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Background/Objectives: Adenoidectomy and tonsillectomy are among the most commonly performed procedures in ENT practice. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are recognized inflammatory markers. This study aims to evaluate the changes in NLR, PLR, and LMR in patients undergoing adenoidectomy and tonsillectomy. Methods: The study group consisted of 980 patients who underwent adenoidectomy and/or tonsillectomy. Preoperative and postoperative inflammatory markers were measured in all patients. The NLR, LMR, and PLR values were then calculated and analyzed. Results: In patients undergoing adenoidectomy and/or tonsillectomy, the postoperative NLR was significantly lower than the preoperative NLR. Similarly, the postoperative LMR was significantly higher, and the postoperative PLR was significantly lower compared to their preoperative values. Conclusions: The significant changes in NLR, LMR, and PLR following adenoidectomy and/or tonsillectomy suggest a reduction in systemic inflammation post-surgery. These findings indicate that these procedures may contribute to the improvement of inflammatory status in patients, highlighting the potential role of these markers in monitoring surgical outcomes. [ABSTRACT FROM AUTHOR]

Abstract Preterm delivery (PTD) is associated with severe adverse maternal and neonatal outcomes and higher medical costs. Therefore, PTD warrants more attention. However, predicting PTD remains a challenge for researchers. This study aimed to investigate potential prenatal predictors of PTD. We retrospectively recruited pregnant women who experienced either PTD or term delivery (TD) and underwent laboratory examinations at 32 weeks of gestation. We compared the test results between the two groups and performed logistic regression analysis and receiver operating characteristic (ROC) curve analysis to identify risk factors and predictive factors for PTD. Our investigation revealed that the PTD cohort exhibited statistically significant elevations in lymphocyte count, mean corpuscular hemoglobin concentration, calcium, uric acid, alkaline phosphatase, triglycerides, and total bile acids. Conversely, the PTD group demonstrated statistically significant reductions in mean corpuscular volume, homocysteine, neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), neutrophils to (white blood cells–neutrophils) ratio (dNLR), and (neutrophils × monocytes) to lymphocyte ratio (SIRI). The ROC curve analysis revealed that calcium had an area under the curve (AUC) of 0.705, with a cut-off value of 2.215. Logistic regression analysis showed that premature rupture of membranes was an independent risk factor for PTD. Our study demonstrated that serum calcium levels, NLR, dNLR, and other laboratory tests conducted at 32 weeks of gestation can serve as predictors for PTD. Furthermore, we identified premature rupture of membranes as a risk factor for PTD.

The disease severity of psoriasis is mainly assessed subjectively via psoriasis area and severity index (PASI) and body surface area (BSA), while an optimal measure of cutaneous response, may overlook systemic inflammation in psoriasis patients. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), monocyte to high density lipoprotein ratio (MHR), and systemic immune-inflammation index (SII) exhibit notable associations with the inflammation severity in multiple diseases. The aim of this retrospective study was to explore the associations between inflammatory parameters and the skin lesions' severity of psoriasis. After analysis, we found that patients with psoriasis had higher NLR, MLR, PLR, MHR, and SII levels compared to the control group. At baseline, the parameters of NLR (r = 0.124, P = 0.003), MLR (r = 0.153, P < 0.001), MHR (r = 0.217, P < 0.001) and SII (r = 0.141, P = 0.001) had a positive correlation with PASI in psoriasis patients. At the same time, we analyzed the patients who received different systemic therapy. We observed a significant decrease in NLR, PLR, MLR, and SII in psoriasis patients after treatment. Notably, TNF-α inhibitors and IL-17A inhibitors subgroups showed a more significant reduction than IL-23/IL-12/23 inhibitors and MTX medication. Additionally, we found the change of NLR (r = 0.194, P < 0.001), PLR (r = 0.104, P = 0.014), MLR (r = 0.191, P < 0.001), MHR (r = 0.106, P = 0.012), and SII (r = 0.228, P < 0.001) had a positive correlation with the change of PASI in psoriasis patients. In conclusion, this study suggests that NLR, MLR, and SII may serve as useful biomarkers for assessing systemic inflammation extent and disease severity in psoriasis patients. [ABSTRACT FROM AUTHOR]

Introduction: The independent diagnostic value of inflammatory markers neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) and the diagnostic efficacy of NLR, derived neutrophil to lymphocyte ratio (dNLR), PLR, and lymphocyte-to-monocyte ratio (LMR) in glioma cases remain unclear. We investigated the correlation of preoperative peripheral blood inflammatory markers with pathological grade, Ki-67 Proliferation Index, and IDH-1 gene phenotype in patients with glioma, focusing on tumor grade and prognosis. Methods: We retrospectively analyzed the clinical, pathological, and laboratory data of 334 patients with glioma with varying grades and 345 with World Health Organization (WHO I) meningioma who underwent initial surgery at the Affiliated Hospital of Jining Medical University from December 2019 to December 2021. The diagnostic value of peripheral blood inflammatory markers for glioma was investigated. Results: The proportion of men smoking and drinking was significantly higher in the glioma group than in the meningioma group (P <.05); in contrast, the age and body mass index (Kg/m2) were significantly lower in the glioma group (P =.01). Significant differences were noted in the pathological grade (WHO II, III, and IV), Ki-67 Proliferation Index, and peripheral blood inflammatory markers such as lymphocyte median, NLR, dNLR, and PLR between the groups (P <.05). No significant correlation existed between peripheral blood inflammatory factors and IDH-1 gene mutation status or tumor location in patients with glioma (P >.05). LMR, NLR, dNLR, and PLR, varied significantly among different glioma types (P <.05). White blood cell (WBC) count, neutrophil, NLR, and dNLR correlated positively with glioma risk. Further, WBC, neutrophil, NLR, dNLR, and LMR had a high diagnostic efficiency. Conclusion: Peripheral blood inflammatory markers, serving as noninvasive biomarkers, offer high sensitivity and specificity for diagnosing glioma, differentiating it from meningioma, diagnosing GBM, and distinguishing GBM from low-grade glioma. These markers may be implemented as routine screening tools. [ABSTRACT FROM AUTHOR]

Preterm delivery (PTD) is associated with severe adverse maternal and neonatal outcomes and higher medical costs. Therefore, PTD warrants more attention. However, predicting PTD remains a challenge for researchers. This study aimed to investigate potential prenatal predictors of PTD. We retrospectively recruited pregnant women who experienced either PTD or term delivery (TD) and underwent laboratory examinations at 32 weeks of gestation. We compared the test results between the two groups and performed logistic regression analysis and receiver operating characteristic (ROC) curve analysis to identify risk factors and predictive factors for PTD. Our investigation revealed that the PTD cohort exhibited statistically significant elevations in lymphocyte count, mean corpuscular hemoglobin concentration, calcium, uric acid, alkaline phosphatase, triglycerides, and total bile acids. Conversely, the PTD group demonstrated statistically significant reductions in mean corpuscular volume, homocysteine, neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), neutrophils to (white blood cells–neutrophils) ratio (dNLR), and (neutrophils × monocytes) to lymphocyte ratio (SIRI). The ROC curve analysis revealed that calcium had an area under the curve (AUC) of 0.705, with a cut-off value of 2.215. Logistic regression analysis showed that premature rupture of membranes was an independent risk factor for PTD. Our study demonstrated that serum calcium levels, NLR, dNLR, and other laboratory tests conducted at 32 weeks of gestation can serve as predictors for PTD. Furthermore, we identified premature rupture of membranes as a risk factor for PTD. [ABSTRACT FROM AUTHOR]

Background and Objective: Anastomotic leak is one of the most dangerous complications of gastrointestinal surgery, leading to significant morbidity and mortality. Early detection of leaks is crucial for reducing mortality, hospital stay duration, and postoperative complications. This study was designed to identify a suitable prognostic factor. Materials and Methods: This cross-sectional study included fifteen patients selected for gastric and esophagogastric cancer surgery between April 2020 and April 2023. They underwent gastrectomy and primary anastomosis. Demographic information was collected. Complete Blood Count (CBC) and inflammatory markers were recorded preoperatively and on the third day postoperatively. Data analysis was divided into descriptive and inferential statistics. All data were analyzed using Statistical Package for Social Sciences (SPSS) version 24 statistical software, with a significance level of 0.05 for all tests considered. Results: Three cases of anastomotic leakage post-surgery were reported. Significant statistical differences were observed between the two groups with and without anastomotic leakage in terms of Neutrophil to Lymphocyte Ratio (NLR) (2.67 ± 1.14 vs. 1.94 ± 1.06) and Systemic Inflammation Response Index (SIRI) (1.36 ± 1.02 vs. 0.87 ± 0.52) preoperatively (p<0.05). Additionally, on the third day post-surgery, significant statistical differences were found between the two groups in terms of leukocyte count (13.54 ± 2.89 vs. 9.47 ± 2.17), lymphocyte count (1.88 ± 1.10 vs. 2.95 ± 1.22), neutrophil count (9.14 ± 1.77 vs. 7.25 ± 1.08), CRP levels (54.12 ± 4.57 vs. 28.44 ± 2.13), NLR (4.86 ± 1.74 vs. 1.45 ± 0.94), and SIRI (3.88 ± 1.50 vs. 1.36 ± 0.78) (p<0.05). There were no significant differences in Platelet to Lymphocyte Ratio (PLR), Lymphocyte to Monocyte Ratio (LMR), and platelet count between the two groups preoperatively and on the third day postoperatively. Conclusion: C-Reactive Protein (CRP) levels, leukocyte and neutrophil counts, as well as NLR and SIRI ratios on the third day post-surgery, have predictive value for anastomotic leakage. [ABSTRACT FROM AUTHOR]

