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    Neutrophil-lymphocyte and platelet-lymphocyte ratios as prognostic factors after stereotactic radiation therapy for early-stage non-small-cell lung cancer. Cannon Nathan A,Meyer Jeffrey,Iyengar Puneeth,Ahn Chul,Westover Kenneth D,Choy Hak,Timmerman Robert Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer INTRODUCTION:The hematologic indices of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are correlated with clinical outcomes after stereotactic radiation. METHODS:We retrospectively evaluated the pretreatment NLR and PLR in patients treated with stereotactic radiation for early stage non-small-cell lung cancer at our institution. A total of 149 patients treated for non-small-cell lung cancer were identified, and 59 had stage I disease with neutrophil, platelet, and lymphocyte levels within a 3-month period before treatment. Receiver operating characteristic (ROC) analysis was performed to examine cutoff values for survival and nonlocal failure followed by Kaplan-Meier analysis for survival. RESULTS:With a median follow-up of 17 months, 28 deaths were observed, and the median overall survival for all patients was 43 months. Based on the ROC analysis, NLR and PLR cutoff values for further survival analysis were determined based on the ROC analysis to be 2.98 and 146. The median overall survival was not reached for patients with low NLR or PLR but the survival was 23 months for patients with high NLR or PLR. There was no correlation between NLR and nonlocal failure, but on multivariate analysis PLR was found to be associated with freedom from nonlocal failure. Nonlocal failure rates were 11% for patients with PLR less than 250 and 58% for PLR greater than 250 (p < 0.001). CONCLUSION:The pretreatment NLR and PLR represented significant prognostic indicators of survival in patients treated for early-stage non-small-cell lung carcinoma with stereotactic radiation. The PLR may be used as a prognostic indicator for nonlocal failure after stereotactic radiation for early-stage lung cancer. 10.1097/JTO.0000000000000399
    Elevated white cell count at commencement of peritoneal dialysis predicts overall and cardiac mortality. Johnson David Wayne,Wiggins Kathryn Joan,Armstrong Kirsten Anne,Campbell Scott Bryan,Isbel Nicole Maree,Hawley Carmel Mary Kidney international BACKGROUND:Higher total white blood cell counts (WCC) have been shown in the general population to be strongly and independently predictive of coronary heart disease and all-cause mortality. The aim of the present study was to evaluate the prognostic value of WCC in patients commencing peritoneal dialysis (PD). METHODS:A cohort of 323 patients (mean age 55.1 +/- 17.7 years, 54% male, 81% Caucasian) commencing PD at the Princess Alexandra Hospital between January 1, 1998 and March 31, 2003 were prospectively followed until death, completion of PD therapy, or otherwise to the end of the study (January 2, 2004), at which point data were censored. Individuals with failed renal transplants (N= 17) and those with acute infections at the time of PD onset (N= 12) were not included. A multivariate Cox's proportional hazards model was applied to calculate hazard ratios and adjusted survival curves for time to death or cardiac death, adjusting for baseline demographic, clinical, and laboratory characteristics. RESULTS:Median actuarial patient survival was 3.9 years [95% confidence interval (CI) 3.2-4.7 years]. The highest quartile of WCC (>9.4 x 10(9)/L) was significantly and independently associated with increased risks of both death from all causes [adjusted hazard ratio (HR) 2.27, 95% CI 1.09-4.74, P < 0.05] and cardiac death (HR 3.75, 95% CI 1.2-11.8, P < 0.05). Other adverse risk factors included older age, lower serum albumin, and the presence of coronary artery disease. Similar associations were found between mortality and PMN count, but not lymphocyte count. CONCLUSION:Elevated baseline WCC or PMN count at the commencement of PD (in the absence of acute infection) strongly predicts all-cause and cardiovascular mortality. These data suggest that new PD patients with higher WCC may warrant closer monitoring and extra attention to modifiable cardiovascular risk factors. 10.1111/j.1523-1755.2005.67135.x
