REFERENCE VALUES OF NEUTROPHIL LYMPHOCYTE RATIO AND PLATELET LYMPHOCYTE RATIO IN HEALTHY ADULTS IN A TERTIARY CARE CENTER IN NORTH INDIA

Main Article Content

RAJAT JHAMB
ROSHAN KUMAR
PRIYANKA GOGOI
G. S. RANGA
BINEETA KASHYAP

Abstract

Background: Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) have been suggested as easily measurable and less invasive marker with predictive and prognostic implications in various inflammatory and ischemic conditions. The studies showing the role of NLR and PLR as a predictive prognostic factor in several inflammatory and ischemic conditions have their cut-off value based on the median, higher quartile, or values determined using receiver-operating curves. Also, their values have been postulated to have geographical, racial, gender, and age differences. A standardized reference value of these attributes is therefore needed to put the results of previous studies into a context that allows for proper interpretation of their potential clinical value.

Objectives: To establish the reference values for Neutrophil-lymphocyte ratio (NLR) and Platelet-lymphocyte ratio (PLR) in healthy adults in a tertiary care center in North India.

Methods: 500 apparently healthy volunteers aged 18-60 years were enrolled for the study and their blood samples were analyzed by an automated counter (MinDr.ay Bc-6800) to get complete hemogram values. Neutrophil Lymphocyte Ratio (NLR) was calculated by dividing absolute neutrophil count by absolute lymphocyte count, likewise, Platelet Lymphocyte ratio (PLR) was calculated by dividing platelet count by absolute lymphocyte count.

Results: The mean NLR and PLR in our study were 1.9±0.6 and 91.77±26.95, respectively. The mean NLR was 1.88±0.61 in males and 1.93±0.59 in females (P-value = 0.373). The mean PLR was 91.55±27.49 in males and 92.08±26.24 in females (P-value = 0.834). The mean NLR for different age groups was 1.87±0.60, 1.93±0.62, and 1.90±0.58 in 18-30, 31-45, and 46-60 years respectively (P-value0.584). The mean PLR was 92.53±27.98, 90.54±26.53, and 92.61±25.75 in 18-30, 31-45, and 46-60 years age groups respectively (P-value = 0.735).

Conclusion: We propose a normal NLR and PLR to be 1.9±0.6 and 91.77±26.95 respectively in our population of North India with no significant difference between males and females. Also, we conclude that NLR and PLR do not differ with age. But more studies with a larger number are required to delineate the difference of NLR and PLR as per sex and age-group is concerned.

 

Keywords:
Reference values, neutrophil lymphocyte ratio, NLR, platelet lymphocyte ratio, PLR.

Article Details

How to Cite
JHAMB, R., KUMAR, R., GOGOI, P., RANGA, G. S., & KASHYAP, B. (2020). REFERENCE VALUES OF NEUTROPHIL LYMPHOCYTE RATIO AND PLATELET LYMPHOCYTE RATIO IN HEALTHY ADULTS IN A TERTIARY CARE CENTER IN NORTH INDIA. BIONATURE, 40(3), 44-52. Retrieved from https://www.globalpresshub.com/index.php/BN/article/view/911
Section
Original Research Article

References

Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy [Internet]. 2001 [Cited 2018 Jul 29];102(1):5–14. Available:http://www.ncbi.nlm.nih.gov/pubmed/11723675

Yoldas H, Karagoz I, Ogun MN, Velioglu Y, Yildiz I, Bilgi M, et al. Novel Mortality Markers for Critically Ill Patients. J Intensive Care Med [Internet]. 2018 Jan 15 [Cited 2018 Aug 17];088506661775338. Available:http://www.ncbi.nlm.nih.gov/pubmed/29334832

Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther [Internet]. 2013 Jan 10 [Cited 2018 Aug 5];11(1):55–9. Available:http://www.ncbi.nlm.nih.gov/pubmed/23259445

Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer [Internet]. 2012 [Cited 2018 Aug 5];107(4):695–9. Available:http://www.nature.com/articles/bjc2012292

Valga F, Monzón T, Henriquez F, Antón-Pérez G. Neutrophil-to-lymphocyte and platelet-to- lymphocyte ratios as biological markers of interest in kidney disease. Nefrologia. Elsevier Espana S.L. 2019;39:243–9.

Ayca D, Erdolu B, Yumun G, Aydin U, Demir A, Tiryakioglu O, et al. Comparing the effecti̇veness of neutrophil- lymphocyte ratio as a mortality predictor on mi̇ddle and advanced age coronary artery bypass graft patients. North Clin Istanbul [Internet]. 2014 [Cited 2018 Aug 17];1(2):95–100. Available:http://www.ncbi.nlm.nih.gov/pubmed/28058310

Kuyumcu ME, Yesil Y, Oztürk ZA, Kizilarslanoglu C, Etgül S, Halil M, et al. The Evaluation of Neutrophil-Lymphocyte Ratio in Alzheimer’s Disease. Dement Geriatr Cogn Disord [Internet]. 2012 [Cited 2018 Aug 17];34(2):69–74. Available:http://www.ncbi.nlm.nih.gov/pubmed/22922667

Xiang Y, Wang JX, Yang DY, Cao XR, Wan FZ, Feng HF, et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther [Internet]. 2013[Cited 2018 Aug 5];6:211. Available:http://www.ncbi.nlm.nih.gov/pubmed/23525143

