Elevated Preoperative Systemic Inflammatory Markers Predict Poor Outcome in Localized Soft Tissue Sarcoma

Background: Otitis media and rhinosinusitis are common inflammatory disorders of the upper airway that frequently coexist due to shared anatomical and immunological pathways. Increasing evidence supports the concept of a unified airway, suggesting that inflammation of the nasal cavity and paranasal sinuses may extend to the middle ear. Objective: To evaluate systemic inflammatory markers in patients with combined otitis media and rhinosinusitis and compare them with healthy controls. Methods: This hospital-based case–control study was conducted at the Department of Otolaryngology, Al-Kindy Teaching Hospital, Baghdad, Iraq, between March 1, 2025, and December 30, 2026. A total of 140 participants were enrolled, including 70 patients diagnosed with combined otitis media and rhinosinusitis and 70 age- and sex-matched healthy controls. Clinical diagnosis was confirmed through otoscopic examination, nasal endoscopy, and radiological assessment when indicated. Venous blood samples were collected to measure systemic inflammatory markers including white blood cell count (WBC), neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet count, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and hemoglobin levels. Results: No significant differences were observed between groups regarding age or sex distribution (p>0.05). Patients with combined OM and RS demonstrated significantly elevated WBC (9.80±2.10 vs. 6.70±1.50 ×10⁹/L), neutrophil count (6.50±1.90 vs. 3.80±1.20 ×10⁹/L), NLR (3.50±1.20 vs. 1.40±0.60), platelet count (320.00±60.00 vs. 260.00±50.00 ×10⁹/L), PLR (160.00±40.00 vs. 95.00±30.00), CRP (12.40±5.60 vs. 3.20±1.80 mg/L), and ESR (28.60±10.20 vs. 12.30±5.40 mm/hr) compared with controls (all p < 0.001). Lymphocyte count was significantly reduced in cases (2.10±0.70 vs. 2.80±0.80 ×10⁹/L, p < 0.001). Hemoglobin was mildly but significantly lower in cases (12.60±1.40 vs. 13.20±1.30 g/dL, p = 0.02). Correlation analysis demonstrated significant associations among inflammatory indices, particularly between NLR and CRP, ESR, and neutrophil count (p<0.001). Conclusion: Combined otitis media and rhinosinusitis are associated with significant systemic inflammatory response. Hematological inflammatory indices such as NLR, PLR, CRP, and ESR may serve as accessible and cost-effective markers reflecting disease burden and inflammatory severity. Incorporating systemic inflammatory markers into clinical evaluation may enhance patient stratification and management strategies.

BackgroundThe neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) have drawn attention in recent years as novel non‐specific inflammatory markers; however, only a few studies have been conducted to investigate their value in RA.ObjectiveTo investigate the value of the neutrophil‐to‐lymphocyte ratio (NLR) and the platelet‐to‐lymphocyte ratio (PLR) as complementary diagnostic tools in rheumatoid arthritis (RA).MethodThis study included 1009 patients with RA, 170 patients with other rheumatic diseases, and 245 healthy individuals from four medical centers. The patients' general data, including complete blood count, C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF), were retrospectively analyzed, and the NLR and PLR were calculated. Potential effective indicators were screened by logistic regression analysis, and a receiver operating characteristic (ROC) curve was plotted to evaluate their diagnostic value for RA.Results(a) The NLR and PLR were significantly higher in the RA group than in the non‐RA group and the control group (P < .05). (b) Spearman's Rho showed that the NLR was positively correlated with the PLR (r = .584, P < .05), RF (r = .167, P < .01), and CRP (r = .280, P < .01) but was not significantly correlated with ESR (r = .100, P > .05). The PLR was positively correlated with RF (r = .139, P < .01), CRP (r = .297, P < .01), and ESR (r = .262, P < .05). (c) Logistic analysis showed that RF, CRP, ESR, and the NLR had diagnostic value for RA. (d) For the NLR, the area under the curve (AUC) of the ROC curve was 0.831; at the cutoff value of 2.13, the diagnostic sensitivity, specificity, accuracy, and Youden index were 76.7%, 75.9%, 76.4%, and 0.5424, respectively.ConclusionThe NLR was less effective than CRP and RF but was superior to ESR in the diagnosis of RA. The NLR can thus be used as a complementary diagnostic indicator in the diagnosis of RA.

