Correlation between neutrophil/lymphocyte ratio and cognitive impairment in cerebral small vessel disease patients: A retrospective study

Hou, Lan; Zhang, Shuhan; Qi, Dandan; Jia, Tongle; Wang, Huan; Zhang, Wei; Wei, Shuyan; Xue, Conglong; Wang, Pei

doi:10.3389/fneur.2022.925218

Cited by 7 publications

(9 citation statements)

References 27 publications

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“…To our knowledge, this is the first evidence in a large amnestic MCI population to explain a relationship between cognitive decline over time and dysregulation in neutrophil and lymphocyte counts and their related ratios. Similar evidence has been obtained in a recent study showing that the NLR correlated with cognitive impairment in individuals with cerebral small vessel disease [ 43 ]. In a second step, to identify variables associated with the conversion to dementia, we classified MCI subjects according to the primary follow-up diagnosis in stable MCI (non-CONVERTERS) and demented patients (CONVERTERS).…”

Section: Discussionsupporting

confidence: 90%

Investigating the Prognostic Role of Peripheral Inflammatory Markers in Mild Cognitive Impairment

Tondo

Aprile

Marchi

et al. 2023

JCM

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Growing evidence suggests that neuroinflammation plays a critical role in the pathogenesis of neurodegenerative diseases. Peripheral markers of inflammation, including blood cell counts and their ratios, such as the neutrophil-to-lymphocyte ratio (NLR), have been reported as an easily accessible and reliable proxy of central nervous system inflammation. However, the role of peripheral inflammation in dementia and Mild Cognitive Impairment (MCI) still needs to be clarified. In the current study, we aimed to assess the prognostic role of the NLR and other peripheral markers of inflammation in a sample of 130 amnestic MCI, followed up for two to five years. The Mini-Mental state examination (MMSE) score at baseline and follow-up visits was used to assess global cognitive status at each visit and the degree of cognitive decline over time. Baseline peripheral markers of inflammation included blood cell counts and ratios, specifically the NLR, the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR), and the systemic immune inflammation index (SII). After classifying subjects into CONVERTERS and non-CONVERTERS (respectively, patients converting to dementia and subjects showing stability at the last available follow-up), we compared peripheral markers of inflammation among groups ed correlated them with cognitive measures, testing the ability of significant factors to predict conversion to dementia. In our cohort, CONVERTERS showed lower baseline MMSE scores (p-value = 0.004) than non-CONVERTERS. In addition, CONVERTERS had statistically elevated NLR (p-value = 0.005), PLR (p-value = 0.002), and SII levels (p-value = 0.015), besides a lower number of lymphocytes (p-value = 0.004) compared with non-CONVERTERS. In a logistic regression analysis, baseline MMSE scores and NLR predicted conversion to dementia. Tertiles analysis showed that MCI with the highest NLR values had a higher conversion risk. Our study supports the hypothesis that a dysregulation of peripheral inflammation involving both lymphocytes and neutrophils may play a role in the pathogenesis of dementia, even at the early stages of neurodegeneration, as in the MCI condition.

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Section: Discussionsupporting

confidence: 90%

Investigating the Prognostic Role of Peripheral Inflammatory Markers in Mild Cognitive Impairment

Tondo

Aprile

Marchi

et al. 2023

JCM

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“…The results of pooled data from included studies showed significantly higher NLR in patients with cognitive impairment (MD = 0.35, 95% CI:0.26–0.44, p < 00001, I 2 = 86%, sensitivity analysis: consistent, range of MD: 0.33-0.38, all p value<0.05) ( Figure 2 ) ( 26 , 27 , 29 – 32 , 34 , 35 ). Nine studies provided information to estimate the pooled risk of cognitive impairment in patients with a high NLR (primary outcome).…”

Section: Resultsmentioning

confidence: 95%

“…The characteristics of the 11 included studies are summarized in Table 1 . The analysis included four studies involving patients aged ≥ 60 years or older ( 26 , 28 , 30 , 36 ), four studies involving patients with stroke ( 27 , 29 , 33 , 35 ), two studies focused on patients with type 2 DM ( 32 , 34 ), and one study involving patients with metabolic syndrome ( 31 ). In one study ( 36 ), even though the main emphasis was on the relationship between NLR and delirium risk, it also presented valuable data on the association between NLR and cognitive impairment.…”

Section: Resultsmentioning

confidence: 99%

Association between the neutrophil-to-lymphocyte ratio and cognitive impairment: a meta-analysis of observational studies

Hung,

Liu,

et al. 2023

Front. Endocrinol.

