The Neutrophil-to-Lymphocyte ratio as a marker of recovery 
status in patients with severe dental infection

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Abstract

Background

The aim of the study was to assess the value of pretreatment neutrophil/lymphocyte (N/L) ratio and mean platelet volume (MPV) and the correlation between these markers with progression in patients with severe odontogenic infection.

Material and Methods

A cohort of 100 patients with severe odontogenic infection were divided into 2 groups according to their length of hospital stay. The N/L ratio and MPV was measured in all patients. The correlation in all patients between preoperative fever, preoperative antibiotic doses, postoperative antibiotic doses, total antibiotic doses and hospital stay with N/L ratio and MPV were analyzed. The Youden index was used to identify the optimal cut-off value.

Results

There were positive and statistically significant correlations between N/L ratio and prolonged hospital stay and postoperative antibiotic doses and total antibiotic doses. The optimum cut –off level of N/L ratio was 5.19 according to ROC analysis. However, there was no correlation between MPV and any of these parameters.

Conclusions

N/L ratio may be used as a prognostic marker for patients with odontogenic infections. These patients may need a higher dose of antibiotics and stay more than 1 day in hospital for the treatment of odontogenic infection when the N/L ratio is detected to be more than 5.19.

Key words:Neutrophil/lymphocyte ratio, mean platelet volume, odontogenic infection.

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Most cited references 16

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The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia

Cornelis de Jager, Peter Wever, Eugenie Gemen … (2012)

Study Objective The neutrophil-lymphocyte count ratio (NLCR) has been identified as a predictor of bacteremia in medical emergencies. The aim of this study was to investigate the value of the NLCR in patients with community-acquired pneumonia (CAP). Methods and Results Consecutive adult patients were prospectively studied. Pneumonia severity (CURB-65 score), clinical characteristics, complications and outcomes were related to the NLCR and compared with C-reactive protein (CRP), neutrophil count, white blood cell (WBC) count. The study cohort consisted of 395 patients diagnosed with CAP. The mean age of the patients was 63.4±16.0 years. 87.6% (346/395) of the patients required hospital admission, 7.8% (31/395) patients were admitted to the Intensive Care Unit (ICU) and 5.8% (23/395) patients of the study cohort died. The NLCR was increased in all patients, predicted adverse medical outcome and consistently increased as the CURB-65 score advanced. NLCR levels (mean ± SD) were significantly higher in non-survivors (23.3±16.8) than in survivors (13.0±11.4). The receiver-operating characteristic (ROC) curve for NLCR predicting mortality showed an area under the curve (AUC) of 0.701. This was better than the AUC for the neutrophil count, WBC count, lymphocyte count and CRP level (0.681, 0.672, 0.630 and 0.565, respectively). Conclusion Admission NLCR at the emergency department predicts severity and outcome of CAP with a higher prognostic accuracy as compared with traditional infection markers.

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Fracture healing is accelerated in the absence of the adaptive immune system.

Daniel Toben, Ireen Schroeder, Thaqif el Khassawna … (2010)

Fracture healing is a unique biologic process starting with an initial inflammatory response. As in other regenerative processes, bone and the immune system interact closely during fracture healing. This project was aimed at further elucidating how the host immune system participates in fracture healing. A standard closed femoral fracture was created in wild-type (WT) and recombination activating gene 1 knockout (RAG1(-/-)) mice lacking the adaptive immune system. Healing was investigated using micro-computed tomography (µCT), biomechanical testing, and histologic and mRNA expression analyses. Biomechanical testing demonstrated a significantly higher torsional moment on days 14 and 21 in the RAG1(-/-) mice compared to the WT group. µCT evaluation of RAG1(-/-) specimens showed earlier mineralization and remodeling. Histologically, endochondral ossification and remodeling were accelerated in the RAG1(-/-) compared with the WT mice. Histomorphometric analysis on day 7 showed a significantly higher fraction of bone and a significantly lower fraction of cartilage in the callus of the RAG1(-/-) mice than in the WT mice. Endochondral ossification was accelerated in the RAG1(-/-) mice. Lymphocytes were present during the physiologic repair process, with high numbers in the hematoma on day 3 and during formation of the hard callus on day 14 in the WT mice. Expression of inflammatory cytokines was reduced in the RAG1(-/-) mice. In contrast, expression of anti-inflammatory interleukin 10 (IL-10) was strongly upregulated in RAG1(-/-) mice, indicating protective effects. This study revealed an unexpected phenotype of enhanced fracture healing in RAG1(-/-) mice, suggesting detrimental functions of lymphocytes on fracture healing. The shift from proinflammatory to anti-inflammatory cytokines suggests that immunomodulatory intervention strategies that maximise the regenerative and minimize the destructive effects of inflammation may lead to enhanced fracture repair. © 2011 American Society for Bone and Mineral Research.