Behcet's disease (BD) is a systemic vasculitis characterized by recurrent episodes of inflammation with aphthous stomatitis, genital ulcers, skin, joint and internal organ involvement. Currently, there are no reliable laboratory markers that can be used to monitor BD activity. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have low sensitivity, so the search for new biomarkers continues. Neutrophil reactivity intensity (NEUT-RI), neutrophil granularity intensity (NEUT-GI), immature granulocytes (IG), neutrophil-to-lymphocyte ratio (NLR), systemic immune inflammation index (SII) are new inflammatory indicators whose role in BD is not well studied.Objective: to evaluate and compare the efficacy of the determination of NEUT-RI, NEUT-GI, IG, SII, NLR, ESR and CRP in the diagnosis of active BD.Material and methods. 84 patients with a reliable diagnosis of BD and 38 healthy controls were included in the study. BD activity was assessed using the Behcet’s Disease Current Activity Form (BDCAF). Patients with BD were divided into two groups according to activity: Group I included 41 patients with high activity (BDCAF &gt;5) and Group II included 43 patients with low activity (BDCAF ≤5). A complete blood count with determination of NEUT-RI, NEUT-GI, IG, SII and NLR was performed in all patients and healthy donors using the Sysmex XN 1000 automated haematology analyzer (Sysmex Сorp, Japan). ESR was determined using the Westergren method. High-sensitivity serum CRP level was determined in all patients with BD (normal range ≤5) by immunonephelometric method.Results and discussion. Patients with active BD had significantly higher levels of neutrophils, SII, NLR, NEUT-RI, IG, ESR and CRP compared to patients with low disease activity. ROC analysis was performed to compare the significance of these inflammatory markers in the assessment of BD activity. The SII had the largest area under the ROC curve (AUC =0.816). The sensitivity and specificity of the SII at a value of 509.75 or higher for determining the active form of BD were 79.4% and 71.8%, respectively.Conclusion. The new inflammatory parameters (SII, NLR, NEUT-RI and IG) and the traditional inflammatory parameters (ESR, CRP, neutrophils) can serve as laboratory markers for BD activity. SII is the most informative parameter to determine BD activity with optimal sensitivity and specificity.

This study investigated the association between atherosclerosis and systemic inflammation markers, specifically the C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in healthy middle-aged adults. A retrospective cross-sectional study was conducted on a total of 1264 Korean adults aged 40-65. We assessed these inflammatory markers and carotid metrics, such as carotid intima-media thickness (cIMT), plaque number (PN), plaque stenosis score (PSS), and plaque score (PS), using linear regression, logistic regression, and receiver operating characteristic analysis. In males, the ESR and CRP were significantly correlated with the PN (p < 0.001 and p = 0.048, respectively). The ESR was correlated with the PN in females (p = 0.004). The NLR and PLR both correlated with the PS in males (p < 0.001 and p = 0.015, respectively) and females (p = 0.015 and p = 0.023, respectively). The odds ratio for the NLR as a risk factor for increased cIMT was 1.15 (95% confidence interval [CI], 1.03-2.15) for males and 1.05 (95% CI, 1.01-1.29) for females. The AUC for the NLR and PLR as a predictor for the PS showed significance in both men and women. Inflammatory markers, particularly the NLR and PLR, demonstrate a correlation with carotid atherosclerosis. Both the NLR and PLR hold potential as valuable surrogate markers for carotid atherosclerosis. To further substantiate their predictive efficacy, further prospective studies are needed.

