Search Results (843)

Background: Pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) in breast cancer is influenced by multiple tumor- and host-related factors, and readily available pretreatment biomarkers of response are still limited. This study aimed to evaluate the association between pretreatment systemic inflammatory and nutritional parameters and pCR assessed by the Miller–Payne grading system, with a specific focus on the independent predictive value of pretreatment serum albumin compared with established inflammatory ratios. Methods: A total of 226 patients with breast carcinoma who received NACT between May 2017 and September 2023 were retrospectively evaluated. Pretreatment laboratory parameters—including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), serum albumin, and the CRP/albumin ratio (CAR)—were recorded. Pathological response was assessed using the Miller–Payne grading system by two breast pathologists blinded to laboratory data. Univariable and multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed, complemented by bootstrap validation of the optimal cut-off, a sensitivity analysis using the contemporary ypT0/is ypN0 definition of pCR, and a subgroup analysis by molecular subtype. Results: pCR was observed in 41 patients (18.1%). Pretreatment serum albumin levels were significantly lower in responders than in non-responders (p = 0.027), whereas NLR, PLR, CRP, and CAR were not significantly associated with response. In multivariable analysis, pretreatment serum albumin, Ki-67, and HER2 status emerged as independent predictors of pCR. ROC analysis demonstrated moderate discriminatory ability for albumin (AUC = 0.64); the optimal cut-off was 4.22 g/dL (bootstrap 95% CI 3.50–4.53 g/dL), with values below this threshold associated with a higher likelihood of pCR. The association between low pretreatment albumin and pCR was particularly pronounced in the triple-negative subgroup (3.30 vs. 4.02 g/dL, p = 0.027). The albumin signal remained significant under the stricter ypT0/is ypN0 definition of pCR in univariable analysis (OR 0.47, p = 0.045). Conclusions: Pretreatment serum albumin, independent of systemic inflammatory ratios, is associated with pCR to NACT in breast cancer and may serve as a candidate biomarker for pretreatment risk stratification, particularly when interpreted alongside established tumor-related predictors such as Ki-67 and HER2 status. The association appears especially relevant in the triple-negative subgroup, suggesting that patients with TNBC and low pretreatment serum albumin may warrant heightened multidisciplinary attention during NACT. Validation in larger, prospective, multicenter cohorts is needed before routine clinical implementation. Full article

Background: Hematological parameters derived from complete blood count (CBC) are inexpensive and widely available markers with potential utility in risk stratification of acute coronary syndrome (ACS). However, their incremental prognostic value when used alongside contemporary risk stratification tools such as the Troponin-only Manchester Acute Coronary Syndrome (T-MACS) score remains unclear. Methods: In this prospective, single-center cohort study, 521 patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina were enrolled. Admission CBC parameters (white blood cell count, neutrophils, monocytes, red cell distribution width, mean platelet volume) and derived inflammatory indices (neutrophil-to-lymphocyte ratio, white blood cell-to-mean platelet volume ratio, lymphocyte-to-monocyte ratio, mean platelet volume-to-platelet ratio, and red cell distribution width-to-platelet ratio) were recorded. T-MACS risk scores were calculated, and patients were followed for 30-day major adverse cardiac events (MACE), mortality, and coronary interventions. Associations were assessed using univariate and multivariate logistic regression analyses. Results: Patients experiencing 30-day MACE or mortality had significantly higher white blood cell counts, neutrophil counts, and WMR values (all p < 0.05). Several hematological indices showed significant associations with T-MACS risk categories. In multivariate analysis, intermediate- and high-risk T-MACS classifications independently predicted 30-day MACE (OR 4.49, 95% CI:1.46–13.77, p = 0.009; OR 9.34, 95% CI:3.00–29.03, p < 0.001, respectively), whereas white blood cell count, neutrophil count, and WMR did not demonstrate independent prognostic value beyond T-MACS classification. Conclusions: Admission white blood cell count, neutrophil count, and WMR are associated with short-term adverse outcomes and T-MACS risk severity in patients with NSTE-ACS. However, these markers do not provide additional prognostic value beyond T-MACS classification. These findings suggest that CBC-derived inflammatory markers primarily reflect disease severity rather than incremental prognostic information in the contemporary high-sensitivity troponin era. Full article

