Roles of the red cell distribution width and neutrophil/lymphocyte ratio in predicting thrombolysis failure in patients with an ST-segment elevation myocardial infarction

The prognostic value of neutrophil-to-lymphocyte ratio across all stages of coronary artery disease

The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor long-term outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.

Financial performance of China's listed firms in presence of coronavirus: Evidence from corporate culture and corporate social responsibility

Motivated from the shortage of the existing research studies on impacts of dangerously contagious diseases on firms' financial performance, this study sheds light on the impacts of Coronavirus (Covid-19) outbreak on financial performance upon on the quarterly data of 126 Chinese listed firms across 16 industries. Overall, the Covid-19 outbreak reduced Chinese listed firms' financial performance proxied by the revenue growth rate, ROA, ROE, and asset turnover. This outbreak's negative effects on Chinese firms' profitability were much smaller than that on their revenue growth rates. While this outbreak's negative effects on financial performance of Chinese listed firms were bigger for those that were seriously affected by this pandemic like airlines, travel, and entertainment (ATE), this pandemic's effects were positive for the medicine industry. In the meanwhile, Chinese listed firms that located in high-risk regions suffered a bigger financial loss during the outbreak, and especially there was a strong Hubei effect. The corporate culture and CSR moderated the inverse relationship between this outbreak and Chinese firms' financial performance. Findings of this study contribute to enrich the existing literature on impacts of the Covid-19 outbreak on firms' financial performance worldwide and suggest helpful practical and theoretical implications.

Predictive value of admission neutrophil/lymphocyte ratio in symptomatic intracranial hemorrhage after stroke thrombolysis

BACKGROUND

Stroke is one of the most common causes of morbidity and mortality. The need for additional objective parameters as well as the existing criteria continues for eligible patients. The objective of this study is to determine whether the baseline neutrophil/lymphocyte ratio (NLR) predicts symptomatic intracranial hemorrhage (SICH) due to intravenous thrombolytic therapy.

MATERIAL AND METHODS

One hundred thirty-three consecutive patients aged 18 years and over who were admitted to the emergency department of a training and research hospital for acute ischemic stroke and underwent intravenous thrombolytic therapy were retrospectively analyzed. For the definition of SICH, European Cooperative Acute Stroke Study III (ECASS III) classification was accepted.

RESULTS

When the groups with and without intracranial hemorrhage were compared, there was a significant difference in terms of the initial National Institutes of Health Stroke Scale (NIHSS) score (p < 0.006), glucose level (p < 0.018), and systolic blood pressure (SBP) (p < 0.050). The NLR value of the patients ranged from 0.47 to 13.74. In the group with SICH, NLR was found to be higher but not statistically significant. (p = 0.125).

CONCLUSION

For predicting SICH, NLR did not provide strong specificity and sensitivity. A precise cut-off value could not be found to predict the hemorrhagic transformation.

The Effect of Red Cell Distribution Width Admission Value on the Outcome of Patients with First-ever ST-elevation Myocardial Infarction in Basrah

Background Red cell distribution width (RDW) reflects the volumetric heterogeneity of red blood cells (RBCs) and has proven to be a prognostic predictor for cardiovascular (CV) morbidity and mortality in ST-elevation myocardial infarction (STEMI). The study aims to evaluate the effect of the RDW admission value on the outcome of patients with STEMI. Materials and methods This is a cross-sectional observational study on (207) patients with first-ever STEMI, grouped according to their baseline RDW and thrombolysis eligibility into two groups. We calculated the in-hospital Global Registry of Acute Coronary Events (GRACE) score within 48 hours of presentation. Results The study demonstrated the impact of RDW on the primary STEMI outcomes (left ventricular ejection fraction (LVEF%), ST-resolution, arrhythmias, and cardiovascular mortality risk). It was nearly a gender-matched study, with a mean RDW of 14.20±1.86%. RDW>14% and age≥65 years were the strongest statistically significant independent predictors of STEMI outcome with LVEF % < 45%, ST-resolution, and CV mortality regardless of thrombolysis. The thrombolysis offers a logical significant negative relation with CV mortality. At the same time, hypertension, diabetes mellitus (DM), and smoking may cause an additional mortality burden, especially in elderly patients with high RDW who are not eligible for thrombolysis. There was a significant association between high GRACE to high RDW, with excellent specificity and sensitivity in predicting CV outcome. Conclusion The RDW is a simple to acquire index, with a good prognostic prediction of major adverse cardiovascular events (MACEs) and CV mortality in the STEMI patients. It is excellent in predicting STEMI outcomes, especially the response to thrombolysis.