BackgroundRheumatoid arthritis (RA) is a systemic autoimmune disease that chronically affects patients with episodes of inflammation. New inflammatory hematological markers were investigated for follow‐up, such as the neutrophil–monocyte ratio (NMR), lymphocyte monocyte ratio (LMR), and neutrophil–lymphocyte ratio (NLR). This study was conducted to determine the most useful marker based on studies of association with RA disease activity and correlation with the classical markers C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF).MethodsThis case‐control study included 62 chronic RA patients who had previously been diagnosed and experienced episodes of symptoms while attending a variety of public and private rheumatology clinics in Ibb City, Republic of Yemen, for the period of September 1 to November 30, 2021. Twenty healthy volunteers were included in this study. Complete blood count, CRP, ESR, and RF levels were measured in all participants.ResultsThe total leukocyte count, neutrophil count, platelet count, NMR, LMR, and NLR were positively correlated with CRP and ESR, but the monocyte count was reversed. The area under the curve (AUC = 0.861, 95% confidence interval [CI] = 0.769–0.948) for the NMR cutoff value of 4.7 was equal to that of CRP and close to that of ESR. This NMR cutoff value had 87% sensitivity and 80% specificity. LMR and NLR cutoff values of 4.35 and 1.35, respectively, resulted in AUCs of (AUC = 0.807, 95% CI, 0.708–0.905) and (AUC = 0.699, 95% CI, 0.571–0.819); their sensitivity and specificity were 62.3%, 90%, 57.4%, and 80%, respectively.ConclusionsAs a convenient and low‐cost inflammatory marker of RA activity, NMR outperformed LMR and NLR.

Background:Pulmonary arterial hypertension (PAH) is one of the main causes of mortality in patients with systemic sclerosis (SSc). Its prevalence ranges between 13 and 35% with echocardiography and between 8...

BackgroundBehçet’s disease (BD) is a complex, inflammatory multisystem disorder. Since the lack of universally recognised pathognomonic laboratory test, the diagnosis relies heavily on clinical findings. Currently, the Monocytes to lymphocytes...

To evaluate the correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) with parameters related to gout activity. The general data of the patients and healthy controls (HCs), including complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum uric acid (SUA), and the presence of tophi were retrospectively analyzed. NLR, MPV, and PLR were calculated in patients with intercritical gout and gout flares. Correlation of the 3 markers with clinical features, like ESR, CRP, SUA, and the presence of tophi, were analyzed. The results revealed that NLR and PLR were elevated and MPV was markedly decreased in patients with gout compared with HCs (all P < .05). In patients with gout flares, NLR, and PLR were higher and MPV was lower than in intercritical gout patients (all P < .05). NLR and PLR were positively correlated with ESR and CRP, whereas MPV was negatively correlated with ESR. NLR, PLR, and MPV showed no obvious correlation with SUA and the presence of tophi. The receiver operating characteristic curve showed that NLR was more valuable in assessing gout disease activity. NLR, PLR, and MPV were correlated with inflammatory parameters in gout; they may be used as complementary tools to evaluate gout activity.

BackgroundThis study aimed to evaluate the ratio of C-reactive protein (CRP) to albumin, inflammatory markers, and parameters from the complete blood count (CBC) in patients with Takayasu arteritis and the association with disease activity.Material/MethodsA retrospective study included thirty-two patients with Takayasu arteritis and 32 healthy controls. Clinical and demographic characteristics of patients with Takayasu arteritis were recorded at baseline, before medication and on remission. Similar data were obtained for the controls at recruitment. Remission was defined as more than six months of stable disease without new vascular lesions in patients who previously had active disease. Kerr’s criteria were used to define active Takayasu arteritis.ResultsIn patients with Takayasu arteritis, the erythrocyte sedimentation rate (ESR), CRP, CRP/albumin ratio, red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) were significantly higher, and albumin and MPV were significantly lower compared with controls. The ESR, CRP, CRP/albumin ratio, NLR, PLR, and MLR were decreased in remission, whereas MPV was increased. CRP and the CRP/albumin ratio were positively correlated and albumin and MPV were negatively correlated with disease activity. The CRP/albumin ratio had the highest correlation with disease activity in Takayasu arteritis. The CRP/albumin ratio, RDW, NLR, PLR, and MLR were positively correlated with CRP and ESR.ConclusionsThe CRP/albumin ratio, RDW, NLR, PLR, MLR, and MPV were markers of remission of active disease, and the CRP/albumin ratio, total albumin, and MPV were markers of disease activity in Takayasu arteritis.

