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Ul Hussain H, Kumar KA, Zahid M, Husban Burney M, Khan Z, Asif M, Rehan ST, Ahmad Cheema H, Swed S, Yasmin F, Ullah W, Alraies MC. Neutrophil to lymphocyte ratio as a prognostic marker for cardiovascular outcomes in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38692. [PMID: 38941418 DOI: 10.1097/md.0000000000038692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Neutrophil to lymphocyte ratio (NLR) has been considered a prognostic biomarker of mortality and other major cardiac events. This study investigates NLR's efficacy in predicting in-hospital and long-term outcomes in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS Electronic databases (PUBMED, Cochrane CENTRAL, ERIC, Embase, Ovid, and Google Scholar) were searched till June 2022 to identify studies having STEMI patients who underwent PCI. Risk ratios and mean differences (MDs), along with their corresponding 95% confidence intervals (Cis) and standard deviations (SDs), were pooled using a random-effect model. This meta-analysis has been registered on Prospero (ID: CRD42022344072). RESULTS A total of 35 studies with 28,756 patients were included. Pooled estimates revealed an increased incidence of primary outcomes; in-hospital all-cause mortality (RR = 3.52; 95% CI = 2.93-4.24), long-term all-cause mortality (HR = 1.07; 95% CI = 1.00-1.14), (RR = 3.32; 95% CI = 2.57-4.30); in-hospital cardiovascular mortality (RR = 2.66; 95% CI = 2.04-3.48), long-term cardiovascular mortality (RR = 6.67; 95% CI = 4.06-10.95); in-hospital major adverse cardiovascular events (MACE) (RR = 1.31; 95% CI = 1.17-1.46), long-term MACE (RR = 2.92; 95% CI = 2.16-3.94); length of hospital stay (WMD = 0.60 days; 95% CI = 0.40-0.79) in patients with high NLR compared to those with a low NLR. CONCLUSION NLR might be a valuable tool for prognostication (in-hospital) and stratification of patients with STEMI who underwent PCI.
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Affiliation(s)
| | | | - Marium Zahid
- Karachi Medical and Dental College, Karachi, Pakistan
| | | | - Zayeema Khan
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muqaddus Asif
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Sarya Swed
- Aleppo University Faculty of Medicine, Aleppo, Syria
| | - Farah Yasmin
- Dow University of Health Sciences, Karachi, Pakistan
| | - Waqas Ullah
- Thomas Jefferson University Hospitals, Philadelphia, PA
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Pang J, Qian LY, Lv P, Che XR. Application of neutrophil-lymphocyte ratio and red blood cell distribution width in diabetes mellitus complicated with heart failure. World J Diabetes 2024; 15:1226-1233. [DOI: 10.4239/wjd.v15.i6.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/04/2024] [Accepted: 04/19/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Accumulating clinical evidence has shown that diabetes mellitus (DM) is a serious risk factor for cardiovascular disorders and an important factor for adverse cardiovascular events.
AIM To explore the value of the combined determination of the neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in the early diagnosis and prognosis evaluation of DM complicated with heart failure (HF).
METHODS We retrospectively analyzed clinical data on 65 patients with type 2 DM (T2DM) complicated with HF (research group, Res) and 60 concurrent patients with uncomplicated T2DM (control group, Con) diagnosed at Zhejiang Provincial People’s Hospital between January 2019 and December 2021. The NLR and RDW values were determined and comparatively analyzed, and their levels in T2DM + HF patients with different cardiac function grades were recorded. The receiver operating characteristic (ROC) curves were plotted to determine the NLR and RDW values (alone and in combination) for the early diagnosis of HF. The correlation between NLR and RDW with the presence or absence of cardiac events was also investigated.
RESULTS Higher NLR and RDW levels were identified in the Res vs the Con groups (P < 0.05). The NLR and RDW increased gradually and synchronously with the deterioration of cardiac function in the Res group, with marked differences in their levels among patients with grade II, III, and IV HF (P < 0.05). ROC curve analysis revealed that NLR combined with RDW detection had an area under the curve of 0.915, a sensitivity of 76.9%, and a specificity of 100% for the early diagnosis of HF. Furthermore, HF patients with cardiac events showed higher NLR and RDW values compared with HF patients without cardiac events.
