High neutrophil to lymphocytes ratio is associated with nutritional risk in hospitalised, unselected cancer patients: a cross-sectional study

Abstract

Cancer patients possess metabolic and pathophysiological changes and an inflammatory environment that leads to malnutrition. This study aimed to (i) determine whether there is an association between neutrophil-to-lymphocyte ratio (NLR) and nutritional risk, and (ii) identify the cut-off value of NLR that best predicts malnutrition by screening for nutritional risk (NRS 2002). This cross-sectional study included 119 patients with unselected cancer undergoing chemotherapy and/or surgery. The NRS 2002 was applied within 24 h of hospitalisation to determine the nutritional risk. Systemic inflammation was assessed by blood collection, and data on C-reactive protein (CRP), neutrophils, and lymphocytes were collected for later calculation of NLR. A receiver operating characteristic (ROC) curve was used to identify the best cut-point for NLR value that predicted nutritional risk. Differences between the groups were tested using the Student’s t-, Mann–Whitney U and Chi-Square tests. Logistic regression analyses were performed to assess the association between NLR and nutritional risk. The ROC curve showed the best cut-point for predicting nutritional risk was NLR > 5.0 (sensitivity, 60.9%; specificity, 76.4%). The NLR ≥ 5.0 group had a higher prevalence of nutritional risk than the NLR < 5.0 group (NLR ≥ 5.0: 73.6% vs. NLR < 5.0: 37.9%, p = 0.001). The NLR group ≥ 5.0 showed higher values of CRP and NLR than the NLR < 5.0 group. In addition, patients with NLR ≥ 5.0 also had higher NRS 2002 values when compared to the NLR < 5.0 group (NLR ≥ 5.0: 3.0 ± 1.1 vs. NLR < 5.0: 2.3 ± 1.2, p = 0.0004). Logistic regression revealed an association between NRS and NLR values. In hospitalised unselected cancer patients, systemic inflammation measured by NLR was associated with nutritional risk. Therefore, we highlight the importance of measuring the NLR in clinical practice, with the aim to detect nutritional risk.

Disparities in inflammation between non-Hispanic black and white individuals with lung cancer in the Greater Chicago Metropolitan area

“…Therefore, we cannot establish temporality, and we encourage readers to interpret this finding with caution. Indeed, nutrition risk is associated with increased NLR ( 60 ), but nutitional status was not assessed in this study, and BMI at diagnosis is not an indicator of nutritional risk.…”

Association between neutrophil to lymphocyte ratio, handgrip strength and nutritional status in geriatric patients

“…Numerous scientific data have confirmed that nutritional status and sarcopenia are associated with NLR, a marker of systemic inflammation (Siqueira et al , 2021; Öztürk et al , 2018). Recently, a community-based cross-sectional study in Japanese older adults has showed that a higher NLR is associated with poorer physical functions such as lower HGS and slower walking speed (Yoshida et al , 2022).…”

“…However, it should be known that age, gender, exogenous steroid use, hematological disorders and chemotherapy can significantly affect NLR (Bedel and Korkut, 2021; Buonacera et al , 2022). Studies have suggested that NLR is associated with nutritional risk in critical illness (Siqueira et al , 2021; Wang et al , 2022). However, it is not clear whether the increase in NLR is a cause or a consequence of malnutrition in older adults.…”

Association between a novel nutrition‐inflammation prognostic grading system and overall survival in hospitalized adults with cancer: A retrospective cohort study

“…24 Siqueira et al recently reported that systemic inflammation assessed using the neutrophilto-lymphocyte ratio (NLR) was associated with nutritional risk. 25 The Global Leadership Initiative on Malnutrition (GLIM) also included inflammation as one important etiologic criterion for malnutrition diagnosis. 26 In the present study, NIPGS incorporating shown GLIM-defined malnutrition is a reliable predictor of survival in patients with cancer.…”