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Mean platelet volume in psoriasis and psoriatic arthritis.

Filiz Canpolat, Hatice Akpinar, Fatma Eskioğlu (2010)

Mean platelet volume (MPV), an indicator of platelet activation, is a newly emerging risk factor for atherothrombosis. There is evidence of platelet activation in psoriasis and psoriatic arthritis (PsA). The association between psoriasis, PsA, and atherosclerosis is well documented, yet, the underlying mechanisms remain unclear. The aim of this study was to investigate the differences of MPV values in patients with psoriasis, PsA, and healthy subjects and the correlation between MPV and the clinical disease activity. A total of 106 patients with psoriasis were included in this study. The study population grouped as 48 patients with PsA (group 1) and 58 patients without PsA (group 2) and 95 healthy controls (group 3). MPV was measured in psoriasis and PsA patients. MPV values were collected from standard complete blood count samples. Clinical features and PASI scores in group 1 and 2 were also recorded. MPV in patients with psoriasis 8.7 +/- 0.9 fL was significantly higher than that of control subjects 7.3 +/- 0.8 fL (p < 0.001). There was also statistical difference between MPV levels of patients with (9.5 +/- 0.8) and without (8.0 +/- 0.7) arthritis (p < 0.001). MPV levels were positively correlated with psoriasis area and severity index score (p = 0.000, r = +0.735). MPV levels showed positive correlation with disease duration (p = 0.01, r = 0.518). MPV levels are increased in patients with psoriasis and PsA. MPV may be a marker for the severity of psoriasis. This study may confirm previous observation indicating increased platelet activation in psoriasis. Increased platelet activity could contribute to increasing the atherosclerotic risk in patients with psoriasis and PsA.

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Author and article information

Journal

Journal ID (nlm-ta): Med Oral Patol Oral Cir Bucal

Journal ID (iso-abbrev): Med Oral Patol Oral Cir Bucal

Journal ID (publisher-id): Medicina Oral S.L.

Title: Medicina Oral, Patología Oral y Cirugía Bucal

Publisher: Medicina Oral S.L.

ISSN (Print): 1698-4447

ISSN (Electronic): 1698-6946

Publication date (Print): July 2017

Publication date (Electronic): 18 June 2017

Volume: 22

Issue: 4

Pages: e440-e445

Affiliations

[1 ]MD, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Assistant Professor in Internal Medicine, Kayseri, Turkey

[2 ]DDs,PhD, Genome and Stem Cell Center and Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Assistant Professor, Kayseri, Turkey

[3 ]MD, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Assistant Professor in Anesthesiology, Kayseri, Turkey

[4 ]PhD, Department of Statistics, Erciyes University Medical School, Kayseri, Assistant Professor, Kayseri, Turkey

[5 ]Turcosa Analytics Solutions Ltd. Co, Erciyes Teknopark, Kayseri, Turkey

[6 ]DDs, PhD, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem University, Professor, İstanbul, Turkey

Author notes

Erciyes University Department of Oral and Maxillofacial Surgery 38039 Kayseri, Turkey , E-mail: fdogruel@ 123456gmail.com

Conflict of interest statement:We have no conflict of interest to state.

Article

Publisher ID: 21915

DOI: 10.4317/medoral.21915

PMC ID: 5549517

PubMed ID: 28624841

SO-VID: 2b720b3e-5d68-4e2f-bd5b-7df5ee664ef5

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Neutrophil-to-Lymphocyte ratio as a marker of recovery status in patients with severe dental infection

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Abstract

Background

Material and Methods

Results

Conclusions

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25th European Students' Conference

Most cited references 16

The Neutrophil-Lymphocyte Count Ratio in Patients with Community-Acquired Pneumonia

Fracture healing is accelerated in the absence of the adaptive immune system.

Mean platelet volume in psoriasis and psoriatic arthritis.

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