CONCLUSION NLR and RDW were useful laboratory indicators for the early diagnosis of DM complicated with HF, and their joint detection was beneficial for improving diagnostic efficiency. Additionally, NLR and RDW values were directly proportional to patient outcomes.
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Affiliation(s)
- Jie Pang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (The Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Lin-Yan Qian
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (The Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Ping Lv
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (The Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Xiao-Ru Che
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (The Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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Mahmood A, Haider H, Samad S, Kumar D, Perwaiz A, Mushtaq R, Ali A, Farooq MZ, Farhat H. Association of white blood cell parameters with metabolic syndrome: A systematic review and meta-analysis of 168,000 patients. Medicine (Baltimore) 2024; 103:e37331. [PMID: 38457562 PMCID: PMC10919507 DOI: 10.1097/md.0000000000037331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Leukocyte parameters are predicted to be affected in patients with metabolic syndrome (MetS). We conducted a systematic review and meta-analysis to study the association between white blood cell parameters (WBC) in people with and without MetS. METHODS PubMed, EMBASE, Scopus and Cochrane Library databases were searched according to the study protocol. The standardized mean difference (SMD) and 95% confidence intervals (CI) of leukocyte markers between individuals with and without MetS were pooled using an inverse variance model. Additionally, a subgroup analysis by sex was performed where possible. Methodological quality assessment was conducted using the Newcastle-Ottawa scale (NOS) for observational studies and the Cochrane Risk of Bias tool 2.0 for Randomized Controlled Trials (RCTs). RESULTS Of 6068 articles identified, 63 were eligible for the study. Compared to controls, individuals with MetS showed significantly higher concentrations of total leukocyte count (SMD [95% CI]: 0.60 [0.55-0.65]; P < .00001; I2 = 100%), neutrophil counts (0.32 [0.28-0.37]; P < .00001; I2 = 99%), lymphocyte counts (0.15 [0.07-0.23]; P = .0004; I2 = 100%), basophil counts (0.01 [0.00-0.02]; P = .02; I2 = 98%), monocyte counts (0.05 [0.02-0.09]; P = .003; I2 = 99%), and neutrophil-to-lymphocyte ratio (0.24 [0.15-0.33]; P < .00001; I2 = 98%). There were no significant differences in the eosinophil count (0.02 [-0.01 to 0.05]; P = .19; I2 = 96%) and monocyte-to-lymphocyte ratio (0.06 [-0.05 to 0.17]; P = .27; I2 = 100%) between patients with and without MetS, however, the lymphocyte-to-monocyte ratio (0.52 [-0.81 to -0.23]; P = .0005; I2 = 52%) tended to be significantly lower in patients with MetS. CONCLUSION Biomarkers such as total leukocyte count, neutrophil count, lymphocyte count, basophil count, monocyte count and neutrophil-to-lymphocyte ratio are associated with higher levels in patients in MetS and thus can potentially be used for early detection of MetS.
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Affiliation(s)
- Aysal Mahmood
- Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Hoorain Haider
- Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Saba Samad
- Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Danisha Kumar
- Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Aimen Perwaiz
- Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Rabeea Mushtaq
- Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Abraish Ali
- Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | | | - Hadi Farhat
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
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Jin P, Wu SJ, Ma Q, Liu W, Zhao YX, Han HY, Hou FJ, Li Y, Zhou YJ. The Relation Between Red Blood Cell Distribution Width and Coronary Atherosclerotic Plaque Vulnerability Detected by Intracoronary Optical Coherence Tomography. Curr Vasc Pharmacol 2022; 20:501-507. [PMID: 35638281 DOI: 10.2174/1570161120666220527093551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/02/2022] [Accepted: 01/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND A higher red blood cell distribution width (RDW) predicts major adverse cardiac events in patients with coronary artery disease (CAD). However, there are only a few studies regarding the relationship between RDW and vulnerable plaques. Thus, the purpose of the present study is to retrospectively explore the predictive value of the association between RDW and plaque vulnerability assessed by optical coherence tomography (OCT) in patients with cardiovascular (CV) diseases. METHODS This study included 35 patients with stable angina pectoris (SAP) and 70 patients with the acute coronary syndrome (ACS). We documented clinical features as well as peripheral RDW. Plaque vulnerability was determined by OCT. We defined thin-cap fibroatheroma (TCFA) as a lipid-rich plaque (fibrous cap <65 μm thick). RESULTS Plaque rupture was detected more frequently in patients with ACS compared with patients with SAP (62.9 vs. 2.9%, p<0.001, and the corresponding TCFA were 50.69±15.68 vs. 80.03±21.60 μm, p<0.001, respectively). A higher RDW was found in patients with ACS than in patients with SAP (p<0.001). A cut-off value of RDW >13.85% could detect ruptured plaque with a sensitivity of 72.3% and a specificity of 62%. CONCLUSION TCFA and plaque rupture were detected more frequently in patients with ACS compared with SAP. Elevated RDW was positively the predictive value of the association between plaque vulnerability.