In this study, we investigated the role of several circulating and drainage fluid biomarkers for detecting postoperative complications (PCs) and anastomotic leakage (AL) in patients undergoing colorectal surgery. All consecutive patients undergoing colorectal surgery between June 2018 and April 2020 were prospectively considered. On postoperative days (POD) 1, 3, and 5, we measured lactate dehydrogenase (LDH) in drainage fluid, C-reactive protein (CRP) in serum and drainage fluid, and neutrophil to lymphocyte ratio (NLR). We enrolled 187 patients. POD1 patients with AL had higher serum CRP levels, while on POD3 and on POD5 higher NLR and serum CRP. LDH and CRP in drainage fluid were also significantly higher at both time points. The area under the curves (AUCs) of serum and drainage fluid CRP were 0.752 (0.629–0.875) and 0.752 (0.565–0.939), respectively. The best cut-off for serum and drainage fluid CRP was 185.23 and 76 mg/dL, respectively. The AUC of NLR on POD3 was 0.762 (0.662–0.882) with a sensitivity and specificity of 84 and 63 %, respectively, at a cut-off of 6,6. Finally, drainage fluid LDH showed the best diagnostic performance for AL, with an AUC, sensitivity, and specificity of 0.921 (0.849–0.993), 82 %, and 90 % at a cut-off of 2,186 U/L. Trends in serum parameters between patients with or without PCs or AL were also evaluated. Interestingly, we found that NLR decreased faster in patients without PCs than in patients with PCs and patients with AL. Drainage fluid LDH and NLR could be promising biomarkers of PCs and AL. [ABSTRACT FROM AUTHOR]

Introduction: Mycoplasma pneumoniae pneumonia (MPP) may lead to various significant outcomes, such as necrotizing pneumonia(NP) and refractory MPP (RMPP). We investigated the potential of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with MPP. Methods and materials: This was a prospective study of patients with MPP who were admitted to our hospital from 2019 to 2021. Demographic and clinical data were collected from patient records and associated with the development of NP and RMPP and other outcome measures. Results: Of the 1,401 patients with MPP included in the study, 30 (2.1%) developed NP. The NLR was an independent predictor of NP (odds ratio 1.153, 95% confidence interval 1.022-1.300, P=0.021). The probability of NP was greater in patients with a high NLR (=1.9) than in those with a low NLR (<1.9) (P<0.001). The NLR was also an independent predictor of RMPP (odds ratio 1.246, 95% confidence interval 1.102-1.408, P<0.005). Patients with a high NLR were more likely to develop NP and RMPP and require intensive care, and had longer total fever duration, longer hospital stays, and higher hospitalization expenses than those with a low NLR (all P<0.005). Discussion: The NLR can serve as a predictor of poor prognosis in patients with MPP. It can predict the occurrence of NP, RMPP, and other poor outcomes. The use of this indicator would allow the simple and rapid prediction of prognosis in the early stages of MPP, enabling the implementation of appropriate treatment strategies. [ABSTRACT FROM AUTHOR]

[Objectives] To observe the effects of daphnetin on mastitis induced by Staphylococcus aureus in mice. [Methods] 18 postpartum ICR female mice were used to establish mastitis animal model, and were randomly divided into three groups (A, B, and C) with 6 mice in each group. Group A: blank control group; group B: S. Aureus model group; group C; S. Aureus model + daphnetin group. The experimental groups were injected 1 ml. of 1.0 x10 CFU/100 µL of S. aureus of along the nipple catheter. The suspension was placed in the 3 and 4th pairs of mammary glands, and the control group was injected with the same dose of normal saline. On the second day after infection, the rats in group A, B and C were given drugs by gavage, while the rats in group A and B were given normal saline and the rats in group C were given daphnetin once a day for 6 consecutive days. Blood samples were collected from living eyeballs, and blood cells were analyzed by automatic flow cytometer after anticoagulation. [Results] The NLR and Systemie Immune Inflammati-on Index (SII) in the blood of mastitis mice in- duced by S. aureus were significantly higher than those in the control group (P<0.01), suggesting that neutrophil to lymphocyte ratio (NLR) and SII can be used as diagnostic indicators of mastitis, and the levels of NLR and SII decreased significantly after daphnetin intervention. [Conclusions] NLR and SII showed high levels in mastitis mice, which are valuable for the diagnosis of mastitis and the evaluation of its prog- nosis. After the intervention of daphnetin, both of them decreased significantly, indicating that daphnetin has a good prognosis trend in mastitis mice induced by S. aureus. [ABSTRACT FROM AUTHOR]

Many studies have shown that recovered coronavirus disease 2019 (COVID-19) patients frequently exhibit recurrent viral RNA positivity (RP) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our study aimed to summarize the clinical characteristics of these patients and explore potential reasons for RP occurrence. We divided 439 participants into four groups based on the severity of illness prior to the COVID-19 recovery and age: mild-child group, moderate-child group, mild-adult group, and moderate-adult group. Laboratory data were collected and statistically analyzed using the SPSS software, version 24.0. Significant differences were observed in age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), interleukin 6 (IL-6), and neutrophil to lymphocyte ratio (NLR) levels between the mild-adult group and the moderate-adult group (P < 0.05). Additionally, AST levels differed significantly between the mild-child group and the moderate-child group (P < 0.05). The proportion of RP patients within the four groups varied from 7.95% to 26.13% within a 2-week period. Logistic regression analysis revealed that younger age and moderate symptoms were risk factors for RP in children, while the presence of comorbidities (such as chronic heart, lung, liver, and kidney diseases), elevated IL-6 levels, and NLR were risk factors for RP in adults. We constructed two predictive models containing these relevant parameters, and the results of the receiver operating characteristic (ROC) curves indicated strong predictive utility. Our findings suggest that younger children with more severe symptoms, as well as adult patients with elevated levels of IL-6 and NLR and underlying diseases, are at higher risk of RP occurrence.

IntroductionMycoplasma pneumoniae pneumonia (MPP) may lead to various significant outcomes, such as necrotizing pneumonia(NP) and refractory MPP (RMPP). We investigated the potential of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with MPP.Methods and materialsThis was a prospective study of patients with MPP who were admitted to our hospital from 2019 to 2021. Demographic and clinical data were collected from patient records and associated with the development of NP and RMPP and other outcome measures.ResultsOf the 1,401 patients with MPP included in the study, 30 (2.1%) developed NP. The NLR was an independent predictor of NP (odds ratio 1.153, 95% confidence interval 1.022–1.300, P=0.021). The probability of NP was greater in patients with a high NLR (≥1.9) than in those with a low NLR (

Background: We know turnaround time for the complete blood count is much faster than that of various inflammatory markers like LDH, CRP, interleukins like IL-6, D-dimer. Thus using cell counts as a marker of severity and the prognosis is need of the hour. This will reduce the burden of the health care facilities. Complete blood count including the variation in RBC, WBC and platelets changes has been thoroughly studied. Various retrospective studies have shown that the absolute lymphocyte count can be taken as a marker of severity in COVID 19 patients. In December 2019, several cases of new corona virus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) have been emerged from Wuhan, China, which was later declared as a global pandemic by World Health Organisation (WHO) on March 11th 2020. Aim: In our study, we analyse and assess the severity of Covid-19 Vs d-NLR and RDW, PLR at our centre. Method and materials: This is the retrospective observational study. We actually collected the data of 300 cases but out of 300 cases only 268 laboratory confirmed COVID-19 cases, Age, neutrophil to lymphocyte ratio (NLR), derived-NLR (d-NLR), platelet to lymphocyte ratio (PLR) and red cell distribution width (RDW) of 268 laboratory confirmed COVID-19 patients, at the time of admission, belonging to clinical category B and C were recorded and compared in this single-center, retrospective observational study. The receiver operating characteristic (ROC) curve was applied to determine the thresholds for bio-markers and their prognostic values were assessed. Results and Observations: A statistically significant elevated NLR (P=0.001), d-NLR ( P=0.001), PLR (P=0.001) and RDW (P=0.026) were noticed in Category C (severe) group when compared to Category B group. From the ROC curve, it was established that d-NLR, NLR and WBC count proved to be a fair distinguisher (area under the curve between 0.7- 0.8) in predicting the clinical severity in COVID-19 patients. NLR and WBC count was found to be having the highest sensitivity of 82%, while d-NLR proved to be highly specific. Elevated age was also significantly associated with illness severity (P=0.001). Conclusion: COVID-19 is giving rise to tremendous challenges in the entire world and over pressurised the health care system and as of yet, efforts have been devoted to artificial intelligence based analysis of HRCT and x-rays have been used to indicate severity in the patients of SARSCoV2. Elevated age, WBC count, NLR, d-NLR, RDW and PLR may be considered as useful prognostic biomarkers for predicting the severity of COVID-19 infection and adverse outcome, with NLR and WBC count showing the highest sensitivity and d-NLR with the highest specificity. [ABSTRACT FROM AUTHOR]

