Composite indices of inflammation, immunity, and nutrition. Calculation formulas, interpretation, and clinical significance (literature review)
https://doi.org/10.24884/2078-5658-2025-22-4-108-116
Abstract
Introduction. New aggregated hemacytometric indices of the ratio of neutrophils, lymphocytes, platelets, monocytes, Creactive protein, albumin can be promising markers of the objective state and dynamics of critical conditions in cardiology, oncology, infectious pathology and intensive care.
The objective was to compare methods for calculating new composite hemacytometric indices and discussion of the conditions of their use and effectiveness in intensive care.
Materials and methods. A literature search was conducted using PubMed, Medline, and Google Scholar databases in the period 2020–2024. The search includes publications indexed in Scopus.
Results. Combined indicators characterizing the status of inflammation, immunity, nutrition during intensive care are more accurate in comparison with traditional single hematological and biochemical parameters. However, the diagnostic value of these indicators is still variable, and little has been studied in intensive care.
Conclusion. It is obvious that the use of hemacytometric, combined (composite) indices in various fields of clinical medicine is an objectively new step in the interpretation of laboratory parameters.
About the Author
Yu. Yu. Kiryachkov
Grodno State Medical University; Grodno University Clinic
Belarus
Belarus
Kiryachkov Yuri Yu., Cand. of Sci. (Med.), Professor of the Department of Anesthesiology and Intensive Care, Grodno State Medical University, Grodno University Clinic
References
1. Arbanasi E. M., Halmaciu I., Kaller R. et al. systemic inflammatory biomarkers and chest CT Findings as predictors of acute limb ischemia risk, intensive care unit admission, and mortality in COVID-19 patients // Diagnostics. – 2022. – Vol. 12, № 10. – P. 2379. http://doi.org/10.3390/diagnostics12102379.
2. Balta O., Astan S., Altınayak H. et al. Can c-reactive protein-lymphocyte ratio be used as a screening tool to confirm the diagnosis of periprosthetic joint infection? // Clin Orthop Surg. – 2023. – Vol. 15, № 6. – P. 917–927. http://doi.org/10.4055/cios22313.
3. Buonacera A., Stancanelli B., Colaci M. et al. Neutrophil to lymphocyte ra tio: an emerging marker of the relationships between the immune system and diseases // Int J Mol Sci. – 2022. – Vol. 23, № 7. – Р. 3636. http://doi.org/10.3390/ijms23073636.
4. Casadei G. A., Scarpi E., Valgiusti M. et al. Prognostic role of a new index (multi inflammatory index) in patients with metastatic colorectal cancer: results from the randomized ITACa trial // Ther Adv Med Oncol. – 2020. – № 12. – P. 1758835920958363. http://doi.org/10.1177/1758835920958363.
5. Celikkol A., Guzel E. Ç., Dogan M. et al. C-reactive protein-to-albumin ratio as a prognostic inflammatory marker in COVID-19 // J Lab Physicians. – 2022. – Vol. 14, № 1. – P. 74–83. http://doi.org/10.1055/s-0041-1741439.
6. Chen X., Guo W., Diao Z. et al. Lymphocyte-to-C reactive protein ratio as novel inflammatory marker for predicting outcomes in hemodialysis pa tients: A multicenter observational study // Front Immunol. – 2023. – № 14. – P. 1101222. http://doi.org/10.3389/fimmu.2023.1101222.
7. Demirel M. E., Akunal T. C. The role of the multi-inflammatory index as a novel predictor of hospital mortality in acute ischemic stroke // Cureus. – 2023. – Vol. 15, № 8. – P. 43258. http://doi.org/10.7759/cureus.43258.
8. El-Menyar A., Mekkodathil A., Al-Ansari A. et al. Platelet-lymphocyte and neutrophil-lymphocyte ratio for prediction of hospital outcomes in patients with abdominal trauma // Biomed Res Int. – 2022. – Vol. 2022. – P. 5374419. http://doi.org/10.1155/2022/5374419.
9. Fois A. G., Paliogiannis P., Scano V. et al. The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients // Molecules. – 2020. – Vol. 25, № 23. – P. 5725. http://doi.org/10.3390/molecules25235725.