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Affiliation(s)
- Peng Jin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China.,Hebei Petrochina Central Hospital, Langfang, Hebei Province, 065000, China
| | - Si-Jing Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
| | - Qian Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
| | - Wei Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
| | - Ying-Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
| | - Hong-Ya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
| | - Fang-Jie Hou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
| | - Ya Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
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Duan S, Wang J, Yu F, Song L, Liu C, Sun J, Deng Q, Wang Y, Zhou Z, Guo F, Zhou L, Wang Y, Tan W, Jiang H, Yu L. Enrichment of the Postdischarge GRACE Score With Deceleration Capacity Enhances the Prediction Accuracy of the Long-Term Prognosis After Acute Coronary Syndrome. Front Cardiovasc Med 2022; 9:888753. [PMID: 35571153 PMCID: PMC9091655 DOI: 10.3389/fcvm.2022.888753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/01/2022] [Indexed: 12/19/2022] Open
Abstract
Background Cardiac autonomic nerve imbalance has been well documented to provide a critical foundation for the development of acute coronary syndrome (ACS) but is not included in the postdischarge GRACE score. We investigated whether capturing cardiac autonomic nervous system (ANS)-related modulations by 24-h deceleration capacity (DC) could improve the capability of existing prognostic models, including the postdischarge Global Registry of Acute Coronary Events (GRACE) score, to predict prognosis after ACS. Method Patients with ACS were assessed with 24-h Holter monitoring in our department from June 2017 through June 2019. The GRACE score was calculated for postdischarge 6-month mortality. The patients were followed longitudinally for the incidence of major adverse cardiac events (MACEs), set as a composite of non-fatal myocardial infarction and death. To evaluate the improvement in its discriminative and reclassification capabilities, the GRACE score with DC model was compared with a model using the GRACE score only, using area under the receiver-operator characteristic curve (AUC), Akaike's information criteria, the likelihood ratio test, category-free integrated discrimination index (IDI) and continuous net reclassification improvement (NRI). Results Overall, 323 patients were enrolled consecutively. After the follow-up period (mean, 43.78 months), 41 patients were found to have developed MACEs, which were more frequent among patients with DC <2.5 ms. DC adjusted for the GRACE score independently predicted the occurrence of MACEs with an adjusted hazard ratio (HR) of 0.885 and 95% CI of 0.831–0.943 (p < 0.001). Moreover, adding DC to the GRACE score only model increased the discriminatory ability for MACEs, as indicated by the likelihood ratio test (χ2 = 9.277, 1 df; p < 0.001). The model including the GRACE score combined with DC yielded a lower corrected Akaike's information criterion compared to that with the GRACE score alone. Incorporation of the DC into the existing model that uses the GRACE score enriched the net reclassification indices (NRIe>0 7.3%, NRIne>0 12.8%, NRI>0 0.200; p = 0.003). Entering the DC into the GRACE score model enhanced discrimination (IDI of 1.04%, p < 0.001). Conclusion DC serves as an independent and effective predictor of long-term adverse outcomes after ACS. Integration of DC and the postdischarge GRACE score significantly enhanced the discriminatory capability and precision in the prediction of poor long-term follow-up prognosis.