Aim: We hypothesized that markers of inflammation correlate with response to radiotherapy in patients with non-metastatic laryngeal cancer (LC). Our aim was to assess peripheral and local markers of inflammation including lymphocyte to monocyte ratio (LMR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), infiltrating CD8+ lymphocytes (TILsCD8), and programmed death 1 ligand (PD-L1) expression. Methods: We performed a retrospective single-center analysis of LC patients administered definitive (R-RT) or postoperative radiotherapy (PORT). The primary endpoint was overall survival (OS) in relation to peripheral and local inflammatory markers and their dynamic changes during RT. Results: Study group included 215 patients (R-RT, n=116; PORT, n=99). The baseline (t0) NLR and LMR were significantly correlated with OS in the R-RT group. In patients with high and low NLR at t0, the five-year OS was 33% and 56% (p=0.010) and in high and low LMR at t0, the five-year OS was 56% and 27% (p=0.003), respectively. The LMR increase during R-RT predicted better prognosis: the five-year OS in high and low LMR was 57% and 31% at t2 (after 2 weeks of RT) (p=0.015), 49% and 26% at t4 (p< 0.001), and 50% and 25% at t6 (p=0.013), respectively. Multivariable analysis shows that the worse performance status (p=0.003), the presence of nodal metastases (p=0.0001), and low baseline LMR (p=0.049) in the R-RT group, and the presence of nodal metastases (p=0.035) and completion treatment on time (p=0.042) in PORT group were associated with poor prognosis. The PD-L1 expression had no significant prognostic value in any of the examined patients. Conclusion: The baseline LMR and its dynamic changes during R-RT and baseline NLR are independent prognostic factors in patients with nonmetastatic LC. PD-L1 expression and number of TILsCD8 have no prognostic value in R-RT and PORT group. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of red cell distribution width (RDW)and neutrophil-lymphocyte ratio (NLR)with the severity of rheumatoid arthritis by using DAS28 ESR. Additionally, toxic granulations were assessed as an indicator of disease severity. Study Design: Cross-sectional study. Place and Duration of Study: Rheumatology Outpatient Department, Federal Government Polyclinic Hospital, Islamabad Pakistan, from Dec 2020 to Jun 2021. Methodology: Two hundred ninety rheumatoid arthritis patients were included. DAS 28 ESR was calculated using the DAS 28 ESR calculator, and RDW and NLR were extracted from the complete blood picture and peripheral smears. Results: There were 238(82.1%) female and 52 17.9%) male study participants. The mean age of patients was 45.2±12.8. The mean RDW, NLR and DAS 28 ESR in the study were 45.67±4.25, 2.93±1.35 and 4.29±1.25, respectively. Toxic granulations on peripheral smears were also found in 188(64.8%) patients. A significant positive association was found using the Spearman rho correlation between the DAS28 ESR score, RDW and NLR (p-value 0.024 and

AimWe hypothesized that markers of inflammation correlate with response to radiotherapy in patients with non-metastatic laryngeal cancer (LC). Our aim was to assess peripheral and local markers of inflammation including lymphocyte to monocyte ratio (LMR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), infiltrating CD8+ lymphocytes (TILsCD8), and programmed death 1 ligand (PD-L1) expression.MethodsWe performed a retrospective single-center analysis of LC patients administered definitive (R-RT) or postoperative radiotherapy (PORT). The primary endpoint was overall survival (OS) in relation to peripheral and local inflammatory markers and their dynamic changes during RT.ResultsStudy group included 215 patients (R-RT, n=116; PORT, n=99). The baseline (t0) NLR and LMR were significantly correlated with OS in the R-RT group. In patients with high and low NLR at t0, the five-year OS was 33% and 56% (p=0.010) and in high and low LMR at t0, the five-year OS was 56% and 27% (p=0.003), respectively. The LMR increase during R-RT predicted better prognosis: the five-year OS in high and low LMR was 57% and 31% at t2 (after 2 weeks of RT) (p=0.015), 49% and 26% at t4 (p< 0.001), and 50% and 25% at t6 (p=0.013), respectively. Multivariable analysis shows that the worse performance status (p=0.003), the presence of nodal metastases (p=0.0001), and low baseline LMR (p=0.049) in the R-RT group, and the presence of nodal metastases (p=0.035) and completion treatment on time (p=0.042) in PORT group were associated with poor prognosis. The PD-L1 expression had no significant prognostic value in any of the examined patients.ConclusionThe baseline LMR and its dynamic changes during R-RT and baseline NLR are independent prognostic factors in patients with nonmetastatic LC. PD-L1 expression and number of TILsCD8 have no prognostic value in R-RT and PORT group.

Abstract Background Investigations on the risk factors for the prognosis of cerebral venous sinus thrombosis (CVST) are limited. This study aimed to explore whether specific inflammatory factors and coagulation indictors are associated with functional outcome in patients treated for CVST. Methods This retrospective study included 137 patients admitted to our hospital between January 2010 and October 2021. The functional outcome was assessed with the modified Rankin Scale (mRS) score at discharge. Patients were divided into two groups, 102 patients with favorable outcomes (mRS 0-1) and 35 patients with poor outcomes (mRS 2-6). The clinical indexes were compared between two groups. Multivariable logistic regression was performed to identify the independent influencing factors for poor outcomes of CVST patients. The prognostic indicators were analyzed using the receiver operating characteristic (ROC) curve. Results Compared with the favorable outcome group, the incidence of impaired consciousness and brain lesion, the levels of D-dimer, RDW, neutrophil count, neutrophil to lymphocyte ratio (NLR) and red blood cell distribution width to platelet ratio (%) on admission were significantly higher in the poor outcome group, while the level of lymphocyte count was significantly lower. After multivariable logistic regression analysis, baseline D-dimer level (odds ratio (OR), 1.180; 95% confidence interval (CI), 1.019-1.366, P = 0.027) and NLR (OR, 1.903; 95%CI, 1.232-2.938, P = 0.004) were significantly associated with unfavorable outcome at discharge. The ROC curve analysis showed that the areas under the curve of D-dimer, NLR and their combined detection for predicting worse outcome were 0.719, 0.707 and 0.786, respectively. Conclusions Elevated D-dimer level and NLR on admission were associated with an increased risk of poor functional outcome in patients with CVST.

Aim: The purpose of this study was to evaluate the role of WBC count, NLR, LMR, PLR, Systemic immune-inflammation index (SII) [(platelet count X neutrophil count) \ lymphocyte count] and platelet count (Plt)×NLR in the differential diagnosis of basal cell carcinoma, squamous cell carcinoma, and malignant melanoma and to determine the effect of tumor type, prediction of lymph node metastasis at initial diagnosis and location on these inflammatory markers. Material and Method: Patients who underwent surgery for basal cell carcinoma, squamous cell carcinoma, or malignant melanoma were retrospectively screened. NLR, LMR, PLR, SII and Plt×NLR were calculated. Relationships between tumor type, prediction of lymph node metastasis at initial diagnosis, tumor localization and the inflammatory and hematological parameters of interest were investigated. Tumor location was classified as head and neck and others. Results: A total of 257 patients were included in the study. No statistically significant differences in WBC, NLR, PLR, LMR, SII or Plt×NLR were detected according to tumor location. The patients with squamous cell carcinoma had higher NLR, PRL, SII and Plt×NLR values than those with basal cell carcinoma. The risk of lymph node metastasis at the time of initial diagnosis was 10.3 times higher in patients with PLR levels of 180.7 and higher. The risk of lymph node metastasis detected at initial diagnosis was 8.9 times higher in patients with Plt×NLR of 747 and higher. The risk of lymph node metastasis detected at initial diagnosis was 7.1 times higher in patients with SII of 414 and higher. Conclusion: Inflammatory markers seem to be useful in the differential diagnosis of skin cancers and determined the risk of lymph node metastasis. However, it does not differ according to tumor localization.

Background: The neutrophil to lymphocyte ratio (NLR) is a cost-effective and easily identifiable inflammatory biomarker that has been shown to be closely associated with tumor prognosis and predict survival in patients with multiple malignancies. However, the predictive value of NLR in patients with gastric cancer (GC) treated with immune checkpoint inhibitors (ICIs) has not been fully explored. Therefore, we conducted a meta-analysis to explore the potential of NLR as a predictor of survival in this population. Methods: We systematically searched the PubMed, Cochrane Library, and EMBASE databases from inception to the present for observational researches on NLR and its relationship with progression or survival in GC patients receiving ICIs. To assess the prognostic significance of NLR on overall survival (OS) or progression-free survival (PFS), we used fixed or random-effect models to derive and combine hazard ratios (HRs) with 95% confidence intervals (CIs). We also examined the relationship between NLR and treatment efficacy by calculating relative risks (RRs) with 95% CIs for objective response rate (ORR) and disease control rate (DCR) in patients with GC receiving ICIs. Results: Nine studies of 806 patients were eligible. OS and PFS data were obtained from 9 and 5 studies, respectively. In nine studies, NLR was associated with poor survival, the pooled HR was 1.98 (95% CI 1.67-2.35, p < 0.001), indicating a significant association between high NLR and worse OS. We conducted subgroup analyses based on study characteristics to confirm the robustness of our findings. A relationship between NLR and PFS were reported in five studies with a HR of 1.49 (95% CI 0.99-2.23, p = 0.056), which was not significantly associated. Pooling four studies that examined the correlation between NLR and ORR/DCR in GC patients, we observed a significant correlation between NLR and ORR (RR = 0.51, p = 0.003), but no significant correlation between NLR and DCR (RR = 0.48, p = 0.111). Conclusion: In summary, this meta-analysis indicates that increased NLR is significantly linked to worse OS in patients with GC receiving ICIs. In addition, lowering NLR can improve ORR. Thus, NLR can serve as a predictor for prognosis and treatment response in GC patients treated with ICIs. Nevertheless, further high-quality prospective studies are required to verify our findings in the future. [ABSTRACT FROM AUTHOR]