Background: Early assessment of myocardial injury severity at presentation remains challenging in acute myocardial infarction (AMI). Complete blood count (CBC)-derived inflammatory indices may provide accessible adjunctive biomarkers reflecting early systemic inflammatory activation associated with myocardial injury. This study evaluated the association and discriminative performance of CBC-derived inflammatory indices for presentation-time myocardial injury severity. Methods: This retrospective study included 252 patients with AMI. CBC-derived inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-lymphocyte × platelet ratio (NLPR), were calculated from blood samples obtained at presentation (0 h). Correlation analysis, multivariable linear regression, logistic regression, incremental model analysis, and receiver operating characteristic (ROC) analysis were performed to assess associations with high-sensitivity Troponin T (hs-Troponin T) levels and high myocardial injury, defined as the highest hs-Troponin T tertile. Results: Both log NLR and log NLPR showed significant positive correlations with log hs-Troponin T (ρ = 0.422 and 0.396, respectively; p < 0.001). In multivariable linear regression adjusted for clinical variables and AMI subtype, log NLR (B = 0.88, p < 0.001) and log NLPR (B =0.77, p < 0.001) remained independently associated with log hs-Troponin T. Incremental model analysis demonstrated significant increases in explanatory performance after addition of log NLR (ΔR² = 0.137) and log NLPR (ΔR² = 0.121, p < 0.001). In logistic regression, log NLR (adjusted OR 2.77, 95% CI 1.65–4.66) and log NLPR (adjusted OR 2.46, 95% CI 1.53–3.95) were independently associated with high myocardial injury. ROC analysis demonstrated modest improvement in discrimination after incorporation of inflammatory indices, with AUC increasing from 0.709 for the baseline clinical model to 0.778 with log NLR and 0.770 with log NLPR. Supplementary reclassification analyses demonstrated improved classification performance. Conclusions: CBC-derived inflammatory indices, particularly NLR and NLPR, were independently associated with presentation-time myocardial injury severity in patients with AMI, even after adjustment for AMI subtype. Although improvements in ROC-based discrimination were modest, supplementary reclassification analyses suggested incremental value beyond conventional clinical variables and AMI subtype. These findings support the potential utility of CBC-derived inflammatory indices for early assessment of myocardial injury during AMI presentation. Full article

Background and Objectives: Reliable pretreatment biomarkers to guide treatment selection in HER2-positive metastatic breast cancer (mBC) remain an unmet need. Systemic inflammatory indices derived from routine blood tests have emerged as accessible prognostic markers. This study evaluated the prognostic value of inflammation-based indices in patients with HER2-positive mBC treated with trastuzumab emtansine (T-DM1). Materials and Methods: In this retrospective single-center cohort study, 50 patients with HER2-positive mBC treated with T-DM1 in the second-line setting were analyzed. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method. ROC analysis assessed the prognostic performance of the CRP/albumin ratio (CAO), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Variables associated with PFS were further evaluated using multivariable Cox regression. Results: The median follow-up was 46 months. Median OS from initial diagnosis and median PFS from T-DM1 initiation were 96 and 7 months, respectively. Metastatic pattern (p = 0.010), CNS involvement at T-DM1 initiation (p = 0.025), liver metastasis (p = 0.041), and best radiologic response (p < 0.001) were associated with PFS. ROC analysis showed modest discrimination (CAO AUC 0.694, NLR 0.658, PLR 0.646, and SII 0.653). In multivariable analysis, best radiologic response to T-DM1 was strongly associated with progression risk and appeared to reflect treatment sensitivity rather than acting as a pretreatment predictor. Conclusions: T-DM1 provided meaningful disease control in this real-world cohort. Treatment response was the main determinant of progression, while baseline inflammatory markers offered modest complementary prognostic value. These findings may aid patient selection for T-DM1, particularly in settings with limited access to trastuzumab deruxtecan. Full article

