Neutrophil-to-lymphocyte ratio in inflammatory bowel disease – As a new predictor of disease severity

Abstract

Background: The aims of this study were to investigate the utility of neutrophil-to-lymphocyte ratio (NLR) as a simple and readily available predictor for clinical disease activity in infl ammatory bowel disease (IBD). Methods: Sixty-six patients (22 CD, 44 UC) and 41 healthy controls were enrolled in the study. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and complete blood count (CBC) were measured. The neutrophil and lymphocyte counts were recorded and NLR was calculated. The patients with active or inactive UC and CD were classifi ed according to the severity of the disease. Result: The serum NLR values of active CD patients were signifi cantly higher than those of inactive ones and controls (p = 0.000, p = 0.000, respectively). NLR values of active UC patients were signifi cantly higher than those of inactive ones and controls (p = 0.000, p = 0.000, respectively. The optimum NLR cut-off point for active CD and UC was 3.2 and 3.1. Conclusion: This study demonstrates that NLR in subjects with IBD is strongly associated with active disease and correlated with clinical and laboratory indices (Tab. 5, Fig. 2, Ref. 31). Text in PDF www.elis.sk. AzabB, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S et al. Usefulness of neutrophil to lymphocyte ratio in predicting short and long term mortality after non-ST-elevation myocardial infarction. Am J Cardiol 2010; 106: 470-476. 31. Zahorec R. Ratio of neutrophil to lymphocyte count -rapid and simple parameter of systemic infl ammation and stress in critically ill. Bratisl Med J 2001; 102 (1): 5 -14.

The Utility of Neutrophil-to-Lymphocyte Ratio as a Severity Predictor of Acute Appendicitis, Length of Hospital Stay and Postoperative Complication Rates

“…Alternatively, total WCC and platelet count have been advocated as indicators of severity of appendicitis, but with varying success [22] . Evidence to date demonstrates that NLR is a good marker of subclinical inflammation, with studies showing that it correlates with the severity of acute inflammatory bowel disease and acute cholecystitis [10,12,13] . Additionally, recent studies have observed that NLR correlates with colorectal cancer stage and oncological outcome and is currently being considered as a biomarker [15,16] .…”

“…The use of simple inexpensive biomarkers could further substantially reduce negative appendicectomy rates, while ensuring that severe appendicitis cases are treated expeditiously. Although the mortality for perforated appendicitis is low, the morbidity can be high, and therefore, surgery remains the gold standard for severe appendicitis (phlegmonous or gangrenous) [11][12][13][14][15][16][17][18][19][20][21][22][23][24] .…”

“…The neutrophil count highlights active and continuing inflammation, whereas the lymphocyte count highlights the regulatory pathway [13] . Studies have shown that it is effective in demonstrating activation of inflammatory bowel disease and correlates with the severity of acute attacks [12,13] . In addition, the NLR is raised in patients with acute coronary syndrome and recently has been observed to reflect aggressiveness of solid neoplasms (colorectal, gastric, ovarian and hepatic), correlating also with overall outcome and survival [14][15][16][17][18][19] .…”

“…However, to select patients suitable for a conservative management approach, there is a need to better delineate the severity of acute appendicitis at the time of admission itself. Neutrophil-to-lymphocyte ratio (NLR) is a simple inexpensive marker of subclinical inflammation, which is easily calculated from the differential white cell count (WCC) [12] . NLR provides information regarding 2 different immune and inflammatory pathways.…”

Prognostic value of preoperative neutrophil-to-lymphocyte ratio in Crohn’s disease

“…assessed NLR and CRP levels using the Harvey-Bradshaw index and the Truelove and Witts criteria, by matching 22 CD and 44 UC patients with active and inactive disease with 41 healthy controls [26]. The authors found that the mean NLR value was 5.25 in CD patients with active disease in contrast to 1.68 in the healthy control group and 1.78 in patients with inactive CD.…”