The value of the neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio as complementary diagnostic tools in the diagnosis of rheumatoid arthritis: A multicenter retrospective study

BackgroundThe neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) have drawn attention in recent years as novel non‐specific inflammatory markers; however, only a few studies have been conducted to investigate their value in RA.ObjectiveTo investigate the value of the neutrophil‐to‐lymphocyte ratio (NLR) and the platelet‐to‐lymphocyte ratio (PLR) as complementary diagnostic tools in rheumatoid arthritis (RA).MethodThis study included 1009 patients with RA, 170 patients with other rheumatic diseases, and 245 healthy individuals from four medical centers. The patients'' general data, including complete blood count, C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF), were retrospectively analyzed, and the NLR and PLR were calculated. Potential effective indicators were screened by logistic regression analysis, and a receiver operating characteristic (ROC) curve was plotted to evaluate their diagnostic value for RA.Results(a) The NLR and PLR were significantly higher in the RA group than in the non‐RA group and the control group (P < .05). (b) Spearman''s Rho showed that the NLR was positively correlated with the PLR (r = .584, P < .05), RF (r = .167, P < .01), and CRP (r = .280, P < .01) but was not significantly correlated with ESR (r = .100, P > .05). The PLR was positively correlated with RF (r = .139, P < .01), CRP (r = .297, P < .01), and ESR (r = .262, P < .05). (c) Logistic analysis showed that RF, CRP, ESR, and the NLR had diagnostic value for RA. (d) For the NLR, the area under the curve (AUC) of the ROC curve was 0.831; at the cutoff value of 2.13, the diagnostic sensitivity, specificity, accuracy, and Youden index were 76.7%, 75.9%, 76.4%, and 0.5424, respectively.ConclusionThe NLR was less effective than CRP and RF but was superior to ESR in the diagnosis of RA. The NLR can thus be used as a complementary diagnostic indicator in the diagnosis of RA.     

The neutrophil‐to‐lymphocyte ratio as a marker of chronic obstructive pulmonary disease and its exacerbations: A systematic review and meta‐analysis

Introduction

The main white blood cell populations, neutrophils and lymphocytes, are involved in the pathophysiology of chronic obstructive pulmonary disease (COPD). We conducted a systematic review and meta‐analysis of studies investigating the relationship between the neutrophil to lymphocyte ratio (NLR, a marker of subclinical inflammation), presence of COPD, and its exacerbations.

Methods

A comprehensive literature search was conducted in Pubmed, Web of Science and Scopus databases; two investigators independently reviewed suitable studies.

Results

Nine studies, from 247 initially identified, were included in the meta‐analysis. Seven studies, in 775 COPD patients with stable disease and 496 healthy controls, showed a significant increase in NLR values in stable COPD (standardised mean difference, SMD, 0.773, 95% CI 0.410‐1.136; P < 0.001). Furthermore, in six studies in 527 COPD patients with acute exacerbation and 620 COPD patients with stable disease, NLR values were significantly higher in patients with exacerbations (random effects SMD 0.850, 95% CI 0.549‐1.151; P < 0.001).

Conclusions

Our meta‐analysis showed that NLR values are significantly higher in stable COPD patients when compared to healthy individuals, although the magnitude of the difference is reduced after trim and fill adjustment, and in patients with COPD exacerbations when compared to patients with stable disease. Further studies, in larger cohorts, are needed to confirm whether the NLR is a useful tool in discriminating between COPD patients with stable disease, those with acute exacerbations, and subjects without the disease.     

Correlation between the platelet‐to‐lymphocyte ratio and diabetic foot ulcer in patients with type 2 diabetes mellitus

ObjectiveTo investigate the correlation between the platelet‐to‐lymphocyte ratio (PLR) and diabetic foot ulcer (DFU) in patients with type 2 diabetes mellitus (T2DM).MethodFrom January 2018 to August 2019, 206 patients with T2DM admitted to the Central Hospital of Wuhan, China, were enrolled in this study, including 104 patients with DFU (DFU group) and 102 patients without DFU (T2DM group). During the same period, 90 healthy subjects were randomly screened as normal controls (NC group). The correlation between PLR and DFU in patients with T2DM was explored by comparing the PLR of the subjects in the three groups.ResultsThe PLRs of the DFU and T2DM groups were higher than that of the NC group, whereas the PLR of the DFU group was higher than that of the T2DM group (p < 0.05). PLR was positively correlated with the Wagner DFU grade (p < 0.001). Based on logistic regression analysis, PLR was found to be an independent risk factor for DFU (OR =1.029, 95% CI: 1.019 ~ 1.039, p < 0.001). The receiver operating characteristic curve analysis of the PLR showed that the area under the curve of the PLR for predicting diabetic foot ulcer was 0.776 (p < 0.001), and the analysis determined that the optimal critical value of the PLR for predicting DFU was 147.6.ConclusionThe PLR is significantly elevated in patients with DFU and positively correlated with the Wagner DFU grade, which might be a valuable marker for early diagnosis and assessment of severity of DFU.     