Predictive value of CHA2DS2-VASc and CHA2DS2-VASc-HS scores for failed reperfusion after thrombolytic therapy in patients with ST-segment elevation myocardial infarction

BACKGROUND

Thrombolytic therapy is recommended for patients with acute ST-segment elevation myo- cardial infarction (STEMI) who cannot undergo primary percutaneous coronary intervention within the first 120 min. The aim of this study was to demonstrate the value of CHA2DS2-VASc and CHA2DS2- -VASc-HS scores in predicting failed reperfusion in STEMI patients treated with thrombolytic therapy.

METHODS

A total of 537 consecutive patients were enrolled in the study; 139 had failed thrombolysis while the remaining 398 fulfilled the criteria for successful thrombolysis. Thrombolysis failure was defined with the lack of symptom relief, < 50% ST resolution-related electrocardiography within 90 min from initiation of the thrombolytic therapy, presence of hemodynamic or electrical instability or in-hospital mortality. CHA2DS2-VASc and CHA2DS2-VASc-HS scores, which incorporate hyperlipi- demia, smoking, switches between female and male gender, were previously shown to be markers of the severity of coronary artery disease (CAD).

RESULTS

History of hypertension, diabetes mellitus, hyperlipidemia, heart failure, smoking, and CAD were significantly common in failed reperfusion patients (for all; p < 0.05). For prediction of failed rep- erfusion, the cut-off value of CHA2DS2-VASc score was ≥ 2 with a sensitivity of 80.90% and a specificity of 41.01% (area under curve [AUC] 0.660; 95% confidence interval [CI] 0.618-0.700; p < 0.001) and the cut-off value of CHA2DS2-VASc-HS score was ≥ 3 with a sensitivity of 76.13% and a specificity of 67.63% (AUC 0.764; 95% CI 0.725-0.799; p < 0.001). The CHA2DS2-VASc-HS score was found to be statistically and significantly better than CHA2DS2-VASc score to predict failed reperfusion (p < 0.001).

CONCLUSIONS

The findings suggest that the CHA2DS2-VASc and especially CHA2DS2-VASc-HS scores could be considered as predictors of risk of failed reperfusion in STEMI patients.

Predictive modeling of inpatient mortality in departments of internal medicine

Despite overwhelming data on predictors of inpatient mortality, it is unclear which variables are the most instructive in predicting mortality of patients in departments of internal medicine. This study aims to identify the most informative predictors of inpatient mortality, and builds a prediction model on an individual level, given a constellation of patient characteristics. We use a penalized method for developing the prediction model by applying the least-absolute-shrinkage and selection-operator regression. We utilize a cohort of adult patients admitted to any of 5 departments of internal medicine during 3.5 years. We integrated data from electronic health records that included clinical, epidemiological, administrative, and laboratory variables. The prediction model was evaluated using the validation sample. Of 10,788 patients hospitalized during the study period, 874 (8.1%) died during admission. We find that the strongest predictors of inpatient mortality are prior admission within 3 months, malignant morbidity, serum creatinine levels, and hypoalbuminemia at hospital admission, and an admitting diagnosis of sepsis, pneumonia, malignant neoplastic disease, or cerebrovascular disease. The C-statistic of the risk prediction model is 89.4% (95% CI 88.4-90.4%). The predictive performance of this model is better than a multivariate stepwise logistic regression model. By utilizing the prediction model, the AUC for the independent (validation) data set is 85.7% (95% CI 84.1-87.3%). Using penalized regression, this prediction model identifies the most informative predictors of inpatient mortality. The model illustrates the potential value and feasibility of a tool that can aid physicians in decision-making.