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BackgroundSystemic inflammation is one of the underlying mechanisms of cognitive impairment. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a systemic inflammation indicator. This meta-analysis aimed to evaluate the association between high NLR and cognitive impairment (CI) risk.MethodA comprehensive systematic search was conducted to identify eligible studies published until May 30, 2023. The reference group comprised patients with the lowest NLR level, whereas the exposure group comprised those with the highest NLR level. The main outcome was to examine the relationship between NLR and CI risk. The secondary outcome included the association between patient characteristics or comorbidities and CI risk.ResultsThis meta-analysis included 11 studies published between 2018 and 2023, involving 10,357 patients. Patients with CI had a higher NLR than those without (mean difference=0.35, 95% confidence interval [CI]: 0.26–0.44, p < 00001, I2 = 86%). Consistently, pooled results revealed an association between high NLR and CI risk (odds ratio [OR]=2.53, 95% CI:1.67–3.82, p<0.0001, I2 = 84%). Furthermore, aging (mean difference =4.31 years, 95% CI:2.83–5.8, p < 0.00001, I2 = 92%), diabetes (OR=1.59, 95% CI:1.35–1.88, p < 0.00001, I2 = 66%), and hypertension (OR=1.36, 95% CI:1.19–1.57, p < 0.00001, I2 = 0%) were significant risk factors for CI. However, no significant associations were observed between CI and male gender (OR = 0.84, 95% CI:0.64–1.11, p = 0.22, I2 = 81%), body mass index (mean = −0.32 kg/m2, 95% CI: −0.82, 0.18, p = 0.2, I2 = 82%), alcohol consumption (OR = 1.11, 95% CI:0.95−1.3, p = 1.35, I2 = 0%), and smoking (OR = 0.99, 95% CI:0.87–1.13, p = 0.86, I2 = 0%). Meta-regression found that diabetes and hypertension, but not age, significantly moderated the association between NLR and CI.ConclusionThis meta-analysis showed a significant association between high NLR and increased CI risk. Moreover, meta-regression identified diabetes and hypertension, but not age, as significant moderating factors in the relationship between NLR and CI. To validate and strengthen these findings, further large-scale studies are required.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023430384, identifier CRD42023430384.

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“… 27 Hou et al also found that elevated NLR is associated with an increased risk of mild cognitive impairment (CI) in patients with cerebral small vessel disease (CSVD). 28 In addition to NLR, other peripheral inflammatory markers such as systemic immune inflammatory index (SII), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV) and platelet distribution width (PDW) also have been widely studied. Oyama and Pasqui et al found that SII, PLR, MPV and PDW can predict the occurrence of postoperative delirium (POD).…”

Section: Discussionmentioning

confidence: 99%

Higher Neutrophil to Lymphocyte Ratio at Admission is Association with Post-PCI Depressive Symptoms in Patients with ACS

Li¹,

Wan²,

Li³

et al. 2022

NDT

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Background: Depression and elevated blood biomarkers of inflammation are common in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Neutrophil to lymphocyte ratio (NLR) is an indicator of peripheral inflammation and has been proved to be associated with both ACS and depression. Purpose: Our aim was to evaluate the possible association between NLR at admission and post-PCI depressive symptoms at 1 month. Patients and Methods: A total of 224 patients with ACS who underwent PCI for the first time were recruited and completed 1-month follow-up. The 24-item Hamilton Depression Scale (HAMD-24) was used to measure depressive symptoms at 1 month after PCI. Logistic regression was used to analyze the relationship between different NLR levels and post-PCI depressive symptoms. A receiver operating characteristic (ROC) curve analysis was performed to assess the value of NLR for predicting post-PCI depressive symptoms and to determine its critical value. Results: Of the 224 enrolled patients, 52 (23.2%) patients were diagnosed with depressive symptoms at 1 month after PCI. Patients with depressive symptoms showed significantly higher level of NLR at admission than patients without depressive symptoms (4.33 (3.26, 7.01) vs 2.57 (1.72, 3.91), P < 0.001). The proportion of depressive symptoms in post-PCI patients increases progressively along with NLR quartile. In the results of multivariate-adjusted logistic regression analysis, the odds ratio (OR) of post-PCI depressive symptoms was 12.028 (95% CI, 2.642-54.752) for the lowest quartile of NLR compared with the highest quartile. According to the receiver operating characteristic curve (ROC), the area under the curve (AUC) for predicting post-PCI depressive symptoms was 0.716 (95% CI, 0.641-0.791; P < 0.001), and the optimal cutoff of NLR levels was 3.235 (sensitivity: 76.9%, specificity: 66.9%). Conclusion:Higher NLR levels at admission were associated with post-PCI depressive symptoms at 1 month, suggesting that NLR might be useful inflammatory markers to predict post-PCI depressive symptoms at 1 month.

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Correlation between neutrophil/lymphocyte ratio and cognitive impairment in cerebral small vessel disease patients: A retrospective study

Cited by 7 publications

References 27 publications

Investigating the Prognostic Role of Peripheral Inflammatory Markers in Mild Cognitive Impairment

Investigating the Prognostic Role of Peripheral Inflammatory Markers in Mild Cognitive Impairment

Association between the neutrophil-to-lymphocyte ratio and cognitive impairment: a meta-analysis of observational studies

Higher Neutrophil to Lymphocyte Ratio at Admission is Association with Post-PCI Depressive Symptoms in Patients with ACS

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