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Psoriasis is a chronic immune-mediated inflammatory skin disorder characterized by multifactorial pathogenesis. Recent studies have extensively highlighted the strong associations between psoriasis and various inflammatory markers, which are considered novel predictive tools for evaluating systemic inflammation. Cross-sectional data from the NHANES were analyzed in this study. To assess model performance and generalizability, the dataset was randomly divided into 70% for training and 30% for validation. To address class imbalance in the training data, a hybrid resampling technique (SMOTEENN) was applied. Subsequently, nine classification algorithms were developed using the processed training set, including random forest, neural networks, XGBoost, k-nearest neighbors, gradient boosting, logistic regression, naïve Bayes, AdaBoost, and SVMs. The final gradient boosting was implemented via the gbm package in R, with hyperparameters selected from the default tuning grid of the caret framework. Inflammatory biomarkers with the highest classification utility were identified based on the predictions of the best-performing model. A total of 22,908 participants were included in the final analysis. Gradient boosting (AUC: 0.629, 95% CI: 0.588-0.669) demonstrated the highest performance, followed closely by logistic regression (AUC: 0.627, 95% CI: 0.588-0.666). Among all the inflammatory markers, MLR exhibited the best classification performance, with an AUC value of 0.662 (95% CI: 0.640-0.683), followed by NLMR, with an AUC value of 0.661 (95% CI: 0.640-0.683). Other markers, including the NLR, dNLR, SII, SIRI, and PLR, had AUC values ranging from 0.658 to 0.661. The MLR had the highest relative importance score, demonstrating its critical role in the model's predictive performance for psoriasis classification. The NLR ranked second, followed by the SII and SIRI, which had moderate contributions, whereas the PLR contributed the least. Among all the tested algorithms, the gradient boosting model achieved the best performance. Not only does it achieve the highest predictive accuracy, but it also excels in classification efficacy and feature importance analysis, highlighting key inflammatory markers such as the MLR, SII, and NLR. These markers are significant as reliable indicators for evaluating systemic inflammation and predicting the development of psoriasis, emphasizing their potential clinical applications.

Objective Immunoglobulin A nephropathy (IgAN) is a chronic immune-mediated inflammatory disorder, and a substantial body of research indicates that the activation of inflammatory responses plays a pivotal role in its onset and progression. We conducted a comprehensive assessment of the influence of systemic inflammatory markers, specifically the neutrophil-to-monocyte ratio (NMR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-albumin ratio (PAR), and the systemic immune-inflammation (SII), on the phenotypic manifestations and disease progression of IgAN. Methods A retrospective cohort study was conducted, involving 559 patients who underwent regular follow-up evaluations spanning a minimum of one year. The utility of these inflammatory indicators in predicting IgAN progression was quantified using the area under the receiver operating characteristic curve (AUROC). The kidney progression event was defined as a 30% estimated glomerular filtration rate (eGFR) decline or end-stage kidney disease or death. A prognostic model was developed using Cox proportional hazards regression. Circulating levels of galactose-deficient IgA1 (Gd-IgA1), factor B, and mannose-binding lectin (MBL) were quantitatively determined through enzyme-linked immunosorbent assay (ELISA). Results Among the investigated markers, NLR demonstrated the highest prognostic utility, with an AUROC of 0.622 ( p  < 0.001) at a cutoff value of 2.11. NMR and SII followed closely, exhibiting AUROCs of 0.611 ( p  < 0.001) and 0.581 ( p  = 0.006) respectively, at their respective cutoff points of 8.25 and 560.11. Conversely, LMR, PLR, and PAR yielded AUROCs below the statistical significance threshold (0.473, 0.532, and 0.556, respectively; all p  > 0.05). Univariate Cox regression analysis revealed that elevated neutrophil counts, NMR, NLR, SII, urinary leukocyte levels, and severe Oxford C score were predictive of IgAN progression. Notably, NMR emerged as an independent risk factor for adverse renal outcomes in IgAN patients, even after adjusting for established risk factors, whereas NLR and SII lost statistical significance. Patients with high NMR displayed more pronounced clinical-pathological features and elevated Gd-IgA1 and factor B levels compared to those with low NMR, whereas no such correlation was observed between Gd-IgA1 and either NLR or SII. Conclusions Our findings highlight the crucial role of NMR as an independent predictor of disease progression in IgAN, underscoring its utility in risk stratification for patients.

