PLATELET TO LYMPHOCYTE RATIO IN THE HEALTHY POPULATION OF VOJVODINA
Abstract
BACKGROUND: Platelet to lymphocyte ratio (PLR) is a simple laboratory index that may be applied in diagnostics and follow up the different diseases, with primary or accompanying systemic inflammatory component. However, due to lack of reference interval in general population, clinical application of PLR index is limited. The aim of this study was to determine the reference interval of PLR index.
METHODS: Retrospective observational study included 4672 adult examinees, which underwent regular systematic check-up, including clinical examination and basic laboratory analyses (complete blood count-CBC). The PLR reference interval was calculated using the Clinical and Laboratory Standards Institute guidelines estimating percentiles and their 95% confidence intervals-CI). Verification of reference interval was performed on the group of 95 healthy adults, age and gender matched to the examined one.
RESULTS: The mean age of all examinees was 43±10 years, dominantly males (83.7%). PLR median value was 109(25thpercentile:90-75thpercentile:131; lower limits of the median-62(95%CI:61-63); upper limits of the median-194(95%CI:188-198)). Female had significantly higher PLR levels compared to male (P<0.0001), while in elderly, PLR was significantly lower, compared to middle and young aged (P=0.02). Determined reference interval for female was 70-231 and for male it was 61-183. PLR did not significantly differ between initially examined and second group of examinees [108.0(87-136) vs. 109.0 (90.0-131.0)], p>0.05.
CONCLUSIONS: In representative sample of examinees, where the majority was of young and middle age, PLR reference interval for women is 70-231, while for men is 61-183. In persons older than 65, the values of PLR index may be lower.
References
2. He W, Tuerxun Z, Balati Y, Saiqi L, Pengyi H. Platelet-to-lymphocyte ratio efficiency in predicting major adverse cardiovascular events after percutaneous coronary intervention in acute coronary syndromes: A Meta-Analysis. Rev Cardiovasc Med. 2025; 26:27942.
3. You HJ, Yena J, Hee-Yeon J, Ji-Young C, Sun-Hee P, Chan-Duck K, et al. Platelet-to-lymphocyte ratio and in-hospital mortality in patients with aki receiving continuous kidney replacement therapy: A Retrospective Observational Cohort Study. Kidney Med. 2023; 5:100642.
4. Koupenova M, Clancy L, Corkrey HA, Freedman JE. Circulating platelets as mediators of immunity, inflammation, and thrombosis. Circ Res. 2018; 122:337-351.
5. Tan S, Zheng Q, Zhang W, Zhou M, Xia C, Feng W. Prognostic value of inflammatory markers NLR, PLR, and LMR in gastric cancer patients treated with immune checkpoint inhibitors: a meta-analysis and systematic review. Front Immunol. 2024; 15:1408700.
6. Fu Y, Chen X, Song Y, Huang X, Chen Q, Lv X, et al. The platelet to lymphocyte ratio is a potential inflammatory marker predicting the effects of adjuvant chemotherapy in patients with stage II colorectal cancer. BMC Cancer. 2021; 21:792.
7. Crusz SM, Balkwill FR. Inflammation and cancer: advances and new agents. Nat Rev Clin Oncol. 2015; 12:584-96.
8. Shen Y, Huang X, Zhang W. Platelet-tolymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity- a retrospective study. BMJ Open. 2019; 9:e022896.
9. Ozcan Cetin EH, Cetin MS, Aras D, Topaloglu S, Temizhan A, Kisacik HL, et al. Platelet to lymphocyte ratio as a prognostic marker of in-hospital and long-term major adverse cardiovascular events in st-segment elevation myocardial infarction. Angiology. 2016; 67:336-45.
10. Fu H, Qin B, Hu Z, Ma N, Yang M, Wei T, et al. Neutrophil- and platelet-to-lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clin Lab. 2015; 61:269-73.
11. Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016; 26:372-6.
12. Li C, Wen TF, Yan LN, Li B, Wang WT, Yang JY, et al. Postoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio predicts the outcomes of hepatocellular carcinoma. J Surg Res. 2015; 1:73–9.
13. Karadeniz G, Aktoğu S, Erer OF, Kır SB, Doruk S, Demir M, et al. Predictive value of platelet-to-lymphocyte ratio in exacerbation of chronic obstructive pulmonary disease. Biomark Med. 2016; 7:701-10.
14. Ozarda Y, Higgins, V, Adeli K. Verification of reference intervals in routine clinical laboratories: practical challenges and recommendations. Clin Chem Lab Med. 2018; 1:30-7.
15. Lishan W, Shan Z, Cantian W, Xuerui T, Min Y. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in Chinese Han population from Chaoshan region in South China. BMC Cardiovasc Disord. 2019; 19:125.
16. Lee JS, Kim NY, Na SH, Youn YH, Shin CS. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine 2018; 97:e11138.
17. Kweon OJ, Lee MK, Kim HJ, Chung JW, Choi SH, Kim HR. Neutropenia and neutrophil-to-lymphocyte ratio in a healthy Korean population: race and sex should be considered. Int J Lab Hematol 2016; 38:308–18.
18. Santimone I, Di Castelnuovo A, De Curtis A, Spinelli M, Cugino D, Gianfagna F, et al. White blood cell count, sex and age are major determinants of heterogeneity of platelet indices in an adult general population: results from the MOLI-SANI project. Haematologica. 2011; 96:1180-8.
19. Balduini CL, Noris P. Platelet count and aging. Haematologica. 2014; 99:953-5.
20. McIlhagger R, Gow AJ, Brett CE, Corley J, Taylor M, Deary IJ, et al. Differences in the haematological profile of healthy 70 year old men and women: normal ranges with confirmatory factor analysis. BMC Blood Disord. 2010; 10:4.
21. Elstrott BK, Lakshmanan HHS, Melrose AR, Jordan KR, Martens KL, Yang CJ, et al. Platelet reactivity and platelet count in women with iron deficiency treated with intravenous iron. Res Pract Thromb Haemost. 2022; 6:e12692.
22. Kadikoylu G, Yavasoglu I, Bolaman Z, Senturk T. Platelet parameters in women with iron deficiency anemia. J Natl Med Assoc. 2006; 98:398–402.
23. Biino G, Santimone I, Minelli C, Sorice R, Frongia B, Traglia M, et al. Age- and sex-related variations in platelet count in Italy: a proposal of reference ranges based on 40987 subjects’ data. PLoS One. 2013; 8:e54289.
24. Han S, Gan D, Wang G, Ru Y, Huang C, Lin J, et al. Associations of platelet indices with body fat mass and fat distribution. Obesity. 2018; 26:1637-1643.
25. Erdal E, İnanir M. Platelet-to-lymphocyte ratio (PLR) and Plateletcrit (PCT) in young patients with morbid obesity. Rev Assoc Med Bras. 2019; 65:1182-1187.
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