Background: Heart failure (HF) remains a major early complication following myocardial infarction (MI), contributing significantly to morbidity and adverse clinical outcomes. Reliable early risk stratification is essential for optimizing post-MI management. This study aimed to evaluate the prognostic performance and incremental value of the HALP (Hemoglobin–Albumin–Lymphocyte–Platelet) score and the AHEAD score in predicting 1-month HF after MI. Methods: This retrospective cohort study included 3205 consecutive patients with MI. The primary endpoint was the development of HF within one month. Three multivariable logistic regression models were constructed: a baseline clinical model (Model 1), a HALP-integrated model (Model 2), and an AHEAD-integrated model (Model 3), with component variables excluded to avoid collinearity. Model performance was assessed using odds ratios (ORs), 95% confidence intervals (CIs), and discrimination metrics (AUC). Incremental predictive value was further evaluated using net reclassification improvement (NRI). Internal validation was performed using bootstrapping and 5-fold cross-validation. A predefined subgroup analysis was conducted in patients with preserved ejection fraction (EF ≥ 40%), excluding EF from the models. Results: In the full cohort, all models demonstrated high discriminative ability for 1-month HF (AUC range: 0.950–0.954), with minimal differences between models. The AHEAD-based model showed the highest point estimate (AUC = 0.954, 95% CI: 0.944–0.963), but ROC curves were largely overlapping. Despite limited changes in AUC, the AHEAD score provided moderate improvement in risk reclassification (NRI = 0.287), whereas the HALP score showed minimal incremental value (NRI = 0.152) and was not independently associated with HF in multivariable analysis. In the EF ≥ 40 subgroup, HF incidence was lower (1.9%), and model performance was attenuated but remained robust (AUC range: 0.839–0.882), with the AHEAD score retaining strong independent predictive value. Peak CKMB and creatinine were consistently associated with increased HF risk. Although the odds ratio for CKMB appeared close to unity, this reflects unit scaling, and clinically meaningful increases corresponded to substantial risk increments. A clear dose–response relationship between AHEAD score and HF probability was observed. Conclusions: While both HALP and AHEAD scores are associated with post-MI HF risk, only the AHEAD score provides consistent independent and incremental prognostic value beyond established clinical predictors. Its simplicity and ability to capture comorbidity burden make it a practical adjunct for early risk stratification, particularly in patients with preserved EF. However, given the minimal differences in discrimination metrics and lack of external validation, these findings should be interpreted cautiously and considered hypothesis-generating. Full article

Background/Objectives: Major depressive disorder (MDD) frequently coexists with chronic diseases and inflammatory processes, particularly in primary care. The primary aim of this study was to investigate the association between MDD and multimorbidity burden (≥2 chronic diseases), while the secondary aim was to examine the relationship between MDD and routinely available inflammatory biomarkers. Methods: This retrospective cross-sectional study used electronic medical records from a Family Health Center in Türkiye between 1 January 2025 and 31 December 2025. Individuals aged ≥18 years with accessible records, complete laboratory data, and recorded sociodemographic/lifestyle variables were included. Patients were considered to have MDD if a psychiatrist-diagnosed MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was recorded in the electronic medical system within the past year. Multimorbidity burden was defined as the total number of chronic diseases and was further dichotomized as ≥2 versus <2 for multivariable regression analysis. Inflammatory biomarkers were calculated from routine blood tests: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune–inflammation index (SII), and monocyte-to-HDL cholesterol ratio (MHR). Group comparisons and logistic regression were performed to evaluate associations with MDD. Results: A total of 3006 patients were analyzed; 375 (12.5%) had MDD. Participants with MDD were older and more frequently female, had higher body mass index and waist circumference, and exhibited a substantially higher burden of chronic comorbidities. PLR was higher in the MDD group (p = 0.019), whereas MHR was lower (p = 0.004); NLR, MLR, and SII did not differ significantly. In multivariable analysis, increasing age (OR 1.029, 95% CI 1.019–1.039, p < 0.001), female sex (OR 2.659, 95% CI 1.949–3.636, p < 0.001), and multimorbidity (OR 2.162, 95% CI 1.650–2.833, p < 0.001) were independently associated with MDD, whereas PLR and MHR were not independently associated after adjustment. Conclusions: In this large real-world primary care cohort, MDD was common and strongly linked to multimorbidity. Although PLR and MHR differed significantly between groups, they were not independently associated with MDD after adjustment, suggesting that these differences may be driven by multimorbidity and related clinical factors rather than independent disease-specific effects. Full article