Background The etiology of intrahepatic cholestasis of pregnancy (ICP) is not fully understood; however, genetic, hormonal, environmental factors, and inflammation are believed to contribute to its development. This study aimed to investigate the relationship between systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and neutrophil-to-monocyte ratio (NMR) levels with disease severity in ICP and to evaluate their potential in predicting adverse perinatal outcomes. Materials and methods A total of 240 pregnant women who delivered at Bursa City Hospital between 2019 and 2024 were retrospectively analyzed. Based on fasting serum bile acid (SBA) levels, patients were divided into three groups: control (SBA < 10 µmol/L), mild (SBA 10–40 µmol/L), and severe (SBA ≥ 40 µmol/L) cholestasis. Inflammatory indices were calculated using complete blood count. Blood samples had been collected at the time of diagnosis, between 28 and 36 weeks of gestation during the third trimester, and prior to the initiation of any treatment. Intergroup comparisons and correlation analyses were conducted. The predictive value of these indices was assessed using receiver operating characteristic (ROC) analysis. Results No significant differences were found between groups in WBC and other complete blood count parameters. Only NMR was significantly higher in the severe cholestasis group compared to the control group ( p  = 0.0057). SII and SIRI levels did not differ significantly among the groups. Gestational age at delivery, birth weight, Apgar scores, and neonatal intensive care unit (NICU) admission rates were significantly worse in the cholestasis groups than in controls ( p  < 0.001). SII showed a negative correlation with gestational age and 5th-minute Apgar score. In ROC analysis, SII predicted preterm birth with an AUC of 0.600 (cut-off: 897.35; sensitivity: 57%; specificity: 67%) and predicted low 5th-minute Apgar scores with an AUC of 0.669 (cut-off: 1248.38; sensitivity: 75%; specificity: 83%). Conclusion The SII and the SIRI may not be reliable markers for the diagnosis or severity assessment of ICP. However, the SII may serve as a potential predictor for preterm birth and low Apgar scores. NMR was significantly elevated in severe ICP patients, suggesting its potential diagnostic value, which should be supported by further studies.

This prospective study investigated the association between elevated neutrophil-to-monocyte ratio (NMR), lymphocyte-to-monocyte ratio (LMR), C-reactive protein (CRP), procalcitonin, and tumor necrosis factor-alpha (TNF-alpha) and the risk of developing neurological complications in mechanically ventilated neonates. The aim was to evaluate these biomarkers’ predictive value for neurological complications. Within a one-year period from January to December 2022, this research encompassed neonates born at ≥35 weeks of gestational age who required mechanical ventilation in the neonatal intensive care unit (NICU) from the first day of life. Biomarkers were measured within the first 24 h and at 72 h. Sensitivity, specificity, and area under the curve (AUC) values were calculated for each biomarker to establish the best cutoff values for predicting neurological complications. The final analysis included a total of 85 newborns, of which 26 developed neurological complications and 59 without such complications. Among the studied biomarkers, TNF-alpha at >12.8 pg/mL in the first 24 h demonstrated the highest predictive value for neurological complications, with a sensitivity of 82%, specificity of 69%, and the highest AUC (0.574, p = 0.005). At 72 h, TNF-alpha levels greater than 14.3 pg/mL showed further increased predictive accuracy (sensitivity of 87%, specificity of 72%, AUC of 0.593, p < 0.001). The NMR also emerged as a significant predictor, with a cutoff value of >5.3 yielding a sensitivity of 78% and specificity of 67% (AUC of 0.562, p = 0.029) at 24 h, and a cutoff of >6.1 showing a sensitivity of 76% and specificity of 68% (AUC of 0.567, p = 0.025) at 72 h. Conversely, CRP and procalcitonin showed limited predictive value at both time points. This study identifies TNF-alpha and NMR as robust early predictors of neurological complications in mechanically ventilated neonates, underscoring their potential utility in guiding early intervention strategies. These findings highlight the importance of incorporating specific biomarker monitoring in the clinical management of at-risk neonates to mitigate the incidence of neurological complications.

