Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis

Wang, Qian; Ma, Jun; Jiang, Zucheng; Ming, Liang

doi:10.23736/s0392-9590.17.03848-2

Cited by 120 publications

(86 citation statements)

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“…In subgroup analysis, we revealed a linear relationship between composite outcome of AKI mortality or mortality and NLR in the medical ICU population. Similar findings have also been reported in a pulmonary embolism population (NLR cut-off value for mortality ranged from 5.4 to 9.2) [13], in a pancreatitis population (NLR cut-off value for severe pancreatitis: 9.6 with sensitivity: 81.7%, specificity: 55.3% and AUROC: 0.72 at day 0) [14], and in a CKD population (HR for all-cause mortality: 1.45, HR for cardiovascular event: 1.52) [39]. In septic patients, the relationship between the NLR and mortality is more complex.…”

Section: Discussionsupporting

confidence: 88%

“…NLR could also be used as a prognostic marker in various diseases (including pulmonary embolism, pancreatitis, sepsis, etc. ), and some studies have demonstrated a linear relationship [13][14][15][16][17]24]. Other studies have demonstrated J-shaped relationships of NLR and cortisol levels with patient survival [18,37].…”

Section: Discussionmentioning

confidence: 99%

“…It is a surrogate marker of systemic response to physiological stress. NLR is associated with adverse outcomes in many diseases [13][14][15][16][17][18][19] and can help in early predicting AKI [20][21][22]. In a study of 10,859 patients admitted to an intensive care unit (ICU), Zheng et al [23] noted that platelet-to-lymphocyte ratio, an inflammatory marker similar to NLR, exhibited a U-shaped relationship with mortality in patients with critical illness and AKI.…”

Section: Introductionmentioning

confidence: 99%

“…In a study of 10,859 patients admitted to an intensive care unit (ICU), Zheng et al [23] noted that platelet-to-lymphocyte ratio, an inflammatory marker similar to NLR, exhibited a U-shaped relationship with mortality in patients with critical illness and AKI. Some studies have reported contradictory results regarding the linear relationship between NLR and outcomes [13,14,18,24]. Furthermore, whether NLR could serve as a predictive marker of AKI progression remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Neutrophil-to-lymphocyte ratio is a marker for acute kidney injury progression and mortality in critically ill populations: a population-based, multi-institutional study

et al. 2021

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Backgrounds Neutrophil-to-lymphocyte ratio (NLR), a surrogate marker of systemic response to physiological stress, is used for prognosis prediction in many diseases. However, the usefulness of this marker for predicting acute kidney injury (AKI) progression is unclear. Methods This retrospective study was based on the Chang Gung Research Database. Patients admitted to the intensive care unit with a diagnosis of stage 1 or 2 AKI were identified. The primary outcome was a composite of progression to stage 3 AKI, requirement of renal replacement therapy, or 14-day in-hospital mortality. The association between NLR and the primary outcome was examined using a logistic regression model and multivariable analysis. The nonlinearity and cutoff points of this relationship were determined using a restricted cubic spline model. Results A total of 10,441 patients were enrolled. NLR level at the time of stage 1-2 AKI diagnosis was a marker of adverse outcomes. After adjustment for confounders, NLR was independently associated with the composite outcome of AKI progression, renal replacement therapy, or mortality. The restricted cubic spline model revealed a J-shaped curve, with the lowest odds ratio for an NLR between 7 and 38. Subgroup analysis revealed linear and J-shaped relationships between NLR and the primary outcome in patients admitted to the intensive care unit for medical reasons and for cardiovascular surgery, respectively. Conclusions NLR is an independent marker of AKI progression and in-hospital mortality. Because it is readily available in daily practice, it might be used for risk stratification in the AKI population.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neutrophil-to-lymphocyte ratio is a marker for acute kidney injury progression and mortality in critically ill populations: a population-based, multi-institutional study

et al. 2021

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“…We appreciate the comments made by Dr. Bedel et al . NLR, PLR, and LMR are affected by various diseases such as oncological, collagen tissue, inflammatory, or severe renal/liver diseases [ 1 ]. Due to this, we have listed some of the disorders mentioned above in the tables.…”

