Clinical characteristics and laboratory profile of symptomatic COVID-19 patients from a tertiary Bangalore rural hospital: the lessons learnt

Background: Aim of study was to analyse clinical and laboratory features and outcome of COVID-19 patients admitted in second wave of pandemic (April1 to May 31, 2021) (SW) and compare with covid 19 patients in third wave (TW). Methods: COVID-19 positivity were confirmed in both SW and TW. Demographic features, symptoms and duration were recorded. X ray chest was done at the time of admission and for monitoring. Complete blood count, C reactive protein, renal function tests, liver function tests, LDH and D dimer levels were done. The positive patients were categorized as mild, moderate and severe based on the clinical, imaging and laboratory features. Results: Among 297 patients screened, 171 patients were diagnosed as positive (57.5%). 107 patients were admitted (62.5%). (M:F ratio - 1.74:1). The most common symptoms for hospitalization were fever, cough and shortness of breath. Though 38 patients had neutrophilia, only 16 of them presented with high NLR ratio. Consolidation on chest X-ray was present in all patients but the degree varied. 38 patients required ICU admission and oxygen support. 18 patients succumbed to disease. Among 140 patients (TW) (December 1 to January 31 2022, 69 (43.1%) were positive. Only 12 patients required hospitalisation. The only symptom was high fever. The NLR ratio ranged from 1-6 and never went beyond 6. All patients were discharged after 2-3 days. Conclusions: The demographic features, co morbidities, presenting symptom of fever and X ray findings were similar in both waves. But the NLR ratio was never beyond 6 in TW. This was probably due to early reporting and vaccination status of the population and less virulent strain of the virus in TW. The present study confirmed that raised NLR and low levels of oxygen saturation at the time of admission are important predictors of disease severity.

Efficacy analysis of blood inflammation and liver function indexes in ICP diagnosis and delivery mode prediction / 重庆医学

Objective To observe the changes of laboratory blood indexes in patients with intrahepatic cholestasis of pregnancy(ICP),and analyze the value of blood inflammation indexes and liver function indexes in the diagnosis of ICP and the prediction of delivery mode.Methods A total of 251 patients diagnosed with ICP in this hospital from January 2021 to December 2022 were selected as the ICP group,and another 200 healthy pregnant women were selected as the control group.The patients with ICP were further divided into the severe ICP group(n=47)and the mild ICP group(n=204),the vaginal delivery group(n=113)and the cesarean section group(n=138)according to the severity of ICP and delivery mode.Mann-Whitney U test was used for comparison of parameters between groups,and Spearman method was used for correlation analy-sis.Receiver operating characteristic(ROC)curves were used to evaluate the efficacy of laboratory indicators in diagnosing ICP and predicting delivery mode.Results Neutrophil/lymphocyte ratio(NLR)[6.01(4.45,8.37)vs.3.36(4.12,3.51)]and aspartate transaminase(AST)level[20.00(16.00,33.00)U/L vs.15.00(13.00,18.00)U/L]in the ICP group were significantly higher than those in the control group(P＜0.05),and NLR in the severe ICP group was significantly higher than that in the mild ICP group[4.93(3.87,7.35)vs.4.14(3.12,5.17),P＜0.05].Correlation analysis showed that NLR was positively correlated with AST level(r=0.279,P＜0.001)and ICP severity(r=0.139,P=0.028)in patients with ICP.The area under ROC curve(AUC)of NLR combined with AST for ICP diagnosis was 0.882(95％CI:0.851-0.913).In ad-dition,cholinesterase(CHE)[6 020.00(5 499.50,6 703.50)U/L vs.5 341.50(4 651.75,6 259.25)U/L]and prealbumin(PA)[199.00(177.71,225.20)mg/Lvs.169.17(139.18,204.40)mg/L]levels in the va-ginal delivery group were significantly higher than those in the cesarean section group(P＜0.05),and the AUC of CHE combined with PA for predicting vaginal delivery in ICP patients was 0.727(95％CI:0.664-0.789).Conclusion NLR and AST have potential value in the diagnosis of ICP,and CHE and PA have poten-tial value in predicting delivery mode of ICP patients.

Serum Cytokines,PCT and NLR Expression Levels and Their Diagnostic Value in Patients with Sepsis / 现代检验医学杂志