Simple Summary: Inflammation markers such as the neutrophil to lymphocyte ratio (NRL), the platelet to lymphocyte ratio (PLR), the lymphocyte to monocyte ratio (LMR) and the CRP to albumin ratio (CAR) have recently gained attention due to their potential as prognostic scores for overall survival (OS) in pancreatic cancer. So far, these parameters have not been validated in a larger cohort to predict OS in terms of potential recurrence after curative intended resection or in terms of patient response to chemotherapy. In the largest single-center analysis of 1294 patients, inflammation markers were compared and a new highly significant combined score, termed the inflammatory benchmark index (IBI), comprising five inflammatory markers was developed. In multivariate analyses NLR (p = 0.001), LMR (p = 0.038), CAR (p < 0.001) and IBI (p < 0.001) were identified as independent prognostic markers for overall survival. Inflammatory properties are known to promote tumor progression leading to an impaired median overall survival (mOS). Various small studies have focused on a wide range of inflammation-based prognostic indicators. By using sufficient data from 1294 out of 2323 patients diagnosed with pancreatic cancer between 2009 and 2021 at our cancer center, inflammatory markers such as the neutrophil to lymphocyte ratio (NRL), the platelet to lymphocyte ratio (PLR), the lymphocyte to monocyte ratio (LMR) and the CRP to albumin ratio (CAR) were evaluated. We identified a new combined score, termed the inflammatory benchmark index (IBI). We performed univariate and multivariate overall survival analyses and identified optimal prognostic cut-off values for each parameter. In univariate analyses, advanced age (p < 0.001), gender (p < 0.001), tumor stage (p < 0.001), CA19-9 (p = 0.001), NLR (p = 0.001), LMR (p = 0.004), PLR (p = 0.004), CAR (p = 0.001) and IBI (p = 0.001) were identified as prognostic markers. In multivariate analyses advanced age (p < 0.001), gender (p = 0.001), tumor stage (p < 0.001), CA19-9 (p < 0.001), NLR (p = 0.001), LMR (p = 0.038), CAR (p < 0.001) and IBI (p < 0.001) were independent prognostic markers. These findings emphasize the impact of inflammation in pancreatic cancer, provide easily accessible prognostic values for the clinician, and may be useful as stratification parameters for trials aimed at patient inflammation or immune response. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the admission neutrophil-to-lymphocyte ratio (NLR) for risk stratification for in-hospital outcomes and complications in non-ST-elevation acute coronary syndrome (non-ST-ACS) patients. Methods: We recruited consecutive patients with non-ST-ACS. The NLR was obtained and stratified as low, intermediate, and high-risk based on <3.0, 3.0-6.0, and >6.0, respectively. The new ST-T changes, arrhythmias, contrastinduced nephropathy (CIN), and mortality were recorded. Results: Median NLR was 3 [2.1-5.3] for 346 patients with 19.9% and 30.6% in high- and intermediate-risk group. New ST-T changes were observed in 3.5% (12) out of which 8, 3, and 1 patient in low, intermediate, and high-risk group (p = 0.424), respectively. Arrhythmias were observed in 5.8% (20) with 7, 5, and 8 patients in low, intermediate, and high-risk group (p = 0.067), respectively. CIN was observed in 4.9% (17) with 5, 5, and 7 in low, intermediate, and high-risk group (p = 0.064), respectively. In-hospital mortality was recorded in 1.4% (5) with 2 and 3 patients in high and low-risk group (p = 0.260), respectively. Conclusion: A significant number of non-ST-ACS patients fall in the high-risk category of NLR. Although, the association between NLR and in-hospital mortality and adverse events was not statistically significant but relatively higher rates of events were observed in high risk group. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the serial changes in inflammatory indices derived from blood cell counts and C-reactive protein (CRP) levels in COVID-19 patients with good and poor outcomes. We retrospectively analyzed the serial changes in the inflammatory indices in 169 COVID-19 patients. Comparative analyses were performed on the first and last days of a hospital stay or death and serially from day 1 to day 30 from the symptom onset. On admission, non-survivors had higher CRP to lymphocytes ratio (CLR) and multi-inflammatory index (MII) values than survivors, while at the time of discharge/death, the largest differences were found for the neutrophil to lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and MII. A significant decrease in NLR, CLR, and MII by the time of discharge was documented in the survivors, and a significant increase in NLR was documented in the non-survivors. The NLR was the only one that remained significant from days 7–30 of disease in intergroup comparisons. The correlation between the indices and the outcome was observed starting from days 13–15. The changes in the index values over time proved to be more helpful in predicting COVID-19 outcomes than those measured on admission. The values of the inflammatory indices could reliably predict the outcome no earlier than days 13–15 of the disease. [ABSTRACT FROM AUTHOR]

Background: Investigations on the risk factors for the prognosis of cerebral venous sinus thrombosis (CVST) are limited. This study aimed to explore whether specific inflammatory factors and coagulation indictors are associated with functional outcome in patients treated for CVST. Methods: This retrospective study included 137 patients admitted to our hospital between January 2010 and October 2021. The functional outcome was assessed with the modified Rankin Scale (mRS) score at discharge. Patients were divided into two groups, 102 patients with favorable outcomes (mRS 0-1) and 35 patients with poor outcomes (mRS 2-6). The clinical indexes were compared between two groups. Multivariable logistic regression was performed to identify the independent influencing factors for poor outcomes of CVST patients. The prognostic indicators were analyzed using the receiver operating characteristic (ROC) curve. Results: Compared with the favorable outcome group, the incidence of impaired consciousness and brain lesion, the levels of D-dimer, RDW, neutrophil count, neutrophil to lymphocyte ratio (NLR) and red blood cell distribution width to platelet ratio (%) on admission were significantly higher in the poor outcome group, while the level of lymphocyte count was significantly lower. After multivariable logistic regression analysis, baseline D-dimer level (odds ratio (OR), 1.180; 95% confidence interval (CI), 1.019-1.366, P = 0.027) and NLR (OR, 1.903; 95%CI, 1.232-2.938, P = 0.004) were significantly associated with unfavorable outcome at discharge. The ROC curve analysis showed that the areas under the curve of D-dimer, NLR and their combined detection for predicting worse outcome were 0.719, 0.707 and 0.786, respectively. Conclusions: Elevated D-dimer level and NLR on admission were associated with an increased risk of poor functional outcome in patients with CVST. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the surgical stress and immunoinflammatory response caused by proximal femoral nail (PFN) and hemiarthroplasty (HA) in patients with unstable intertrochanteric fractures. Materials and Methods: We retrospectively evaluated 344 patients who had undergone surgery for intertrochanteric fractures. Inclusion criteria were defined as being between the ages of 65 and 80, having an ASA score of 3, and the time between fracture formation and surgery being less than 72 hours. PFN was performed in 42 of the patients whereas HA was performed in 40 patients. In the two groups, data such as age, gender, pre-operative waiting and operation times, length of hospital stay, change in hemoglobin levels, and erythrocyte suspension (ES) need were recorded. Venous blood samples were collected from all the patients at the first admission to the emergency department after fracture, 6 hours after the operation, and 3 days after the operation. neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) were compared between the two procedures at three different time points. Results: The age, gender distribution, and preoperative wait duration did not differ significantly (p>0.05) between the two groups. The operation duration, hospitalization duration, and number of ES use were significantly higher (p<0.05) in the HA group than in the PFN group. In both groups, NLR and SII values increased significantly (p<0.05) between the day 0 and the 3rd postoperative day. The postoperative day 0 NLR and SII values in the HA group were significantly higher than those in the PFN group (p<0.05). Conclusion: We conclude that the PFN procedure causes less surgical stress than HA; therefore, it is a safer procedure. [ABSTRACT FROM AUTHOR]

Background: Preoperative inflammatory status has been widely used in assessing the prognosis of malignant tumor. This study aimed to establish a novel nomogram combining preoperative inflammatory factors and clinicopathologic features to predict the prognosis of gastric cancer (GC) patients after distal radical gastrectomy. Methods: A total of 522 GC patients from Fujian Provincial Hospital were retrospectively reviewed. Propensity score matching was performed and Cox regression models were used to analyze the clinical and pathological factors to determine their impact on survival. A prognostic nomogram was established and validated based on these factors. Results: The multivariate analysis indicated that tumor stage, pathological type, and neutrophil to lymphocyte ratio (NLR) were independent risk factors for the prognosis of GC patients. The nomogram was established based on these factors. In the primary cohort, the concordance index (C-index) of the nomogram was 0.753 (95% CI 0.647–0.840), which was higher than that of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) stage. The calibration curve showed the actual overall survival (OS) probabilities were in good keeping with those predicted by the nomogram. Furthermore, we divided the patients into two distinct risk groups for OS according to the nomogram points: low and high risk. The OS rates were significantly different among the subgroups (p ˂ 0.001). Conclusions: We proposed a novel nomogram combining preoperative NLR and clinicopathologic features that is economical, routinely available, and highly predictive of OS in GC patients after distal radical gastrectomy. Compared with the current AJCC TNM staging, this model was more accurate in prognostic prediction. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) has been linked to and is associated with increased cardiovascular and cerebrovascular morbidity. Ongoing inflammatory responses play an important role in this association. Systemic inflammation is important in pathophysiology of OSA and its comorbidity. In this study, we aimed to evaluate the role of neutrophil-to-lymphocyte ratio (NLR) in OSA patients and comparing with other well-known inflammatory marker, C-reactive protein (CRP) along with thyroid-stimulating hormone(TSH) and body-mass index(BMI). We conducted a retrospective analysis of 162 patients with OSA and divided them into 2 categories based on apnea–hypopnea index (AHI) (< 30 and > = 30), and recorded their leukocyte profiles, sex, age and body mass index. 80 matched healthy controls were taken. Patients were excluded if they had underlying cancer, chronic inflammatory disease, any systemic infection, uncontrolled hypertension and diabetes mellitus, a known acute coronary syndrome, valvular heart disease, renal or hepatic dysfunction. We found that N/L Ratio in severe OSA patients was significantly higher compared with mild and moderate OSA patients and healthy controls (p < 0.001). CRP levels were not different in all OSA stages (p = 0.595). We noted a significant difference in mean BMI of the two groups. In the wake of increase in prevalence of OSA in a developing country like India coupled with inadequate proportion of sleep labs, NLR is an inexpensive, easy to obtain, widely available marker of inflammation that might in combination with other markers assist in identifying patients with severe OSA. [ABSTRACT FROM AUTHOR]

