Inflammatory Markers and Thromboembolic Risk in Patients with Non-Muscle-Invasive Bladder Cancer

Abstract

Introduction: Patients with bladder cancer have a high risk of venous thrombosis that represents a key challenge for physicians in the decision-making for initiating anticoagulation therapy. Non-muscle-invasive bladder cancer (NMIBC) represents more than 70% of all diagnosed bladder malignancies; therefore, we aimed to evaluate the relationship of the neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and risk of thrombosis by using the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score as well as the risk of bleeding by using the IMPROVE Bleeding Risk Assessment Score in a study cohort. Material and Methods: This was a retrospective observational study involving 130 patients who met the inclusion criteria: age > 18 years, stage pTa-pT1 NMIBC. The exclusion criteria were age < 18 years; stage pT2 or higher; or a presentation of metastasis, inflammatory, liver or autoimmune diseases, or other systemic neoplasms. In order to evaluate the risk of thromboembolic events as well as those of bleeding, the IMPROVE scores were calculated for each patient. Subjects were categorized in a Low IMPROVE group (< 4 points) or a High IMPROVE group. By using uni- and multivariate regression models, we analyzed CBC-derived parameters which could be associated with a higher risk of venous thrombosis in subjects with low or high IMPROVE scores. Results: Patients with IMPROVE score greater than 4 were associated with higher NLR, LMR and lymphocyte values (p < 0.05). In a multivariate regression model, the IMPROVE score was significantly influenced by lymphocyte count (p = 0.007) as well as the NLR value (p < 0.0001). Conclusions: In our study population, subjects with NMIBC with low lymphocytes and NLR > 3 were at a higher risk of developing venous thromboembolic events, reflected by an IMPROVE score of greater than 4. The IMPROVE and IMPROVE Bleeding Risk Assessment Scores are easy to use, and, complemented with the CBC-derived lymphocyte to monocyte ratio as a prothrombotic marker, could aid in the decision of prophylactic anticoagulation therapy during admission.

Increased Plasma Concentrations of Extracellular Vesicles Are Associated with Pro-Inflammatory and Pro-Thrombotic Characteristics of Left and Right Ventricle Mechanical Support Devices

“…Its increased levels were proposed, by Xiong et al, as a risk biomarker for thrombotic complications following surgery [ 49 ]. Monocyte to lymphocyte ratio (MLR) is a simple index that is mainly related to inflammatory activation, however increased thrombotic risk was also postulated [ 50 , 51 ].…”

Predicting the risk of radiation enteritis in cervical cancer patients using inflammatory markers through machine learning

“…In the past decade, research has primarily focused on in ammatory markers derived from complete blood count (CBC) parameters, such as neutrophils (N), monocytes (M), lymphocytes (L), platelets (P), albumin (ALB), hemoglobin (Hb), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-in ammation index (SII). These markers have demonstrated predictive effects on the survival and prognosis of malignant tumors, including colorectal cancer [22], gastric cancer [23], breast cancer [24][25][26], lung cancer [27][28], rectal cancer [29], ovarian cancer [30], bladder cancer [31], neurological diseases [32], and oral cancer [33]. Multiple lines of evidence suggest that radiation enteritis is an in ammatory reaction [34][35][36][37][38].…”

Machine Learning to Predict Radiation Enteritis in Patients Undergoing Radical Radiotherapy for Cervical Squamous Cell Carcinoma

“…Certain studies (19)(20)(21)(22)(23)(24) have reported the impact of RE, such as on the distribution characteristics of intestinal ora, and signi cant changes in fecal metabolites are closely related to the severity of RE during RT. In the past 10 years, research has focused on the in ammatory markers of complete blood count (CBC)-derived parameters such as neutrophils (N), monocytes (M), lymphocytes (L), platelets (PLT), albumin (ALB), hemoglobin (Hb), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-in ammation index (SII), which have predictive effects on the survival and prognosis of malignant tumors, such as CC (25), gastric cancer (26), breast cancer (27)(28)(29), lung cancer (30,31), rectal cancer (32), ovarian cancer (33), bladder cancer (34), neurological diseases (35), and oral cancer (36). Multiple lines of evidence have suggested that RE is an in ammatory reaction (37)(38)(39)(40)(41).…”