Objective To explore the value of cytokines,procalcitonin(PCT)and neutrophil-lymphocyte ratio(NLR)in the early diagnosis and prognosis evaluation in the patients with sepsis.Methods 98 patients with sepsis admitted to the First Affiliated Hospital of Air Force Medical University from January 2020 to January 2023 were selected as research objects,including 82 patients in the sepsis non-shock group and 16 patients in the sepsis shock group.According to the death within 28 days,the patients was divided into survival group(n=82)and death group(n=16).Meantime,95 cases of non-septic infection group were included as control.The expression of interleukin(IL)-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17,tumor necrosis factor(TNF)-α,interferon(IFN)-γ,IFN-α,PCT,and NLR were detected within 24h after admission,and their relationship with sepsis was analyzed by ROC curve.Results ①The IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17,TNF-α,IFN-α,NLR and PCT in patients with sepsis were significantly higher than those in healthy subjects(Z=0.43～30.54,all P＜0.05)except IL-1β,IFN-γ.Further analysis of ROC showed that IL-8,NLR,PCT and IL-17 had strong predictive ability,with area under curve(AUC)of 0.78(95%CI:0.71～0.84),0.81(95%CI:0.75～0.87),0.83(95%CI:0.78～0.88),0.86(95%CI:0.81～0.92),respectively.Combined detection of the four indicators can effectively improve the diagnostic efficiency of sepsis,with the AUC of 0.90(95%CI:0.85～0.93).② There were no significant differences in cytokines,PCT and NLR concentration between positive and negative blood culture groups(P＞0.05),suggesting that these indexes were not affected by blood culture detection results.③Among the patients in the shock group,IL-6[122.10(10.77～10 000.00)ng/L]was significantly higher than that in non-shock group[25.56(1.02～9 096.74)ng/L],the difference was statistically significant(Z=74.55,P=0.01),with the AUC of 0.73(95%CI:0.59～0.87).The levels of IL-10[10.69(1.12～1 338.00)ng/L],IL-2[12.52(0.86～280.42)ng/L]and IL-5[9.55(0.93～259.57)ng/L]in sepsis death group were higher than those[2.55(0.34～695.13)ng/L,4.46(0.13～625.43)ng/L,2.75(0.01～117.88)ng/L]in survival group,the differences were statistically significant(Z=3.64,6.37,4.74,all P＜0.05),and the AUC were 0.69(95%CI:0.53～0.85),0.71(95%CI:0.56～0.85)and 0.72(95%CI:0.58～0.87),respectively.Conclusion The combined detection of IL-8,NLR,PCT and IL-17 is helpful for the early diagnosis of sepsis.The increase of IL-6 level can effectively predict the occurrence of septic shock,and the high expression of IL-10,IL-2 and IL-5 has a good predictive value for the death of sepsis patients.

Prediction of isocitrate dehydrogenase status of glioma via diffusion tensor imaging parameters and clinical features / 实用放射学杂志

Objective To noninvasively predict isocitrate dehydrogenase(IDH)status of glioma via combining imaging and clini-cal features before surgery,so as to provide basis for individualized clinical treatment decision.Methods A total of 47 patients with glioma confirmed by pathological and molecular genetic tests were included,including 20 with IDH mutant type and 27 with IDH wild type.After diffusion tensor imaging(DTI)scanning,fractional anisotropy(FA)and mean diffusivity(MD)values of tumor paren-chyma were calculated.Combining DTI parameters with MRI morphological features of tumor,blood neutrophil/lymphocyte ratio(NLR)and patient's age,binary logistic regression model was established to effectively predict IDH status of glioma patients before surgery.Results There were significant differences in FAmean/FANAWM,MDmin,NLR,tumor location and age between IDH mutant type and IDH wild type groups(P<0.05).The binary logistic regression model concluding,FAmean/FANAWM,MDmin,cystic degeneration,NLR and age,predicted IDH status of glioma with area under the curve(AUC)of 0.961 and 95%confidence interval(CI)of 0.914-1.00.Conclusion The regression model established via combining DTI,MRI morphological features and blood NLR has great performance in classifying IDH status of glioma,and can help predict IDH status noninvasively before surgery,so as to assist clinical individualized treatment.

The value of neutrophil lymphocyte ratio and systemic immune inflammatory index for diagnosis of coronary artery lesions in patients with Kawasaki disease / 中华全科医师杂志

Objective:To investigate the value of neutrophil lymphocyte ratio (NLR) and systemic immune inflammatory index (SII) for the diagnosis of coronary artery lesions in patients with acute phase of Kawasaki disease (KD).Methods:It was a cross-sectional study. Children with acute Kawasaki disease admitted to Linyi Central Hospital from January 2018 to December 2021 were enrolled and divided into the Kawasaki disease complicated with coronary artery disease group (KD-CAL group) and the Kawasaki disease without coronary artery disease group (KD-NCAL group). The demographic data, blood routine and C-reactive protein (CRP) test results before intravenous injection of γ globulin were collected, and NLR and SII were calculated. Multivariate logistic regression model was used to analyze the risk factors of coronary artery disease in children with Kawasaki disease. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of NLR and SII for coronary artery lesions in children with Kawasaki disease.Results:A total of 109 children with acute phase of KD aged 1 month to 9 years were enrolled, including 66 boys (60.6%). There were no significant differences in age and gender composition between the KD-CAL group ( n=17) and the KD-NCAL group ( n=92) (all P>0.05). Compared with the KD-NCAL group, the NLR, SII and CRP levels in the KD-CAL group were higher (all P<0.05). Multivariate logistic regression analysis showed that NLR and SII were independent risk factors of coronary artery disease in children with Kawasaki disease (NLR, OR=1.265, 95% CI:1.066-1.502, P=0.007; SII, OR=1.001, 95% CI:1.000-1.002, P=0.015). ROC curve results showed that thearea under the curve ( AUC) of NLR in diagnosis of coronary artery lesions was 0.812 (95% CI:0.703-0.921, P<0.05), taking 5.4 as cutoff value, the sensitivity was 73.9% and specificity was 76.5%; the AUC of SII in diagnosis of coronary artery lesions was 0.830 (95% CI:0.741-0.919, P<0.05), taking 1 623 as the cut-off value, the sensitivity was 66.3% and specificity was 88.2%; the AUC of the combination of NLR and SII was 0.875(95% CI:0.790-0.959, P<0.05), the sensitivity and specificity were 85.9% and 76.5%, respectively. Conclusion:NLR and SII have certain diagnostic value for coronary artery disease in children with acute Kawasaki disease, and the combination of NLR and SII has better value than single index.