    Tumour-associated neutrophils in patients with cancer. Shaul Merav E,Fridlender Zvi G Nature reviews. Clinical oncology The role and importance of neutrophils in cancer has become increasingly apparent over the past decade. Neutrophils accumulate in the peripheral blood of patients with cancer, especially in those with advanced-stage disease, and a high circulating neutrophil-to-lymphocyte ratio is a robust biomarker of poor clinical outcome in various cancers. To date, most studies investigating the role of neutrophils in cancer have involved animal models or investigated the function of circulating human neutrophils. Thus, only limited information is available on the roles of intratumoural neutrophils (also known as tumour-associated neutrophils (TANs)) in patients with cancer. In this Review, we initially describe the evidence correlating the neutrophil-to-lymphocyte ratio with prognosis, followed by a discussion on the predictive value of TANs, which remains debatable, with conflicting data from different cancer types, including variations based on neutrophil location within and/or around the tumour. We then explore available data on the implications of TAN phenotypes and functions for cancer development and progression, highlighting the reported effects of various treatments on TANs and how neutrophils might affect therapeutic efficacy. Finally, we examine the various compounds capable of modulating neutrophils and suggest future research directions that might ultimately enable the manipulation of TANs in patients with cancer. 10.1038/s41571-019-0222-4
    Total Bilirubin Levels Predict Subclinical Atherosclerosis in Patients With Prediabetes. Hamur Hikmet,Duman Hakan,Demirtas Levent,Bakirci Eftal Murat,Durakoglugil Murtaza Emre,Degirmenci Husnu,Kalkan Kamuran,Yildirim Erkan,Vuruskan Ertan Angiology Bilirubin may have important antiatherosclerotic effects. Prediabetes (PD), the intermediate stage before diabetes mellitus, is associated with increased cardiovascular morbidity and mortality. We evaluated the relationship between serum bilirubin levels and carotid intima-media thickness (cIMT), as a surrogate marker of subclinical atherosclerosis, in patients with PD. We enrolled 170 consecutive patients with PD. The patients underwent ultrasonography to evaluate cIMT. The patients were divided into groups according to cIMT values (<0.9 vs ≥0.9 mm). The patients with cIMT ≥ 0.9 mm had significantly higher diastolic blood pressure, neutrophil-lymphocyte ratio (NLR), and glycated hemoglobin values compared with patients having cIMT < 0.9 mm, whereas total and direct bilirubin values were significantly lower in this group. Multivariate regression analyses revealed NLR and total bilirubin as the independent predictors of subclinical atherosclerosis. The present study demonstrated that NLR and lower total bilirubin levels were independent predictors of subclinical atherosclerosis in patients with PD. Simple measures such as NRL and total bilirubin may provide predictive information regarding the risk of cardiovascular disease in patients with PD. 10.1177/0003319716632394
    Platelet-to-lymphocyte ratio is associated with cardiovascular disease in continuous ambulatory peritoneal dialysis patients. Chen Tianlei,Yang Min International immunopharmacology BACKGROUND:Chronic kidney disease (CKD) patients have a high incidence of cardiovascular disease (CVD) events, which is related to the inflammatory status of this population. Platelet-to-lymphocyte ratio (PLR) is a relatively new indicator of inflammation. The aim of this study was to investigate the relationship between PLR and the CVD events in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS:A total of 70 stable CAPD patients were included in this study from February 2014 to March 2017, and complete demographic characteristics and clinical laboratory baseline data were collected at enrollment. The primary endpoint was defined as the experienced of CVD events during the follow-up period. Binary logistic regression was used to assess the association between PLR and CVD events in CAPD patients. RESULTS:During a median follow-up period of 22 months, 28 (40%) CAPD patients experienced CVD events. Patients in the CVD event group had a high level of platelets (P < 0.01), C-reactive protein (P < 0.01), PLR (P < 0.01) and neutrophil-to-lymphocyte ratio (NLR) (P < 0.01). However, lymphocyte counts (P < 0.01) were significantly lower than patients without CVD events. Following adjusted binary regression analysis revealed no relationship between high NLR and CVD events (OR, 1.21; 95% CI, 0.52-2.85; p = 0.44). However, the correlation between high PLR and CVD events was significant (OR, 1.05; 95% CI, 1.02-1.08; p < 0.01). High PLR was confirmed as an independent predictor of CVD events. CONCLUSION:Our results demonstrated that PLR was independently associated with CVD events. High PLR can be used to predict the risk of CVD events in CAPD patients. PLR was easy to obtain and can be considered as a routine test to serve the clinic. 10.1016/j.intimp.2019.106063
    Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients? Öztürk Z A,Kuyumcu M E,Yesil Y,Savas E,Yıldız H,Kepekçi Y,Arıoğul S Journal of endocrinological investigation BACKGROUND:Chronic inflammation plays an important role on development and progression of Type 2 diabetes (T2DM) through immunologic inflammatory mechanisms. Neutrophil to lymphocyte ratio (NLR) is a new, simple and cheap marker of subclinical inflammation. NLR has recently been used as a systemic inflammation marker in chronic diseases as well as a predictor of prognosis in cardiovascular diseases and malignancies. AIM:The objective of the present study was to investigate the relationship between NLR and microvascular complications of diabetes mellitus (DM) in elderly population. SUBJECTS AND METHODS:Two hundred and forty-two patients with DM (145 diabetic patients with complications, 97 diabetic patients without complications) and 218 control subjects were enrolled in this study. NLR and microvascular complications because of DM were evaluated and compared with other inflammatory markers. RESULTS:NLR was higher in the diabetic group (2.21±1.14) than in the controls (2.18±0.76). Furthermore, there was a statistically significant difference between NLR levels in diabetic patients with and without complications (2.46±1.26 vs 2.04±0.51, respectively; p<0.001). The results of themultiple logistic regression analysis depicted that NLR is also an independent predictor for microvascular complications (odds ratio 2.217; 95%confidence interval 1.086-4.526, p=0.029). Receiver operating curve analysis suggested that the optimum NLR cutoff point for microvascular complication was 2.89 with 96.72% specificity, 94.4% positive predictive value. CONCLUSION:Increased NLR levels may be associated with microvascular complications of DM in the elderly population. 10.3275/8894
    The relationship between neutrophil lymphocyte ratio with urinary protein and albumin excretion in newly diagnosed patients with type 2 diabetes. Afsar Baris The American journal of the medical sciences BACKGROUND:Recent evidence suggests that neutrophil/lymphocyte (N/L) ratio play a role in the development and progression of cardiovascular complications. Increased urinary albumin and protein excretion has been shown to be a risk factor for cardiovascular disease. Thus, this study aimed to investigate the relationship between circulating total and differential leukocyte counts including N/L ratio with urinary protein and albumin excretion in patients with newly diagnosed type 2 diabetes. METHODS:All patients underwent history taking, physical examination, blood pressure measurement, 12-lead electrocardiographic evaluation, routine urine analysis, biochemical analysis, 24-hour urine collection to measure protein and albumin excretion and creatinine clearance. Peripheral total and differential leukocyte analyses were performed using an automated cell counter. RESULTS:In total, 80 patients were included. Spearman correlation analysis revealed that 24-hour urinary protein excretion was correlated with neutrophil count (ρ = 0.280, P = 0.012), lymphocyte count (ρ = -0.365, P = 0.001) and N/L ratio (ρ = 0.474, P < 0.0001). Spearman correlation analysis revealed that 24-hour urinary albumin excretion was correlated with neutrophil count (ρ = 0.261, P = 0.019), lymphocyte count (ρ = -0.278, P = 0.013) and N/L ratio (ρ = 0.415, P < 0.0001). In stepwise linear regression analysis, 24-hour urinary protein excretion was independently associated with high-density lipoprotein cholesterol (P = 0.01), blood urea (P = 0.014) and N/L ratio (P = 0.041). On the other hand, 24-hour urinary albumin excretion was independently associated with creatinine clearance (P = 0.004), albumin (P < 0.0001) and N/L ratio (P = 0.011). CONCLUSIONS:This study demonstrated that increased N/L ratio was independently related with both 24-hour urinary protein and urinary albumin excretion in newly diagnosed patients with type 2 diabetes. 10.1097/MAJ.0b013e31828365cc
