Objective To investigate the prognostic value of preoperative inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and fibrinogen-to-prealbumin ratio (FPR), for postoperative survival in patients with resectable esophageal squamous cell carcinoma (ESCC). Additionally, to construct and validate a prognostic model for ESCC based on these inflammatory markers combined with TNM staging. Methods We retrospectively analyzed the clinical data of patients with histologically confirmed ESCC who underwent surgical resection at the First Affiliated Hospital of the University of Science and Technology of China during 2017. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values for preoperative NLR, PLR, SII, and FPR. Clinicopathological characteristics were compared between patient groups with different levels of these markers. Survival analysis was performed using the Kaplan-Meier method, and univariate and multivariate regression analyses were conducted using the Cox proportional hazards model to identify prognostic factors. Nomograms for predicting overall survival (OS) and disease-free survival (DFS) were constructed using R software. The model's discrimination was assessed with ROC curves, its calibration was evaluated with calibration curves, and its clinical utility was determined by decision curve analysis (DCA). Results A total of 224 patients who underwent surgery for ESCC were included, comprising 180 males and 44 females. The optimal preoperative cut-off values of NLR, PLR, SII, and FPR for predicting postoperative OS were 2.70, 140.34, 360.73, and 0.015, respectively. The 5-year OS and DFS rates in the high-NLR group were lower than in the low-NLR group (both P<0.001). Similarly, patients in the high-PLR group (P=0.005 and P=0.009, respectively), high-SII group (P=0.008 and P=0.018, respectively), and high-FPR group (both P<0.001) had lower 5-year OS and DFS rates compared to their low-level counterparts. Multivariate Cox regression analysis revealed that patient age, T stage, N stage, tumor differentiation, and NLR>2.70 et al were independent prognostic factors for both OS and DFS. Based on these factors, nomograms for OS and DFS were constructed. The area under the ROC curve (AUC) for 3- and 5-year OS were 0.966 and 0.907, respectively, and for 3- and 5-year DFS were 0.960 and 0.919, respectively. The calibration curves showed good agreement between predicted and actual outcomes. DCA demonstrated that the models provided a positive net benefit for all patients under intervention. Conclusion Preoperative levels of NLR, PLR, SII, and FPR are associated with the prognosis of patients with ESCC, with NLR being an independent prognostic predictor. The nomogram models, constructed based on patient age, tumor differentiation, T stage, N stage, and preoperative NLR level, can accurately predict the prognosis of patients with ESCC. These models may help guide preoperative clinical decision-making and tailor treatment and follow-up strategies.
Objective To explore the clinical and inflammatory characteristics and risk factors of severe asthma to improve clinicians' awareness of the disease. Methods The general information of patients with asthma who visited the Department of Respiratory Medicine, the First Hospital of Shanxi Medical University from May 2018 to May 2021, as well as the diagnosis and treatment of asthma, personal history, comorbidities, auxiliary examination, asthma control test (ACT) score were collected. A total of 127 patients were included, including 40 in the severe asthma group and 87 in the mild-to-moderate asthma group. Chi-square test, independent sample t test and logistic regression were used to analyze the clinical characteristics, inflammatory markers and risk factors of severe asthma. Results Compared with the patients with mild to moderate asthma, the patients with severe asthma were more older (51.0±12.0 years vs 40.7±12.8 years, P<0.05), had more smokers (32.5% vs. 14.9%, P<0.05), and more males (67.5% vs. 40.2%, P<0.05). The patients with severe asthma got poor FEV1%pred [(56.1±23.8)% vs. (93.2±18.0)%, P<0.05] and FEV1/FVC [(56.7±13.2)% vs. (75.8±9.0)%, P<0.05)], and more exacerbations in the previous year (2.7±3.1 vs. 0.1±0.4, P<0.05), lower ACT score (14.4±3.7 vs. 18.0±5.0, P<0.05), and higher blood and induced sputum eosinophil counts [(0.54±0.44)×109/L vs. (0.27±0.32)×109/L, P<0.05; (25.9±24.2)% vs. (9.8±17.5)%, P<0.05]. There was no significant difference in the proportion of neutrophils in the induced sputum or FeNO between the two groups (P>0.05). Analysis of related risk factors showed that smoking (OR=2.740, 95%CI 1.053 - 7.130), combined with allergic rhinitis (OR=14.388, 95%CI 1.486 - 139.296) and gastroesophageal reflux (OR=2.514, 95%CI 1.105 - 5.724) were risk factors for severe asthma. Conclusions Compared with patients with mild to moderate asthma, patients with severe asthma are characterized by poor lung function, more exacerbations, and a dominant eosinophil inflammatory phenotype, which is still poorly controlled even with higher level of treatment. Risk factors include smoking, allergic rhinitis, and gastroesophageal reflux, etc.
Objective This study aims to investigate the changes of inflammatory markers of oropharynx and its correlation with prognosis in the stable phase of chronic obstructive pulmonary disease (COPD). Methods Sixty-two patients with COPD in stable stage were divided into smoking and non-smoking groups, and 31 healthy persons were selected as controls. The pharyngeal swabs were collected to determine tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), collagen type Ⅳ (COL-4), and fibronectin (FN) by an enzyme-linked immunosorbent assay. Meanwhile, eosinophil count and C-reactive protein (CRP) in peripheral blood were measured. The correlations between the above metrics and COPD and the prognosis of the patients were analyzed. Results TNF-α, IL-8, COL-4, FN and CRP levels in patients with COPD were significantly higher compared with control groups (P<0.05), and there were significant differences between smoking and non-smoking groups in inflammatory markers such as TNF-α, IL-8, FN, CRP (P<0.05). The forced expiratory volume in one second (FEV1) and FEV1%pred of patients with COPD were significantly lower than the control group (P<0.05). The smoking index of patients with COPD in smoking group was significantly higher than that in smoking control group (P<0.05). TNF- α and IL-8 were positively associated with blood CRP in patients with COPD. Conclusion The inflammatory markers of oropharynx in patients with COPD are different from those in healthy persons and smoking may promote the increase of inflammatory markers of oropharynx in patients with COPD; the non-invasive detection of paired pharyngeal inflammatory markers may be helpful in determining acute onset and prognosis.