Masuda M, Kanzaki S, Minami S, Kikuchi J, Kanzaki J, Sato H, et al. Correlations of inflammatory biomarkers with the onset and prognosis of idiopathic sudden sensorineural hearing loss. Otol Neurotol [Internet]. 2012 [Cited 2018 Aug 5];33(7):1142–50. Available:http://www.ncbi.nlm.nih.gov/pubmed/22872174

Azab B, Shah N, Akerman M, McGinn JT. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis [Internet]. 2012[cited 2018 Aug 17]; 34(3):326–34. Available:http://www.ncbi.nlm.nih.gov/pubmed/22466812

Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Platelet-to-lymphocyte ratio: A novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. Kirchmair R, editor. PLoS One [Internet]. 2013[cited 2018 Aug 17]; 8(7):e67688. Available:http://www.ncbi.nlm.nih.gov/pubmed/23844064

Turkmen K. Platelet-to-Lymphocyte Ratio: One of the novel and valuable platelet indices in hemodialysis patients. Hemodialysis international. International Symposium on Home Hemodialysis. 2013;17.

Henriques A, RoDr.íguez-Caballero A, Nieto WG, Langerak AW, Criado I, Lécrevisse Q, et al. Combined Patterns of IGHV Repertoire and Cytogenetic/Molecular Alterations in Monoclonal B Lymphocytosis versus Chronic Lymphocytic Leukemia. Thomas PG, editor. PLoS One [Internet]. 2013[cited 2018 Aug 17]; 8(7):e67751. Available:http://www.ncbi.nlm.nih.gov/pubmed/23844084

Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol [Internet]. 2012[Cited 2018 Aug 17];23(4):265–73. Available:http://www.ncbi.nlm.nih.gov/pubmed/23094130

Lee JS, Kim NY, Na SH, Youn YH, Shin CS. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine (Baltimore) [Internet]. 2018[Cited 2018 Aug 18];97(26): e11138. Available:http://www.ncbi.nlm.nih.gov/pubmed/29952958

Meng X, Chang Q, Liu Y, Chen L, Wei G, Yang J, et al. Determinant roles of gender and age on SII, PLR, NLR, LMR and MLR and their reference intervals defining in Henan, China: A posteriori and big-data-based. J Clin Lab Anal. 2018;32(2).

Fest J, Ruiter R, Ikram MA, Voortman T, Van Eijck CHJ, Stricker BH. Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: A population-based prospective cohort study. Sci Rep. 2018;8(1).

Moosazadeh M, Maleki I, Alizadeh-Navaei R, Kheradmand M, Hedayatizadeh-Omran A, Shamshirian A, et al. Normal values of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio among Iranian population: Results of Tabari cohort. Casp J Intern Med. 2019; 10(3):320–5.

Huguet E, Maccallini G, Pardini P, Hidalgo M, Obregon S, Botto F, et al. Reference values for neutrophil to lymphocyte ratio (NLR), a biomarker of cardiovascular risk, according to age and sex in a latin american population. Current Problems in Cardiology. Mosby Inc.; 2019.

Azab B, Camacho-Rivera M, Taioli E. Average values and racial differences of neutrophil lymphocyte ratio among a nationally representative sample of United States subjects. PLoS One. 2014;9(11).

NI A, NI er. Reference values of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and mean platelet volume in healthy adults in North Central Nigeria. J Blood Lymph [Internet]. 2016[Cited 2018 Aug 18]; 6(1):1–4. Available:https://www.omicsgroup.org/journals/reference-values-of-neutrophillymphocyte-ratio-plateletlymphocyte-ratio-and-mean-platelet-volume-in-healthy-adults-in-north-centra-.php?aid=68492

Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes [Internet]. 2017[Cited 2018 Aug 18];10(1):12. Available:http://www.ncbi.nlm.nih.gov/pubmed/28057051

Kweon OJ, Lee MK, Kim HJ, Chung JW, Choi SH, Kim HR. Neutropenia and neutrophil-to-lymphocyte ratio in a healthy Korean population: Race and sex should be considered. Int J Lab Hematol. 2016;38(3):308–18.

Wu L, Zou S, Wang C, Tan X, Yu M. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in Chinese Han population from Chaoshan region in South China. BMC Cardiovasc Disord [Internet]. 2019[Cited 2020 Jan 5];19(1): 125. Available:https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-019-1110-7

Shiny A, Bibin YS, Shanthirani CS, Regin BS, Anjana RM, Balasubramanyam M, et al. Association of neutrophil-lymphocyte ratio with glucose intolerance: An indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Technol Ther [Internet]. 2014[Cited 2020 Jun 29];16(8):524-30. Available:https://pubmed.ncbi.nlm.nih.gov/24455985/

Acharya AB, Shetty IP, Jain S, Padakannaya I, Acharya S, Shettar L, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in chronic periodontitis before and after nonsurgical therapy. J Indian Soc Periodontol [Internet]. 2019[Cited 2020 Jul 15];23(5):419–23. Available:https://pubmed.ncbi.nlm.nih.gov/31543614/

Lee JS, Kim NY, Na SH, Youn YH, Shin CS. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine (Baltimore) [Internet]. 2018[Cited 2018 Aug 13];97(26): e11138. Available:http://www.ncbi.nlm.nih.gov/pubmed/29952958

Luo H, He L, Zhang G, Yu J, Chen Y, Yin H, et al. Normal reference intervals of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and systemic immune inflammation index in healthy adults: A large multi-center study from western China. Clin Lab. 2019;65(3):255–65.