Availability of preoperative neutrophil-lymphocyte ratio to predict postoperative delirium after head and neck free-flap reconstruction: A retrospective study

Kinoshita, Haruhito; Saito, Junichi; Takekawa, Daiki; Ohyama, Tasuku; Kushikata, Tetsuya; Hirota, Kazuyoshi

doi:10.1371/journal.pone.0254654

Cited by 26 publications

(35 citation statements)

References 35 publications

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“…This can be interpreted as the NLR may be the more effective inflammatory marker in early detection of delirium occurrence, compared to CRP (Figure 5). This result is in line with recent studies using NLR for prediction of delirium (31,32).…”

Section: Discussionsupporting

confidence: 93%

Neutrophil-Lymphocyte Ratio as a Potential Biomarker for Delirium in the Intensive Care Unit

Seo

Park

et al. 2021

Front. Psychiatry

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Background: Recognition and early detection of delirium in the intensive care unit (ICU) is essential to improve ICU outcomes. To date, neutrophil-lymphocyte ratio (NLR), one of inflammatory markers, has been proposed as a potential biomarker for brain disorders related to neuroinflammation. This study aimed to investigate whether NLR could be utilized in early detection of delirium in the ICU.Methods: Of 10,144 patients who admitted to the ICU, 1,112 delirium patients (DE) were included in the current study. To compare among inflammatory markers, NLR, C-reactive protein (CRP), and white blood cell (WBC) counts were obtained: the mean NLR, CRP levels, and WBC counts between the initial day of ICU admission and the day of initial delirium onset within DE were examined. The inflammatory marker of 1,272 non-delirium patients (ND) were also comparatively measured as a supplement. Further comparisons included a subgroup analysis based on delirium subtypes (non-hypoactive vs. hypoactive) or admission types (elective vs. emergent).Results: The NLR and CRP levels in DE increased on the day of delirium onset compared to the initial admission day. ND also showed increased CRP levels on the sixth day (the closest day to average delirium onset day among DE) of ICU admission compared to baseline, while NLR in ND did not show significant difference over time. In further analyses, the CRP level of the non-hypoactive group was more increased than that of the hypoactive group during the delirium onset. NLR, however, was more significantly increased in patients with elective admission than in those with emergent admission.Conclusion: Elevation of NLR was more closely linked to the onset of delirium compared to other inflammatory markers, indicating that NLR may play a role in early detection of delirium.

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Section: Discussionsupporting

confidence: 93%

Neutrophil-Lymphocyte Ratio as a Potential Biomarker for Delirium in the Intensive Care Unit

Seo

Park

et al. 2021

Front. Psychiatry

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“… 22–24 Recent studies found that preoperative NLR can be a predictive factor for POD after head and neck free-flap reconstruction, total hip arthroplasty, esophagectomy, and carotid endarterectomy. 4 , 5 , 7 , 9 In this study, both preoperative NLR and postoperative NLR were higher in patients with POD after lower limb fracture than those in patients without POD. Multivariate analyses revealed that among the hematological biomarkers examined, postoperative NLR was still associated with the development of POD.…”

Section: Discussionmentioning

confidence: 46%

“…Some of this can be attributed to the exclusion of patients with preoperative delirium, as some relative studies did not include this exclusion criteria. 4 , 7 , 9 In addition, change of NLR (postoperative value− preoperative value) in the POD group was significantly higher than that in the non-POD group and was positive value, which meant that NLR in patients with POD increased significantly after surgery. This result may indicate more severe systemic inflammation and neuroinflammation caused by surgery and anaesthesia in patients with POD.…”

Section: Discussionmentioning

confidence: 92%

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White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General Anaesthesia