Construction and verification of nomogram prediction model for survival prognosis of patients with esophageal squamous cell carcinoma / 中国胸心血管外科临床杂志

@#Objective To investigate the prognostic value of preoperative serum albumin-to-globulin ratio (AGR) and neutrophil-lymphocyte ratio (NLR) in the overall survival (OS) of patients with esophageal squamous cell carcinoma (ESCC), and to establish an individualized nomogram model and evaluate its efficacy, in order to provide a possible evaluation basis for the clinical treatment and postoperative follow-up of ESCC patients. Methods AGR, NLR, clinicopathological and follow-up data of ESCC patients diagnosed via pathology in the Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University from 2010 to 2017 were collected. The correlation between NLR/AGR and clinicopathological data were analyzed. Kaplan-Meier analysis and log-rank test were used for survival analysis. The optimal cut-off values of AGR and NLR were determined by X-tile software, and the patients were accordingly divided into a high-level group and a low-level group. At the same time, univariate and multivariate Cox regression analyses were used to identify independent risk factors affecting OS in the ESCC patients, and a nomogram prediction model was constructed and internally verified. The diagnostic efficacy of the model was evaluated by receiver operating characteristic (ROC) curve and calibration curve, and the clinical application value was evaluated by decision curve analysis. Results A total of 150 patients were included in this study, including 105 males and 45 females with a mean age of 62.3±9.3 years, and the follow-up time was 1-5 years. The 5-year OS rate of patients in the high-level AGR group was significantly higher than that in the low-level group (χ2=6.339, P=0.012), and the median OS of the two groups was 25 months and 12.5 months, respectively. The 5-year OS rate of patients in the high-level NLR group was significantly lower than that in the low-level NLR group (χ2=5.603, P=0.018), and the median OS of the two groups was 18 months and 39 months, respectively. Multivariate Cox analysis showed that AGR, NLR, T stage, lymph node metastasis, N stage, and differentiation were independent risk factors for the OS of ESCC patients. The C-index of the nomogram model was 0.689 [95%CI (0.640, 0.740)] after internal validation. The area under the ROC curve of predicting 1-, 3-, and 5-year OS rate was 0.773, 0.724 and 0.725, respectively. At the same time, the calibration curve and the decision curve suggest that the model had certain efficacy in predicting survival and prognosis. Conclusion Preoperative AGR and NLR are independent risk factors for ESCC patients. High level of AGR and low level of NLR may be associated with longer OS in the patients; the nomogram model based on AGR, NLR and clinicopathological features may be used as a method to predict the survival and prognosis of ESCC patients, which is expected to provide a reference for the development of personalized treatment for patients.

The association of fibrinogen-albumin ratio and neutrophil-lymphocyte ratio with the severity of respiratory syncytial virus infection in children

ABSTRACT Respiratory syncytial virus (RSV) is a common cause of respiratory infections. It is responsible for more than half of lower respiratory tract infections in infants requiring hospitalization. This study aimed to investigate the correlation between the fibrinogen-albumin ratio (FAR) and the severity of RSV infection and to compare its effectiveness with the neutrophil-lymphocyte ratio (NLR). This was a retrospective cohort study with patients aged from 29 days to two years who had been admitted to the pediatric clinic of our hospital. Patients were divided into four groups: group 1 (mild disease), group 2 (moderate disease), group 3 (severe disease), and group 4 (control). FAR and NLR were measured in all groups. FAR was significantly higher in group 3 than in the other groups, in group 2 than in groups 1 and 4, and in group 1 than in group 4 (p<0.001 for all). NLR was significantly higher in group 4 than in the other groups and in group 3 than in groups 1 and 2 (p<0.001 for all). FAR totaled 0.078 ± 0.013 in patients with bronchiolitis; 0.099 ± 0.028, in patients with bronchopneumonia; and 0.126 ± 0.036, in patients with lobar pneumonia, all with statistically significant differences (p<0.001). NLR showed no significant statistical differences. This study found a statistically significant increase in FAR in the group receiving invasive support when compared to that receiving non-invasive support (0.189 ± 0.046 vs. 0.112 ± 0.030; p=0.003). Mechanical ventilation groups showed no differences for NLR. FAR was used to identify severe RSV-positive patients, with a sensitivity of 84.4%, a specificity of 82.2%, and a cutoff value of >0.068. This study determined a cutoff value of ≤1.49 for NLR, with a sensitivity of 62.2% and a specificity of 62.2% to find severe RSV-positive patients. Also, statistically significant associations were found between FAR and hospitalization and treatment length and time up to clinical improvement (p<0.001 for all). NLR and hospitalization and treatment length showed a weak association (p<0.001). In children with RSV infection, FAR could serve to determine disease severity and prognosis and average lengths of hospitalization, treatment, and clinical improvement. Additionally, FAR predicted disease severity more efficiently than NLR.