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Affiliation(s)
- Shoupeng Duan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Fu Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Lingpeng Song
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Chengzhe Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Ji Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Qiang Deng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yijun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Zhen Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Fuding Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Liping Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Yueyi Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Wuping Tan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
- Hong Jiang
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiac Autonomic Nervous System Research Centre of Wuhan University, Wuhan, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
- *Correspondence: Lilei Yu
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Yılmaz F, Yılmaz FK, Karagöz A, Yıldırım A, Gunes HM, Akbas RB, Efe SÇ, Barutçu İ. Usefulness of neutrophil-to-lymphocyte ratio for predicting acute pericarditis outcomes. Acta Cardiol 2021; 77:422-430. [PMID: 34275415 DOI: 10.1080/00015385.2021.1951998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In daily practice, C-reactive protein (CRP) may be used to predict recurrence and treatment response in patients with acute pericarditis; however, the predictive role of CRP might be insufficient for clinical prediction in some patients. In this study, we aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and the composite endpoint of pericarditis recurrence and/or tamponade within 1 year in patients with acute pericarditis. METHODS A total of 104 patients diagnosed with acute idiopathic pericarditis (mean age 42.8 ± 15.2 years, 55.8% male) were included in the study. Physical examination findings of these patients, electrocardiography, echocardiography, chest X-ray and laboratory findings were evaluated and analysed. During the 1-year follow-up, the composite of cardiac tamponade and/or pericarditis recurrence was investigated as the primary endpoint of the study. RESULTS Compared to the group without the composite outcome, the group with the composite outcome had significantly higher rates of moderate and severe pericardial effusion (p < 0.01) and higher white blood cell (WBC) count (p:0.001), platelet count (p = 0.003), NLR (2.14 (1.49-3.02) vs 6.60 (5.50-8.68); p < 0.001) and high-sensitivity C-reactive protein (hs-CRP) (8.01 (5.1-24.5 vs 69.5 (40.8-128); p:0.001). Higher hs-CRP (p < 0.001), WBC (p:0.001), NLR (p < 0.001) and platelets (p:0.02) were associated with pericarditis recurrence. NLR and hs-CRP were independently associated with the composite endpoint (p < 0.001 and p < 0.001, respectively). CONCLUSION NLR and hs-CRP were found to be independent predictors for the composite endpoint of tamponade and/or recurrence in acute pericarditis patients during the 1-year follow-up. Similar to hs-CRP, NLR may also be used for risk assessment in patients with idiopathic pericarditis.
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Affiliation(s)
- Fatih Yılmaz
- Kartal Kosuyolu Research and Education Hospital, Kartal, Turkey
| | | | - Ali Karagöz
- Kartal Kosuyolu Research and Education Hospital, Kartal, Turkey
| | - Arzu Yıldırım
- Faculty of Medicine, Cardiology Department, Medipol University, Istanbul, Turkey
| | - Haci Murat Gunes
- Faculty of Medicine, Cardiology Department, Medipol University, Istanbul, Turkey
| | | | | | - İrfan Barutçu
- Faculty of Medicine, Cardiology Department, Medipol University, Istanbul, Turkey
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The relationship between corrected QT interval and neutrophil to lymphocyte ratio in patients with acute coronary syndrome. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.867770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Li C, Wang Y, Zhang Q, Wang L, Li K, Yang X. Incorporating the erythrocyte sedimentation rate for enhanced accuracy of the global registry of acute coronary event score in patients with ST-segment elevated myocardial infarction: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e22523. [PMID: 33031294 PMCID: PMC7544386 DOI: 10.1097/md.0000000000022523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
There is scarce evidence that the erythrocyte sedimentation rate (ESR) could efficiently improve the prediction accuracy of the Global Registry of Acute Coronary Events (GRACE) risk score in cases of ST-elevation myocardial infarction (STEMI).A cohort of 1094 STEMI patients undergoing primary percutaneous coronary intervention was retrospectively recruited. Patients were categorized based on the ESR values. Final endpoints included cardiovascular death and major adverse cardiovascular event (MACE) occurrence. The predictive value of combined models with the GRACE score and ESR was assessed by receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI), and integrated discrimination improvement.During the mean follow-up of 23 months, 34 patients died and 190 experienced MACEs, of which 23 patients died in the first year; both endpoints were more frequent in the higher group. The ESR and high-sensitivity C-reactive protein (hs-CRP) were independent risk factors of 1-year cardiovascular death, together with the GRACE score (ESR: hazard ratio = 1.03, P = .006 hs-CRP: hazard ratio = 1.00, P = .001; GRACE: 1.03, P = .012). Although no statistical improvement in the area under the ROC curve was observed in either the GRACE/ESR or the GRACE/hs-CRP model (GRACE/ESR models: 0. 8073 vs GRACE: 0.7714, P = .22; GRACE/ESR models: 0. 7815 vs GRACE: 0.7714, P = .61), the GRACE score and ESR together significantly improved the NRI (0.633; P< .001) compared with the GRACE alone. Regarding the mid-term mortality, adding the ESR to the GRACE score not only improved the NRI (0.8433; P < .001), but also increased the integrated discrimination improvement (0.0509; P = .04).The ESR is an independent risk factor of cardiovascular death and MACE in STEMI patients receiving primary percutaneous coronary intervention. The ESR comparatively enhanced the predictive values of the prognostic model, including the GRACE risk score.
