosis. We conducted a systematic review of studies investigating whether blood cell count indexes of systemic inflammation are linked to the risk and the outcome of lower limb amputations due to ischemia. Overall, in 22 studies involving 8832 patients selected for review, several blood cell count indexes, particularly the neutrophil lymphocyte ratio, showed some promise in terms of predicting amputations and general outcomes of conservative and surgical treatments, as well as postamputation complications and prognosis. However, largely due to methodological limitations, further prospective studies are required to establish the clinical utility and applicability of blood cell indexes in the routine management of patients with ischemia-related lower limb amputations.

Blood Cell Count Derived Inflammation Indexes in Patients with Idiopathic Pulmonary Fibrosis

Purpose

Inflammation and immunity play a pivotal but yet unclear role in idiopathic pulmonary fibrosis (IPF), a chronic disorder characterized by progressive damage of lung parenchyma and severe loss of lung function despite optimal treatment. However, the pathophysiological and predictive role of combined blood cell count indexes of inflammation in IPF is uncertain.

Methods

Seventy-three patients with IPF and 62 healthy subjects matched for age, gender and smoking status were included in this cross-sectional study.

Results

We found significant differences in neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), systemic inflammation response index (SIRI) and aggregate index of systemic inflammation (AISI) between IPF patients and healthy controls. In logistic regression, all combined blood inflammation indexes, barring PLR, were independently associated with the presence of IPF after adjusting for age, gender, body mass index and smoking status. Furthermore, significant associations between FVC% and NLR, LMR, SIRI and AISI, and between DLCO% and NLR, dNLR, LMR, SIRI and AISI, were observed.

Conclusions

In conclusion, our data indicate significant alterations of combined blood cell count indexes of inflammation in IPF.

Mean Platelet Volume, Red Cell Distribution Width, and Complete Blood Cell Count Indices in Retinal Vein Occlusions

PURPOSE

To evaluate the role of some complete blood cell count (CBC)-derived measures in retinal vein occlusion (RVO).

METHODS

This was a retrospective case-control study, including 127 newly diagnosed RVO patients and 127 sex- and age-matched subjects without RVO. A blood sample was obtained and a complete blood cell count was performed. Neutrophil/lymphocyte ratio (NLR), derived NLR [dNLR = neutrophils/(white blood cells‒neutrophils)], and platelet/lymphocyte ratio (PLR) were calculated. We also performed a meta-analysis of the available data, ours included, on the correlation between mean platelet volume (MPV) and RVO. Standardized mean differences (SMD) were used to build forest plots and assess differences in MPV values between RVO patients and controls.

RESULTS

Median MPV and red cell distribution width (RDW) were 8.7 fL (IQR = 7.8-9.5) and 13.2% (IQR = 12.4-14.2) in RVO patients and 7.8 fL (IQR = 7.1-8.5) and 13% (IQR = 12-14) in controls. RVO patients had significantly higher values of MPV (P < .0001) and RDW (P = .005). There were no significant differences between the values of white blood cells, lymphocytes, neutrophils, platelets, NLR, dNLR, and PLR. Multivariable logistic regression analysis revealed a statistically significant correlation between increased MPV and RVO (OR = 1.74, 95% CI = 1.38-2.2, P < .0001). 519 RVO patients and 414 controls from 6 case-control studies were included in the meta-analysis. Pooled results disclosed that MPV values were significantly higher in RVO patients (SMD = 0.41 fL, 95% CI = 0.04-0.79, P = .032), but extreme heterogeneity was observed (I² = 86.1%, P < .001).

CONCLUSION

Results suggest lack of association between CBC-derived inflammatory indices and RVO. Conversely, MPV and, to a lesser extent, RDW may be disease biomarkers in RVO.