Although the potential relationship between headaches, particularly migraine, and peripheral inflammatory markers (PIMs) has been investigated, it is unclear whether PIMs are involved in the pathogenesis of migraine or can differentiate it from non-migraine headaches (nMHs). Using 10 years of data from the Smart Clinical Data Warehouse, patients who visited the neurology outpatient department (OPD) within 30 days after visiting the emergency room (ER) for headaches were divided into migraine and nMH groups, the PIMs were compared including the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte (PLR) ratios, and neutrophil-to-monocyte ratio (NMR). Of the 32,761 patients who visited the ER for headaches, 4005 patients visited the neurology OPD within 30 days. There were significant increases in the NLR, MLR, and NMR, but a lower PLR in the migraine and nMH groups than the controls. The NMR was significantly higher in the migraine than the nMH group. A receiver operating characteristic curve analysis showed that the ability of the NLR and NMR to differentiate between migraine and nMHs was poor, whereas it was fair between the migraine groups and controls. The elevated PIMs, particularly the NLR and NMR, during headache attacks in migraineurs suggest that inflammation plays a role in migraine and PIMs may be useful for supporting a migraine diagnosis.

Background: Heart transplantation represents the treatment for patients with end-stage heart failure (HF) being symptomatic despite optimal medical therapy. We investigated the role of NMR (neutrophil-to-monocyte ratio), NLR (neutrophil-to-lymphocyte ratio), NPR (neutrophil-to-platelet ratio), NWR (neutrophil-to-white cells ratio), MLR (monocyte-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), MWR (neutrophil-to-white cells ratio), and LWR (lymphocyte-to-white cells ratio) at the same cut-off values previously studied, to predict complications after heart transplant within 2 months after surgery. Methods: From May 2014 to January 2021, was included 38 patients in our study from the Cardiovascular and Transplant Emergency Institute of Târgu Mureș. Results: Preoperative NMR > 8.9 (OR: 70.71, 95% CI: 3.39–1473.64; p = 0.006) was a risk factor for the apparition of post-operative paroxysmal atrial fibrillation (Afib). In contrast, preoperative MWR > 0.09 (OR: 0.04, 95% CI: 0.003–0.58; p = 0.0182) represented a protective factor against AFib, but being the risk of complications of any cause (OR: 14.74, 95% CI: 1.05–206.59, p = 0.0458). Conclusion: Preoperative elevated levels of NMR were associated with the apparition of documented AFib, with high levels of MWR as a protective factor. High MWR was a risk factor in developing complications of any cause in the first 2 months after heart transplantation.

Objective Accumulating data show that platelet to lymphocyte ratio (PLR) and neutrophil to monocyte ratio (NMR) undergo changes during inflammation in various diseases; however, the clinical features remain unclear in knee osteoarthritis (OA) patients. The purpose of our study was to evaluate PLR and NMR in knee OA patients, and assess their relationship to knee OA’s radiographic grades. Methods A retrospective study on 132 adult knee OA patients and 162 healthy controls (HC) was performed. All clinical characteristics of the knee OA patients were obtained from their medical records. PLR and NMR were compared between knee OA patients and HC by non-parametric tests. Correlations of PLR and NMR with Kellgren-Lawrence (KL) classification (KL grade 2, KL grade 3, and KL grade 4) were also analyzed through a Spearman correlation test. Ordinal polytomous logistic regression was used to determine independent factors influencing radiographic grades of knee OA patients. Results PLR was increased significantly in knee OA patients, while a statistical difference in NMR was not observed. However, PLR was not relevant to KL grades, while NMR was negatively correlated with these (r = −0.330, P  < 0.01) and was independently associated with KL grades of knee OA. Conclusion PLR could reflect the inflammation response of knee OA. NMR emerged as an independent factor and could be used as a potential marker indicating the severity of knee OA.