The predictive value of hemogram parameters for early preterm delivery in pregnant women undergoing cervical cerclage

SUMMARY OBJECTIVE: This study aims to investigate the predictive value of hemogram parameters in early preterm delivery (32 gestational weeks and below) among pregnant women who have undergone cervical cerclage, based on cervical changes determined before the cerclage procedure. METHODS: Between 2010 and 2020, a total of 161 patients underwent cervical cerclage. The participants were divided into three groups. Group 1 (n=92) consisted of pregnant women who underwent prophylactic cerclage. Group 2 (n=31) included those with cervical shortening (<5 mm) and/or dilation (≤3 cm). Group 3 (n=38) comprised pregnant women with cervical dilation >3 cm. Each group was further divided based on delivery weeks, with a cutoff at 32 weeks. Demographic parameters and laboratory parameters were assessed. RESULTS: In Group 1, all hemogram parameters showed no significant differences between deliveries below and above 32 weeks. In Group 2, the neutrophil-to-lymphocyte ratio value before cerclage was higher in the early preterm delivery group (p=0.002), with a cutoff value of 4.75 in receiver operating characteristic analysis. In Group 3, the white blood cell value before cerclage was higher in the early preterm delivery group (p=0.005), with a cutoff value of 13.05×103/μL in receiver operating characteristic analysis. CONCLUSION: The use of hemogram parameters to predict early preterm delivery in pregnant women undergoing prophylactic cerclage is not appropriate. However, neutrophil-to-lymphocyte ratio value can predict early preterm delivery when cervical dilation is 3 cm or less and/or cervical shortening is 5 mm or less. When cervical dilation exceeds 3 cm, the white blood cell value is more appropriate for predicting early preterm delivery.

Índice neutrófilo-linfocito e índice plaquetas-linfocito: herramientas pronósticas del cáncer de pulmón

El cáncer de pulmón es la neoplasia maligna que causa mayor mortalidad en el mundo. Dentro de los factores pronósticos de esta entidad, se encuentran el índice neutrófilo-linfocito y el índice plaquetas-linfocito, parámetros hematológicos que se utilizan para evaluar la inflamación y la respuesta inmunitaria en el cuerpo humano. Se realizó una revisión bibliográfica con el objetivo de exponer el valor que presentan el índice neutrófilo-linfocito y el índice plaquetas-linfocito como herramientas pronósticas del cáncer de pulmón, teniendo en cuenta la evidencia científica publicada hasta el momento. Se estudiaron 46 artículos, 28 de los cuales resultaron seleccionados para la elaboración de la investigación. Se emplearon como criterios de selección la calidad de los estudios, el nivel de actualización sobre el tema en cuestión, así como la fiabilidad de la fuente. Se usaron los recursos disponibles en la red Infomed para la selección de la información, entre ellos: PubMed, SciELO, EBSCO, Cumed, LILACS y Scopus, además de Medline, Academic Search Premier y MedicLatina. Se expuso el valor que presentan el índice neutrófilo-linfocito y el índice plaquetas-linfocito como herramientas pronósticas del cáncer de pulmón de células no pequeñas, en todos los estadios y con modalidades terapéuticas diferentes.

Lung cancer is the malignant neoplasm that causes higher mortality in the world. Among the prognostic factors of this entity are the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio, hematological parameters that are used to assess inflammation and the immune response in the human body. A bibliographic review was carried out with the objective of exposing the value of the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as a prognostic tool for lung cancer, taking into account the scientific evidence published to date. A total of 46 articles were studied, of which 28 were selected for the development of the research. The quality of the studies, the level of updating on the subject in question, as well as the reliability of the source was used as selection criteria. The resources available in the Infomed network were used to select the information, including PubMed, SciELO and EBSCO, Cumed, LILACS and Scopus, as well as Medline, Academic Search Premier and MedicLatina databases. The value of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as a prognostic tool in non-small cell lung cancer at all stages and with different therapeutic modalities was exposed.

Significance of maternal hemogram parameters as new inflammatory markers for prediction of threatened preterm labor and preterm premature rupture of membranes

Background: Non-invasive, inexpensive and easily available simple markers are needed for timely prediction of preterm labor and preterm premature rupture of membranes (PPROM) in women at risk. Aims and objectives of current study was to study the significance of maternal hemogram parameters i.e., NLR, PLR, MPV, PDW and plateletcrit in TPL, PPROM.Methods: A total number of 150 pregnant women, 50 with PPROM (group 1), 50 with TPL (group 2) and 50 gestation matched healthy controls (group 3) attending antenatal clinic and labor room in SVBP Hospital and associated LLRM Medical College, Meerut were recruited in study. Complete blood count was done from blood sample collected in EDTA vials using 5-part automated cell analyzer device. Hematological parameters like NLR, PLR, MPV, PDW and plateletcrit were measured from CBC.Results: Patients with PPROM had increased NLR, PLR, MPV, PWD and plateletcrit than patients with threatened preterm labor group and healthy control group.Conclusions: NLR, PLR, MPV, PDW, and Plateletcrit were significantly increased in both PPROM group and TPL group compared to healthy control group and have a predictive value in PPROM and TPL. Monitoring of these parameters can be promising and cost-effective methods in prediction of TPL and PPROM.