Background: Acute respiratory distress syndrome (ARDS) remains one of the most serious causes of respiratory failure and mortality in critically ill patients. Although the Berlin Definition provides a standardized framework for diagnosis, it offers limited predictive value for clinical outcomes. In this context, there is growing interest in the use of routinely available hematological markers as practical tools for early risk stratification. This study aimed to examine the association between hematological parameters and mortality in patients with ARDS, with particular emphasis on complete blood count-derived inflammatory indices. Methods: This multicenter retrospective cohort study included 404 adult patients with a confirmed diagnosis of ARDS who were admitted to intensive care units in Saudi Arabia. Demographic, clinical, and laboratory data were collected from electronic medical records. In addition to standard hematological parameters, the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and hemoglobin–albumin–lymphocyte–platelet (HALP) score were calculated from admission laboratory findings. Comparisons between survivors and non-survivors were performed using non-parametric statistical tests, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the prognostic performance of these indices for in-hospital mortality. Results: Of the 404 included patients, 295 survived, and 109 died during hospitalization. Non-survivors demonstrated significantly higher white blood cell and neutrophil counts, alongside significantly lower lymphocyte, eosinophil, hemoglobin, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and albumin levels. The derived inflammatory indices further demonstrated clear differences between outcome groups, as NLR and SII were significantly higher in non-survivors, whereas HALP scores were significantly lower. In ROC analysis, NLR showed the strongest discriminatory ability for mortality (AUC = 0.80, 95% CI 0.74–0.85), followed by SII (AUC = 0.76, 95% CI 0.71–0.81) and HALP (AUC = 0.76, 95% CI 0.70–0.81). The optimal cutoff values were 4.26 for NLR, 958 for SII, and 2.15 for HALP. No significant correlations were identified between age and any of the three indices. Upon applying multivariable regression analysis, only NLR maintained its prognostic ability for ARDS-related mortality. Conclusions: Routine hematological parameters, together with derived inflammatory and nutritional indices, were significantly associated with mortality in patients with ARDS. Among the evaluated markers, NLR demonstrated the strongest prognostic performance, both in univariate and multivariate analysis, followed by SII and HALP. As these indices are derived from inexpensive, readily available laboratory tests, they may offer practical value for early risk stratification and clinical decision-making, particularly in resource-limited settings. Full article

Background: Bronchiectasis is a heterogeneous chronic inflammatory airway disease characterized by recurrent exacerbations. Data on composite inflammatory biomarkers for assessing disease activity remain limited. Methods: This retrospective study included 97 patients with non-cystic fibrosis bronchiectasis categorized as stable (n = 39) or with exacerbated bronchiectasis (n = 58). Demographic, clinical, and laboratory data were analyzed, and inflammatory indices—NLR (neutrophil–lymphocyte ratio), PLR (platelet–lymphocyte ratio), SII (Systemic Immune-Inflammation Index), PIV (Pan-Immune-Inflammation Value), CAR (C-reactive protein-to-albumin ratio), and HALP score (hemoglobin × albumin × lymphocyte/platelet)—were calculated, followed by multivariate logistic regression and ROC analyses. Results: Patients with bronchiectasis exacerbations had a higher NLR, PLR, PIV, SII, and CAR and lower HALP (all p < 0.001). The C-reactive protein-to-albumin ratio demonstrated the highest discriminative ability (AUC = 0.995), followed by SII and NLR, while lower HALP and SII were independent predictors of exacerbation. The C-reactive protein-to-albumin and sedimentation-to-albumin ratios were strongly correlated with hospitalization duration (both p < 0.001). Conclusions: Composite inflammatory indices are strongly associated with disease activity in bronchiectasis. CAR showed excellent discriminative performance, while HALP and SII independently predicted exacerbation. These simple, cost-effective biomarkers may support risk stratification and clinical monitoring in routine practice. Full article

