Neutrophil–lymphocyte ratio as an important assessment tool

Abstract

Response to: Akhtar MS, Bhat T, Teli S et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev. Cardiovasc. Ther. 11(1), 55-59 (2013).We read the article 'Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: a review' by MS. Akhtar et al. with great interest [1]. In this wellpresented review, the authors discussed the association of N/L ratio with various cardiovascular diseases and its possibility of emerging as a cheap, reliable and independent prognostic marker of cardiovascular disease.Some studies have indicated that NLR is a novel inflammatory marker in various diseases. In this particular review of M. Akhtar that he made reference to in our publication, the authors evaluated the relationship between NLR and the various cardiovascular diseases and their outcomes. White blood cell count is one of the useful inflammatory biomarkers in clinical practice. However, the sub-types, particularly the neutrophils and lymphocytes, and subsequent calculation of NLR are relatively more stable than individual leukocytic parameters. This ratio is significantly altered by many conditions (e.g., dehydration, over-hydration, diluted blood specimens, in-vitro blood specimen handling). As highlighted by this article [1], the authors provided a very concise review of NLR and its association with heart failure, coronary artery bypass surgery and various cardiac rhythm abnormalities [1].Based on this particular review, we designed our research to assess the presence of left atrial thrombus in patients with non-valvular atrial fibrillation (AF). A total of 309 (70.1 ± 9.8 years, 49% males) patients with nonvalvular AF underwent transesophageal echocardiography to assess the presence of left atrium (LA) thrombus. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. Left atrial thrombus was detected in 32 (10.3%) of 309 patients. Mean NLR (2.2 ± 1.0 vs 2.7 ± 1.1, p = 0.026) was significantly higher among patients with LA thrombus compared to patients without LA thrombus. On multivariate analysis, NLR (odds ratio 1.59; 95% CI: 0.87-4.18; p < 0.02) was an independent risk factor for the presence of LA thrombus in patients with non-valvular AF. We concluded that NLR, an emerging marker of inflammation, was independently associated with the presence of LA thrombus in patients with non-valvular AF [2]. I have also developed an association between NLR and anti-hypertensive therapy [3], NLR and its association with metabolic syndrome [4] as well as NLR association with carotid artery thickness in patients with slow coronary flow [5]. In all these studies, M. Akhtar's review [1] provided with greater guidance at each level of research.Recent evidence has extensively indicated that the NLR is a significant predictor of subclinical atherosclerosis. Atherosclerosis plays an important role in the pathogenesis of coronary artery ectasia. We also showed that the NLR was significantly higher in patients with coronary artery ectasia compared to controls [6] in another study that to...

Neutrophil‐to‐lymphocyte ratio and its relation with pro‐inflammatory mediators, visceral adiposity and carotid intima‐media thickness in population with obesity

“…41 Our results also show that percentile distribution of NLR associates with progressive subclinical atherogenesis, as measured by CIMT. This is consistent with previous studies, which postulate that NLR is related to endothelial dysfunction, 33 atherosclerosis and inflammatory disorders like Behcet's disease, 42 as well as its role as predictor of coronary subclinical calcification, 8,43 severity of the atherogenic injury, either in coronary or peripheral artery disease 44 or independent association with severe multi-level peripheral artery disease. 26,45 Indeed, there is experimental evidence that the accumulation of neutrophils on the vascular wall might promote inflammation, endothelial dysfunction and atherosclerosis.…”

“…3,4 Moreover, early leucocyte recruitment is known to be closely associated with vascular endothelial dysfunction. [5][6][7] Immune cells are involved from earliest fatty streaks to late-stage complex vascular plaques, 5,8 where neutrophils play a role in the progression of atherogenesis and atherosclerosis. 9,10 Invasion and local activation of neutrophils in the atherosclerotic plaque have been evidenced by direct visualization with consequent triggering of atherogenic process.…”

Association between Neutrophil-to-Lymphocyte Ratio with Abdominal Obesity and Healthy Eating Index in a Representative Older Spanish Population

“…In addition, according to our results, in a study carried out in 26,016 middle-aged and older adults (>35 years old) with metabolic syndrome in Taiwan, obesity, high body fat, high WC or hip circumference, and high WHtR were significantly associated with increased odds ratios of high CRP and NLR [12]. Furthermore, some studies in obese adults showed that weight loss improved inflammation parameters [91,92]. Nevertheless, in some previous studies, increased BMI was associated with total WBC and individual subtypes, but not with NLR [92][93][94].…”

“…Furthermore, some studies in obese adults showed that weight loss improved inflammation parameters [91,92]. Nevertheless, in some previous studies, increased BMI was associated with total WBC and individual subtypes, but not with NLR [92][93][94]. More research is needed to clarify this relationship.…”

Study of neutrophil lymphocyte ratio in patients with type 2 diabetes mellitus and its correlation with glycemic control

“…Even patients with increase NLR but normal TLC count could have increased risk of atherosclerosis related diseases. [12][13][14] HbA1c is commonly advised to measure the long term glycemic control and it also tells about the severity of hyperglycemia. 15 However HbA1c usually do not predict ongoing inflammation and diabetes associated complications accurately.…”