Nuevo sistema de calificación diagnóstica para apendicitis pediátrica basado en parámetros hematológicos ajustados por edad y sexo / A novel diagnostic scoring system for pediatric appendicitis based on age and sex-adjusted hematological parameters

Resumen Antecedentes: El diagnóstico de apendicitis aguda representa un reto en pacientes pediátricos. Objetivo: Establecer la importancia del índice neutrófilos-linfocitos (INL), índice plaquetas-linfocitos (IPL) y otros parámetros hematológicos ajustados por edad y sexo en la predicción de apendicitis aguda, así como describir un nuevo sistema de calificación. Material y métodos: Se analizaron retrospectivamente expedientes clínicos de 946 niños hospitalizados por apendicitis aguda. Se desarrolló un sistema de calificación basado en INL, IPL, ILM y proteína C reactiva (PCR) ajustados por edad y sexo. Resultados: Los pacientes se dividieron en grupo I de exploración negativa y grupo II de apendicitis aguda; las medias de edad correspondientes fueron 12.20 ± 2.31 y 11.56 ± 3.11. El recuento leucocitario, porcentaje de neutrófilos, INL, IPL, ILM y PCR fueron superiores en el grupo II. La calificación osciló entre 0 y 8 puntos; se determinó que 4.5 fue el mejor punto de corte para apendicitis aguda con mayor área bajo la curva (0.96), sensibilidad (94 %), especificidad (86 %), valor predictivo positivo (97.5 %), valor predictivo negativo (65 %), precisión (92.6 %) y tasa de clasificación errónea (7.4 %). Conclusión: El sistema de calificación que se propone, calculado por edad y sexo de los pacientes, se puede utilizar para evitar cirugías innecesarias.

Abstract Background: Acute appendicitis diagnosis can sometimes be a real challenge in pediatric patients. Objective: To establish the importance of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and other hematological parameters adjusted for age and sex in the prediction of acute appendicitis, as well as to describe a new scoring system. Material and methods: Medical records of 946 children hospitalized for acute appendicitis were retrospectively analyzed. A scoring system based on NLR, PLR, lymphocyte/monocyte ratio (LMR), and C-reactive protein (CRP) adjusted for age and sex was developed. Results: Patients were divided into group I, with negative examination, and group II, with acute appendicitis; mean ages were 12.20 ± 2.31 and 11.56 ± 3.11, respectively. Leukocyte count, neutrophil percentage, NLR, PLR, LMR and PCR were higher in group II. The scores ranged from 0 to 8 points; 4.5 was determined to be the best cut-off point for acute appendicitis with the highest area under the curve (0.96), sensitivity (94%), specificity (86%), positive predictive value (97.5%), negative predictive value (65%), accuracy (92.6%) and misclassification rate (7.4%). Conclusion: The proposed scoring system, calculated based on patient age and gender, can be used for unnecessary surgeries to be avoided.

Preoperative NLR-PLR may help to predict the prognosis of UTUC patients / 现代泌尿外科杂志

【Objective】 To investigate the predictive value of preoperative platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) (NLR-PLR) in peripheral blood for the prognosis of patients with upper urinary tract urothelial carcinoma (UTUC) undergoing radical surgery. 【Methods】 The clinical data of 104 UTUC patients who underwent radical nephroureterectomy plus bladder sleeve resection in our hospital during Jan.2015 and Dec.2020 were retrospectively analyzed. The receiver operating characteristic (ROC) curve was drawn according to NLR and PLR, the optimal cut-off values of NLR and PLR were calculated, and NLR-PLR was determined accordingly. The patients were divided into NLR-PLR group 1 (PLR ≥161.46 and NLR≥ 2.51) and NLR-PLR group 0 (remaining patients). Chi-square test was used for comparison between groups, and the Kaplan-Meier method was used to draw survival curves. According to the Cox univariate and multivariate risk regression models, the risk factors for decreased overall survival (OS) were determined. 【Results】 The optimal cut-off values of PLR and NLR were 161.46 and 2.51, respectively. There were 74 patients in the NLR-PLR group 0 and 30 in the NLR-PLR group 1. Cox multivariate regression analysis showed that T stage, maximum tumor diameter and NLR-PLR were independent risk factors for reduced OS (P<0.05). 【Conclusion】 Preoperative NLR-PLR is a potential predictor of the prognosis of UTUC patients. Higher NLR-PLR is associated with poorer prognosis.