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ÖZMEN FN, SULTANOĞLU H, ÇAVUŞ U, ÖZTÜRK A. Diagnostic Comparison Of Troponin and Scube 1 Levels In Patients Diagnosed with Stemi and Nstemi In The Emergency Department. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.759490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Association between Neutrophil Percentage-to-Albumin Ratio and All-Cause Mortality in Critically Ill Patients with Coronary Artery Disease. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8137576. [PMID: 32934964 PMCID: PMC7479485 DOI: 10.1155/2020/8137576] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/31/2020] [Accepted: 08/13/2020] [Indexed: 12/19/2022]
Abstract
Background Neutrophil percentage-to-albumin ratio (NPAR) has been proved to be associated with clinical outcome of many diseases. This study was aimed at exploring the independent effect of NPAR on all-cause mortality of critically ill patients with coronary artery disease (CAD). Method NPAR was calculated as neutrophil percentage numerator divided by serum albumin concentration. Clinical endpoints were 30-day, 90-day, and 365-day all-cause mortality. Multivariable Cox proportional hazard models were performed to confirm the association between NPAR and all-cause mortality. Result 3106 patients with CAD were enrolled. All-cause mortality rates of 30 days (P < 0.001), 90 days (P < 0.001), and 365 days (P < 0.001) increased as NPAR tertiles increased. And after adjusting for possible confounding variables, NPAR was still independently associated with 30-day (third tertile group versus first tertile group: HR, 95% CI: 1.924, 1.471-2.516; P for trend < 0.001), 90-day (third tertile group versus first tertile group: HR, 95% CI: 2.053, 1.646-2.560; P for trend < 0.001), and 365-day (third tertile group versus first tertile group: HR, 95% CI: 2.063, 1.717-2.480; P for trend < 0.001) all-cause mortality in patients with CAD. Subgroup analysis did not find obvious interaction in most subgroups. Conclusion NPAR was independently correlated with 30-day, 60-day, and 365-day all-cause mortality in critically ill patients with CAD.
