Neutrophil-to-Lymphocyte Ratio as a Marker in Patients with Non-arteritic Anterior Ischemic Optic Neuropathy

Abstract

Background: Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in patients over the age of 50 and is the second most common cause of permanent optic nerve-related visual loss in adults after glaucoma. Although the precise cause of NAION remains elusive, the etiology of NAION is believed to be multifactorial. Aims: To evaluate the utility of neutrophil-to-lymphocyte ratio (NLR) as a simple and readily available prognostic factor for clinical disease activity in patients with NAION. Study Design: Case-control study. Methods: Forty-five patients with the diagnosis of NAION and 50 age- and sex-matched controls with/without any systemic or ocular diseases except cataract were retrospectively enrolled in the study. Demographic characteristics and laboratory findings including complete blood count of all patients and control subjects were obtained from the electronic medical record. The neutrophil and lymphocyte counts were recorded and the NLR was calculated. Results: White blood cell, neutrophil, NLR and platelet values of the NAION patients were significantly higher than those of the controls (p<0.001, p<0.001, p=0.004, p=0.037, respectively). Initial NLR values were negatively correlated with initial and the third month best corrected visual acuity levels in the study group. The optimum NLR cut-off point for NAION was 1.94. Conclusion: NLR could be considered as a new inflammatory marker for assessment of the severity of inflammation in NAION patients with its quick, cheap, easily measurable property with routine complete blood count analysis.

Keywords

• Disease severity, marker, neutrophil-to-lymphocyte ratio, non-arteritic anterior ischemic optic neuropathy

References

1. 1. Hayreh SS, Joos KM, Podhajsky PA, Long CR. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol 1994;118:766-80. [CrossRef]
2. 2. Johnson LN, Arnold AC. Incidence of nonarteritic and arteritic anterior ischemic optic neuropathy. Population based study in the state of Missouri and Los Angeles County, California. J Neuroophthalmol 1994;14:38-44. [CrossRef]
3. 3. Hayreh SS. Ischemic optic neuropathies - where are we now?. Graefes Arch Clin Exp Ophthalmol 2013;251:1873-84. [CrossRef]
4. 4. Arnold AC. Pathogenesis of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 2003;23:157-63. [CrossRef]
5. 5. McCulley TJ, Lam BL, Feuer WJ. A comparison of risk factors for postoperative and spontaneous nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 2005;25:22-4. [CrossRef]
6. 6. Buck BH, Liebeskind DS, Saver JL, Bang OY, Yun SW, Starkman S, et al. Early neutrophilia is associated with volume of ischemic tissue in acute stroke. Stroke 2008;39:355-60. [CrossRef]
7. 7. Haumer M, Amighi J, Exner M, Mlekusch W, Sabeti S, Schlager O, et al. Association of neutrophils and future cardiovascular events in patients with peripheral artery disease. J Vasc Surg 2005;41:610-7. [CrossRef]
8. 8. Stewart GJ. Neutrophils and deep venous thrombosis. Haemostasis 1993;23:127-40. [CrossRef]

9. 9. Pitsavos C, Tampourlou M, Panagiotakos DB, Skoumas Y, Chrysohoou C, Nomikos T, et al. Association Between LowGrade Systemic Inflammation and Type 2 Diabetes Mellitus Among Men and Women from the ATTICA Study. Rev Diabet Stud 2007;4:98-104. [CrossRef]
10. 10. Nakanishi N, Sato M, Shirai K, Suzuki K, Tatara K. White blood cell count as a risk factor for hypertension; a study of Japanese male office workers. J Hypertens 2002;20:851-7. [CrossRef]
11. 11. Marsland AL, McCaffery JM, Muldoon MF, Manuck SB. Systemic inflammation and the metabolic syndrome among middle-aged community volunteers. Metabolism 2010;59:1801-8. [CrossRef]
12. 12. Brooks GC, Blaha MJ, Blumenthal RS. Relation of C-reactive protein to abdominal adiposity. Am J Cardiol 2010;106:56-61. [CrossRef]
13. 13. Rudiger A, Burckhardt OA, Harpes P, Muller SA, Follath F. The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med 2006;24:451-4. [CrossRef]
14. 14. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102:653-7. [CrossRef]
15. 15. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005;91:181-4. [CrossRef]
16. 16. Bernstein SL, Johnson MA, Miller NR. Nonarteritic anterior ischemic optic neuropathy (NAION) and its experimental models. Prog Retin Eye Res 2011;30:167-87. [CrossRef]
17. 17. Salgado C, Vilson F, Miller NR, Bernstein SL. Cellular inflammation in nonarteritic anterior ischemic optic neuropathy and its primate model. Arch Ophthalmol 2011;129:1583-91. [CrossRef