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14.08.2024 | Retinal Disorders

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in retinal artery occlusion: a meta-analysis

verfasst von: Shu-Han Chuang, Cheng-Hsien Chang

Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology | Ausgabe 1/2025

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Abstract

Purpose

The goal of this meta-analysis is to examine the association between Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in patients with Retinal Artery Occlusion (RAO). The analysis aims to provide insight into the potential of NLR and PLR as inflammatory biomarkers for RAO.

Methods

Following PRISMA guidelines, a systematic search in PubMed, Embase, and Scopus identified eight eligible studies. The analysis assessed serum NLR and PLR levels in RAO and non-RAO groups by employing standardized mean differences (SMDs). Sensitivity analyses and publication bias were examined. The diagnostic performance of these markers was evaluated with a quantitative synthesis.

Results

The meta-analysis, involving 1,444 participants, demonstrated significantly elevated NLR (SMD = 0.88, 95% CI: 0.49–1.28, P < 0.001) and PLR (SMD = 0.45, 95% CI: 0.16–0.73, P < 0.001) levels in individuals with RAO. Significant heterogeneity was noted. Sensitivity analysis showed robustness and no significant publication bias was found. Summary results of diagnostic performance revealed promising discriminatory power for NLR and PLR.

Conclusions

The results support a possible connection between systemic inflammation, as indicated by NLR and PLR, and the occurrence of RAO. Although there was heterogeneity, sensitivity analyses showed the findings to be robust. While immediate diagnostic applications are limited, understanding the role of NLR and PLR in the pathological process of RAO provides valuable insights for developing future predictive models, risk management approaches, and treatment strategies. Further research exploring mechanistic insights and conducting prospective studies is warranted to validate their clinical utility.