Introduction: Immunotherapy with immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 axis has become an established treatment strategy across various malignancies. In this context, PD-L1 expression plays a key role in the clinical management of cancer patients. However, the prognostic significance of PD-L1 expression remains inconsistent across different cancer types. This study aimed to evaluate the prevalence of PD-L1 expression in three cancer types and to examine its association with key clinicopathological parameters, systemic inflammatory markers and patient outcomes. Methods: A retrospective cohort of 141 patients with lung, breast and head and neck cancers diagnosed between 2016 and 2021 was analysed. PD-L1 expression was analysed by immunohistochemistry using clone 22C3 and the scoring system for positivity was determined according to standard clinical scoring practices for each tumour type. Systemic inflammatory markers, including the platelet-to-lymphocyte ratio (PLR), were calculated from pre-treatment blood counts. Correlation and survival analyses were performed to evaluate the associations between PD-L1 expression levels, clinicopathological characteristics and prognosis. Bioinformatics analyses using GeneMania, STRING and TIMER (v.3) databases were conducted to explore functional enrichment, protein–protein interactions and immune-cell infiltration associated with PD-L1 expression. Results: PD-L1 positivity (≥1%) was observed in 56.75% of lung cancer cases, 44% of breast cancer cases and 92.85% of head and neck cancer cases. PD-L1 expression alone was not significantly associated with overall survival across the cancer cohorts. However, it was significantly associated with PLR in the lung cancer cohort (p = 0.036). Notably, low PLR was associated with improved survival in both lung cancer (p = 0.007) and breast cancer (p = 0.031). Bioinformatics analysis identified several PD-L1-interacting genes, including PD-1, CTLA4 and PTPN and demonstrated strong positive correlations between PD-L1 expression and the infiltration of CD8+ T cells, neutrophils and dendritic cells across the analysed malignancies. Conclusions: Despite its high expression in advanced solid tumours, PD-L1 showed limited prognostic value in our cancer cohort. In contrast, systemic inflammatory markers particularly PLR, emerged as a potential indicator of clinical outcome. Our data suggest that integrating PD-L1 status with systemic inflammatory markers may improve outcome prediction and help inform therapeutic decision-making in patients with advanced malignancies. Full article

Background and Objectives: Sinonasal carcinomas are heterogeneous malignancies often associated with poor prognosis because of the locally advanced stage at presentation and high recurrence rates. Easily accessible prognostic biomarkers are therefore of increasing clinical interest. Systemic inflammatory blood markers have shown prognostic value in several solid tumors, but their role in sinonasal carcinomas remains unclear. Materials and Methods: A scoping review was performed according to PRISMA-ScR recommendations. The PubMed/MEDLINE, Scopus, and Embase databases were searched from inception to March 2026. Original English-language studies evaluating preoperative or pre-treatment inflammatory blood biomarkers in sinonasal malignant tumors were included. Results: Six retrospective single-center studies met the inclusion criteria, comprising 1049 patients. All studies evaluated biomarkers before treatment initiation in cohorts managed primarily with upfront surgery. The neutrophil-to-lymphocyte ratio (NLR) was the most frequently investigated biomarker and the one most commonly associated with adverse oncologic outcomes, including poorer survival, advanced stage, and increased recurrence risk. Additional biomarkers included the platelet-to-lymphocyte ratio, advanced lung cancer inflammation index (ALI), systemic immune-inflammation index (SII), and other composite scores. Preliminary evidence suggests that ALI and SII may provide additional prognostic information beyond isolated inflammatory ratios, although current evidence remains limited. Conclusions: Preoperative inflammatory blood biomarkers, particularly NLR, appear to be promising, low-cost, and widely accessible prognostic tools for risk stratification in sinonasal carcinomas. However, current evidence is limited by retrospective study design, heterogeneous cohorts, and non-standardized cut-off values. Prospective multicenter studies are needed before routine clinical implementation can be recommended. Full article

Background: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis characterized by chronic inflammation, endothelial dysfunction, and high residual risk of major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). This review aimed to summarize the prognostic role of inflammatory biomarkers in PAD and to discuss their therapeutic implications. Methods: A comprehensive narrative review was performed using PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library, focusing mainly on English-language studies published in recent years. Randomized trials, observational studies, systematic reviews, and meta-analyses evaluating inflammatory biomarkers and anti-inflammatory or vasculoprotective therapies in PAD were included. Results: Both classical and emerging inflammatory biomarkers were associated with PAD severity and adverse outcomes. C-reactive protein, fibrinogen, interleukins, tumor necrosis factor-α, myeloperoxidase, galectin-3, and growth differentiation factor-15 showed prognostic value for MACEs, MALEs, restenosis, amputation, and mortality. Among newer indices, the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, C-reactive protein-to-albumin ratio, and HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) score appear especially promising for risk stratification. Anti-inflammatory and pleiotropic therapies, including canakinumab, colchicine, statins, and PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors, may help reduce residual inflammatory risk. Conclusions: Inflammatory biomarkers may improve prognostic stratification and support more personalized management in PAD. Their integration into clinical practice could enhance limb preservation and long-term cardiovascular outcomes. Full article