Assessment of red blood cell distribution width and mean platelet volume in children with epistaxis

OBJECTIVE

This study aimed to investigate whether there is a relationship between red blood cell distribution width, mean platelet volume and epistaxis in children.

METHODS

Between January 2015 and July 2016, 105 children who were referred to our clinic with epistaxis and 100 sex- and age-matched controls were retrospectively analyzed. Red blood cell distribution width (RDW) and mean platelet volume (MPV) values were determined in both groups.

RESULTS

RDW values were found significantly (P < 0.05) lower in the group with epistaxis than in the control group (11.95 ± 1.31 vs. 12.74 ± 1.21). MPV was 7.49 ± 1.33 in the group with epistaxis and 7.23 ± 1.06 in the control group, and there was no significant difference between the groups (p > 0.05).

CONCLUSION

We found no difference between MPV values of both groups and significantly lower RDW values in children with epistaxis. Decreased RDW values were considered as an accompanying marker rather than a result of epistaxis. In addition, it may be thought that low RDW values may increase the bleeding tendency by disrupting the thrombotic activities. Further studies are needed to validate the relation of these parameters with epistaxis and its mechanisms.

Association Between Complete Blood Count Parameters and Urinary Stone Disease

BACKGROUND

Complete blood count (CBC) parameters may associated with multiple diseases. Urinary stone disease is common public problem. Predictive value of CBC parameters may be associated with urinary stone disease.

OBJECTIVES

To analyze the association between complete blood count (CBC) parameters and urinary stone disease.

PATIENTS AND METHODS

This study was a retrospective observational study of 3,099 patients who were admitted to the urology outpatient clinic or diagnosed with urinary stone disease in the emergency services department. There were 353 patients included in the study that had ultrasonography (USG) and/or non-contrast computerized tomography (NCCT) and a CBC. Patients who had non-urinary system inflammatory disease in USG or NCCT, had fever, non-urinary system infection, anemia or diagnosed hematologic malignancy were excluded (n = 27). Patients were divided into two groups: a stone group (n = 74) and a control group (n = 252). Data of patients were retrieved from the hospital database and statistical analysis was performed.

RESULTS

An increase in RDW, MPV, PDW, WBC, granulocyte percentage and a decrease in lymphocyte percentage is statistically associated with urinary stone disease (P < 0,001, P < 0.001, P = 0.006, P < 0.001, P = 0.003, P = 0.034, respectively). Microscopic hematuria is associated with urinary stone disease and the odds ratio for urinary stone prediction is 67.7 (P < 0.001). In addition, none of the CBC parameters were associated with stone burden.

CONCLUSIONS

When evaluating flank pain in patients, it is important to remember that CBC parameters may support urinary stone disease, and considering CBC results may be useful in the diagnosis of urinary stone disease.

Red cell distribution width and neutrophil-to-lymphocyte ratio predict left ventricular dysfunction in acute anterior ST-segment elevation myocardial infarction

OBJECTIVES

Red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) are the two markers used to determine risk of mortality and adverse cardiovascular outcomes in patients with acute myocardial infarction. The relationship between RDW, NLR, and left ventricular (LV) systolic functions has not been reported. In this report, we aimed to investigate the relationship between RDW, NLR, and LV systolic function in anterior ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PCI).

METHODS

RDW and NLR were measured on admission in 106 STEMI patients treated with primary PCI. Patients were divided into two groups according to left ventricular ejection fraction (LVEF), as Group I (systolic dysfunction, LVEF <50%) and Group II (preserved global left ventricle systolic function, LVEF ⩾50%). The first group included 47 patients and the second group included 59 patients.

RESULTS

Mean RDW and NLR were significantly higher in Group I compared to Group II [13.7 ± 0.9% vs. 13.4 ± 0.7%, p = 0.03 and 5.86 (range, 0.66-40.50) vs. 2.75 (range, 0.51-39.39), p = 0.013, respectively].