Key messages

What is known
  • Retinal artery occlusion (RAO) is a serious condition with potential links to systemic inflammation and thrombosis.
  • Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are emerging inflammatory markers.
What is new
  • This is the first meta-analysis examining the association between NLR, PLR and RAO.
  • Elevated NLR and PLR levels were observed in patients with RAO compared to controls.
  • NLR and PLR show potential as indicators of systemic inflammation in RAO pathogenesis.
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Literatur
1.
Zurück zum Zitat Flaxel CJ et al (2020) Retinal and ophthalmic artery occlusions preferred practice pattern®. Ophthalmology 127(2):P259–P287PubMedCrossRef Flaxel CJ et al (2020) Retinal and ophthalmic artery occlusions preferred practice pattern®. Ophthalmology 127(2):P259–P287PubMedCrossRef
2.
Zurück zum Zitat Brown GC, Magargal LE (1982) Central retinal artery obstruction and visual acuity. Ophthalmology 89(1):14–19PubMedCrossRef Brown GC, Magargal LE (1982) Central retinal artery obstruction and visual acuity. Ophthalmology 89(1):14–19PubMedCrossRef
3.
Zurück zum Zitat Hwang DD et al (2023) Incidence of retinal artery occlusion and related mortality in Korea, 2005 to 2018. JAMA Netw Open 6(3):e233068PubMedCrossRef Hwang DD et al (2023) Incidence of retinal artery occlusion and related mortality in Korea, 2005 to 2018. JAMA Netw Open 6(3):e233068PubMedCrossRef
4.
Zurück zum Zitat Brown GC (1994) Retinal arterial obstructive disease. Retina 2:1361–1377 Brown GC (1994) Retinal arterial obstructive disease. Retina 2:1361–1377
5.
Zurück zum Zitat Park SJ et al (2014) Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011. Ophthalmology 121(10):1933–1938PubMedCrossRef Park SJ et al (2014) Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011. Ophthalmology 121(10):1933–1938PubMedCrossRef
6.
Zurück zum Zitat Hayreh SS, Podhajsky PA, Zimmerman MB (2009) Retinal artery occlusion: associated systemic and ophthalmic abnormalities. Ophthalmology 116(10):1928–1936PubMedCrossRef Hayreh SS, Podhajsky PA, Zimmerman MB (2009) Retinal artery occlusion: associated systemic and ophthalmic abnormalities. Ophthalmology 116(10):1928–1936PubMedCrossRef
7.
Zurück zum Zitat Callizo J et al (2015) Cardiovascular risk factors in central retinal artery occlusion: results of a prospective and standardized medical examination. Ophthalmology 122(9):1881–1888PubMedCrossRef Callizo J et al (2015) Cardiovascular risk factors in central retinal artery occlusion: results of a prospective and standardized medical examination. Ophthalmology 122(9):1881–1888PubMedCrossRef
8.
Zurück zum Zitat Jauch EC et al (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 44(3):870–947PubMedCrossRef Jauch EC et al (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 44(3):870–947PubMedCrossRef
9.
Zurück zum Zitat Rudkin AK et al (2010) Clinical characteristics and outcome of current standard management of central retinal artery occlusion. Clin Exp Ophthalmol 38(5):496–501PubMedCrossRef Rudkin AK et al (2010) Clinical characteristics and outcome of current standard management of central retinal artery occlusion. Clin Exp Ophthalmol 38(5):496–501PubMedCrossRef
10.
Zurück zum Zitat Ørskov M et al (2022) Clinical risk factors for retinal artery occlusions: a nationwide case-control study. Int Ophthalmol 42(8):2483–2491PubMedCrossRef Ørskov M et al (2022) Clinical risk factors for retinal artery occlusions: a nationwide case-control study. Int Ophthalmol 42(8):2483–2491PubMedCrossRef
11.
Zurück zum Zitat Elbeyli A et al (2022) Assessment of red cell distribution width, platelet/lymphocyte ratio, systemic immune-inflammation index, and neutrophil/lymphocyte ratio values in patients with central retinal artery occlusion. Ocul Immunol Inflamm 30(7–8):1940–1944PubMedCrossRef Elbeyli A et al (2022) Assessment of red cell distribution width, platelet/lymphocyte ratio, systemic immune-inflammation index, and neutrophil/lymphocyte ratio values in patients with central retinal artery occlusion. Ocul Immunol Inflamm 30(7–8):1940–1944PubMedCrossRef
12.
Zurück zum Zitat Djordjevic D et al (2018) Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injured patients: which ratio to choose to predict outcome and nature of bacteremia? Mediators Inflamm 2018:3758068PubMedPubMedCentralCrossRef Djordjevic D et al (2018) Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injured patients: which ratio to choose to predict outcome and nature of bacteremia? Mediators Inflamm 2018:3758068PubMedPubMedCentralCrossRef
13.
14.
Zurück zum Zitat Ng WW et al (2022) NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit. Sci Rep 12(1):15974PubMedPubMedCentralCrossRef Ng WW et al (2022) NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit. Sci Rep 12(1):15974PubMedPubMedCentralCrossRef
15.
Zurück zum Zitat Urbanowicz T et al (2021) The prognostic significance of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) on long-term survival in off-pump coronary artery bypass grafting (OPCAB) procedures. Biology (Basel) 11(1):34PubMed Urbanowicz T et al (2021) The prognostic significance of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) on long-term survival in off-pump coronary artery bypass grafting (OPCAB) procedures. Biology (Basel) 11(1):34PubMed
16.
Zurück zum Zitat Bhat T et al (2013) Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 11(1):55–59PubMedCrossRef Bhat T et al (2013) Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 11(1):55–59PubMedCrossRef
17.