10. Ghobadi H., Mohammadshahi J., Javaheri N., et al. Role of leukocytes and systemic inflammation indexes (NLR, PLR, MLP, dNLR, NLPR, AISI, SIRI, and SII) on admission predicts in-hospital mortality in non-elderly and elderly COVID-19 patients // Front Med (Lausanne). – 2022. – № 9. – P. 916453. http://doi.org/10.3389/fmed.2022.916453.
11. Hashimoto I., Tanabe M., Onuma S. et al. Clinical impact of the C-reac tive protein-albumin-lymphocyte index in post-gastrectomy patients with gastric cancer // In Vivo. – 2024. – Vol. 38, № 2. – P. 911–916. http://doi.org/10.21873/invivo.13518.
12. Han J., Yang L., Lou Z., Zhu Y. Association between systemic immune-in flammation index and systemic inflammation response index and outcomes of acute ischemic stroke: a systematic review and meta-analysis // Ann Indian Acad Neurol. – 2023. – Vol. 26, № 5. – P. 655–662. http://doi.org/10.4103/aian.aian_85_23.
13. Heidarpour M., Bashiri S., Vakhshoori M. et al. The association between plate let-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure // BMC Cardiovasc Disord. – 2021. – Vol. 21, № 1. – P. 454. http://doi.org/10.1186/s12872-021-02260-7.
14. Hossein M., Fazeli P., Hajivalili M. et al. The prognostic values of neutrophil to lymphocyte ratio traumatically patients upon admission: a mini-review // European Journal of Inflammation. – 2023. – Vol. 21. – P. 1–5. http://doi.org/10.1177/1721727X231197494.
15. Huang Y., Zhang Q., Li P. et al. The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarc tion // BMC Cardiovasc Disord. – 2023. – Vol. 23, № 1. – P. 339. http://doi.org/10.1186/s12872-023-03350-4.
16. Huang Y. W., Zhang Y., Li Z. P. et al. Association between a four-parame ter inflammatory index and all-cause mortality in critical ill patients with non-traumatic subarachnoid hemorrhage: a retrospective analysis of the MIMIC-IV database (2012-2019) // Front Immunol. – 2023. – № 14. – P. 1235266. http://doi.org/3389/fimmu.2023.1235266.
17. Iida H., Tani M., Komeda K. et al. Superiority of CRP-albumin-lymphocyte index (CALLY index) as a non-invasive prognostic biomarker after hepa tectomy for hepatocellular carcinoma // HPB (Oxford). – 2022. – Vol. 24, № 1. – P. 101–115. http://doi.org/10.1016/j.hpb.2021.06.414.
18. Jiang D., Bian T., Shen Y. et al. Association between admission systemic im mune-inflammation index and mortality in critically ill patients with sepsis: a retrospective cohort study based on MIMIC-IV database // Clin Exp Med. – 2023. – Vol. 23, № 7. – P. 3641–3650. http://doi.org/10.1007/s10238-023-01029-w.
19. Khadzhieva M. B., Gracheva A. S., Belopolskaya O. B. et al. Serial changes in blood-cell-count-derived and CRP-derived inflammatory indices of COVID-19 patients // Diagnostics (Basel). – 2023. – Vol. 13, № 4. – P. 746. http://doi.org/10.3390/diagnostics13040746.
20. Kilercik M., Demirelce O., Serdar M. A. et al. A new haematocytometric index: Predicting severity and mortality risk value in COVID-19 patients // PLoS One. – 2021. – Vol. 16, № 8. – Р. 0254073. http://doi.org/10.1371/journal.pone.0254073.
21. Kunutsor S. K., Laukkanen J. A. Serum C-reactive protein-to-albumin ratio is a potential risk indicator for pneumonia: Findings from a prospective cohort study // Respir Med. – 2022. – Vol. 199. – P. 106894. http://doi.org/10.1016/j.rmed.2022.106894.
22. Li X., Chen Y., Yuan Q. et al. Neutrophil-to-lymphocyte ratio, mono cyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio associated with 28-day all-cause mortality in septic patients with coronary artery disease: a retro spective analysis of MIMIC-IV database // BMC Infect Dis. – 2024. – Vol. 24, № 1. – P. 749. http://doi.org/10.1186/s12879-024-09516-5.
23. Li Y., Zou Z., Zhang Y. et al. Dynamics in perioperative neutro phil-to-lymphocyte*platelet ratio as a predictor of early acute kidney in jury following cardiovascular surgery // Ren Fail. – 2021. – Vol. 43, № 1. – P. 1012–1019. http://doi.org/10.1080/0886022X.2021.1937220.