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Rodríguez-Rodríguez E, López-Sobaler AM, Ortega RM, Delgado-Losada ML, López-Parra AM, Aparicio A. Association between Neutrophil-to-Lymphocyte Ratio with Abdominal Obesity and Healthy Eating Index in a Representative Older Spanish Population. Nutrients 2020; 12:nu12030855. [PMID: 32210070 PMCID: PMC7146141 DOI: 10.3390/nu12030855] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/12/2022] Open
Abstract
Poor diet quality and obesity, especially abdominal obesity, have been associated with systemic inflammation. The neutrophil-to-lymphocyte Ratio (NLR) is an available and inexpensive inflammation biomarker. The aim of the present study was to determine the association of dietary patterns and obesity with an inflammatory state. A group of 1747 Spanish noninstitutionalized older adults individuals were included, and a food-frequency questionnaire was applied. The Global Food Score (GFS) and Healthy Eating Index for Spanish population (SHEI) were calculated. Weight, height and waist (WC) and hip circumferences were measured, and BMI, waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) determined. In addition, body-fat percentage was measured by bioimpedance. NLR was calculated (NLR ≥ p80: 2.6; 2.8 and 2.4 as inflammatory status in the entire population, men and women, respectively). The men with inflammatory status presented significative higher values of WC, WHtR, WHR, and body-fat percentage (101.82 ± 10.34 cm, 0.61 ± 0.06, 0.98 ± 0.06, and 31.68 ± 5.94%, respectively) than those with better inflammatory status (100.18 ± 10.22 cm, 0.59 ± 0.06, 0.97 ± 0.07, and 30.31 ± 6.16%, respectively). Those males with worse inflammatory state had lower scores for protein foods (OR = 0.898 (0.812–0.993); p = 0.037). The women with NLR ≥ 2.4 had higher WHtR and WHR (0.62 ± 0.09 and 0.91 ± 0.09) than those with NLR < 2.4 (0.60 ± 0.08 and 0.90 ± 0.08). In multiple linear regression analysis, NLR was positively related with WHtR and negatively related with SHEI score (β = 0.224 ± 0.094; R2 = 0.060; p < 0.05 and β = −0.218 ± 0.101; R2 = 0.061; p < 0.05), adjusting by sex, age, marital status, education level, smoking, hours of sleeping and inflammatory diseases. In women, the higher the SHEI and GFS scores were and the better meeting the aims of cereal and vegetable servings, the less the odds of inflammatory status (OR = 0.970 (0.948–0.992); p = 0.008; OR = 0.963 (0.932–0.995); p = 0.024; OR = 0.818 (0.688–0.974); p = 0.024 and OR = 0.829 (0.730–0.942); p = 0.004, respectively). WHtR and quality of diet is related to the inflammation status in older adults regardless to the sex.
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Affiliation(s)
- Elena Rodríguez-Rodríguez
- Department of Chemistry in Pharmaceutical Sciences, Analytical Chemistry, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain;
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain; (A.M.L.-S.); (R.M.O.); (M.L.D.-L.)
| | - Ana M. López-Sobaler
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain; (A.M.L.-S.); (R.M.O.); (M.L.D.-L.)
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Rosa M. Ortega
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain; (A.M.L.-S.); (R.M.O.); (M.L.D.-L.)
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - M. Luisa Delgado-Losada
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain; (A.M.L.-S.); (R.M.O.); (M.L.D.-L.)
- Department of Experimental Psychology, Psychological Processes and Speech Therapy, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
| | - Ana M. López-Parra
- Department of Legal Medicine, Psychiatry and Pathology, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain;
| | - Aránzazu Aparicio
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain; (A.M.L.-S.); (R.M.O.); (M.L.D.-L.)
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-91-394-1837
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12
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Chen C, Zhao HY, Zhang YH. Correlation between neutrophil-to-lymphocyte ratio and kidney dysfunction in undiagnosed hypertensive population from general health checkup. J Clin Hypertens (Greenwich) 2019; 22:47-56. [PMID: 31786831 DOI: 10.1111/jch.13749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/30/2019] [Accepted: 10/07/2019] [Indexed: 12/25/2022]
Abstract
Recently, neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are frequently used to evaluate disease progression and outcome. Here, we aim to analyze the associations between NLR or MLR and kidney function in undiagnosed hypertensive individuals from general population during routine health checkup. Liver function was analyzed for comparison. From 2011 to 2016, 53 939 examiners have registered for health checkup in Yanbian University Hospital, Yanbian, China. Among 15 219 participants who have complete datasets, 4997 individuals were hypertensive (HTN, SBP/DBP: ≥ 140/90 mm Hg). NLR, glucose, lipids (Chol, TG, LDL), kidney (CREA, BUN), and liver (AST, ALT, GGT, ALB, TBIL) functional parameters were significantly higher in HTN. Pearman correlation analysis showed that NLR was positively correlated with SBP and CREA only in HTN. MLR was associated with CREA in both HTN and non-HTN. NLR or MLR was associated with liver functions similarly in HTN and non-HTN. The authors then divided NLR or MLR into tertiles (NLR: 0-1.7276, 1.7276-3, >3; MLR: 0-0.1845, 0.1845-0.3, >0.3). NLR was positively associated with BUN at NLR >1.7276 and with CREA at all tertiles in HTN. MLR was correlated with CREA and BUN at high MLR in non-HTN. Further analysis showed that age or gender did not affect the associations of NLR and MLR with kidney function in HTN, but strong association was observed in male or aged (>65 years old) non-HTN group. These results showed that NLR could be used as a cost-effective predictor of kidney abnormality in HTN patients even in a general population.
