Neutrophil Lymphocyte Ratio as a Predictor of Chronic Low Back Pain Severity
Keywords:
Neutrophil to Lymphocyte Ratio, Low Back Pain, Numerical Pain Rating Scale, Lumbar Disc HerniationAbstract
Low back pain is a frequently seen problem in the society and causes loss of productivity. In recent studies, inflammatory mediators and inflammation itself has an efficient role in pain mechanism. We aimed to investigate the association between the neutrophil to lymphocyte ratio level as an inflammatory biomarker with pain severity patients with chronic low back pain. A retrospective analysis was conducted on medical records of low back pain patients between Januari until December 2024 in Neurology Department of Bhakti Rahayu Denpasar Hospital. Seventy-three medical record patients between 27-81 years old were included in the study. The neutrophil-to-lymphocyte ratio (NLR) is calculated by dividing the absolute neutrophil count by the absolute lymphocyte count based on blood samples. The patients were divided into two groups based on pain severity. The average age of the participants was 56,63 years (±15,56) (p= 0,077), with 40 males (54,85) and 33 females (45,2%) with average neutrophil count 5,99 x 109/L (±1,45) (p= 0,200) and lymphocyte count 1,75x 109/L (±0,39) (p= 0,093). NLR cut-off was 3,55 (±0,72) (p= 0,200). Higher NLR correlated with age (r = 0.243, p = 0.038) and pain score (r = 0.394 p < 0.001). High NLR increased the risk of 33, 43 LBP patients experiencing moderate pain (p= <0.001). NLR may be used as a simple and reliable premise independent predictor of pain severity in patients with chronic low back pain
References
Ferreira ML, De Luca K, Haile LM, Steinmetz JD, Culbreth GT, Cross M, et al. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 Jun 1;5(6):e316–29.
Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet [Internet]. 2020 Oct;396(10258):1204–22. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673620309259
Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020 Mar;8(6):299–299.
Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.
Chen S, Chen M, Wu X, Lin S, Tao C, Cao H, et al. Global, regional and national burden of low back pain 1990–2019: A systematic analysis of the Global Burden of Disease study 2019. Vol. 32, Journal of Orthopaedic Translation. Elsevier (Singapore) Pte Ltd; 2022. p. 49–58.
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Vol. 391, The Lancet. Lancet Publishing Group; 2018. p. 2356–67.
YILMAZ A, ALTAŞ H, YILDIRIM T, KAYGISIZ Ş, IŞIK HS. The Clinical Predictive Value of the Neutrophil to Lymphocyte Ratio as a Biomarker in Lumbar Disc Herniation. Middle Black Sea Journal of Health Science. 2019 Aug 28;5(2):145–50.
Wuertz K, Haglund L. Inflammatory Mediators in Intervertebral Disk Degeneration and Discogenic Pain. Global Spine J. 2013 Jun;3(3):175–84.
Li W, Liu T, Wu L, Chen C, Jia Z, Bai X, et al. Blocking the function of inflammatory cytokines and mediators by using IL-10 and TGF-β: A potential biological immunotherapy for intervertebral disc degeneration in a beagle model. Int J Mol Sci. 2014 Sep 26;15(10):17270–83.
Ji RR, Chamessian A, Zhang YQ. Pain regulation by non-neuronal cells and inflammation. Vol. 354, Science. American Association for the Advancement of Science; 2016. p. 572–7.
Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology. 2018 Aug 1;129(2):343–66.
Kaya A, Kaya Y, Topçu S, Günaydın ZY, Kurt M, Tanboğa IH, et al. Neutrophil-to-Lymphocyte Ratio Predicts Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention. Angiology. 2014 Jan;65(1):51–6.
Kavelaars A, Heijnen CJ. Immune regulation of pain: Friend and foe. Sci Transl Med. 2021 Nov 10;13(619).
Parisien M, Lima L V., Dagostino C, El-Hachem N, Drury GL, Grant A V., et al. Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Sci Transl Med. 2022 May 11;14(644).
Guo K, Zeng J, Lu J, Guo Y, Shan P, Huang Y, et al. The clinical significance of the Neutrophil-to-Lymphocyte Ratio as a novel inflammatory biomarker for assessing the severity of intervertebral disc degeneration. Front Med (Lausanne). 2024;11.
Livshits G, Kalinkovich A. Hierarchical, imbalanced pro-inflammatory cytokine networks govern the pathogenesis of chronic arthropathies. Vol. 26, Osteoarthritis and Cartilage. W.B. Saunders Ltd; 2018. p. 7–17.
Chen X, Wang Z, Deng R, Yan H, Liu X, Kang R. Intervertebral disc degeneration and inflammatory microenvironment: expression, pathology, and therapeutic strategies. Inflammation Research. 2023 Sep 4;72(9):1811–28.
Molinos M, Almeida CR, Caldeira J, Cunha C, Gonçalves RM, Barbosa MA. Inflammation in intervertebral disc degeneration and regeneration. J R Soc Interface. 2015 Mar 6;12(104):20141191.
Taniguchi K, Karin M. NF-κB, inflammation, immunity and cancer: coming of age. Nat Rev Immunol. 2018 May 22;18(5):309–24.
Kang L, Zhang H, Jia C, Zhang R, Shen C. Targeting Oxidative Stress and Inflammation in Intervertebral Disc Degeneration: Therapeutic Perspectives of Phytochemicals. Front Pharmacol. 2022 Jul 12;13.
Dolan RD, Lim J, McSorley ST, Horgan PG, McMillan DC. The role of the systemic inflammatory response in predicting outcomes in patients with operable cancer: Systematic review and meta-analysis. Sci Rep. 2017 Dec 1;7(1):16717.
Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic Immune-Inflammation Index Predicts Prognosis of Patients after Curative Resection for Hepatocellular Carcinoma. Clinical Cancer Research. 2014 Dec 1;20(23):6212–22.
Guo Y, Zhao H, Lu J, Xu H, Hu T, Wu D. Preoperative Lymphocyte to Monocyte Ratio as a Predictive Biomarker for Disease Severity and Spinal Fusion Failure in Lumbar Degenerative Diseases Patients Undergoing Lumbar Fusion. J Pain Res. 2022 Sep;Volume 15:2879–91.
Adamstein NH, MacFadyen JG, Rose LM, Glynn RJ, Dey AK, Libby P, et al. The neutrophil–lymphocyte ratio and incident atherosclerotic events: analyses from five contemporary randomized trials. Eur Heart J. 2021 Mar 1;42(9):896–903.
Iwata E, Shigematsu H, Koizumi M, Nakajima H, Okuda A, Morimoto Y, et al. Lymphocyte Count at 4 Days Postoperatively and CRP Level at 7 Days Postoperatively. Spine (Phila Pa 1976). 2016 Jul 15;41(14):1173–8.
Bozkurt H, Arac D, Cigdem B. The effect of the preoperative uric acid level and neutrophil lymphocyte ratio on preoperative and postoperative visual pain scores in patients with lumbar disc hernia: a cross-sectional study. Turk Neurosurg. 2019;
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Copyright (c) 2024 Putu Setiani, Rindha Dwi Sihanto, I Gusti Ngurah Purna Putra, I Gusti Ngurah Angga Nugraha, Kadek Ayu Meilinda Dusak, Kadek Ayu Savitri Mahadewi
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