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confidence: 99%

Can NLR, PLR and LMR be used as prognostic indicators in patients with pulmonary embolism? Author’s reply on commentary

Köse¹,

Yıldırım²,

Akın³

et al. 2020

Bosn J of Basic Med Sci

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We appreciate the comments made by Dr Bedel and colleagues. NLR, PLR and LMR are affected by various diseases such as oncological, collagen tissue, inflammatory, or severe renal/liver diseases [1]. Because of this, we have listed some of the above-mentioned disorders in the tables. Hematological diseases, collagen tissue disease, inflammatory diseases, congenital heart disease, or severe renal/liver disease were therefore excluded from the study. However, the presence of malignancy did not affect our results in regression analysis.Platelets swell until 120 minutes in ethylene diamine tetra acetic (EDTA) and until 60 minutes in citrate [2]. Authors suggest that optimal measuring time should not exceed 120 minutes. The blood samples of the patients were taken within 1 hour after their emergency admission. All blood samples in our study were tested within 1 hour of collection [3]. We used EDTA for whole blood anticoagulation. The mean duration of symptoms prior to admission was 5.04 ± 6.9 days. The drugs such as corticosteroids affect inflammatory parameters. Therefore, we excluded inflammatory diseases without emphasizing corticosteroids or other anti-inflammatory drugs.

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The prognostic value of blood cellular indices in pulmonary embolism

Siddiqui,

Tafur,

Hussain

et al. 2024

American J Hematol

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Prognostication in acute pulmonary embolism (PE) requires reliable markers. While cellular indices such as neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and systemic immune‐inflammation index (SII) appear promising, their utility in PE prognostication needs further exploration. We utilized data from the RIETE registry and the Loyola University Medical Center (LUMC) to assess the prognostic value of NLR, PLR, and SII in acute PE, using logistic regression models. The primary outcome was 30‐day all‐cause mortality. We compared their prognostic value versus the simplified Pulmonary Embolism Severity Index (sPESI) alone. We included 10 085 patients from RIETE and 700 from the LUMC. Thirty‐day mortality rates were 4.6% and 8.3%, respectively. On multivariable analysis, an elevated NLR (>7.0) was associated with increased mortality (adjusted odds ratio [aOR]: 3.46; 95% CI: 2.60–4.60), outperforming the PLR > 220 (aOR: 2.36; 95% CI: 1.77–3.13), and SII > 1600 (aOR: 2.52; 95% CI: 1.90–3.33). The c‐statistic for NLR in patients with low‐risk PE was 0.78 (95% CI: 0.69–0.86). Respective numbers were 0.66 (95% CI: 0.63–0.69) and 0.68 (95% CI: 0.59–0.76) for intermediate‐risk and high‐risk patients. These findings were mirrored in the LUMC cohort. Among 9810 normotensive patients in RIETE, those scoring 0 points in sPESI and with an NLR ≤ 7.0 (35% of the population) displayed superior sensitivity (97.1%; 95% CI: 95.5–98.7) and negative predictive value (99.7%; 95% CI: 99.5–99.8) than sPESI alone (87.1%; 95% CI: 83.9–90.3, and 98.7%; 95% CI: 98.4–99.1, respectively) for 30‐day mortality. The NLR is a significant prognostic marker for 30‐day mortality in PE patients, especially useful to identify patients with very low‐risk PE.

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Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis

Cited by 120 publications

References 0 publications

Neutrophil-to-lymphocyte ratio is a marker for acute kidney injury progression and mortality in critically ill populations: a population-based, multi-institutional study

Neutrophil-to-lymphocyte ratio is a marker for acute kidney injury progression and mortality in critically ill populations: a population-based, multi-institutional study

Can NLR, PLR and LMR be used as prognostic indicators in patients with pulmonary embolism? Author’s reply on commentary

The prognostic value of blood cellular indices in pulmonary embolism

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