Background: Hashimoto’s thyroiditis (HT) is a chronic autoimmune disorder characterized not only by thyroid dysfunction but also by metabolic disturbances, micronutrient inadequacies, and low-grade inflammation. Composite indices derived from routine laboratory parameters may therefore help capture the broader systemic profile of the disease. This study explored within-cohort associations of immunonutritional indices including the Prognostic Nutritional Index (PNI), Nutritional Risk Index (NRI), and Controlling Nutritional Status (CONUT), and hemogram-derived inflammatory markers including the Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII), with thyroid function, thyroid autoimmunity, metabolic characteristics, disease duration, and vitamin D status in adults with Hashimoto’s thyroiditis. Methods: This cross-sectional study included 229 adults diagnosed with HT. PNI, NRI, CONUT, and complete blood count-derived inflammatory markers were evaluated in relation to thyroid function, thyroid autoimmunity, disease duration, metabolic characteristics, and vitamin D status. Because most variables were not normally distributed, the main analyses were conducted using non-parametric tests. Correlations were evaluated using Spearman’s rank correlation coefficients. Exploratory regression models were estimated using HC3 heteroscedasticity-consistent robust standard errors, and CRP-based sensitivity analyses were performed by excluding participants with CRP > 10 mg/L. Results: Vitamin D deficiency was highly prevalent and affected 70.3% of the participants. Among the immunonutritional indices, NRI differed significantly according to BMI category and HOMA-defined insulin resistance (both p < 0.001), indicating a closer relationship with metabolic burden. PNI was associated with disease duration (p = 0.009), whereas the inflammatory indices were largely similar across the clinical groupings examined. In exploratory robust regression models, the explanatory power remained modest (R² = 0.066–0.171). PLR showed the most consistent index-related association with TSH, whereas the CONUT–FT3 association observed in the full-sample robust model was not retained after CRP-based sensitivity analysis. Conclusions: Adults with HT in this study showed frequent vitamin D deficiency together with a substantial burden of excess weight and insulin resistance. Routine immunonutritional and inflammatory indices may provide supportive information on within-cohort biochemical and metabolic heterogeneity, but they should not be interpreted as stand-alone diagnostic or prognostic markers. In particular, NRI appeared to reflect metabolic and adiposity-related burden more than nutritional risk alone, while PLR showed the most internally consistent index-related association with TSH. Full article

Background: Sepsis and septic shock are associated with high mortality in intensive care units (ICUs), with a substantial risk persisting after ICU discharge. However, it remains unclear whether inflammatory biomarkers retain their prognostic value at the time of ICU discharge. This study aimed to evaluate whether discharge inflammatory biomarkers—including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-mean platelet volume ratio (PLT/MPV), and C-reactive protein-to-albumin ratio (CAR)—remain predictive of short- and long-term mortality in patients with sepsis and septic shock. Methods: In this single-center, retrospective cohort study, adult patients with sepsis or septic shock discharged from a tertiary ICU specializing in chest diseases between January 2013 and January 2015 were included. Sepsis and septic shock were retrospectively re-classified according to Sepsis-3 criteria. Inflammatory biomarkers measured at ICU admission and discharge, along with clinical variables and disease severity scores (APACHE II and SOFA), were recorded. Patients were followed for 28-day, 6-month, and 2-year mortality. The prognostic performance of biomarkers was assessed using receiver operating characteristic (ROC) analysis, and optimal cut-off values were determined. Independent predictors of mortality were evaluated using Cox proportional hazards regression analysis. Results: A total of 461 patients were included. In total, 291 (63.1%) had sepsis without shock and 170 (36.9%) had septic shock. The overall male proportion was 62%, with a median age of 65 (IQR 54–74) years in the sepsis group and 70 (63–79) years in the septic shock group. Mortality rates were significantly higher in patients with septic shock compared to those with sepsis at 28 days (24% vs. 10%, p < 0.001), 6 months (44% vs. 27%, p < 0.001), and 2 years (71% vs. 57%, p = 0.003). In unadjusted survivor/non-survivor comparisons, elevated discharge NLR and CAR were associated with early post-ICU mortality. However, in multivariable Cox regression, discharge NLR, but not discharge CAR, remained independently associated with 28-day and 6-month mortality. On ROC analysis, discharge NLR showed moderate discriminative performance for 28-day mortality (AUC 0.67, 95% CI 0.60–0.74), as did discharge CAR (AUC 0.68, 95% CI 0.60–0.76), although CAR did not retain independent prognostic significance after adjustment. An NLR value ≥ 5 was identified as an independent predictor of 28-day mortality (HR 2.44; 95% CI 1.24–4.80; p = 0.010) and was also significantly associated with 6-month mortality (HR 2.02; 95% CI 1.18–3.45; p = 0.011), although its predictive value decreased over longer follow-up periods (HR 1.37; 95% CI 0.93–2.01; p = 0.11 at 2 years). Conclusions: Inflammatory biomarkers measured at ICU discharge, particularly NLR, remain predictive of short-term mortality in patients with sepsis and septic shock, but their prognostic value diminishes over time. Assessment of inflammatory status at ICU discharge may provide a practical tool for early post-ICU risk stratification and may support clinical decisions regarding intensified outpatient surveillance and follow-up scheduling in this vulnerable population. Full article

