Is the Neutrophil-to-Lymphocyte Ratio a Crucial Indicator of Systemic Inflammation, Coronary Artery Ectasia, and Atherogenesis?

Abstract

We read the article ''Association Between Coronary Artery Ectasia and Neutrophil-Lymphocyte Ratio'' by Balta et al 1 with interest. The authors 1 evaluated the neutrophil-tolymphocyte (N/L) ratio in patients with coronary artery ectasia (CAE). The N/L ratio and mean platelet volume (MPV) levels were significantly higher in both CAE and coronary artery disease (CAD) groups compared with the control group. However, there was no significant difference in the N/L ratio and the MPV levels among the subgroups of CAE and between CAE and CAD groups. 1 We would like to make a few comments.The incidence of CAE varies from 1.5% to 5%, and its pathogenesis is unclear. However, a number of local and systemic abnormalities including atherosclerosis, endothelial dysfunction, and systemic inflammation have been reported. 2 Additionally, atherosclerosis is an inflammatory response to a variety of traditional risk factors. Therefore, new studies have focused on inflammatory markers to determine their importance in cardiovascular disease including CAE. The N/L ratio represents the balance between neutrophil and lymphocyte counts. Most of conditions including traditional risk factors (ie, hypertension, atherogenic lipoproteins, and hyperglycemia) and many other inflammatory conditions (ie, infection and chronic renal failure) can change this ratio. 3 The glomerular filtration rate (GFR) provides more sensitive information about renal function than the serum creatinine level. 4 The GFR can be measured via the formula of modification of diet in renal disease and Cockcroft-Gault equation. 4 Renal dysfunction from stages 1 to 5 is an ongoing systemic inflammatory process, and most of the large-scale studies investigating inflammatory markers have recommended the calculation of GFR. 4 However, in this study, the authors 1 defined the exclusion criteria with a serum creatinine level >1.5 mg/dL, which is insufficient for renal dysfunction.In addition, the authors 1 did not analyze markers of inflammation such as C-reactive protein (CRP), although the role of inflammation was previously reported in those patients. If the CRP levels of these patients had been screened and correlated with the N/L ratio, it would provide a better perspective. Recently, the same group has reported that the N/L ratio without other inflammatory markers may not provide information to clinicians about chronic endothelial inflammation. 5 Despite

Inflammatory microenvironment in the initiation and progression of bladder cancer

“…The neutrophil-to-lymphocyte ratio (NLR) in peripheral blood samples has been indicated as a crucial indicator for the systemic inflammatory response [ 85 ] and the prognosis of some solid malignancies including BCa [ 11 , 86 , 87 ]. Elevated serum NLR level among BCa patients undergoing radical cystectomy (RC) is associated with significantly increased risk for disease recurrence and progression (Table 1 ) [ 88 , 89 ].…”

Inflammatory Condition in Coronary Artery Ectasia

“…We read with interest the letter by Bugan 1 regarding our manuscript entitled “Association between coronary artery ectasia and neutrophil–lymphocyte ratio.” 2…”