Influence of Pre-treatment Lymphocyte/Monocyte Ratio and Neutrophil/Lymphocyte Ratio on the Prognosis of Patients with Extranodal NK/T-Cell Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To explore the influence of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) on the prognosis of patients with extranodal NK/T cell lymphoma (ENKTL).@*METHODS@#The clinical data of 203 patients with ENKTL admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2020 were retrospectively analyzed. The ROC curve determined the limit values of LMR and NLR; Categorical variables were compared using a chi-square test, expressed as frequency and percentage (n,%). Continuous variables were expressed as medians and extremes and compared with the Mann-Whitney U test; Progression-free survival (PFS) and overall survival (OS) of different grouped LMR and NLR patients were analyzed using Kaplan-Meier curves and compared with log-rank tests. The COX proportional risk regression model was used to perform one-factor and multi-factor analysis of PFS and OS.@*RESULTS@#The optimal critical values of LMR and NLR were determined by the ROC curve, which were 2.60 and 3.40, respectively. LMR≤2.60 was more likely to occur in patients with bone marrow invasion (P=0.029) and higher LDH (P=0.036), while NLR≥3.40 was more likely to occur in patients with higher ECOG scores (P=0.002), higher LDH (P=0.008), higher blood glucose (P=0.024), and lower PLT (P=0.010). Kaplan-Meier survival analysis showed that PFS and OS of patients in the high LMR group were significantly better than the low LMR group, while PFS and OS in the low NLR group were significantly better than the high NLR group. The results of multivariate COX analysis showed that EBV-DNA positive (P=0.047), LMR≤2.60 (P=0.014), NLR≥3.40 (P=0.023) were independent risk factors affecting PFS in patients with ENKTL. LMR≤2.60 (P<0.001), NLR≥3.40 (P=0.048), and high β2-MG (P=0.013) were independent risk factors affecting OS in patients with ENKTL.@*CONCLUSION@#Low LMR and high NLR before treatment are associated with poor prognosis in patients with ENKTL, which also can be used as an easily testable, inexpensive, and practical prognostic indicator in the clinic.

Neutrophil-lymphocyte and platelet-lymphocyte ratios for assessing disease activity in patients with rheumatoid arthritis receiving tofacitinib treatment / 南方医科大学学报

OBJECTIVE@#To evaluate the value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for assessing disease activity in patients with rheumatoid arthritis (RA) treated with tofacitinib.@*METHODS@#This retrospective study was conducted among 98 RA patients in active stage treated with tofacitinib in Third Xiangya Hospital and 100 healthy control subjects from the Health Management Center of the hospital from 2019 to 2021. We collected blood samples from all the participants for measurement of erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and other blood parameters 1 month before and 6 months after tofacitinib treatment. We further evaluated PLR and NLR before and after tofacitinib treatment in the RA patients, and analyzed their correlations with RA disease activity.@*RESULTS@#PLR and NLR increased significantly in RA patients as compared with the healthy controls. In the RA patients, PLR and NLR were positively correlated with the levels of hs- CRP, ESR, IL- 6, Disease Activity Score of 28 joints-ESR (DAS28-ESR), anti-cyclic citrullinated peptide (CCP), and rheumatoid factor (RF) before and after tofacitinib treatment. Tofacitinib treatment for 6 months significantly decreased hs-CRP, ESR, IL-6, CCP, RF and DAS28-ESR levels in the RA patients.@*CONCLUSION@#NLR and PLR can be useful biomarkers for assessing disease activity in RA patients treated with tofacitinib.

The predictive value of SAA and NLR for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team / 中华急诊医学杂志

Objective:To evaluate the predictive value of serum amyloid A (SAA) and neutrophil-lymphocyte ratio (NLR) for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team.Methods:A total of 105 patients with severe preeclampsia admitted to the ICU of Hangzhou First People's Hospital from October 2014 to July 2022 were retrospectively enrolled. They were divided into the adverse pregnancy outcome group ( n = 62) and the non-adverse pregnancy outcome group ( n = 43) according to the pregnancy outcome. SAA, NLR and other laboratory indicators and related clinical data of all patients were collected within 24 h after admission. The general clinical data of the two groups were compared, and multivariate Logistic regression analysis was used to find the risk factors affecting adverse pregnancy outcome of patients with severe preeclampsia. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SAA and NLR for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team. Results:The ICU length of stay [4.00 (3.00, 5.00) vs. 3.00 (3.00, 4.00), P=0.022], acute physiology and chronic health evaluationⅡ (APACHEⅡ) score [9.00 (7.00, 11.25) vs. 7.00 (5.00, 9.00), P=0.002], white blood cell count [(12.29±4.25) vs. (10.41±4.00), P=0.025], SAA [37.85 (11.00, 72.83) vs. 9.00 (8.00, 20.70), P<0.001] and NLR [7.95 (5.22, 12.37) vs. 5.20 (3.25, 8.77), P=0.002] in the adverse pregnancy outcome group were higher than those in the non-adverse pregnancy outcome group. The gestational weeks [30.00 (26.75, 31.00) vs. 33.00 (32.00, 35.00), P<0.001], direct bilirubin [2.10 (1.50, 2.50) vs. 2.20 (1.90, 4.60), P=0.019] and alkaline phosphatase (99.00 (74.00, 124.25) vs. 133.00 (95.00, 188.00), P<0.001] levels in the adverse pregnancy outcome group were significantly lower than those in the non-adverse pregnancy outcome group ( P<0.05). Multivariate Logistic regression analysis showed that earlier gestational weeks ( OR=0.564, 95% CI: 0.408-0.780, P<0.001), higher SAA ( OR=1.028, 95% CI: 1.002-1.055, P=0.036) and APACHE Ⅱ score ( OR=1.282, 95%CI: 1.048-1.569, P=0.016) were the risk factors affecting adverse pregnancy outcomes in patients with severe preeclampsia. The area under the curve of SAA, NLR and SAA, NLR combined with APACHE Ⅱ score were 0.770, 0.678, and 0.844, respectively. The combined prediction efficiency of SAA, NLR and APACHE Ⅱ score was higher than that of single prediction ( P<0.05). Conclusions:SAA and NLR have good predictive efficacy for adverse pregnancy outcomes in patients with severe preeclampsia treated by multidisciplinary team. The predictive efficacy of SAA and NLR combined with APACHE Ⅱ score is higher than that of single index.