Introduction: The platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) are markers of inflammation that have been reported to be elevated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) compared to stable state. The aim of this study was to determine the association between these parameters and the severity and outcomes of AECOPD. Patients and Methods: We conducted a retrospective study of patients admitted with a diagnosis of AECOPD between January 2014 and December 2017. Clinical characteristics, NLR, PLR, and serum levels of C-reactive protein (CRP) and other data on admission were recorded. Results: A total of 100 patients (91% male; average age 66.89years±11.05 were included in the study. COPD was severe (GOLD C and D) in 57% of cases. The mean level of NLR and PLR were respectively 7.66+/-8.62 and 33.57+/-23.32. NLR and PLR correlated with serum CRP level (r=0.658; p=0.02). Negative and statistically significant correlation was found between NLR and VEMS/CVF (r=0.632; p=0.007). NLR was significantly associated to hypercapnia level (r=0.568; p=0.04) and arterial oxygen saturation (r=0.568; p=0.05). Otherwise, PLR was higher among patients with acidosis (p=0.005) and desaturation (p=0.01) and was associated to longer hospitalization duration (p=0.02). Patients who needed non invasive ventilation, mechanic ventilation or died had higher NLR and PLR levels (p>0.05). Conclusion: NLR and PLR were increased in severe AECOPD and were associated with poor prognosis.

This study aimed to assess the variation in the levels of the neutrophil lymphocyte ratio (NLR) and platelet indices in patients with stable chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD) patients and its association with GOLD stages. COPD is heterogeneous in nature. AECOPD is diagnosed clinically, which is subjective, and clinical judgement may vary from clinician to clinician. Since chronic inflammation underlies the pathogenesis of COPD, markers of inflammation have generated considerable interest in their potential to be used as biomarkers of COPD. This prospective analytical study was carried out at the Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, from December 2018 to July 2020. A total of 64 subjects (32 stable COPD, 32 AECOPD) who satisfied the study criteria were included. Blood samples were taken from stable and AECOPD patients and were compared. It was observed that the NLR, the platelet distribution width, the erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) increased in AECOPD patients compared to stable COPD patients (P <0.001). A positive correlation was observed between the neutrophil lymphocyte ratio, the platelet distribution width, the ESR and the CRP (P <0.001). The NLR and platelet distribution width values increased significantly in AECOPD patients compared to stable COPD patients.

Background Hyperphosphatemia can lead to detrimental effects such as cardiovascular calcification, renal osteodystrophy, secondary hyperparathyroidism, and increased mortality. The neutrophil-to-lymphocyte ratio (NLR) in chronic kidney disease (CKD) patients provides information on the inflammation status, used as a marker of poor prognosis in several disorders such as malignancies, CKD, and myocardial infarction. To study the impact of hyperphosphatemia on NLR and on the inflammatory state in patients with stage 5 CKD under maintenance hemodialysis. Patients and methods This observational cross-sectional study was carried out in Benha University Hospitals on 100 patients on maintenance hemodialysis who were recruited and subjected to careful history, clinical examination, and NLR; serum phosphorus was done with different inflammatory markers. Patients who had significant infection, malignancy, and who had undergone parathyroidectomy were excluded. Results The mean±SD age of the studied group was 61.28±13.7, 40% were males. There were two (2%) with hypophosphatemia, 44 (44%) with normal phosphate, 34 (34%) with mild hyperphosphatemia, and 20 (20%) with severe hyperphosphatemia. There was high statistically significant difference between categories of serum phosphate as regards white blood cell, neutrophil, NLR, and platelets. There was high statistically significant difference between categories of serum phosphate as regards erythrocyte sedimentation rate and C-reactive protein (CRP), and statistically significant difference as regards serum albumin and serum intact-parathyroid hormone. There was positive significant correlation between serum phosphorus and both CRP and NLR (P&lt;0.001). Conclusion There is high prevalence of hyperphosphatemia in hemodialysis patients. Hyperphosphatemia was associated with higher intact-parathyroid hormone, white blood cell, neutrophil, NLR, CRP, and platelets.