Zurück zum Zitat Duman TT et al (2019) Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus. Afr Health Sci 19(1):1602–1606PubMedPubMedCentralCrossRef Duman TT et al (2019) Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus. Afr Health Sci 19(1):1602–1606PubMedPubMedCentralCrossRef
18.
19.
Zurück zum Zitat Ozgonul C et al (2016) Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as novel biomarkers of primary open-angle glaucoma. J Glaucoma 25(10):e815–e820PubMedCrossRef Ozgonul C et al (2016) Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as novel biomarkers of primary open-angle glaucoma. J Glaucoma 25(10):e815–e820PubMedCrossRef
20.
Zurück zum Zitat Ulu SM et al (2013) Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy. Diabetes Technol Ther 15(11):942–947PubMedCrossRef Ulu SM et al (2013) Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy. Diabetes Technol Ther 15(11):942–947PubMedCrossRef
21.
Zurück zum Zitat Obata S et al (2023) Blood neutrophil-to-lymphocyte ratio as a risk factor in treatment for retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 261(4):951–957PubMedCrossRef Obata S et al (2023) Blood neutrophil-to-lymphocyte ratio as a risk factor in treatment for retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 261(4):951–957PubMedCrossRef
22.
Zurück zum Zitat Atum M, Alagöz G (2020) Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with retinal artery occlusion. J Ophthalmic Vis Res 15(2):195–200PubMedPubMedCentralCrossRef Atum M, Alagöz G (2020) Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with retinal artery occlusion. J Ophthalmic Vis Res 15(2):195–200PubMedPubMedCentralCrossRef
23.
Zurück zum Zitat Chen T et al (2023) Sex differences in major adverse cardiovascular and cerebrovascular event risk among central retinal artery occlusion patients. Sci Rep 13(1):14930PubMedPubMedCentralCrossRef Chen T et al (2023) Sex differences in major adverse cardiovascular and cerebrovascular event risk among central retinal artery occlusion patients. Sci Rep 13(1):14930PubMedPubMedCentralCrossRef
24.
Zurück zum Zitat Dursun ME et al (2023) Evaluation of plasma inflammatory markers in patients with nonarteritic retinal artery occlusion. Ret Vit 32(2):91–96CrossRef Dursun ME et al (2023) Evaluation of plasma inflammatory markers in patients with nonarteritic retinal artery occlusion. Ret Vit 32(2):91–96CrossRef
25.
Zurück zum Zitat Guven S, Kilic D (2021) Neutrophil to lymphocyte ratio (NLR) is a better tool rather than monocyte to high-density lipoprotein ratio (MHR) and platelet to lymphocyte ratio (PLR) in central retinal artery occlusions. Ocul Immunol Inflamm 29(5):997–1001PubMedCrossRef Guven S, Kilic D (2021) Neutrophil to lymphocyte ratio (NLR) is a better tool rather than monocyte to high-density lipoprotein ratio (MHR) and platelet to lymphocyte ratio (PLR) in central retinal artery occlusions. Ocul Immunol Inflamm 29(5):997–1001PubMedCrossRef
26.
Zurück zum Zitat Pinna A et al (2021) Complete blood cell count measures in retinal artey occlusions. Acta Ophthalmol 99(6):637–643PubMedCrossRef Pinna A et al (2021) Complete blood cell count measures in retinal artey occlusions. Acta Ophthalmol 99(6):637–643PubMedCrossRef
27.
Zurück zum Zitat Qin G et al (2022) Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) are more prominent in retinal artery occlusion (RAO) compared to retinal vein occlusion (RVO). PLoS ONE 17(2 February):e0263587PubMedPubMedCentralCrossRef Qin G et al (2022) Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) are more prominent in retinal artery occlusion (RAO) compared to retinal vein occlusion (RVO). PLoS ONE 17(2 February):e0263587PubMedPubMedCentralCrossRef
28.
Zurück zum Zitat Zhang Y, Xing Z, Deng A (2023) Unveiling the predictive capacity of inflammatory and platelet markers for central retinal artery occlusion. Thromb Res 232:108–112PubMedCrossRef Zhang Y, Xing Z, Deng A (2023) Unveiling the predictive capacity of inflammatory and platelet markers for central retinal artery occlusion. Thromb Res 232:108–112PubMedCrossRef
29.
Zurück zum Zitat Grory BM et al (2021) Management of central retinal artery occlusion: a scientific statement from the American heart association. Stroke 52(6):e282–e294 Grory BM et al (2021) Management of central retinal artery occlusion: a scientific statement from the American heart association. Stroke 52(6):e282–e294
30.
31.
Zurück zum Zitat Liberati A et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100PubMedPubMedCentralCrossRef Liberati A et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100PubMedPubMedCentralCrossRef
33.
Zurück zum Zitat Herzog R et al (2013) Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 13:154PubMedPubMedCentralCrossRef Herzog R et al (2013) Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 13:154PubMedPubMedCentralCrossRef
34.
Zurück zum Zitat Shi J et al (2023) Detecting the skewness of data from the five-number summary and its application in meta-analysis. Stat Methods Med Res 32(7):1338–1360PubMedCrossRef Shi J et al (2023) Detecting the skewness of data from the five-number summary and its application in meta-analysis. Stat Methods Med Res 32(7):1338–1360PubMedCrossRef
35.
Zurück zum Zitat Higgins JP, Li T, Deeks JJ (2019) Choosing effect measures and computing estimates of effect. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) Cochrane handbook for systematic reviews of interventions. https://doi.org/10.1002/9781119536604.ch6 Higgins JP, Li T, Deeks JJ (2019) Choosing effect measures and computing estimates of effect. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) Cochrane handbook for systematic reviews of interventions. https://​doi.​org/​10.​1002/​9781119536604.​ch6
