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BACKGROUND: Studies have shown that the absolute lymphocyte count (ALC) and the neutrophil-to-lymphocyte ratio (NLR) are related to the outcomes in patients with breast cancer receiving specific chemotherapies. However, the reports have focussed on the initial blood test and there is a lack of evidence or data to support that dynamic changes of ALC or NLR are associated with the patients' survival outcomes. METHODS: We retrospectively reviewed electronic medical records from patients with breast cancer treated with eribulin from 2015 to 2019 at our institution. Blood test data were available prior to starting eribulin (baseline), and at 1, 3 and 6 months after initiating eribulin. We classified the patients into ALC and NLR high and low groups using the following cut-offs: 1000/µl for ALC and 3 for NLR. We defined ALC and NLR trends as increasing or decreasing compared with the initial data. We assessed the associations between the ALC and NLR with progression-free survival and overall survival. RESULTS: There were 136 patients with breast cancer treated with eribulin. Of these patients, 60 had complete blood tests and follow-up data. Neither a high ALC nor a low baseline NLR was associated with the survival outcome. One month after initiating eribulin treatment, a high ALC and a low NLR were significantly associated with longer progression-free survival (p = 0.044 for each). Three months after initiating eribulin, a high ALC was significantly associated with better overall survival (p = 0.006). A high NLR at 3 or 6 months after initiating eribulin was associated with worse overall survival (p = 0.017 and p = 0.001, respectively). The ALC and NLR trends across times were not associated with survivals. CONCLUSION: We showed that 1, 3 and 6 months after initiating eribulin, a high ALC and a low NLR may be related to the patients' survival outcomes. The ALC and NLR trends were not associated with survival. Accordingly, we believe patients who maintain a high ALC and a low NLR may have better clinical outcomes after initiating eribulin.

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Background and Objective: Increasing evidence suggests that inflammation plays an essential role in cancer development and progression. The levels of inflammation-related indicators are correlated with prognosis across a wide variety of tumor types, including prostate cancer (PCa), but its diagnostic and prognostic value in PCa remains controversial. In the present review, the diagnostic and prognostic value of inflammation-related indicators in PCa patients is investigated. Methods: A literature review was performed using the PubMed database, screening articles from English and Chinese journals published mainly from 2015 to 2022. Key Content and Findings: Inflammation-related indicators based on haematological tests have some diagnostic and prognostic value not only when used alone but also in combination with common clinical indicators such as prostate-specific antigen (PSA), and can significantly improve the accuracy of diagnostic results. Elevated neutrophil-to-lymphocyte-count ratio (NLR) is strongly associated with the detection of PCa in men with PSA levels of 4-10 ng/mL. Preoperative NLR levels in localized PCa patients affect their overall survival (OS), cancer-specific survival (CSS), and biochemical recurrence-free survival (BCRFS) after radical prostatectomy (RP). In patients with castration-resistant prostate cancer (CRPC), a high NLR is associated with poorer OS, progression-free survival (PFS), CSS, and radiographic PFS. Platelet-to-lymphocyte-count ratio (PLR) appears to have the greatest accuracy in predicting an initial diagnosis of clinically significant PCa. The PLR also has the potential to predict the Gleason score. Patients with higher PLR levels have a higher risk of death compared to those with a lower PLR. Elevated procalcitonin (PCT) is correlated with the development of PCa and may be useful in improving the diagnostic accuracy of PCa. Elevated C-reactive protein (CRP) levels are an independent predictor of poorer OS in metastatic PCa. Conclusions: Numerous studies have been conducted on the value of inflammation-related indicators in guiding the diagnosis and treatment of PCa. The value of inflammation-related indicators in predicting the diagnosis and prognosis of PCa patients is now becoming clear.