Background. Although the use of inflammatory markers in diagnosing Brucella-related complications has been the subject of research, studies on osteoarticular disease are insufficient, especially in children. This study aimed to compare inflammatory markers in children diagnosed with brucellosis, distinguishing between those with and without osteoarticular involvement (OI). Methods. In this retrospective study, patients diagnosed with brucellosis from 1 month to 18 years of age were evaluated. Data collected included age, gender, OI, treatment duration, complete blood count, inflammatory markers including neutrophil-monocyte ratio (NMR), monocyte-lymphocyte ratio, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and Brucella serum agglutination test (SAT) results. OI was confirmed by MRI in symptomatic patients. The results of patients with and without OI were compared. Results. The study included 38 patients, 23.7% having OI (8 with sacroiliitis and 1 with spondylitis). The median age of patients with OI was significantly higher than those without (p=0.037). All patients with OI (n = 9, 100%) had an SAT titer ≥ 1/640. Among patients without OI, 62% (n = 18) had an SAT titer ≥1/640. This difference was statistically significant (p = 0.028). Patients with OI had higher CRP levels (p=0.038) but similar ESR levels compared to those without. WBC levels were significantly lower in the group with OI (p=0.015). NMR was significantly higher in those with OI (p=0.012). Conclusions. Lower WBC counts and higher CRP and NMR levels can predict OI in children with brucellosis at the time of admission. However, our findings should be validated through prospective studies involving larger patient groups.

Background Rheumatoid arthritis (RA) is a systemic autoimmune disease that chronically affects patients with episodes of inflammation. New inflammatory hematological markers were investigated for follow‐up, such as the neutrophil–monocyte ratio (NMR), lymphocyte monocyte ratio (LMR), and neutrophil–lymphocyte ratio (NLR). This study was conducted to determine the most useful marker based on studies of association with RA disease activity and correlation with the classical markers C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF). Methods This case‐control study included 62 chronic RA patients who had previously been diagnosed and experienced episodes of symptoms while attending a variety of public and private rheumatology clinics in Ibb City, Republic of Yemen, for the period of September 1 to November 30, 2021. Twenty healthy volunteers were included in this study. Complete blood count, CRP, ESR, and RF levels were measured in all participants. Results The total leukocyte count, neutrophil count, platelet count, NMR, LMR, and NLR were positively correlated with CRP and ESR, but the monocyte count was reversed. The area under the curve (AUC = 0.861, 95% confidence interval [CI] = 0.769–0.948) for the NMR cutoff value of 4.7 was equal to that of CRP and close to that of ESR. This NMR cutoff value had 87% sensitivity and 80% specificity. LMR and NLR cutoff values of 4.35 and 1.35, respectively, resulted in AUCs of (AUC = 0.807, 95% CI, 0.708–0.905) and (AUC = 0.699, 95% CI, 0.571–0.819); their sensitivity and specificity were 62.3%, 90%, 57.4%, and 80%, respectively. Conclusions As a convenient and low‐cost inflammatory marker of RA activity, NMR outperformed LMR and NLR.

Objective: Bone metastasis is common in advanced prostate cancer (PCa). Recently, there has been a growing interest in the potential role of inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-monocyte ratio (NMR), in predicting advanced disease in patients with solid tumors. In the current study, we aimed to assess the relationship of bone metastasis detected on bone scintigraphy (BS) with NLR, PLR, and NMR in patients with Pca. Materials and Methods: The study group included 85 PCa patients. Patient characteristics, prostate-specific antigen (PSA) values, Gleason score, histopathological features, presence of metastatic focus on BS and complete blood count values were retrospectively evaluated. The relationship of the presence of bone metastasis on BS with clinicopathological features such as PSA, Gleason score, histopathological findings and NLR, PLR and NMR values were investigated. Results: Median NLR, PLR and NMR were 2.90, 125.69 and 8.38, respectively. Thirty-six patients had metastatic disease on BS. Our findings showed a statistically significant relationship between high NLR value and the presence of bone metastasis (p=0.018) and high Gleason score (p=0.034). However, no significant statistical relationship was found between clinicopathological features and PLR and NMR values (p>0.05). Conclusion: Despite the limited number of patients, a significant relationship between high NLR and metastatic bone disease was found. While high NLR has been generally considered an independent risk factor for poor PCa prognosis, we assume that larger scale studies are warranted to assess its value as a prognostic indicator in PCa patients.