Abstract Background Glioblastoma (GBM) is the most frequent and lethal brain tumor, which possesses highly malignant characteristics and predominates in elder patients. Systemic inflammatory response index (SIRI) is a novel prognostic marker from peripheral blood, which is defined as neutrophil count × monocyte count/lymphocyte count. In the current research, we aim to explore the relationship between SIRI and newly diagnosed GBM underwent gross total resection (GTR). Methods A retrospective analysis was conducted on consecutive newly diagnosed GBM patients underwent operation at West China Hospital from March 2015 to January 2019. X-tile software was used to determine the optimal cut-off values of SIRI, and neutrophil to lymphocyte ratio (NLR). All statistical analyses were performed using SPSS software and R software. Propensity score matching (PSM) was conducted to adjust for imbalance of all potential confounding covariates. Results The current research included a total of 291 consecutive newly diagnosed GBM patients underwent gross total resection. Among them, 186 were male patients and 105 were female patients. In original cohort, only gender was evidently related to SIRI level. SIRI and NLR were independent prognostic indicators both in original cohort and PSM cohort. Prognostic models based on the independent prognostic factors were established, and prognostic capacity of Model SIRI was superior to Model NLR. Conclusion In the current research, SIRI was determined to be an independent prognostic indicator for GBM. And the prognostic predictive ability of SIRI was stronger than NLR.

The beneficial immunomodulation effects of a biological response modifier glucan (BRMG) produced by two strains of Aureobasidium pullulans, AFO-202 and N-163, have already been reported. Herein, we compared their efficacy on immune-inflammatory parameters in Sprague Dawley (SD) rats. This study was performed on four groups of healthy SD rats, n=6 in each group: Group 1, euthanised on Day 0 for baseline values; Group 2, control (drinking water); Group 3, AFO-202 beta glucan, 200 mg/kg/day; and Group 4, N-163 beta glucan, 300 mg/kg/day. The neutrophil to lymphocyte ratio (NLR) decreased and leukocyte-to C-reactive protein ratio (LeCR) increased in Group 3 (AFO-202) at 15 and 29 days whereas the lymphocyte to C-reactive protein ratio (LCR) increased in group 4 (N-163), within the normal physiological range. These promising results warrant further investigations in larger numbers of healthy and diseased models to develop appropriate strategies for balancing immune system dysregulation.

Background: Hematological parameters, such as white blood cell count (WBC), mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and WBC to MPV ratio (WMR), could provide data in prognosis, risk stratification, and optimal management in patients with acute coronary syndromes. Aim: We aimed to investigate the prognostic value of hematological parameters and their relationship with the TIMI risk score in non-ST elevation myocardial infarction (NSTEMI) patients. Material and Methods: A total of 259 adult patients with NSTEMI were included in this retrospective and observational cohort study. During a 1-year follow-up period, the efficacy of the main hematological parameters in predicting major adverse cardiovascular events (MACE) and their correlation with the TIMI risk score was analyzed. Results: Among the 259 patients, 188 (72.6%) were male, and the mean age was 60.4 ± 11.9 years. MACE was observed in 60 patients (23.2%). Elevated baseline levels of WBC, neutrophils, NLR, PLR, and WMR were associated with MACE development throughout the 1-year follow-up. Moreover, WBC, WMR, and NLR were correlated with the TIMI risk score. When the predictive power of these parameters for MACE was evaluated by ROC analysis, the AUC values for WBC, WMR, and NLR were 0.670 (95% CI 0.590–0.750), 0.666 (95% CI 0.582–0.746), and 0.689 (95% CI 0.610–0.767), respectively. Conclusion: WBC, NLR, and WMR predicted MACE in NSTEMI patients and were consistent with the TIMI risk score. On this basis, they could provide supportive data for early risk stratification and optimized therapeutic approach, particularly in high-risk patients.

We aimed to investigate the relationship between the neutrophil to lymphocyte ratio (NLR) and nutritional parameters in chronic kidney disease (CKD) patients. In this cross-sectional study, 187 non-dialysis CKD patients were enrolled. Daily dietary energy intake (DEI) and daily dietary protein intake (DPI) were assessed by 3-d dietary records. Protein-energy wasting (PEW) was defined as Subjective Global Assessment (SGA) class B and C. Spearman correlation analysis, logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed. The median NLR was 2·51 (1·83, 3·83). Patients with CKD stage 5 had the highest NLR level. A total of 19·3 % (n 36) of patients suffered from PEW. The NLR was positively correlated with SGA and serum P, and the NLR was negatively correlated with BMI, waist and hip circumference, triceps skinfold thickness, mid-arm muscle circumference, DPI and Hb. Multivariate logistic regression analysis adjusted for DPI, DEI, serum creatinine, blood urea nitrogen, uric acid and Hb showed that a high NLR was an independent risk factor for PEW (OR = 1·393, 95 % CI 1·078, 1·800, P = 0·011). ROC analysis showed that an NLR ≥ 2·62 had the ability to identify PEW among CKD patients, with a sensitivity of 77·8 %, a specificity of 62·3 % and an AUC of 0·71 (95 % CI 0·63, 0·81, P < 0·001). The NLR was closely associated with nutritional status. NLR may be an indicator of PEW in CKD patients. [ABSTRACT FROM AUTHOR]

Background Emergency abdominal surgeries pose significant challenges, especially in the Indian population, due to comorbidities, delayed presentations, and limited resources. Accurately predicting morbidity and mortality is crucial for timely interventions and improved patient care. The neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein-to-albumin ratio (CAR) have shown potential as prognostic markers, balancing inflammation and nutritional status. Aim The study aims to evaluate the predictive efficacy of NLR and CAR with regard to postoperative morbidity and mortality in patients undergoing emergency abdominal surgery, thereby contributing to better risk stratification and management strategies. Patients and methods A prospective observational study was conducted in a tertiary teaching hospital in northern Karnataka from August 2022 to June 2024, involving 102 patients undergoing emergency abdominal surgeries. The sample size (71) was calculated using G*Power software, targeting a 95% power with a 5% significance level. The inclusion criterion was patients aged over 18 years undergoing emergency abdominal surgeries; those who were immunocompromised, on steroid therapy, having malignancies, undergoing radiotherapy, or having chronic liver diseases were excluded from the study. Patients coming into the surgical inpatient department (IPD) with an acute abdomen requiring emergency abdominal surgeries as an emergency were preoperatively assessed using complete blood count (CBC), CRP, and serum albumin tests. NLR and CAR were evaluated preoperatively and at 24 and 48 hours postoperatively. The outcome measures included surgical site infection rates, hospital stay duration, and outcome in the form of recovery or death. SPSS version 20 was used for statistical analyses. Results The study included 102 patients whose mean age was 43.7 ± 18.9 years; 74 of the participants (72.5%) were male. The most common procedures were exploratory laparotomy (64 patients; 62.7%) and appendicectomy (32 patients; 31.4%). A significant increase in CAR levels was observed on postoperative days 1 and 2 compared to baseline (p < 0.05). Preoperative NLR ≥ 8 was significantly associated with higher mortality (65% vs. 50%, p < 0.01). Preoperative albumin > 3.2 g/dL was associated with better outcomes (recovery in 54 patients; 65.9%) compared to < 3.2 g/dL (15 patients; 75% mortality). This study showed that NLR and CAR are valuable predictors of postoperative outcomes, with CAR indicating the risk for surgical site infections (SSI) and NLR predicting mortality. Conclusion The preoperative NLR had a significant association with mortality among the patients. Hence the NLR can be a good marker for the worst outcome and CAR during the postoperative period can be considered as a marker to detect the risk of SSI. NLR and CAR are simple, inexpensive tests readily available from routine blood investigations. The utility of NLR and CAR as valuable prognostic markers in the perioperative assessment of patients undergoing emergency abdominal surgery could enhance the prediction of patient outcomes and guide more effective management strategies to improve patient outcomes in high-risk emergency abdominal surgery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. BLDE (DU)'s Shri B M Patil Medical College, Hospital and Research Centre issued approval BLDE (DU)/IEC/668/2022-23. The Ethical Committee of this University met on Friday, 26th August 2022 at 3.30 p.m. in the Department of Pharmacology scrutinizes the Synopsis of Post Graduate Student of BLDE (DU)'s Shri B.M.Patil Medical College Hospital & Research Centre from ethical clearance point of view. After scrutiny, the following original/corrected and revised version synopsis of the thesis/ research projects has been accorded ethical clearance. Title: "The Role of the Neutrophil: Lymphocyte Ratio (NLR) and the C-Reactive Protein:Albumin Ratio (CAR) In Predicting Morbidity and Mortality Following Emergency Abdominal Surgeries". Name of the Student/Principal Investigator: Dr Shrihari V. Name of the Guide: Dr. Ramakanth Baloorkar. Professor, Dept. of Surgery. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shrihari et al.)

