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The Anatolian Journal of Cardiology Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome? [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(10): 816-822 | DOI: 10.5152/akd.2014.5787  

Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome?

Anzel Bahadır1, Davut Baltacı2, Yasemin Türker3, Yasin Türker4, Darkov Iliev5, Serkan Öztürk6, Mehmet Harun Deler2, Yunus Cem Sarıgüzel2
1Department of Biophysics, Faculty of Medicine, Düzce University, Düzce-Turkey
2Department of Family Medicine, Faculty of Medicine, Düzce University, Düzce-Turkey
3Family Health Center, Düzce-Turkey
4Departments of Cardiology, Faculty of Medicine, Düzce University, Düzce-Turkey
5Department of Family Medicine, University Ss Cyril and Metodius, Medical Faculty, Skopje 1109 R-Macedonia
6Department of Cardiology, Faculty of Medicine, Abant İzzet Baysal University, Bolu-Turkey
7Department of Family Medicine, Faculty of Medicine, Düzce University, Düzce-Turkey
8Department of Family Medicine, Faculty of Medicine, Düzce University, Düzce-Turkey

Objective: Obesity causes subclinical inflammation. Leukocyte count and high-sensitivity C-reactive protein (hs-CRP) are used to indicate inflammation in clinical practice. Also, inflammatory markers are evaluated as important indicators of cardiovascular risk in patients with obesity and metabolic syndrome (MetS). We aimed to investigate the usage of the neutrophil-lymphocyte ratio (NLR) as an inflammatory marker in obese patients with and without MetS. Methods: The study included a total of 1267 patients. The patients were assigned groups according to degree of obesity and status of MetS. Metabolic and inflammatory markers were compared between groups, and correlation analysis was performed. Results: Leukocyte count and hs-CRP were significantly different (p<0.001), but NLR was not different between body mass index (BMI) groups (p=0.168). Both lymphocyte and neutrophil counts were significantly increased with increased degree of obesity (p<0.001, p=0.028, respectively). Leukocyte, neutrophil, and lymphocyte counts and hs-CRP level showed a significant correlation with BMI (r=0.198, p<0.001; r=0.163, p<0.001; r=0.167, p<0.001; r=0.445, p<0.001, respectively), whereas NLR was not correlated with BMI (r=0.017, p=0.737). Only a significant association between a MetS severity of 5 and 4 with hs-CRP level was observed (p=0.028), whereas there was no statistically significant association for leukocyte count and NLR (p=0.246; p=0.643, respectively). Conclusion: NLR was not a good indicator of inflammation, while leukocyte and hs-CRP were more useful biomarkers to indicate inflammation in non-diabetic patients with obesity and MetS.

Keywords: metabolic syndrome, neutrophil-lymphocyte ratio, obesity, inflammation


Obez ve metabolik sendromlu hastalarda nötrofil-lenfosit oranı enflamasyon göstergesi midir?

Anzel Bahadır1, Davut Baltacı2, Yasemin Türker3, Yasin Türker4, Darkov Iliev5, Serkan Öztürk6, Mehmet Harun Deler2, Yunus Cem Sarıgüzel2
1Department of Biophysics, Faculty of Medicine, Düzce University, Düzce-Turkey
2Department of Family Medicine, Faculty of Medicine, Düzce University, Düzce-Turkey
3Family Health Center, Düzce-Turkey
4Departments of Cardiology, Faculty of Medicine, Düzce University, Düzce-Turkey
5Department of Family Medicine, University Ss Cyril and Metodius, Medical Faculty, Skopje 1109 R-Macedonia
6Department of Cardiology, Faculty of Medicine, Abant İzzet Baysal University, Bolu-Turkey
7Department of Family Medicine, Faculty of Medicine, Düzce University, Düzce-Turkey
8Department of Family Medicine, Faculty of Medicine, Düzce University, Düzce-Turkey

Amaç: Obezite klinik belirti göstermeyen enflamasyona neden olmaktadır. Klinik uygulamalarda lökosit sayısı ve yüksek duyarlıklı C-reaktif protein (hs-CRP), enflamasyonu göstermede kullanılmaktadır. Ayrıca enflamatuvar marker'lar, obez ve metabolik sendrom (MetS)' lu hastalarda, önemli bir kardiyovasküler risk göstergesi olarak değerlendirilmektedir. Biz, MetS olan ve olmayan obez hastalarda, nötrofil-lenfosit oranının (NLR) enflamatuvar marker olarak kullanımını araştırdık. Yöntemler: Çalışma toplam 1267 hastayı içermektedir. Hastalar, obezite derecesi ve MetS durumlarına göre gruplara ayrıldı. Gruplar arasında metabolik ve enflamatuvar marker'lar karşılaştırıldı ve korelasyon analizi yapıldı. Bulgular: Lökosit sayısı ve hs-CRP anlamlı (p<0,001) bir şekilde farklı idi, NLR ile vücut kitle indeksi grupları arasında farlılık yoktu (p=0,168). Hem lenfosit hem de nötrofil sayıları obezite derecesindeki artış ile anlamlı derecede arttı (p<0,001, p=0,028, sırasıyla). Lökosit, nötrofil ve lenfosit sayıları ve hs-CRP seviyesi, BMI ile anlamlı bir ilişki gösterdi (r=0,198, p<0,001; r=0,163, p<0,001; r=0,167, p<0,001; r=0,445, p<0,001, sırasıyla), fakat NLR, BMI ile ilişkili değil idi (r=0,017, p=0,737). Yalnızca hs-CRP seviyesi ve MetS ciddiyeti 4 ve 5 kriteri arasında anlamlı ilişki gözlendi (p=0,028), fakat lökosit sayısı ve NLR için istatistiksel olarak anlamlı bir ilişki yoktu (p=0,246; p=0,643, sırasıyla). Sonuç: Obez ve MetS'li diyabetik olmayan hastalarda, lökosit ve hs-CRP enflamasyonu göstermede çok yararlı bir marker iken, NLR enflamasyonu göstermede iyi bir marker değildir.

Anahtar Kelimeler: metabolik sendrom, nötrofil-lenfosit oranı, obesite, enflamasyon


Anzel Bahadır, Davut Baltacı, Yasemin Türker, Yasin Türker, Darkov Iliev, Serkan Öztürk, Mehmet Harun Deler, Yunus Cem Sarıgüzel. Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome?. Anatol J Cardiol. 2015; 15(10): 816-822


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