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Affiliation(s)
- Chen Chen
- Yanbian University Hospital, Clinical Research Center, Yanji, China
| | - Hai Yan Zhao
- Yanbian University Hospital, Clinical Research Center, Yanji, China
| | - Yin Hua Zhang
- Yanbian University Hospital, Clinical Research Center, Yanji, China.,Department of Physiology & Biomedical Sciences, Ischemic/hypoxic Disease Institutes, Seoul National University, College of Medicine, Seoul, Korea.,Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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13
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Bayrak M, Tosun V, Kilinç AY, Saydam G, Korucuk N, Altekin RE, Yilmaz H. Association of neutrophil lymphocyte ratio and C-reactive protein with left atrial appendage thrombus: a transesophageal echocardiography study. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Neutrophil-to-lymphocyte ratio and exercise intensity are associated with cardiac-troponin levels after prolonged cycling: the Indonesian North Coast and Tour de Borobudur 2017 Troponin Study. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Liu CC, Ko HJ, Liu WS, Hung CL, Hu KC, Yu LY, Shih SC. Neutrophil-to-lymphocyte ratio as a predictive marker of metabolic syndrome. Medicine (Baltimore) 2019; 98:e17537. [PMID: 31651856 PMCID: PMC6824790 DOI: 10.1097/md.0000000000017537] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Neutrophil-to-lymphocyte ratio (NLR) serves as a strong prognostic indicator for patients suffering from various diseases. Neutrophil activation promotes the recruitment of a number of different cell types that are involved in acute and chronic inflammation and are associated with cancer treatment outcome. Measurement of NLR, an established inflammation marker, is cost-effective, and it is likely that NLR can be used to predict the development of metabolic syndrome (MS) at an early stage. MS scores range from 1 to 5, and an elevated MS score indicates a greater risk for MS. Monitoring NLR can prevent the risk of MS.A total of 34,013 subjects were enrolled in this study. The subjects (score 0-5) within the 6 groups were classified according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, and all anthropometrics, laboratory biomarkers, and hematological measurements were recorded. For the 6 groups, statistical analysis and receiver operating characteristic (ROC) curves were used to identify the development of MS.Analysis of the ROC curve indicated that NLR served as a good predictor for MS. An MS score of 1 to 2 yielded an acceptable discrimination rate, and these rates were even higher for MS scores of 3 to 5 (P < .001), where the prevalence of MS was 30.8%.NLR can be used as a prognostic marker for several diseases, including those associated with MS.