Association of serum NLR and SII with postmenopausal osteoporotic vertebral compression fractures and their predictive value for short-term prognosis / 中华内分泌外科杂志

Objective:To explore the correlation between serum NLR and SII levels and postmenopausal osteoporotic vertebral compression fracture (OVCF) and to analyze the short-term prognostic value.Methods:A total of 132 patients with postmenopausal OVCF admitted to our hospital from Dec. 2018 to Dec. 2021 were selected as the study group, and 98 patients with postmenopausal osteoporosis but did not suffer from OVCF were selected as the control group. According to the recurrence of postmenopausal OVCF fractures, the ROC curves of NLR and SII were plotted, and their prognostic value for postmenopausal osteoporosis OVCF was analyzed.Results:NLR level was 2.96±0.41 and STI level was 39.41±23.45 in the control group. The level of NLR was 3.42±0.32 and SII was 431.77±31.14 in the research group ( P<0.05) . Multivariate Logistic regression analysis showed that lumbar bone density ( OR=0.030, 95%CI: 0.001-0.832, P=0.042) , NLR level ( OR=29.43, 95%CI: 9.840-103.6, P=0.001) and SII level ( OR=1.048, 95%CI: 1.034-1.066, P=0.001) were all risk factors affecting postmenopausal OVCF. NLR (3.77±0.22) and SII (441.32±29.68) in the recurrent fracture group were higher than NLR (3.27±0.22) and SII (426.87±30.57) in the non-recurrent fracture group, and the differences were statistically significant (all P<0.05) , multivariate Logistic regression analysis showed lumbar spine bone density ( OR=8.56×10 4, 95% CI: 3.884-2.992×10 10, P=0.045) , NLR level ( OR=1.243×10 -8, 95% CI: 2.911×10 -13-1.072×10 -5, P=0.001) and SII level ( OR=0.938, 95% CI: 0.885-0.976, P=0.008) were all influencing factors affecting the postoperative treatment effect of postmenopausal OVCF, and ROC results showed that both NLR (AUC=0.86, 95% CI: 0.77-0.94, P<0.001) and SII (AUC=0.76, 95% CI: 0.67-0.85, P<0.001) had good prognostic value for postmenopausal OVCF. Conclusion:NLR and SII are risk factors for OVCF in postmenopausal osteoporosis patients, and have good short-term prognostic value.

The correlation between white blood cell count, neutrophil-lymphocyte ratio and depression severity in patients with first episode depression / 中华行为医学与脑科学杂志

Objective:To investigate the relationship between white blood cells, neutrophil-lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR) and monocyte-lymphocyte ratio(MLR) with patients suffering from first episode depression.Methods:This retrospective study was conducted among inpatients of Hebei General Hospital from January 2021 to December 2021.Ultimately, 193 patients with first-episode depression were enrolled.According to the score of Hamilton depression scale-24 (HAMD-24), the patients were divided into mild-moderate depression group(20≤HAMD-24<35 score, n=98) and severe depression group (HAMD-24 score ≥35, n=95). White blood cells and the counts of each cell subtype were detected and the NLR, MLR and PLR were calculated.SPSS 25.0 statistical software was used to analyze the data.Mann-Whitney U test was used to compare differences in the two groups and Binary Logistic regression analyses were performed to recognize the predictive factors of the severity of first episode depression. Results:(1) The white blood cells and NLR in the severe depression group were significantly higher than those in the mild-moderate depression group (white blood cells: 5.77(2.05)×10 9/L vs 5.11(1.31)×10 9/L; NLR: 1.86 (1.04) vs 1.57(0.55), P<0.05). There were no significant differences in PLR and MLR between the two groups ( P>0.05). (2)Multiple regression analysis of NLR, white blood cells and HAMD-24 score showed that there were significant differences in the effect of different white blood cells and NLR levels on HAMD-24 score( B=1.398, P=0.003; B=2.624, P=0.001). (3)Binary Logistic regression revealed that white blood cell count and NLR were risk factors for the severity of depression patients( OR were 1.612 and 2.336, respectively, P<0.05). Conclusion:The results suggest that white blood cells and NLR may be relate with the severity of first episode depression.