Background: A proinflammatory diathesis, as measured by the neutrophil to lymphocyte ratio (NLR), heralds an adverse disease course for non–small cell lung cancer (NSCLC). Methods: This post hoc analysis used data from the phase 3 OAK trial (NCT02008227), which randomized previously treated patients with NSCLC to atezolizumab or docetaxel. The main objective was assessing the differential impact of the pretreatment NLR on overall survival according to the treatment modality. In addition, patients' genomic characteristics were assessed according to their inflammatory status with a circulating free DNA (cfDNA) next‐generation sequencing (NGS) analysis. Results: In all, 600 and 575 patients with NLR data were included in the atezolizumab and docetaxel cohorts, respectively, with a median NLR of 4 (interquartile range, 2.6–6.7) for the pooled population. An NLR ≥4 was associated with a positive smoking status (88.6% vs. 78.1%; p <.01), male sex (66.4% vs. 57.6%; p =.01), a worse performance status (71.3% vs. 55.2%; p <.01), a higher number of metastatic sites (63.2% vs. 51.6%; p =.01), squamous histology (32.1% vs. 21.4%; p <.01), and tissue KRAS mutations (30% vs. 18.7%; p =.02) but not with programmed death ligand 1 (PD‐L1) expression or the tissue epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK) status. A pretreatment NLR ≥4 was more strongly associated with mortality after atezolizumab (adjusted hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.35–2.01) versus docetaxel (HR, 1.32; 95% CI, 1.08–1.60; multivariable [MVA] interaction p =.08). The HR for an increased risk of death for PD‐L1–negative/NLR ≥4 patients (compared with PD‐L1–positive/NLR <4 patients) was significantly higher in the atezolizumab cohort (MVA interaction p =.01). The exclusion of EGFR/ALK‐positive patients further increased the prognostic ability of the baseline NLR in favor of atezolizumab (MVA interaction p =.02). Pretreatment cfDNA data from NGS showed that patients with a high blood tumor mutation burden (cutoff, 16 mut/Mb) had a higher median NLR (4.6 vs. 3.7; p =.01). After adjustments for multiple comparisons, none of the selected variants of interest (EGFR, KRAS, TP53, KEAP1, STK11, SMARCA4, ARID1A, and targeted DNA damage response and repair genes) were significantly associated with the NLR. Conclusions: A low baseline NLR identified patients with NSCLC who derived a greater survival benefit from atezolizumab in comparison with those identified in the docetaxel cohort. The NLR could complement PD‐L1 expression in tailoring treatment in this setting. The prognostic role of inflammatory indices in non–small cell lung cancer is already known, but an unanswered question exists about their possibly enhanced role with immunotherapy. In this post hoc analysis, the population of the OAK trial (NCT02008227) is used to demonstrate that the baseline neutrophil to lymphocyte ratio retains a differential effect depending on the treatment strategy (immunotherapy vs. chemotherapy). [ABSTRACT FROM AUTHOR]

OBJECTIVE: Intensive care units (ICU) are tasked with critical care and treatment with a view to improving prognosis. The Acute Physiology and Chronic Health Evaluation II (APACHE II) is one of the most commonly used scoring systems to predict prognosis. In this context, the objective of this study is to evaluate the prognostic value of Red Cell Distribution Width (RDW), Neutrophil-Lymphocyte ratio (NLR), and C-reactive protein to albumin ratio (CAR) in predicting the prognosis and mortality in patients admitted to the ICU. PATIENTS AND METHODS: The RDW, NLR, and CAR values and APACHE II scores of patients admitted into an ICU, where heterogeneous groups of patients are usually treated, were recorded, categorized based on survival status, and investigated for any correlation between surviving patients' mortality and length of stay (LoS) in ICU and the said parameters. RESULTS: The ICU mortality among the 2,147 patients included in the study was 43.2%. The most common diagnosis of the patients admitted to the ICU was sepsis. The RDW, NLR, and CAR values and APACHE II scores of the deceased patients were significantly higher than those of the survived patients. There was a significant correlation between LoS in ICU and the said parameters in the positive direction in the survived group only. The APACHE II score had the highest prognostic value in predicting mortality, followed by RDW, CAR, and NLR values in descending order. CONCLUSIONS: Among the parameters investigated in this study, RDW had the highest prognostic value in predicting the prognosis and mortality. Hence, it may be incorporated into or used alongside the APACHE II scoring system to predict patient outcomes with higher accuracy. However, further randomized controlled studies are needed to determine the cut-off values in predicting the prognosis and mortality. [ABSTRACT FROM AUTHOR]

Background: Alpha-fetoprotein (AFP) is a biomarker used in clinical management of hepatocellular carcinoma (HCC), however, approximately 40% of HCC patients do not present with elevated serum AFP levels. This study aimed to investigate the clinical and pathologic characteristics between AFP positive and negative HCC patients to allow for improved clinical management and prognostication of the disease.Methods: This study observed a cohort of HCC patients from Eastern and Southern China with comparisons of the clinical and pathologic features between serum AFP positive and negative patient groups; patients with decompensated hepatic cirrhosis, those with chronic hepatitis B, and hepatitis B virus (HBV) asymptomatic carrier patients were used as controls. Data included the laboratory results, pathology diagnosis, clinical staging and scores were obtained from routine clinical diagnostic methods.Results: Patients with HCC, larger tumor sizes, liver cancer with hepatic cirrhosis, portal vein thrombosis, metastasis, high Child-Pugh score, high Barcelona-Clínic Liver Cancer (BCLC) stage, and advanced clinical stage had significantly higher serum AFP levels. Also, patients with HBsAg and HBeAg positive, high HBV DNA levels had significantly higher serum AFP levels. Patients with high serum AFP levels had higher protein induced by vitamin K absence or antagonist-II (PIVKA-II), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alpha-l-fucosidase (AFU), gamma-glutamyl transpeptidase (γ-GT), γ-GT /ALT, direct bilirubin (DBIL), indirect bilirubin (IDBIL), fibrinogen, and D-dimer levels. Patients with AFP positive had higher white blood cells (WBC), neutrophil, monocyte, and platelet count and neutrophil to lymphocyte ratio (NLR).Conclusions: The are significant differences in clinical pathologic characteristics between AFP positive and negative HCC patients which may be helpful for the management and prognostication of the disease. [ABSTRACT FROM AUTHOR]

Background & Objective: The aim of this study was to investigate the relationship of neutrophil to lymphocyte ratio (NLR) and other blood cells markers in craniocervical artery dissection patients and the dynamic changes of these biomarkers during the disease course, and effects on prognosis of the patients. Method: Cranial MR imaging, cranial and cervical MR angiography and DSA were examined, and diffusion weighted imaging (DWI) was performed to show the acute lesion(s). Results: Forty-six patients with craniocervical artery dissection were included in this study; they had a mean age of 42 years. Almost 60% of the patients (n=27) were admitted during acute state. Almost 2/3 of cases had extracranial dissection (n=31) and nearly 40% of the patients (n=18) had trauma. Neutrophil to lymphocyte ratio (NLR) was observed to be higher in the acute phase of the disease while the ratio decreased in the chronic phase. Low hemoglobin, high lymphocyte and a high NLR were found to have a negative correlation with the National Institutes of Health Stroke Scale (NIHSS). Conclusion: Elevation of neutrophil was higher in acute craniocervical artery dissection as a marker of acute inflammatory response. High NLR, low hemoglobin and high eosinophil levels were associated with worse prognosis and functional outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the predictive and prognostic role of pretreatment hematological parameters for tumor response and outcomes in locally advanced rectal cancer (LARC) patients undergoing surgery after neoadjuvant chemoradiotherapy (nCRT). Methods: From 2010 to 2016, 53 patients with LARC who underwent surgery following nCRT were analyzed. All hematological parameters were obtained from the initial blood tests performed before nCRT. The optimal cutoff values of significant hematological parameters for pathological tumor response (pTR), disease-free survival (DFS), and overall survival (OS) were determined using receiver operating characteristic (ROC) analysis. Patients have categorized into "good" and "poor" response groups according to their pathological results, and clinical-pathologic variables compared between the two groups. All survival analysis was calculated by the Kaplan-Meier method. Uni-multivariate analyses were performed using the Cox proportional hazard model. Results: In the ROC analysis, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) for OS and absolute platelet count and PLR for DFS were found as significant prognostic factors. In multivariate analysis, surgical margin, ypN stage, and elevated PLR were significantly associated with OS, and likewise, high PLR was found as an independent poor prognostic factor for DFS. The 5-year OS and DFS rates were worse in patients with high PLR group (82.3 vs. 47.3% for OS, p = 0.018 and 88.2 vs. 51.3% for DFS, p = 0.002). Conclusion: Pretreatment high PLR is associated with worse OS and DFS in patients with rectal cancer. To use in daily practice, further studies are needed on its validation. [ABSTRACT FROM AUTHOR]