Background and Objectives: Sepsis is a life-threating organ dysfunction condition caused by the body’s uncontrolled response to an infection. Many traditional and novel inflammatory markers have been used to determine poor prognosis in patients’ sepsis. The inflammatory prognostic index (IPI) is also a novel marker of inflammation. As there are no studies examining the association of the IPI with in-hospital mortality in patients with sepsis nor its performance compared with other inflammatory markers, we aimed to investigate the clinical importance of the IPI for predicting in-hospital mortality in sepsis patients. Materials and Methods: A total of 157 consecutive patients diagnosed with sepsis were retrospectively included in this study. The systemic immune-inflammation index (SII; platelet × neutrophil/lymphocyte), the systemic inflammatory response index (SIRI; neutrophil × monocyte/lymphocyte), the aggregate index of systemic inflammation (AISI; neutrophil × platelet × monocyte/lymphocyte) and the IPI (C-reactive protein × neutrophil-to-lymphocyte ratio [NLR]/albumin) were calculated for all patients. Patients were divided into two groups: survivors (n = 81) and non-survivors (n = 76). Results: Non-survivor patients had significantly higher SII (p = 0.002), SIRI (p < 0.001), AISI (p = 0.002) and IPI (p < 0.001) than survivors. The AUC of the IPI was significantly higher than those of the SII (0.751 vs. 0.645; p = 0.010) and the AISI (0.751 vs. 0.648; p = 0.021) and tended to be higher than that of the SIRI (0.751 vs. 0.687; p = 0.091). Based on logistic regression analysis, the IPI was found to be an independent predictor of mortality (OR: 1.007, 95%CI: 1.002–1.012, p = 0.006). Conclusions: The IPI is a novel combined inflammatory marker that can be easily obtained from laboratory parameters. We determined that the IPI had moderately higher discriminatory ability than the SII and the AISI in patients with sepsis, which indicates that it may be used for risk stratification in this population. Full article

Background/Objectives: This study evaluates the prognostic value of baseline inflammatory biomarkers, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV) in advanced cutaneous melanoma treated with first-line immunotherapy. Methods: This multicenter retrospective study included 162 patients with unresectable stage III/IV cutaneous melanoma treated with first-line pembrolizumab, nivolumab, or nivolumab plus ipilimumab. Biomarkers were calculated from complete blood counts obtained within 30 days before treatment start. Cut-offs were defined by ROC analysis. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan–Meier and Cox regression. Response was assessed by RECIST v1.1. Results: Higher baseline NLR, PLR, MLR, SII, and PIV were more common in patients with adverse baseline features, including liver metastases, elevated LDH, and poorer ECOG performance status. Patients with biomarker values below the cut-offs had significantly longer PFS and OS. In biomarker-specific multivariable models adjusted for selected clinical covariates, PIV retained the most consistent association with PFS and OS, while MLR was associated with PFS, and PLR with OS. Conclusions: Baseline inflammatory biomarkers from routine blood counts provide useful prognostic information in advanced melanoma treated with first-line ICIs. PIV showed the most consistent association with survival outcomes and may support initial risk stratification alongside LDH, ECOG, and metastasis pattern. However, prospective validation in independent cohorts is needed before routine clinical implementation. Full article