BackgroundThe prognostic effect of elevated systemic inflammatory markers, including neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), remains controversial in cancer patients. This meta-analysis was conducted to evaluate the predictive values of these markers for prognoses in ovarian cancer patients.MethodsPotentially relevant publications in PubMed, ISI Web of Science, and EBSCO were searched. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) for overall survival (OS) and progression-free survival (PFS) were determined using a fixed or random effects model.ResultsTen studies involving 2919 patients were included in this meta-analysis. In multivariate analysis, the group with higher NLR had worse OS (HR = 1.34, 95% CI = 1.16-1.54) and shorter PFS (HR = 1.36, 95% CI = 1.17-1.57) than the control group. Furthermore, PLR values higher than the cut-off were associated with not only poorer OS (HR = 1.97, 95% CI = 1.61-2.40) but also more unfavorable PFS (HR = 1.79, 95% CI = 1.46-2.20). Univariate analysis also indicated the same results. Additionally, subgroup analysis showed that when the cut-off values for NLR and PLR were higher, their predictive effects became stronger.ConclusionThis comprehensive meta-analysis suggested that the values of inflammatory markers such as NLR and PLR were associated with ovarian cancer survival. Therefore, inflammatory markers can potentially serve as prognostic biomarkers.

Objective To investigate the correlation between neutrophils lymphocytes ratio (NLR) and disease activity of ulcerative colitis (UC). Methods Case-control study was used to compare NLR differences of 82 active UC patients, 45 inactive UC patients, and 254 healthy controls. The multivariate analysis was applied to analyze the correlation between the NLR, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cells (WBCs), and UC activity. The sensitivity and specificity of NLR to identify UC activity was evaluated. Results NLR of active UC group was 2.45±1.22, which was significantly higher than that of inactive UC group and healthy control group, their NLR were 1.92±0.68 and 1.83±0.75, respectively (H=9.991, P=0.007). The multivariate analysis showed that only CRP was correlated with UC activity (OR=1.396, 95% CI: 1.086~1.795, P=0.009). Receiver operating characteristic (ROC) curve analysis showed that the optimum NLR cut-off point for UC activity was 2.23, the sensitivity and specificity were 55.82% and 62.75%, respectively. Conclusions NLR has a certain reference value for the evaluation of UC activity, but it cannot be independent as a clinical index to evaluate the UC activity. Key words: Colitis, ulcerative/IM; Neutrophils; Lymphocytes

This study evaluated the effectiveness of preoperative inflammatory response markers in distinguishing clear cell carcinoma (CCC) and endometrioid carcinoma (EC) from ovarian endometrioma. Patients with stage I ovarian cancer with histology CCC/EC or endometrioma who underwent surgery at our institution between 2010 and 2021 were included. Preoperative inflammatory response markers evaluated were white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, D-dimer, neutrophil/lymphocyte ratio (NLR), platelet count/lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The tumor markers CA125 and CA19-9 were analyzed. The median values of these markers were compared between the CCC/EC and the endometrioma groups. The areas under the curve (AUC) in Receiver Operating Characteristic analysis were compared. Fifty patients with stage I CCC/EC and 247 patients with endometrioma were included in the study. Inflammatory response markers were significantly higher in CCC/EC cases than in endometrioma cases (P < 0.01). Tumor markers demonstrated higher specificity than inflammatory response markers. The AUCs of CRP, ESR, D-dimer, NLR, and SII were significantly higher than those of CA125 and CA19-9 (P < 0.01). The values of NLR, PLR, and SII in four cases of ovarian cancer with preoperative suspected endometrioma were higher than the cut-off value. Inflammatory response markers may be useful for the detection of stage I ovarian cancer. Notably, the NLR or SII, calculated using a complete blood count, appears particularly efficient. Combining tumor and inflammatory response markers may enhance diagnostic accuracy in distinguishing ovarian cancer from endometrioma.