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BACKGROUND: Neutrophil-to-lymphocyte count ratio (NLCR) has been shown as a feasible parameter associated with outcomes of tumor patients and an accessible predictor of bacteremia. However, only a handful of research shed the light on the association between NLCR and outcomes of septic patients. This study is aimed to evaluate the association between NLCR and all-cause mortality in a population of adult septic patients. METHODS: We extracted clinical data from Medical Information Mart for Intensive Care (MIMIC)-III V1.4, a free, large-scale, single-center database. NLCR was computed individually. Patients were categorized by quartiles of NLCR. The associations between NLCR quartiles and 28-day all-cause mortality in septic patients were assessed using Cox proportional hazards models and subgroup analyzes. To evaluate the accuracy of NLCR in predicting 28-day mortality of sepsis, receiver operator characteristic curves (ROC), areas under the curve (AUC), and the Youden's J Index were calculated. Other outcomes included 7-day all-cause mortality, mortality in the intensive care units (ICU), in-hospital mortality and length of ICU stay. RESULTS: A total of 3,043 eligible patients were included in the study, of which, 760, 759, 766 and 758 patients were fallen in the first quartile (≤5.89), the second quartile (>5.89, ≤10.69), the third quartile (>10.69, ≤20.25) and the fourth quartile (>20.25) of NLCR, respectively. The 7-day mortality (13.4%, 9.9%, 13.6% and 14.2%; P=0.064) showed no difference in the four quartiles. In multivariate analysis, after adjusting for confounding factors, the highest NLCR quartile (>20.25) was associated with increased 28-day all-cause mortality [hazard ratio (HR) 1.22, 95% Cl: 1.01-1.49; P=0.046]. The areas under the receiver operating characteristic curves (AUROCs) for NLCR was 0.553 (95% CI: 0.529-0.576) for 28-day mortality. CONCLUSIONS: High NLCR (>20.25) is independently related to increased 28-day all-cause mortality in adult septic patients of a limited sensibility and specificity. Further large multi-center prospective studies are needed to confirm such relationship and to validate whose clinical significance.

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Introduction@#White blood cell (WBC) count, from which neutrophil-to-lymphocyte count ratio (NLCR) can be derived, is commonly requested in the hospital setting among admitting patients with community acquired pneumonia (CAP). This study aims to establish the predictive value of WBC count and NLCR in classifying CAP which guides the clinicians in the choice of antibiotics and site-of-care. The researchers aim to evaluate the predictive value of WBC count and NLCR during consultation and admission in classifying patients with CAP based on the managementoriented risk stratification of the 2016 Philippine Clinical Practice Guidelines on CAP.@*Methods@#This was a prospective cross-sectional study conducted in St. Luke’s Medical Center, Quezon City. Adult patients diagnosed with CAP were classified according to severity of infection based on the 2016 Philippine Clinical Practice Guidelines on CAP. WBC count of each patient was determined, and their corresponding NLCR was derived. The differences of WBC count and NLCR per risk were evaluated using chi-square and ANOVA test adjusted for the distribution of the outcome. Sensitivity and specificity of WBC and NLCR were determined for the following: (1) between CAP low risk (LR) versus CAP moderate risk (MR) and CAP high risk (HR) and (2) between CAP LR and CAP MR versus CAP HR. Receiver operating characteristic (ROC) curve was constructed to evaluate the sensitivity and specificity of WBC and NLCR in classifying. ROC curves displayed sensitivity versus 1-specificity such that area under the curve (AUC) ROC for WBC and NLCR.@*Results@#Two hundred eighty (280) CAP patients from June 2016 until April 2017 were studied. Among the CAP patients, 69 (24.6%) were classified as LR, 172 (61.5%) were classified as MR, and 39 (13.9%) were classified as HR. The mean WBC count was 11,725.8 (±5,205.82)/ụl. The mean WBC per risk were as follows: 9,178/ụl for LR; 12,251/ụl for MR, and 13,916/ ụl for CAP HR. It showed that the higher the risk, the higher the mean of the WBC count (<0.00001). The mean NLCR was 8.9 (±8.4). The mean average of NLCR per risk were as follows: 5.4 for LR, 8.6 for MR, and 16.1 for HR. It showed that the higher the risk, the higher the NLCR (<0.00001). In predicting CAP patients with HR and MR from LR, the AUC of NLCR (0.700) was almost the same as that of the WBC count (0.698). In predicting CAP patients with HR from MR and LR, the AUC of NLCR (0.726) was higher than the WBC (0.621), indicating that NLCR is a fair predictive marker in distinguishing HR from MR and LR.@*Conclusion@#As the severity of CAP increases, the mean of the WBC count and NLCR increases. Between the two biomarkers, NLCR predicts CAP severity more than the WBC count. Furthermore, NLCR better predicts HR from MR and LR