24. Luo X., Wan D., Xia R. et al. Prognostic value of the baseline and early changes in monocyte-to-lymphocyte ratio for short-term mortality among critically ill patients with acute kidney injury // J Clin Med. – 2023. – Vol. 12, № 23. – P. 7353. http://doi.org/10.3390/jcm12237353.
25. Meng Y., Long C., Huang X. et al. Prognostic role and clinical significance of C-re active protein-lymphocyte ratio in colorectal cancer // Bioengineered. – 2021. – Vol. 12, №1. – P. 5138–5148. http://doi.org/10.1080/21655979.2021.1960768.
26. Mullen J. L., Buzby G. P., Matthews D. C. et al. Reduction of operative mor bidity and mortality by combined preoperative and postoperative nutritional support // Ann Surg. – 1980. – Vol. 192, № 5. – P. 604–613. http://doi.org/10. 1097/00000658-198019250-00004.
27. Müller L., Hahn F., Mähringer-Kunz A. et al. Immunonutritive scoring for patients with hepatocellular carcinoma undergoing transarterial chemoembo lization: evaluation of the CALLY index // Cancers (Basel). – 2021. – Vol. 13, № 19. – P. 5018. http://doi.org/10.3390/cancers13195018.
28. Mungan I., Bostancı E. B., Turksal E. et al. The predictive power of C-reactive protein - lymphocyte ratio for in-hospital mortality after colorectal cancer surgery // Cancer Rep (Hoboken). – 2021. – Vol. 4, № 3. – P. e1330. http://doi.org/10.1002/cnr2.1330.
29. Oh A. R., Park J., Lee J. H. et al. Association between inflammation-based prognostic markers and mortality of non-cardiac surgery // Korean J Anes thesiol. – 2023. – Vol. 76, № 6. – P. 550–558. http://doi.org/10.4097/kja.23068.
30. Paliogiannis P., Ginesu G. C., Tanda C. et al. Inflammatory cell indexes as pre operative predictors of hospital stay in open elective thoracic surgery // ANZ J Surg. – 2018. – Vol. 88, № 6. – P. 616–620. http://doi.org/10.1111/ans.14557.
31. Rubio G., Chavez-Galan L., Hernandez-Zenteno R. J. et al. Outcome predic tors in COVID-19: An analysis of emergent systemic inflammation indices in Mexican population // Front. Med. – 2022. – Vol. 9. – P. 1000147. http://doi.org/10.3389/fmed.2022.1000147.
32. Sant’Ana M., Gameiro J., Costa C. et al. C-reactive protein-to-albumin ratio and six-month mortality in incident hemodialysis patients // Ren Fail. – 2023. – Vol. 45, № 1. – P. 2182615. http://doi.org/10.1080/0886022X.2023.2182615.
33. Schietroma M., Romano L., Schiavi D. et al. Systemic inflammation response index (SIRI) as predictor of anastomotic leakage after total gastrectomy for gastric cancer // Surg Oncol. – 2022. – Vol. 43. – P.101791. http://doi.org/10.1016/j.suronc.2022.101791.
34. Shi Y., Yang C., Chen L. et al. Predictive value of neutrophil-to-lymphocyte and platelet ratio in in-hospital mortality in septic patients // Heliyon. – 2022. – Vol. 8, № 11. – P. e11498. http://doi.org/10.1016/j.heliyon.2022.e11498.
35. Tsunematsu M., Haruki K., Taniai T. et al. The impact of C-reactive protein-al bumin-lymphocyte (CALLY) index on the prognosis of patients with distal cholangiocarcinoma following pancreaticoduodenectomy // Ann Gastroenter ol Surg. – 2022. – Vol. 7, № 3. – P. 503–511. http://doi.org/10.1002/ags3.12637.
36. Vakhshoori M., Bondariyan N., Sabouhi S. et al. The impact of plate let-to-lymphocyte ratio on clinical outcomes in heart failure: a systematic review and meta-analysis // Ther Adv Cardiovasc Dis. – 2024. – Vol. 18. – P. 17539447241227287. http://doi.org/10.1177/17539447241227287.
37. Wang D., Gao Y., Lai Q. Q. et al. Dynamic lymphocyte-CRP ratio as a pre dictor: a single-centre retrospective study on disease severity and progres sion in adult COVID-19 patients // J Int Med Res. – 2024. – Vol. 52, № 3. – P. 3000605241236278. http://doi.org/10.1177/03000605241236278.
