Neutrophil-to-lymphocyte ratio may aid diagnosis of infectious, idiopathic orbital disease
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Key takeaways:
- Patients with idiopathic orbital inflammation had lower neutrophil-to-lymphocyte ratios vs. those with orbital cellulitis or necrotizing fasciitis.
- The ratios were not different between infectious diseases.
The neutrophil-to-lymphocyte ratio appeared to distinguish between acute orbital infectious disease and noninfectious inflammation and may aid in clinical intervention, according to a study in Ophthalmic Plastic and Reconstructive Surgery.
“The neutrophil-to-lymphocyte ratio (NLR) is a relatively new biomarker that measures the relative roles of the innate (via neutrophils) and adaptive (via lymphocytes) immune systems,” Edward J. Wladis, MD, and colleagues at Albany Medical College wrote. “The NLR may be elevated in multiple emergent diseases, including infectious processes, cerebrovascular accidents, myocardial infarction, severe trauma and oncologic disorders.”
They continued, “Emerging evidence suggests that the NLR may be more effective than other parameters in assessing the impact of acute stressors, including leukocyte counts and C-reactive protein levels.”
Seeking to determine whether NLR could distinguish between infectious orbital disease and idiopathic orbital inflammation, researchers reviewed a single surgeon’s case logs to identify adult patients diagnosed with idiopathic orbital inflammation (n = 10), orbital cellulitis (n = 12) and necrotizing fasciitis (n = 12) after presenting acutely to the ED over a 3-year period. The groups were generally balanced in terms of age and gender.
According to results, the mean NLR was 3.48 for idiopathic orbital inflammation, 13.5 for necrotizing fasciitis and 8.15 for orbital cellulitis. Patients with idiopathic orbital inflammation had statistically significantly lower NLRs compared with patients with necrotizing fasciitis (P = .037) and orbital cellulitis (P = .034), but the NLRs of those with ocular cellulitis were not significantly different than those with necrotizing fasciitis (P = .27).
“These results are highly translational and may help to guide the clinical decision-making of clinicians assessing patients with the new onset of orbital signs,” Wladis and colleagues wrote. “Specifically the presence of an elevated NLR should prompt appropriate consideration of infectious disease and should likely initiate rapid interventions to address this problem and avoid potentially vision- and life-threatening complications.”
They added, “Of course, this biomarker must be coupled with appropriate clinical evaluations and radiographic evaluations.”
Perspective
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This study is not relevant to most optometrists. Patients with idiopathic orbital inflammation, necrotizing fasciitis and orbital cellulitis are less likely to present to the outpatient eye clinic and, if they do, they will be promptly sent to the ED for further workup.
Thus, NLR is more likely to be utilized by ED physicians and hospitalists rather than ODs. It may, however, be pertinent to those who take calls for hospitals and provide consultations for these types of cases. Although clinical findings coupled with neuroimaging are superior in pinning down a diagnosis, the NLR can be used as an adjunct to help discern between inflammation and infection.
A larger study design in the future would be helpful to provide more confidence in the findings. It would also be interesting to explore whether NLR may be able to differentiate between types of infection in future studies.
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