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There is a number of publications evaluating the eosinophil count and the neutrophil-to-lymphocyte count ratio for diagnosis, prognosis or monitoring of patients. Of special interest is the use of these parameters for discrimination between the different causes of fever (e.g. bacterial versus viral vs. non-infectious causes of fever) and for monitoring the efficacy of therapy and predict the course of the patient. However, pitfalls in previous study designs prevent applicability to clinical practice. Here, we provide a short review of the relevant literature and summarize important factors that should be taken into account when designing studies, with special attention to the selection of a proper and clinically meaningful study population and the effects of the stress response and of corticosteroids.

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BACKGROUND: Both in endemic countries and in imported malaria, changes in total and differential leukocyte count during Plasmodium falciparum infection have been described. To study the exact dynamics of differential leukocyte counts and their ratios, they were monitored in a group of healthy non-immune volunteers in two separate Controlled Human Malaria Infection (CHMI) studies. METHODS: In two CHMI trials, CHMI-a and CHMI-b, 15 and 24 healthy malaria-naïve volunteers, respectively, were exposed to bites of infected mosquitoes, using the P. falciparum research strain NF54 and the novel clones NF135.C10 and NF166.C8. After mosquito bite exposure, twice-daily blood draws were taken to detect parasitaemia and to monitor the total and differential leukocyte counts. All subjects received a course of atovaquone-proguanil when meeting the treatment criteria. RESULTS: A total of 39 volunteers participated in the two trials. Thirty-five participants, all 15 participants in CHMI-a and 20 of the 24 volunteers in CHMI-b, developed parasitaemia. During liver stage development of the parasite, the median total leukocyte count increased from 5.5 to 6.1 × 109 leukocytes/L (p = 0.005), the median lymphocyte count from 1.9 to 2.2 (p = 0.001) and the monocyte count from 0.50 to 0.54 (p = 0.038). During the subsequent blood stage infection, significant changes in total and differential leukocyte counts lead to a leukocytopenia (nadir median 3.3 × 109 leukocytes/L, p = 0.0001), lymphocytopenia (nadir median 0.7 × 109 lymphocytes/L, p = 0.0001) and a borderline neutropenia (nadir median 1.5 × 109 neutrophils/L, p = 0.0001). The neutrophil to lymphocyte count ratio (NLCR) reached a maximum of 4.0. Significant correlations were found between parasite load and absolute lymphocyte count (p < 0.001, correlation coefficient - 0.46) and between parasite load and NLCR (p < 0.001, correlation coefficient 0.50). All parameters normalized after parasite clearance. CONCLUSIONS: During the clinically silent liver phase of malaria, an increase of peripheral total leukocyte count and differential lymphocytes and monocytes occurs. This finding has not been described previously. This increase is followed by the appearance of parasites in the peripheral blood after 2-3 days, accompanied by a marked decrease in total leukocyte count, lymphocyte count and the neutrophil count and a rise of the NLCR.

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The aim of this study was to search for any relations between the neutrophil-to-lymphocyte ratio (NLR) and the development of osteomyelitis and the need for amputation in patients with diabetic foot infection (DFI). All data included DFI patients who were hospitalized in our Infectious Diseases Clinic between 2012 and 2015 and who were classified according to International Classification Disease Code System. 75 patients were analyzed in the study. The DFI patients were stratified into 3 groups of whom had amputation procedure, whom had only debridement/drainage procedure and whom had any surgery procedure. Sidac post hoc analysis was used to perform the effects of NLR, C-reactive protein, erythrocyte sedimentation rate and glycosylated hemoglobin on the surgery procedure status. The DFI patients were also stratified into two another separate group for another analysis to search for the effect of NLR values on the development of osteomyelitis. The mean value of NLR in the amputated patients' group (15.7±10.3 was significantly higher than those with debridement procedure (9.9±5.6) and those without any surgery (6.0±2.8) (P=0.001). NLR values were also found significantly higher in patients with osteomyelitis in the second analysis (P=0.004). In this study, the NLR was found to have a predictive value on the development of osteomyelitis and on the progression to amputation in patients with DFI.