Circular RNA profiling facilitates the diagnosis and prognostic monitoring of breast cancer: A pair‐wise meta‐analysis

BackgroundAs circular RNAs (circRNAs) have been found to significantly involve in the onset and progression of multiple malignant tumors including breast cancer (BC), this study aims at evaluating the diagnostic and prognostic values of circRNAs in this malady.MethodsAvailable databases were thoroughly searched to collect studies on the diagnosis and/or prognosis of BC using circRNA profiling. The updated Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2) tool and the Newcastle Ottawa Scale (NOS) were used to assess the underlying bias of included studies. Clinical characteristics of the studies were merged by the quantitative‐weighted integral method to obtain the combined effects.ResultsSixteen studies were included, comprising 2438 BC cases and 271 noncancerous controls. The expression signature covered 24 circRNAs (down‐regulated: circ‐VRK1, hsa_circ_0068033, hsa_circ_103110, hsa_circ_104689, and hsa_circ_104821; up‐regulated: circAGFG1, hsa_circ_0001785, hsa_circ_0108942, hsa_circ_0001785, hsa_circ_006054, hsa_circ_100219, hsa_circ_406697, circEPSTI1, circANKS1B, circGFRA1, circ_0103552, CDR1‐AS, has_circ_001569, hsa_circ_001783, circFBXL5, circ_0005230, circAGFG1, circ‐UBAP2, and circ_0006528). The sensitivity and specificity of circRNAs in distinguishing BC patients from noncancerous controls were 0.65 and 0.68, and the corresponding area under the curve was 0.66. Survival analysis revealed that patients showing highly expressed oncogenic circRNAs were associated with increased mortality risks of BC in overall survival (univariate analysis: hazard ratio [HR] = 3.30, P = .000; multivariate analysis: HR = 3.07, P = .000), and disease‐free survival (HR = 8.26, P = .000). Stratified analysis based on circRNA expression status and control type also showed robust results.ConclusionsCircular RNA profiling presents prominent diagnostic and prognostic values in BC, and can be rated as a promising tool facilitating its early diagnosis and survival.     

Prognostic value of glucose‐to‐lymphocyte ratio in critically ill patients with acute respiratory distress syndrome: A retrospective cohort study

BackgroundThere is need to identify biomarkers for prognosis of acute respiratory distress syndrome (ADRS). This may allow early and accurate identification of patients with high‐risk ARDS to guide adjustment of clinical treatment and nursing intervention, which would ultimately improve prognosis of patients with ARDS. Biomarkers based on a combination of fasting glucose and lymphocyte counts to predict prognosis in critically ill patients with ARDS remain undefined. In this study, we investigated the association between glucose‐to‐lymphocyte ratio (GLR) and in‐hospital mortality.MethodsThe study obtained data from Medical Information Mart for Intensive Care‐IV (MIMIC‐IV Version 1.0) database. We defined the GLR as fasting glucose/lymphocyte count and the patient in‐hospital mortality was considered as the outcome. In addition, we employed linear and logistic regression models for analysis.ResultsIn total, 1,085 patients with ARDS were included in this study. The eligible participants included 498 female and 587 males, with a mean age of 64.2 ± 17.5 years. Logistic regression analysis demonstrated that higher GLR was an independent risk factor for all‐cause mortality (OR =1.67, 95% CI: 1.26–2.22) after adjusting for age, sex, anion gap, white blood cell count, congestive heart failure, sequential organ failure assessment (SOFA), SBP, DBP, and respiratory rate in both the dichotomized group and subgroups. We also analyzed the in‐hospital mortality to ROC curves by comparing the value between SOFA + GLR and SOFA. The area under the curve (AUC) was 0.6991 for the SOFA + GLR (95% CI: 0.6634–0.7348), and 0.6613 for the SOFA (95% CI: 0.6238–0.6988).ConclusionOur data showed that the GLR was an independent predictor of in‐hospital mortality for patients with ARDS. The GLR is an integrated, readily available clinical biomarker for mortality in patients with ARDS.