    The association of neutrophil to lymphocyte ratio with presence and severity of obstructive sleep apnea. Sunbul M,Sunbul E A,Kanar B,Yanartas O,Aydin S,Bacak A,Gulec H,Sari I Bratislavske lekarske listy BACKGROUND:Obstructive sleep apnea (OSA) is characterized by reductions in breathing amplitude during sleep caused by an obstructed or collapsed upper airway. The neutrophil to lymphocyte ratio (NLR) has been proposed as a novel biomarker for systemic inflammatory response. The aim of the present study was to evaluate the relationship between NLR and OSA. METHODS:The study population consisted of 195 consecutive patients with clinical suspicion of OSA. Full night polysomnography was performed for all patients. Patients with an apnea hypopnea index (AHI) ≥ 5 were considered to have OSA. NLR was calculated as the ratio of neutrophil count to lymphocyte count. RESULTS:While 130 patients (91 male, mean age: 49.9±9.8 years) had OSA, 65 patients (42 male, mean age: 48.7 ± 10.2 years) had normal findings according to AHI scores. Cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking were more common in patients with OSA. Patients with OSA had significantly higher NLR than controls (1.87±0.80 vs 1.49±0.48, p=0.005). AHI score was significantly correlated with NLR (r=0.228, p=0.001). NLR and presence of hyperlipidemia were independent predictors of OSA (OR: 2.451, 2.850, p=0.001, 0.004, respectively). NLR of 1.62 or higher predicted OSA with a sensitivity of 56.2 % and specificity of 63.1 %. CONCLUSIONS:NLR was higher and also correlated with AHI score in patients with OSA which has not been reported previously. NLR more than 1.62 was an independent predictor of OSA. A simple, cheap white blood cell count may also give an idea about the presence and severity of OSA (Tab. 3, Fig. 3, Ref. 30). 10.4149/bll_2015_125
    The neutrophil-to-lymphocyte ratio in patients with obstructive sleep apnoea syndrome and its relationship with cardiovascular disease. Uygur Firat,Tanriverdi Hakan,Aktop Ziyaeddin,Erboy Fatma,Altinsoy Bulent,Damar Murat,Atalay Figen Heart & lung : the journal of critical care OBJECTIVE:To investigate the association between the neutrophil-to-lymphocyte ratio (NLR) and obstructive sleep apnoea syndrome (OSAS) severity and whether the NLR predicts cardiovascular disease (CVD) in patients with OSAS. BACKGROUND:OSAS is known as a risk factor for CVD. An increased NLR was strongly correlated with cardiovascular outcomes in several studies. METHODS:We retrospectively examined the laboratory data for 289 patients with suspected OSAS evaluated using polysomnography. RESULTS:The study included 171 OSAS patients and 118 controls. The NLR was higher in OSAS group than control group. The NLR was significantly higher in patients with CVD than in those without (3.31 ± 1.1 vs. 1.93 ± 0.8, p = 0.002). There were also significant correlations between the NLR and apnoea-hypopnoea index, mean SaO2, and oxygen desaturation index. CONCLUSIONS:There was a significant correlation between the NLR and OSAS severity and the NLR was independently associated with CVD in patients with OSAS. 10.1016/j.hrtlng.2016.01.002
    Neutrophil-lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients. Neuen Brendon L,Leather Nicole,Greenwood Alice M,Gunnarsson Ronny,Cho Yeoungjee,Mantha Murty L Renal failure Neutrophil-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been shown to predict mortality in patients with malignancies, ischemic heart disease and peripheral vascular disease. Its prognostic value in hemodialysis patients is unclear. The aims of this study were to: (i) explore the relationship between NLR and other biochemical parameters and (ii) to examine the value of NLR as a predictor of cardiovascular and all-cause mortality in hemodialysis patients. The study included all the incident hemodialysis patients from a single center between 2007 and 2012. NLR was calculated using samples obtained 3 months after commencing hemodialysis. One hundred seventy hemodialysis patients were included with a median follow-up of 37 months. There were 54 deaths (32%). NLR was positively correlated with C-reactive protein (r = 0.24, p = 0.0023) and negatively correlated with hemoglobin (r = -0.27, p = 0.00048), albumin (r = -0.23, p = 0.0034) and total cholesterol (r = -0.17, p = 0.049) levels. In multivariate Cox regression, NLR was independently associated with both all-cause mortality (adjusted hazard ratio [HR] 1.4; 95% confidence interval [CI], 1.2-1.6; p ≤ 0.0001) and cardiovascular death (HR 1.3, 95% CI 1.1-1.6, p = 0.0032). Other predictors of all-cause mortality were age (HR 1.6 per decade; 95% CI, 1.2-2.1; p = 0.0017), body mass index (HR 0.93; 95% CI, 0.88-0.98; p = 0.0047), albumin (HR 0.91; 95% CI, 0.86-0.97; p = 0.0035) and peripheral vascular disease (HR 2.7; 95% CI, 1.4-5.1; p = 0.0023). NLR is a practical, cost-efficient and easy to use predictor of cardiovascular and all-cause mortality in incident hemodialysis patients. 10.3109/0886022X.2015.1104990