36.
Zurück zum Zitat Luo D et al (2018) Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 27(6):1785–1805PubMedCrossRef Luo D et al (2018) Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 27(6):1785–1805PubMedCrossRef
37.
Zurück zum Zitat Wan X et al (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135PubMedPubMedCentralCrossRef Wan X et al (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135PubMedPubMedCentralCrossRef
38.
Zurück zum Zitat Altman D et al (2001) eds 2000: statistics with confidence, 2nd edn. BMJ Books, London, pp 240 + diskette,£ 19.95 (PB). ISBN 0 7279 1375 1. Citeseer Altman D et al (2001) eds 2000: statistics with confidence, 2nd edn. BMJ Books, London, pp 240 + diskette,£ 19.95 (PB). ISBN 0 7279 1375 1. Citeseer
39.
Zurück zum Zitat Borenstein M et al (2010) A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 1(2):97–111PubMedCrossRef Borenstein M et al (2010) A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 1(2):97–111PubMedCrossRef
41.
Zurück zum Zitat Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463PubMedCrossRef Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463PubMedCrossRef
42.
Zurück zum Zitat Libby P, Hansson GK (2019) From focal lipid storage to systemic inflammation: JACC review topic of the week. J Am Coll Cardiol 74(12):1594–1607PubMedPubMedCentralCrossRef Libby P, Hansson GK (2019) From focal lipid storage to systemic inflammation: JACC review topic of the week. J Am Coll Cardiol 74(12):1594–1607PubMedPubMedCentralCrossRef
43.
Zurück zum Zitat Jiang H et al (2017) Neutrophil-to-lymphocyte ratio correlates with severity of extracranial carotid stenosis-a study using digital subtraction angiography. J Stroke Cerebrovasc Dis 26(6):1182–1190PubMedCrossRef Jiang H et al (2017) Neutrophil-to-lymphocyte ratio correlates with severity of extracranial carotid stenosis-a study using digital subtraction angiography. J Stroke Cerebrovasc Dis 26(6):1182–1190PubMedCrossRef
44.
Zurück zum Zitat Massberg S et al (2003) Activated platelets trigger an inflammatory response and enhance migration of aortic smooth muscle cells. Thromb Res 110(4):187–194PubMedCrossRef Massberg S et al (2003) Activated platelets trigger an inflammatory response and enhance migration of aortic smooth muscle cells. Thromb Res 110(4):187–194PubMedCrossRef
45.
Zurück zum Zitat Hayreh SS, Piegors DJ, Heistad DD (1997) Serotonin-induced constriction of ocular arteries in atherosclerotic monkeys. Implications for ischemic disorders of the retina and optic nerve head. Arch Ophthalmol 115(2):220–8PubMedCrossRef Hayreh SS, Piegors DJ, Heistad DD (1997) Serotonin-induced constriction of ocular arteries in atherosclerotic monkeys. Implications for ischemic disorders of the retina and optic nerve head. Arch Ophthalmol 115(2):220–8PubMedCrossRef
46.
Zurück zum Zitat Núñez J et al (2009) Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. Atherosclerosis 206(1):251–257PubMedCrossRef Núñez J et al (2009) Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. Atherosclerosis 206(1):251–257PubMedCrossRef
47.
Zurück zum Zitat Soop A et al (2013) Effect of lipopolysaccharide administration on the number, phenotype and content of nuclear molecules in blood microparticles of normal human subjects. Scand J Immunol 78(2):205–213PubMedCrossRef Soop A et al (2013) Effect of lipopolysaccharide administration on the number, phenotype and content of nuclear molecules in blood microparticles of normal human subjects. Scand J Immunol 78(2):205–213PubMedCrossRef
48.
Zurück zum Zitat Gu HF, Tang CK, Yang YZ (2012) Psychological stress, immune response, and atherosclerosis. Atherosclerosis 223(1):69–77PubMedCrossRef Gu HF, Tang CK, Yang YZ (2012) Psychological stress, immune response, and atherosclerosis. Atherosclerosis 223(1):69–77PubMedCrossRef
49.
Zurück zum Zitat Yang Y et al (2020) Predictive efficacy of neutrophil-to-lymphocyte ratio for long-term prognosis in new onset acute coronary syndrome: a retrospective cohort study. BMC Cardiovasc Disord 20(1):500PubMedPubMedCentralCrossRef Yang Y et al (2020) Predictive efficacy of neutrophil-to-lymphocyte ratio for long-term prognosis in new onset acute coronary syndrome: a retrospective cohort study. BMC Cardiovasc Disord 20(1):500PubMedPubMedCentralCrossRef
50.
Zurück zum Zitat Balta S, Ozturk C (2015) The platelet-lymphocyte ratio: a simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets 26(7):680–681PubMedCrossRef Balta S, Ozturk C (2015) The platelet-lymphocyte ratio: a simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets 26(7):680–681PubMedCrossRef
51.
Zurück zum Zitat Ferroni P et al (2015) Venous thromboembolism risk prediction in ambulatory cancer patients: clinical significance of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio. Int J Cancer 136(5):1234–1240PubMedCrossRef Ferroni P et al (2015) Venous thromboembolism risk prediction in ambulatory cancer patients: clinical significance of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio. Int J Cancer 136(5):1234–1240PubMedCrossRef
Metadaten
Titel
Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in retinal artery occlusion: a meta-analysis
verfasst von
Shu-Han Chuang
Cheng-Hsien Chang
Publikationsdatum
14.08.2024
Verlag
Springer Berlin Heidelberg
Erschienen in
Graefe's Archive for Clinical and Experimental Ophthalmology / Ausgabe 1/2025
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-024-06594-8

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