38. Wang R. H., Wen W. X., Jiang Z. P. et al. The clinical value of neutro phil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage // Front Immunol. – 2023. – Vol. 14. – P. 1115031. http://doi.org/10.3389/fimmu.2023.1115031.
39. Wang H., Nie H., Bu G. et al. Systemic immune-inflammation index (SII) and the risk of all-cause, cardiovascular, and cardio-cerebrovascular mortality in the general population // Eur J Med Res. – 2023. – Vol. 28, № 1. – P. 575. http://doi.org/10.1186/s40001-023-01529-1.
40. Yao W., Wang W., Tang W. et al. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) to predict postoperative pneumonia in elderly hip fracture patients // J Orthop Surg Res. – 2023. – Vol. 18, № 1. – P. 673. http://doi.org/10.1186/s13018-023-04157-x.
41. Yang Y., Xu Y., Lu P. et al. The prognostic value of monocyte-to-lymphocyte ratio in peritoneal dialysis patients // Eur J Med Res. – 2023. – Vol. 28, № 1. – P. 152. http://doi.org/10.1186/s40001-023-01073-y.
42. Yu J., Hong B., Park J. Y. et al. Impact of prognostic nutritional index on postoperative pulmonary complications in radical cystectomy: a propen sity score-matched analysis // Ann Surg Oncol. – 2021. – Vol. 28, № 3. – P. 1859–1869. http://doi.org/10.1245/s10434-020-08994-6.
43. Yu Y., Wu W., Dong Y. et al. C-reactive protein-to-albumin ratio predicts sepsis and prognosis in patients with severe burn injury // Mediators Inflamm. – 2021. – Vol. 2021. – P. 6621101. http://doi.org/10.1155/2021/6621101.
44. Zhang Z., Hu Q., Hu T. Association of lymphocyte to monocyte ratio and risk of in-hospital mortality in patients with cardiogenic shock: a propensity score matching study // Int J Gen Med. – 2021. – Vol. 14. – P. 4459–4468. http://doi.org/10.2147/IJGM.S325907.
45. Zhang Q., Zhang G., Wang L. et al. Clinical value and prognosis of c reac tive protein to lymphocyte ratio in severe aneurysmal subarachnoid hemor rhage // Front Neurol. – 2022. – Vol. 13. – P. 868764. http://doi.org/10.3389/fneur.2022.868764.
46. Zhuang J., Wang S., Wang Y. et al. Prognostic value of CRP-albumin-lymphocyte (CALLY) index in patients undergoing surgery for breast cancer // Int J Gen Med. – 2024. – Vol. 17. – P. 997–1005. http://doi.org/10.2147/IJGM.S447201.
47. Zhang J., Zhao Q., Liu S. et al. Clinical predictive value of the CRP-albumin-lym phocyte index for prognosis of critically ill patients with sepsis in intensive care unit: a retrospective single-center observational study // Front Public Health. – 2024. – Vol. 12. – P. 1395134. http://doi.org/10.3389/fpubh.2024.1395134.
48. Zinellu A., Paliogiannis P., Mangoni A. A. Aggregate index of systemic inflam mation (AISI), Disease Severity, and Mortality in COVID-19: a systematic review and meta-analysis // J Clin Med. – 2023. – Vol. 12, № 14. – P. 4584. http://doi.org/10.3390/jcm12144584.
49. Zinellu A., Scano V., Masotto E. et al. The Systemic Inflammation Index on admission is independently associated with length of stay in hospitalized COVID-19 patients // Minerva Respir. Med. – 2021. – Vol. 60, № 3. – P. 65–72. http://doi.org/10.23736/S2784-8477.21.01932-5.
50. Zinellu A., Collu C., Nasser M. et al. The aggregate index of systemic inflamma tion (AISI): a novel prognostic biomarker in idiopathic pulmonary fibrosis // J Clin Med. – 2021. Vol. 10, № 18. – P. 4134. http://doi.org/10.3390/jcm10184134.
Review
For citations:
Kiryachkov Yu.Yu. Composite indices of inflammation, immunity, and nutrition. Calculation formulas, interpretation, and clinical significance (literature review). Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2025;22(4):108-116. (In Russ.) https://doi.org/10.24884/2078-5658-2025-22-4-108-116
Email this article 