Accepted Article
Neutrophil/lymphocyte ratio in granulomatous disease 1 Raim Iliaz1, Sinem Iliaz2
1
Department of Internal Medicine, Istanbul University, Istanbul Medical Faculty, IstanbulTurkey 2 Department of Pulmonary Medicine, Istanbul Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul-Turkey We read with great interest the article entitled “The clinical significance of
hematologic parameters in patients with sarcoidosis” by Dirican and colleagues. In that well organized study Dirican et al examined the usability of the neutrophil/lymphocyte ratio (NLR)
and other hematologic parameters in sarcoidosis. In the study, NLR is higher in patients with sarcoidosis compared to healthy volunteers and found that NLR showed a positive correlation with erythrocyte sedimentation rate (1). NLR as a new inflammatory marker is very popular subject and was studied in many
clinical situations. The NLR has been studied in malignancies, demantia and cardiovascular disease. In pulmonary medicine the NLR has been studied mostly in lung cancer and high level of NLR was associated with poor prognosis in patiens with lung cancer (2). Also NLR has been studied in chronic obstructive pulmonary disease (COPD) and has been shown to be higher in patients with exacerbations compared with stable COPD and healthy controls (3). NLR is a marker that can be calculated easily from complete blood count. This
inflammatory marker is repeatable and easily accessible. Therefore can reach wide area of use. Sarcoidosis is a multisystemic granulomatous disease and frequently presents with lung involvement. Tuberculosis is a common infectious disease in the world and like sardoidosis it
is a granulomatous disease that mostly affects lungs. Because, both diseases involve lung and lymph node, the differential diagnosis of sarcoidosis and tuberculosis may create a challange.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/crj.12313 This article is protected by copyright. All rights reserved.
Accepted Article
A recent study demonstrated that NLR was significantly higher in the tuberculosis patients compared with the patients with sarcoidosis. Also, the same study showed that NLR is higher in patients with sarcoidosis and tuberculosis compared to healthy volunteers (4). In an other study, it was reported that NLR is a good marker in the differentiation of pulmonary tuberculosis from bacterial pneumonia (5). NLR is a new inflammatory marker that can be usefull in pulmonary medicine. But it
is a bit early to make solid conclusions. A lot of studies showed that NLR is high in many cases and is a nonspecific parameter.
Conflict of interest: We have no conflict of interest to declare.
References
1. Dirican N, Anar C, Kaya S, Bircan HA, Colar HH, Cakir M. The clinical significance of hematologic parameters in patients with sarcoidosis. Clin Respir J. 2014 Jul 3. doi: 10.1111/crj.12178 2. Cedrés S, Torrejon D, Martínez A, Martinez P, Navarro A, Zamora E, et al. Neutrophil to
lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol 2012;14:864-9.
3. Gunay E, Sarınç Ulasli S, Akar O, Ahsen A, Gunay S, Koyuncu T, et al. Neutrophil-tolymphocyte ratio in chronic obstructive pulmonary disease: A retrospective study. Inflammation 2014;37:374
4. Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, Bagci BA, Caglar E. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis. Ann Thorac Med 2014;9:232-5.
This article is protected by copyright. All rights reserved.
Accepted Article
5. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med. 2013 Mar;33(2):105-10
This article is protected by copyright. All rights reserved.
Neutrophil/lymphocyte ratio in granulomatous disease 1 Raim Iliaz1, Sinem Iliaz2
1
Department of Internal Medicine, Istanbul University, Istanbul Medical Faculty, IstanbulTurkey 2 Department of Pulmonary Medicine, Istanbul Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul-Turkey We read with great interest the article entitled “The clinical significance of
hematologic parameters in patients with sarcoidosis” by Dirican and colleagues. In that well organized study Dirican et al examined the usability of the neutrophil/lymphocyte ratio (NLR)
and other hematologic parameters in sarcoidosis. In the study, NLR is higher in patients with sarcoidosis compared to healthy volunteers and found that NLR showed a positive correlation with erythrocyte sedimentation rate (1). NLR as a new inflammatory marker is very popular subject and was studied in many
clinical situations. The NLR has been studied in malignancies, demantia and cardiovascular disease. In pulmonary medicine the NLR has been studied mostly in lung cancer and high level of NLR was associated with poor prognosis in patiens with lung cancer (2). Also NLR has been studied in chronic obstructive pulmonary disease (COPD) and has been shown to be higher in patients with exacerbations compared with stable COPD and healthy controls (3). NLR is a marker that can be calculated easily from complete blood count. This
inflammatory marker is repeatable and easily accessible. Therefore can reach wide area of use. Sarcoidosis is a multisystemic granulomatous disease and frequently presents with lung involvement. Tuberculosis is a common infectious disease in the world and like sardoidosis it
is a granulomatous disease that mostly affects lungs. Because, both diseases involve lung and lymph node, the differential diagnosis of sarcoidosis and tuberculosis may create a challange.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/crj.12313 This article is protected by copyright. All rights reserved.
Accepted Article
A recent study demonstrated that NLR was significantly higher in the tuberculosis patients compared with the patients with sarcoidosis. Also, the same study showed that NLR is higher in patients with sarcoidosis and tuberculosis compared to healthy volunteers (4). In an other study, it was reported that NLR is a good marker in the differentiation of pulmonary tuberculosis from bacterial pneumonia (5). NLR is a new inflammatory marker that can be usefull in pulmonary medicine. But it
is a bit early to make solid conclusions. A lot of studies showed that NLR is high in many cases and is a nonspecific parameter.
Conflict of interest: We have no conflict of interest to declare.
References
1. Dirican N, Anar C, Kaya S, Bircan HA, Colar HH, Cakir M. The clinical significance of hematologic parameters in patients with sarcoidosis. Clin Respir J. 2014 Jul 3. doi: 10.1111/crj.12178 2. Cedrés S, Torrejon D, Martínez A, Martinez P, Navarro A, Zamora E, et al. Neutrophil to
lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol 2012;14:864-9.
3. Gunay E, Sarınç Ulasli S, Akar O, Ahsen A, Gunay S, Koyuncu T, et al. Neutrophil-tolymphocyte ratio in chronic obstructive pulmonary disease: A retrospective study. Inflammation 2014;37:374
4. Iliaz S, Iliaz R, Ortakoylu G, Bahadir A, Bagci BA, Caglar E. Value of neutrophil/lymphocyte ratio in the differential diagnosis of sarcoidosis and tuberculosis. Ann Thorac Med 2014;9:232-5.
This article is protected by copyright. All rights reserved.
Accepted Article
5. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med. 2013 Mar;33(2):105-10
This article is protected by copyright. All rights reserved.