Li¹,

Wang²,

He³

et al. 2022

CIA

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Purpose The aim of this study was to investigate whether white-cell derived biomarkers could serve as potential markers in prediction of postoperative delirium (POD) after lower limb fracture. Patients and Methods Elderly patients with surgery for lower limb fracture under non-general anaesthesia were included. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet-to-white cell ratio (PWR), which were most recently measured preceding surgery and measured within 24h after surgery, were calculated. Delirium was measured with Confusion Assessment Method (CAM) once daily from preoperative day 1 to postoperative day 3 or hospital discharge. Results The incidence of POD was 32.6% (60/184). Between patients with and those without POD, there were significant differences in preoperative hematological biomarkers (neutrophil count, lymphocyte count, NLR and PWR) and postoperative hematological biomarkers (white cell count, neutrophil count, lymphocyte count, NLR, PLR and PWR). More obvious changes before and after operation for NLR, PLR and C-reactive protein (CRP) were found in patients with POD. Multivariate logistic regression showed that benzodiazepines (OR, 7.912; 95% CI, 1.884–33.230; p = 0.005), change of CRP (OR, 1.017; 95% CI, 1.007–1.027; p = 0.001) and postoperative NLR (OR, 1.358; 95% CI, 1.012–1.823; p = 0.041) were associated with POD. When the changes of NLR, PLR and PWR entered multivariate logistic regression, older age (OR, 1.073; 95% CI, 1.001–1.149; p = 0.046), benzodiazepines (OR, 6.811; 95% CI, 1.652–28.081; p = 0.008), greater change of CRP (OR, 1.015; 95% CI, 1.006–1.023; p = 0.001) and greater change of NLR (OR, 1.266; 95% CI, 1.035–1.549; p = 0.022) were associated with increased risk of POD. Postoperative NLR had high accuracy to predict POD with area under curve (AUC) of 0.790 (95% CI 0.708 to 0.872). Conclusion Age, benzodiazepines, postoperative NLR, change of NLR and change of CRP were independent predictable markers for POD in elderly patients undergoing surgery for lower limb fracture under non-general anaesthesia. Early postoperative NLR may help to recognize POD as soon as possible.

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“…We reported that higher preoperative NLR was associated with the development of postoperative delirium that is also caused by neuroinflammation 6 , 7 . In addition, several studies reported that the NLR and the PLR were associated with generated psychiatric diseases, schizophrenia, attention-deficit/hyperactivity disorder (ADHD), and epileptic seizure 8 – 10 .…”

Section: Introductionmentioning

confidence: 92%

Higher neutrophil–lymphocyte ratio is associated with depressive symptoms in Japanese general male population

Kinoshita

Takekawa

Kudo

et al. 2022

Sci Rep

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Relationships between the neutrophil–lymphocyte ratio (NLR) and/or the platelet-lymphocyte ratio (PLR) and neuroinflammatory diseases have been reported. Depression is also associated with neuroinflammation. Here, we determined the association between the NLR, PLR, and depressive symptoms. This cross-sectional study is a secondary analysis of the data of the Iwaki Health Promotion Project 2017. We analyzed the characteristics and laboratory data of 1,015 Japanese subjects (597 females, 408 males) including their NLR and PLR values. We assigned the subjects with a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16 to the depressive symptoms group. We performed a multivariate logistic regression analysis to determine whether the NLR and/or PLR were associated with depressive symptoms (CES-D ≥ 16). Two hundred subjects (19.7%; 122 [20.4%] females, 78 [19.1%] males) were assigned to the depressive symptoms group. There were significant differences between the non-depressive symptoms and depressive symptoms groups in the NLR [median (25th to 75th percentile): 1.54 (1.24, 1.97) vs. 1.76 (1.32, 2.37), P = 0.005] and the PLR [median (25th to 75th percentile): 123.7 (102.0, 153.9) vs. 136.8 (107.0, 166.5), P = 0.047] in males, but not in females. The multivariate logistic regression analysis demonstrated that the NLR was significantly associated with depressive symptoms in males (adjusted odds ratio: per 1 increase, 1.570; 95% confidence interval: 1.120–2.220; P = 0.009). In conclusion, our findings indicate that higher NLR may be associated with depressive symptoms in males.

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Availability of preoperative neutrophil-lymphocyte ratio to predict postoperative delirium after head and neck free-flap reconstruction: A retrospective study

Cited by 26 publications

References 35 publications

Neutrophil-Lymphocyte Ratio as a Potential Biomarker for Delirium in the Intensive Care Unit

Neutrophil-Lymphocyte Ratio as a Potential Biomarker for Delirium in the Intensive Care Unit

White-Cell Derived Inflammatory Biomarkers in Prediction of Postoperative Delirium in Elderly Patients Undergoing Surgery for Lower Limb Fracture Under Non-General Anaesthesia

Higher neutrophil–lymphocyte ratio is associated with depressive symptoms in Japanese general male population

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