The appropriate surgical management of early-stage oral tongue squamous cell carcinoma (OTSCC) remains a debated topic. The aim of this study is to investigate the role of the pre-treatment neutrophil to lymphocyte ratio (NLR) and tumor depth of invasion (DOI) in predicting the presence of occult neck metastases in early-stage OTSCC. A retrospective analysis of patients affected by early-stage (cT1-T2 cN0) OTSCC who were submitted to elective neck dissection (END) was performed. Tumors were classified retrospectively according to the 8th TNM classification, the DOI was assessed on the pre-operative magnetic resonance imaging, and the pre-treatment NLR was calculated for each patient. A logistic regression model to estimate the probability π (x) of cervical metastases by studying the NLR and DOI was carried out. Next, the correlation between the two variables, the NLR and DOI, was preliminarily studied. A cohort of 110 patients was analyzed (mean age, 62 years old; male to female ratio 1.2:1). The patients were staged as cT1 in 53 cases and cT2 in 57 cases. A DOI greater than 5.4 mm and a NLR greater than 2.93 are associated with an increased risk of presenting occult cervical metastases. Furthermore, the variables NLR and DOI are linearly associated with a positive correlation, proved by Spearman's rank correlation coefficient rho of 0.64, with a unitary increase in the DOI of 1 mm directly associated with an increase of 0.47 in the NLR. The DOI and NLR can be effectively used to predict the occurrence of occult neck metastasis and therefore to plan an END in early-stage OTSCC. [ABSTRACT FROM AUTHOR]

Wenwen Chen,1,* Kun Chen,2,* Zhixiao Xu,3 Yepeng Hu,1 Yiying Liu,1 Wenyue Liu,1 Xiang Hu,1 Tingting Ye,1 Jing Hong,1 Hong Zhu,1 Feixia Shen1 1Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 2Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Feixia ShenDepartment of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of ChinaEmail shenfeixia@wmu.edu.cnPurpose: Elevated platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are associated with poor outcomes in various diseases. The objectives of this study were to explore the utility of PLR and NLR in predicting all-cause mortality in patients with diabetic foot ulcers (DFU) undergoing amputations.Patients and Methods: A retrospective observational study was performed that included a total of 348 DFU patients undergoing amputations. The primary end-point was all-cause death. According to the PLR and NLR cut-off values, patients were divided into two groups and Kaplan–Meier survival curves were constructed. Multivariable Cox regression was conducted to test the independent predictors of mortality in the study cohort.Results: All-cause mortality was significantly higher in patients with a high PLR/NLR compared to those with a low PLR/NLR. In the low NLR group, the overall survival (OS) rates at 1, 3, and 5 years after amputation were 96.8%, 84% and 80.1%, respectively (p=0.001). In the high NLR group the corresponding OS rates at 1, 3, and 5 years were 85.2%, 58.6% and 23.9% (p< 0.001). According to the multivariate analysis, age (HR 1.074, 95% CI 1.045– 1.104, p< 0.001), Wagner classification (HR 2.274, 95% CI 1.351– 3.828, p=0.002), PLR (HR 1.794, 95% CI 1.014– 3.174, p=0.045), NLR (HR 2.029, 95% CI 1.177– 3.499, p=0.011), creatinine (HR 1.003, 95% CI 1.001– 1.004, p< 0.001) and direct bilirubin (HR 1.154, 95% CI 1.081– 1.232, p< 0.001) were independent predictors of mortality following amputation.Conclusion: Postoperative PLR and NLR values may be reliable predictive biomarkers of mortality in patients following amputation for DFU. Considering the high mortality in those patients, the patients with elevated PLR/NLR should be given more intensive in clinical practice.Keywords: amputation, platelet-to-lymphocyte ratio, PLR, neutrophil-to-lymphocyte ratio, NLR, diabetic foot ulcer, mortality

Abstract Study Objective Enhancement of a routine complete blood count (CBC) for detection of sepsis in the emergency department (ED) has pragmatic utility for early management. This study evaluated the performance of monocyte distribution width (MDW) alone and in combination with other routine CBC parameters as a screen for sepsis and septic shock in ED patients. Methods A prospective cohort analysis of adult patients with a CBC collected at an urban ED from January 2020 through July 2021. The performance of MDW, white blood count (WBC) count, and neutrophil‐to‐lymphocyte‐ratio (NLR) to detect sepsis and septic shock (Sepsis‐3 Criteria) was evaluated using diagnostic performance measures. Results The cohort included 7952 ED patients, with 180 meeting criteria for sepsis; 43 with septic shock and 137 without shock. MDW was highest for patients with septic shock (median 24.8 U, interquartile range [IQR] 22.0–28.1) and trended downward for patients with sepsis without shock (23.9 U, IQR 20.2–26.8), infection (20.4 U, IQR 18.2–23.3), then controls (18.6 U, IQR 17.1–20.4). In isolation, MDW detected sepsis and septic shock with an area under the receiver operator characteristic curve (AUC) of 0.80 (95% confidence interval [CI] 0.77–0.84) and 0.85 (95% CI 0.80–0 .91), respectively. Optimal performance was achieved in combination with WBC count and NLR for detection of sepsis (AUC 0.86, 95% CI 0.83–0.89) and septic shock (0.86, 95% CI 0.80–0.92). Conclusion A CBC differential panel that includes MDW demonstrated strong performance characteristics in a broad ED population suggesting pragmatic value as a rapid screen for sepsis and septic shock.

ObjectivesPlaque vulnerability and rupture rather than plaque size are the major cause of clinical events in patients with intermediate coronary lesions. Therefore, the present study was aimed to explore potential markers associated with plaque rupture in acute coronary syndrome (ACS) patients with intermediate coronary lesions.MethodsA total of 82 ACS patients presenting with only intermediate coronary lesions (40–70% stenosis demonstrated by quantitative coronary angiography) and no severe stenosis in other main coronary arteries [median age 63 years, 53 male and 29 female] were enrolled. Plaque morphology were assessed by optical coherence tomography (OCT). Hematological indices were assayed by automated hematological analyzer.ResultsPlaque rupture was identified in 14 patients by OCT. Neutrophil to lymphocyte ratio (NLR) in patients with plaque rupture (n = 14) was significantly higher than that in patients with non-plaque rupture (n = 68) [3.85 (3.28, 4.77) vs. 2.13 (1.40, 2.81), p < 0.001]. Multivariate logistic regression analysis revealed that NLR was one of the independent risk factors for plaque rupture in intermediate coronary artery lesions (odds ratio 1.64, 95% confidence intervals 1.18–2.29, p = 0.003). ROC curve analysis found a cutoff point of NLR > 2.94 for plaque rupture with 93.8% sensitivity and 77.9% specificity.ConclusionNLR, an inflammatory biomarker, is closely associated with plaque rupture in intermediate coronary artery lesions. Monitoring NLR may be useful in risk stratification and management for intermediate coronary artery lesions.

Objective: Poststroke cognitive impairment (PSCI) is a serious complication of stroke. The neutrophil-to-lymphocyte ratio (NLR) is a marker of peripheral inflammation. The relationship between the NLR and PSCI is far from well studied, and the thesis of this study was to assess the predictive value of the NLR in patients with PSCI, and establish and verify the corresponding prediction model based on this relationship. Methods: A total of 367 stroke patients were included in this study. Neutrophils, lymphocytes, and NLRs were measured at baseline, and clinical and neuropsychological assessments were conducted 3 months after stroke. The National Institutes of Health Scale (NIHSS) was used to assess the severity of stroke. A Chinese version of the Mini Mental State Examination (MMSE) was used for the assessment of cognitive function. Results: After three months of follow-up, 87 (23.7%) patients were diagnosed with PSCI. The NLR was significantly higher in PSCI patients than in non-PSCI patients (P < 0.001). Patient age, sex, body mass index, NIHSS scores, and high-density lipoprotein levels also differed in the univariate analysis. In the logistic regression analysis, the NLR was an independent risk factor associated with the patients with PSCI after adjustment for potential confounders (OR = 1.67, 95%CI: 1.21–2.29, P = 0.002). The nomogram based on patient sex, age, NIHSS score, and NLR had good predictive power with an AUC of 0.807. In the validation group, the AUC was 0.816. Conclusion: An increased NLR at admission is associated with PSCI, and the model built with NLR as one of the predictors can increase prognostic information for the early detection of PSCI. [ABSTRACT FROM AUTHOR]

