Neutrophil Lymphocyte Ratio: A Predictor of Disease Severity in Nasal Polyposis and Allergic Fungal Rhinosinusitis
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ORIGINAL ARTICLE
Neutrophil Lymphocyte Ratio: A Predictor of Disease Severity in Nasal Polyposis and Allergic Fungal Rhinosinusitis Anand Subash1 • Rijuneeta Gupta1 • Ashok Gupta1 • Sandeep Bansal1 Abhijeet Singh1 • Shano Naseem2
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Received: 9 April 2020 / Accepted: 10 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract To evaluate Neutrophil Lymphocyte ratio (NLR) as a predictor of disease severity in Nasal Polyposis and Allergic Fungal Rhinosinusitis (AFRS). This was a prospective non-randomized interventional study. Disease severity was graded based on endoscopic and CT scoring. Patients were given pre-operative oral steroids for two weeks and taken up for surgery. The pre-treatment neutrophil lymphocyte ratios were calculated from the differential leucocyte counts and compared with the disease severity and post-operative values. In the interventional arms, the disease severity correlated with the NLR. The mean pre-treatment NLR showed a statistically significant change after the intervention at eight weeks. The NLR normalized in patients with nasal polyposis and continued to be higher in patients with AFRS. NLR correlated to the disease severity and showed a linear correlation with the This original study was a part of the first author’s Thesis during his residency The preliminary results of the study was presented as a podium presentation at the 22nd Annual Meeting of the Haryana State Chapter, Chandigarh and Punjab State Chapter of AOI, Bhatinda, India in 2017, and as a poster presentation at the IFOS 2017, Paris, France by the first author. The results were presented as a Podium presentation at 3rd European Otolaryngology-ENT Surgery Conference, October 08–10, 2018 London, UK by the second author. & Rijuneeta Gupta [email protected] 1
Department of Otolaryngology-Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2
Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
extent of the disease. NLR could be a potential cost-effective marker for disease severity and prognostication. Level of Evidence: Individual Cohort Study (2b) Keywords AFRS Nasal polyposis Neutrophil lymphocyte ratio Recurrence
Introduction Allergic Fungal Rhinosinusitis (AFRS) is a variant of chronic rhinosinusitis characterized by nasal polyps, type I hypersensitivity, heterogeneous soft tissue density on computed tomography (CT), eosinophilic mucin with a positive fungal smear. Patients with AFRS are immunocompetent. The causative agents are dematiaceous fungal species (Bipolaris, Curvularia, Alternaria) and rarely Aspergillus. The condition is more prevalent in a warm and humid environment [1]. Altered leukocyte count correlates with systemic inflammation. Neutrophils are well recognized for their role in an acute inflammatory response, and the lymphocytes play a role in regulating and modulating the inflammation. Often, if one particular cell lineage increases as a part of an inflammatory process, the other
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