Value of nomogram based on preoperative ultrasound and inflammatory indexes in predicting axillary high nodal burden in early breast cancer / 中华超声影像学杂志

Objective:To explore the values of ultrasound, pathology combined with inflammatory indicators in predicting high nodal burden (HNB) in patients with early breast cancer and to construct a nomogram to provide reference for individualized diagnosis and treatment.Methods:The ultrasonographic, pathological features and preoperative inflammatory indicators of 378 female patients diagnosed with early breast cancer confirmed by pathology in the South Hospital of the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University from January 2014 to July 2022 were retrospectively analyzed. They were randomly divided into training set ( n=302) and test set ( n=76) in a ratio of 8∶2, and the baseline data of the two groups were compared. The optimal cutoff values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) were obtained by ROC curve. In the training set, with axillary high lymph node load (≥3 metastatic lymph nodes) as the dependent variable, independent influencing factors of HNB were identified by univariate and multivariate Logistic regression analyses, and the nomogram was established. The test set data were used to verify the model. The discrimination, calibration and clinical applicability of the model were assessed by the area under the ROC curve (AUC), C-index, the calibration curve, Brier score and the decision curve analysis, respectively. Results:There were no significant differences in all variables between the training set and the test set (all P>0.05). ROC curve analysis results showed that AUCs of NLR, PLR and LMR were 0.578, 0.547 and 0.516, respectively, and the optimal cut-off values were 2.184, 150 and 3.042, respectively. Univariate Logistic regression analysis showed that age, pathological type, histological grade, Ki-67, lymphovascular invasion, NLR, PLR, ultrasonic characteristics (maximum diameter of primary tumor, shape, long/short diameter of lymph node, cortical thickness, cortical and medullary boundary, lymph node hilum, lymph node blood flow pattern) were correlated with HNB of early breast cancer (all P<0.05). Multivariate Logistic regression analysis showed that ultrasonic characteristics (maximum diameter of primary tumor >2 cm, effacement of lymph node hilum, non-lymphatic portal blood flow), lymphovascular invasion, Ki-67>14% and NLR>2.184 were independent risk factors for HNB in early breast cancer ( OR=7.258, 8.784, 6.120, 8.031, 3.394 and 3.767, respectively; all P<0.05) and were used to construct the nomogram model. The AUC of the training set was 0.914 (95% CI=0.878-0.949), C-index was 0.914; The AUC of the test set was 0.871 (95% CI=0.769-0.973), C-index was 0.871, indicating good discrimination. Calibration curve and Brier score were 0.090, indicating high calibration degree of the model. The clinical decision curve indicated good clinical benefit. Conclusions:The nomogram based on ultrasonic characteristics (maximum diameter of primary tumor, lymph node hilum, lymph node blood flow pattern), lymphovascular invasion, Ki-67 and NLR can effectively predict the risk of HNB in patients with early breast cancer, and provide a reference for precision diagnosis and treatment to avoid excessive or insufficient treatment.

Research advances of neutrophil/lymphocyte ratio in clinical management of skin diseases / 中华全科医师杂志

Neutrophil/lymphocyte ratio (NLR) is a inflammatory indicator, which can be easily calculated from the results of complete blood cell count. More and more studies have shown that NLR has its unique value in the diagnosis, and evaluation of severity, complications, treatment efficacy and prognosis of skin diseases. This article reviews the recent progress on the application of NLR in clinical management of skin diseases, such as psoriasis, systemic lupus erythematosus and Behcet disease.

Predictive value of blood platelet-lymphocyte ratio and neutrophil-lymphocyte ratio in the therapeutic efficacy of neoadjuvant therapy for breast cancer patients / 肿瘤研究与临床

Objective:To investigate the predictive value of the changes of platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) in the therapeutic efficacy of the neoadjuvant treatment for breast cancer.Methods:The clinical data of 72 breast cancer patients who received neoadjuvant therapy in Nantong Tumor Hospital between February 2020 and January 2022 were retrospectively analyzed and the changes of PLR and NLR before and after neoadjuvant therapy were also analyzed. The receiver operating characteristic (ROC) curves were used to assess the predictive value of PLR, NLR and their changes in pathological complete remission (pCR) after neoadjuvant therapy.Results:The area under the ROC curve of PLR and NLR before the treatment, the difference in PLR before and after the treatment (ΔPLR), the difference in NLR before and after the treatment (ΔNLR) in predicting pCR was 0.520, 0.505,0.724 and 0.686,and the corresponding cut-off value was 269.231, 2.559, -2.840 and -1.457; the patients were divided into high and low groups according to the cut-off values. NLR before the treatment was not correlated with clinicopathological characteristics (all P > 0.05),while PLR before the treatment was correlated with tumor size ( P = 0.029), and ΔPLR was correlated with progesterone receptor expression ( P = 0.025), human epidermal growth factor receptor 2 (HER2) expression ( P < 0.001), molecular subtype ( P < 0.001), N stage ( P = 0.002), clinical stage ( P = 0.002) and treatment modality ( P < 0.001). ΔNLR was associated with HER2 expression ( P = 0.002), molecular subtype ( P = 0.024), tumor size ( P = 0.007), neural invasion ( P = 0.006), N stage ( P = 0.006), clinical stage ( P = 0.016) and treatment modality ( P = 0.014). ΔPLR and ΔNLR were influencing factors for patients achieving pCR after neoadjuvant therapy (all P < 0.05). Conclusions:Stage Ⅲ invasive breast cancer patients with higher ΔPLR and ΔNLR after neoadjuvant therapy have better prognosis.