The Interplay Between Systemic Inflammatory Factors and MicroRNAs in Age-Related Macular Degeneration

We aimed to explore the expression of systemic inflammatory factors and selected intracellular miRNAs that regulate inflammatory signaling pathways potentially involved in age-related macular degeneration (AMD) pathogenesis. A total of 179 patients with wet AMD, 175 with dry AMD and 121 controls were enrolled in the study. Soluble inflammatory factors were analyzed in plasma samples using Luminex technology. Expression of selected miRNAs was analyzed in isolated nucleated peripheral blood cells (PBNCs) using real-time qPCR. Wet AMD was an independent factor associated with higher concentrations of IL-6 (β = +0.24, p = 0.0004), GM-CSF (β = +0.31, p < 0.001), IFN-γ (β = +0.58, p < 0.001), higher expression of miRNA-23a-3p (β = +0.60, p < 0.0001), miRNA-30b (β = +0.32, p < 0.0001), miRNA-191-5p (β = +0.28, p < 0.0001) and lower concentration of IL-1β (β = −0.25, p = 0.0003), IL-5 (β = −0.45, p < 0.001), IL-10 (β = −0.45, p < 0.001), IL-12 (β = −0.35, p < 0.001), lower expression of miRNA-16-5p (β = −0.31, p < 0.0001), miRNA-17-3p (β = −0.18, p = 0.01), miRNA-150-5p (β = −0.18, p = 0.01) and miRNA-155-5p (β = −0.47, p < 0.0001). Multivariate analysis revealed that dry AMD was an independent factor associated with higher concentration of GM-CSF (β = +0.34, p < 0.001), IL-6 (β = +0.13, p = 0.05), higher expression of miRNA-23a-3p (β = +0.60, p < 0.0001), miRNA-126-3p (β = +0.23, p = 0.0005), miRNA-126-5p (β = +0.16, p = 0.01), miRNA 146a (β = +0.14, p = 0.03), and mRNA191-5p (β = +0.15, p = 0.03) and lower concentrations of TNF-α (β = +0.24, p = 0.0004), IL-1β (β = −0.39, p < 0.001), IL-2 (β = −0.20, p = 0.003), IL-5 (β = −0.54, p < 0.001), IL-10 (β = −0.56, p < 0.001), IL-12 (β = −0.51, p < 0.001), lower expression of miRNA-16-5p (β = −0.23, p = 0.0004), miRNA-17-3p (β = −0.20, p = 0.003) and miRNA-17-5p (β = −0.19, p = 0.004). Negative correlations between visual acuity and WBC, lymphocyte count, TNF-α, IL-1 β, IL-2, IL-4, IL-6, IL-10 concentrations and miRNA-191-5p, as well as positive correlations between visual acuity and miRNA-126-3p, -126-5p, and -155-5p PBNCs expression were found in AMD patients. No such correlations were found in the control group. Our results may suggest the role of both intra- and extracellular mechanisms implicated in inflammatory response regulation in multifactorial AMD pathogenesis.

Neutrophil-to-lymphocyte ratio in age-related macular degeneration: a systematic review and meta-analysis

Age-related macular degeneration (AMD) is aetiologically linked to immunological ageing and dysfunction. One aspect of this is the altered neutrophil-to-lymphocyte ratio (NLR), which in other domains have been associated with inflammation and angiogenesis, and therefore investigated in patients with AMD in several papers. In this systematic review and meta-analysis, we summarize findings in patients with AMD in relation to NLR, both qualitatively and quantitatively. We searched PubMed/MEDLINE, EMBASE, Web of Science, and the Cochrane Central and identified six studies from where we extracted data on 1178 individuals (777 patients with AMD and 401 healthy controls). Patients with AMD had a higher NLR (weighted mean difference: 0.37, CI 95% 0.08 to 0.66, p = 0.013) when compared to healthy controls. In subgroup analyses, we did not find a significant difference between patients with dry AMD and healthy controls (weighted mean difference: 0.34, CI 95% -0.03 to 0.69, p = 0.068), but did find a strong significant difference between patients with neovascular AMD and healthy controls (weighted mean difference: 0.54, CI 95% 0.23 to 0.86, p = 0.00068). Hence, we find that the association between AMD and elevated NLR may have stronger relevance to the neovascular subtype of AMD. However, the clinical value of measuring the NLR remains unclear.