Background: Cellular indices provide integrative information about systemic inflammation status which is readily available from routine laboratory parameters. This study aimed to evaluate the prognostic role of three cellular indices in patients with venous thromboembolism (VTE). Methods: The RIETE registry database was used to determine the association between the baseline neutrophil-to-lymphocyte-ratio (NLR), platelet-to-lymphocyte-ratio (PLR) and systemic-immune-inflammation-index (SII) for 90-day adverse outcomes in patients with acute VTE. Results: From January 2020 to April 2021, 4487 patients with acute VTE were recruited in the RIETE registry. Of these, 2683 presented with symptomatic pulmonary embolism (PE); 283 with incidental PE; 1129 with lower-limb deep vein thrombosis (DVT); 175 with upper-limb DVT; 69 with splanchnic vein thrombosis; 142 with superficial vein thrombosis and 20 with retinal vein thrombosis. Mean values were: NLR 5.9 ± 7.1, PLR 190 ± 158 and SII 1459 ± 2028. During the first 90-days, 38 patients (0.8%) developed recurrent DVT, 45 (1.0%) had recurrent PE, 152 (3.4%) suffered major bleeding, and 484 (11%) died. On multivariable analysis, patients with NLR >4.41 were at an increased risk for major bleeding and patients with NLR >4.96 were at the risk of death, while those with SII >1134.5 were at increased risk for death. Conclusions: This study reports the results of a large cohort to date which evaluate the prognostic value of three cellular indices simultaneously in patients with acute VTE. Results support that none of the three baseline cellular indices were sufficient for prediction of VTE recurrences in acute VTE patients. The patients with higher baseline NLR values were at an increased risk of major bleeding or death, those with high SII values were only at an increased risk for mortality. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with procalcitonin in cord blood. Study Design: Case control study. Place and Duration of Study: Study was conducted in Army Medical College and Pak Emirates Military Hospital Rawalpindi, Jul 2018 to Mar 2019. Methodology: Those mothers, having deliveries with early rupture of membranes (EROM), premature rupture of membranes (PROM), preterm, dai handled, meconium and failure of induction have been included. Total 60 neonates were included in this study. Nineteen neonates were taken as a continuous clinical unsteadiness with a clearly documented suspicion of sepsis and two neonatologists decided sepsis within 1-3 days of life. While remaining neonates were control who have no infection. Results: Laboratory values show there was a gross difference in mean values of case and control for white blood cell (WBC), platelets, neutrophil, platelet to lymphocyte ratio and procalcitonin with statistical significance except lymphocyte count and neutrophil to lymphocyte ratio. In combined ROC curve. The cutoff of procalcitonin was calculated to be 0.4ng/ml with an area under curve of 84.5%. Similarly, cutoff of neutrophil to lymphocyte ratio was determined to be 1.39 with an area under curve of 65.1% at sensitivity of 63% and specificity of 58.5%. Cutoff of platelet to lymphocyte ratio was determined to be 47.48 with an area under curve of 66.8% at sensitivity of 78.9% and specificity of 49%. Conclusion: Combined hematological markers neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with procalcitonin in cord blood could be used as a simple, sensitive and predictive parameter for identifying neonates susceptible to sepsis.

ObjectivePoststroke cognitive impairment (PSCI) is a serious complication of stroke. The neutrophil-to-lymphocyte ratio (NLR) is a marker of peripheral inflammation. The relationship between the NLR and PSCI is far from well studied, and the thesis of this study was to assess the predictive value of the NLR in patients with PSCI, and establish and verify the corresponding prediction model based on this relationship.MethodsA total of 367 stroke patients were included in this study. Neutrophils, lymphocytes, and NLRs were measured at baseline, and clinical and neuropsychological assessments were conducted 3 months after stroke. The National Institutes of Health Scale (NIHSS) was used to assess the severity of stroke. A Chinese version of the Mini Mental State Examination (MMSE) was used for the assessment of cognitive function.ResultsAfter three months of follow-up, 87 (23.7%) patients were diagnosed with PSCI. The NLR was significantly higher in PSCI patients than in non-PSCI patients (P < 0.001). Patient age, sex, body mass index, NIHSS scores, and high-density lipoprotein levels also differed in the univariate analysis. In the logistic regression analysis, the NLR was an independent risk factor associated with the patients with PSCI after adjustment for potential confounders (OR = 1.67, 95%CI: 1.21–2.29, P = 0.002). The nomogram based on patient sex, age, NIHSS score, and NLR had good predictive power with an AUC of 0.807. In the validation group, the AUC was 0.816.ConclusionAn increased NLR at admission is associated with PSCI, and the model built with NLR as one of the predictors can increase prognostic information for the early detection of PSCI.

Background: Over the last three years, the coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a global impact. COVID-19 has led to diagnostic and treatment delays in head and neck squamous cell cancers (HNSCCs). Both cancer and COVID-19 trigger systemic inflammatory responses that can result in cytokine storms, creating a favorable tumor microenvironment that supports tumor growth. Various studies have shown a positive association between increasing neutrophil-to-lymphocyte ratio (NLR) and disease severity in COVID-19. Studies have also shown that high NLR is associated with poor survival outcomes in cancer patients. Our aim is to investigate whether an increased NLR is linked to rapid tumor progression in patients with HNSCC who have also been affected by infections like COVID-19 in the pre-operative period., Methods: This was a retrospective analysis of patients of HNSCC who were scheduled for surgery and had contracted COVID-19 in their pre-operative period between April 2021 and May 2021. The study analyzed pre- and post-COVID NLR in relation to disease progression in HNSCC. Statistical analysis was presented as an interquartile range and numbered with the percentage. Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY) was utilized for the analysis., Results: We evaluated 200 operable cases of which 38/200 (20%) patients with HNSCC were COVID-19 positive. Out of those COVID-19-positive patients, 27/38 (71%) patients got operated. Around, 11/38 (28.9%) patients were inoperable. And, 14/27 (53.8%) operated patients also had a change in treatment plan. The mean duration from the joint clinic treatment plan to the date of surgery was 25.18 days. Patients who had contracted COVID-19 and had a change in their treatment plan due to disease progression exhibited mean NLR values of 3.84 (pre-COVID) and 11.11 (post-COVID), with respective medians of 3.04 and 10.50. These differences showed a statistically significant p-value of 0.000. In contrast, patients who had no change in treatment plan displayed mean NLR values of 4.51 (pre-COVID) and 9.70 (post-COVID), with respective medians of 3.47 and 3.42, resulting in with a non-significant p-value of 0.082., Conclusion: This is a one-of-its-kind study that has evaluated the role of elevated NLR in patients with a COVID-19 virus infection and its relationship with the clinical progression of the disease. The findings suggest that elevated NLR in patients with HNSCC, along with concurrent SARS-CoV2 infection, may contribute to accelerated disease progression with an increase in tumor burden and nodal metastasis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethical Committee (MPMMCC) issued approval 2020/46. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sarkar et al.)

Objectives: To identify association of neutrophil to lymphocyte ratio with disease severity and mortality. Methods: Total 720 Corona Virus RT-PCR positive patients were included in this cross-sectional study. Patients were admitted to KRL Hospital Islamabad from April 2020 to August 2020. Neutrophil to lymphocyte ratio (NLR) was recorded on admission and then serially. NLR cut-off was 3.0. WHO categories for disease severity (asymptomatic, mild, moderate and severe) were used. Demographic profile, symptoms and comorbidities were recorded. Results: The mean age of patients was 40 - 12.4 years with 96% being males. Majority patients (76.5%) were asymptomatic. Amongst symptoms, fever was the most common symptom. Diabetes mellitus was most common recorded co-morbidity. The mean NLR 2.5 - 2.78. Significant association was found between NLR and disease severity as well as mortality. Difference in mean NLR amongst disease severity categories was also significant. Conclusion: Results are compatible with worldwide studies and NLR is a cheap and easily available marker of disease severity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Glioblastoma multiform is the most common primary brain tumor that releases inflammatory mediators and changes in blood cells. This study answers the question of whether GBM patients can be distinguished from healthy individuals using changes in blood markers. Methods: This study was performed retrospectively using the records of newly diagnosed GBM patients and healthy individuals between February 2016 and February 2019. Blood markers including RBCs, WBCs, neutrophils, lymphocytes, monocytes, platelets, NLR, LMR, PLR, dNLR are examined in two groups of tumor patients and healthy individuals. Changes in blood markers were examined separately by statistical analysis and an artificial neural network (ANN). Statistically significant differences between blood markers in the two groups are investigated and the correlation between blood markers and GBM is determined. In this study, blood markers were specifically studied by artificial neural network. The accuracy of the artificial neural network in differentiating GBM and healthy individuals are determined. Results: In this study, 124 GBM patients and 124 healthy individuals were studied. In the statistical analysis, except for monocytes, other blood markers were significantly different in the two groups. WBC, neutrophils, NLR, PLR and dNLR were positively correlated with a GBM tumor. RBCs, lymphocytes, platelets, and LMR had a negative correlation with the presence of the tumor. The best predictive value among blood markers was related to dNLR (AUC=0.796) In the data analysis using an artificial neural network, the accuracy of differentiation between healthy and sick patients was 84.2%. Based on the characteristics of the artificial neural network used in this study, the placement accuracy and the predictive value of the artificial neural network in differentiating healthy and GBM cases were appropriate (MCC = 0.685, AUC = 0.875). Conclusion: All blood markers except monocytes are significantly different in healthy and GBM cases. The artificial neural network can differentiate between the two groups with appropriate accuracy and can be used clinically in predicting the presence of GBM. [ABSTRACT FROM AUTHOR]

Background: Blood markers are used as non-invasive predictive factor for tumor grade. They vary in different grades of tumor and therefore, they can be used to predict the tumor grade. Material and Methods: In this retrospective study, blood markers including the leukocyte, lymphocyte, neutrophil, monocyte, Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), Lymphocyteto-Monocyte Ratio (LMR) and derived Neutrophil-to-Lymphocyte Ratio (dNLR) were extracted. Firstly, the blood markers were statistically analyzed and then, an artificial neural network was used to assess the predictive value of blood markers. The network was trained with the data and then, its characteristics such as accuracy and reliability were determined. Results: Totally, 139 patients were evaluated in this study. NLR and dNLR were significantly and positively correlated with the tumor grade and LMR and lymphocytes were significantly and negatively correlated with the tumor grade. LMR had the best diagnostic value among the blood markers in prediction of tumor grade (AUC = 0.655). Artificial neural network in two separate designs represented higher accuracy and efficiency in differentiating the low and high grade glioma compared to the four grades of tumor and it could differentiate between the low and high grade glioma tumors with 74.8% of accuracy These results are reliable considering the specifications of the artificial neural network (AUC = 0.78). Conclusion: This study revealed that the artificial neural network can be used to differentiate between the low and high grade glioma tumor with the accuracy of 74.8%. [ABSTRACT FROM AUTHOR]