CONCLUSION

Increased RDW and NLR on admission, in anterior STEMI patients treated with primary PCI are associated with LV systolic dysfunction.

Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update

As we know, inflammatory and oxidative stresses have a role in the pathogenesis of cardiovascular disease. This knowledge has triggered many investigations targeted to inflammatory markers. One such example, the neutrophil to lymphocyte ratio (NLR), is an inexpensive and easily accessible inflammatory marker whose role in cardiovascular disease has been studied extensively in the past few years. The neutrophil lymphocyte ratio has been shown to predict cardiac arrhythmias as well as short- and long-term mortality in patients with acute coronary syndromes (ACS). It has correlated well with ACS risk prediction models such as the GRACE and SYNTAX scores. A higher NLR has also been associated with frequent congestive heart failure decompensation and long-term mortality. The neutrophil to lymphocyte ratio also appears to have a prognostic role in patients undergoing transaortic valve replacement and the progression of valvular heart diseases. Despite the science of inflammatory biomarkers having been described decades ago, NLR appears to be enjoying a renaissance as a cost-effective biomarker with immediate clinical predictability and prognostication.

The Prognostic Role of Red Blood Cell Distribution Width in Coronary Artery Disease: A Review of the Pathophysiology

Red blood cell distribution width (RDW) is a measure of red blood cell volume variations (anisocytosis) and is reported as part of a standard complete blood count. In recent years, numerous studies have noted the importance of RDW as a predictor of poor clinical outcomes in the settings of various diseases, including coronary artery disease (CAD). In this paper, we discuss the prognostic value of RDW in CAD and describe the pathophysiological connection between RDW and acute coronary syndrome. In our opinion, the negative prognostic effects of elevated RDW levels may be attributed to the adverse effects of independent risk factors such as inflammation, oxidative stress, and vitamin D₃ and iron deficiency on bone marrow function (erythropoiesis). Elevated RDW values may reflect the intensity of these phenomena and their unfavorable impacts on bone marrow erythropoiesis. Furthermore, decreased red blood cell deformability among patients with higher RDW values impairs blood flow through the microcirculation, resulting in the diminution of oxygen supply at the tissue level, particularly among patients suffering from myocardial infarction treated with urgent revascularization.

The neutrophil to lymphocyte ratio is associated with severity of rheumatic mitral valve stenosis

Background

Rheumatic heart disease (RHD) is a serious health concern in developing countries. Rheumatic mitral stenosis (RMS) is the most long-term sequel in RHD. The neutrophil to lymphocyte ratio (NLR) is a novel marker, and a higher NLR has been associated with poor clinical outcomes in various cardiovascular disorders. We evaluated the availability of NLR to predict severity of mitral stenosis (MS) in patients with RHD.

Methods

We analyzed 300 consecutive patients with RMS. The patients were divided into tertiles according to NLR: 0.85< NLR ≤1.85 (n=100, tertile 1), 1.86≤ NLR ≤2.46 (n=100, tertile 2), and 2.47≤ NLR ≤7.08 (n=100, tertile 3). Patients with RMS were divided into three groups based on the degree of MS as mild, moderate, and severe MS. After the initial evaluation, 187 patients with moderate-to-severe RMS (Group 1) and 113 patients with mild RMS (Group 2) were reassessed.

Results

The patients with severe RMS had significantly elevated NLR, mean platelet volume, and pulmonary artery systolic pressure values compared to patients with moderate and mild MS (P<0.001, P<0.001, P<0.001 respectively). Multivariate binary logistic regression analysis revealed that high levels of NLR was an independent predictor of severe RMS (odds ratio =0.68, P=0.008). Moderate-to-severe RMS incidence was significantly higher among patients in the tertile 3 (odds ratio =2.8, P=0.001).

Conclusion

NLR is a new inflammatory marker and a simple, rapid, and easily accessible prognostic parameter that can be associated with severity of RMS in patients with RHD.