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Affiliation(s)
- Chuan-Chuan Liu
- The Institute of Health Policy and Management, College of Public Health, National Taiwan University
- Health Evaluation Center, Mackay Memorial Hospital
| | - Hung-Ju Ko
- Health Evaluation Center, Mackay Memorial Hospital
| | - Wan-Shan Liu
- Health Evaluation Center, Mackay Memorial Hospital
| | - Chung-Lieh Hung
- Mackay Medical College
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital
| | - Kuang-Chun Hu
- Health Evaluation Center, Mackay Memorial Hospital
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lo-Yip Yu
- Health Evaluation Center, Mackay Memorial Hospital
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital
| | - Shou-Chuan Shih
- Health Evaluation Center, Mackay Memorial Hospital
- Mackay Medical College
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital
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Meeuwsen JAL, de Vries JJ, van Duijvenvoorde A, van der Velden S, van der Laan SW, van Koeverden ID, van de Weg SM, de Borst GJ, de Winther MPJ, Kuiper J, Pasterkamp G, Hoefer IE, de Jager SCA. Circulating CD14 +CD16 - classical monocytes do not associate with a vulnerable plaque phenotype, and do not predict secondary events in severe atherosclerotic patients. J Mol Cell Cardiol 2019; 127:260-269. [PMID: 30629987 DOI: 10.1016/j.yjmcc.2019.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 12/01/2018] [Accepted: 01/04/2019] [Indexed: 12/25/2022]
Abstract
AIMS Mouse studies have established distinct monocyte subtypes that participate in the process of atherosclerotic lesion formation. The pro-inflammatory Ly6Chigh monocyte subtype actively contributes to murine plaque progression and destabilization. Also in humans, different peripheral monocyte subtypes have been identified, of which the CD14+CD16- classical monocyte is suggested to display similar pro-atherosclerotic properties as the murine Ly6Chigh subtype. We aimed to investigate if circulating CD14+CD16- classical monocytes associate with characteristics of a vulnerable carotid atherosclerotic plaque and if they associate with the risk of secondary adverse manifestations of atherosclerotic disease. METHODS AND RESULTS We enrolled 175 carotid endarterectomy patients of the Athero-Express biobank in our study. Just prior to surgical procedure, blood was collected and peripheral blood mononuclear cells were isolated. Characterization of monocyte subsets was performed by flow cytometry. Plaque characteristics were semi-quantitatively scored for the presence of fat, collagen, intraplaque hemorrhage and calcification. Vessel density, smooth muscle cells and macrophages were assessed quantitatively on a continuous scale. All features of a vulnerable plaque phenotype, including low amounts of collagen and smooth muscle cells, and increased fat content, vessel density, intraplaque hemorrhage and plaque macrophages were not significantly associated with differential levels of peripheral classical CD14+CD16- monocytes or other monocyte subsets. Using Cox regression models to evaluate the prognostic value of circulating monocyte subtypes, we found that total counts of peripheral monocytes, as well as CD14+CD16- classical and other monocyte subtypes were not associated with the risk of secondary cardiovascular events during 3 years follow-up. CONCLUSION Circulating classical CD14+CD16- monocytes do not associate with specific vulnerable plaque characteristics. In addition, they do not predict secondary adverse manifestations. This suggests that in patients with established carotid artery disease, the circulating monocytes do not reflect plaque characteristics and have no value in identifying patients at risk for future cardiovascular events.
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Affiliation(s)
- John A L Meeuwsen
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Judith J de Vries
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Amerik van Duijvenvoorde
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia van der Velden
- Department of Medical Biochemistry, Experimental Vascular Biology, Academic Medical Center, Amsterdam, the Netherlands
| | - Sander W van der Laan
- Laboratory for Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ian D van Koeverden
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sander M van de Weg
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Menno P J de Winther
- Department of Medical Biochemistry, Experimental Vascular Biology, Academic Medical Center, Amsterdam, the Netherlands
| | - Johan Kuiper
- Division of Biotherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - Gerard Pasterkamp
- Laboratory for Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Imo E Hoefer
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.; Laboratory for Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia C A de Jager
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Guo TM, Cheng B, Ke L, Guan SM, Qi BL, Li WZ, Yang B. Prognostic Value of Neutrophil to Lymphocyte Ratio for In-hospital Mortality in Elderly Patients with Acute Myocardial Infarction. Curr Med Sci 2018; 38:354-359. [DOI: 10.1007/s11596-018-1887-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/07/2017] [Indexed: 01/22/2023]
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Prognostic value of hematological parameters in patients with acute myocardial infarction: Intrahospital outcomes. PLoS One 2018; 13:e0194897. [PMID: 29668734 PMCID: PMC5905886 DOI: 10.1371/journal.pone.0194897] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/12/2018] [Indexed: 01/16/2023] Open
Abstract
Background The intensity of the inflammatory response and hemodynamic repercussion in acute myocardial infarction causing the presence in the peripheral circulation of nucleated red blood cells (NRBCs), increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are associated with a poorer prognosis. The aim of this study was to assess the role of these hematological biomarkers as predictors of all causes of mortality during the hospitalization of patients with acute myocardial infarction. Methods Nucleated red blood cells, mean platelet volume and neutrophil to lymphocyte ratio were measured daily during the hospitalization of the patients with acute myocardial infarction. We excluded patients younger than 18 years, on glucocorticoid therapy, with cancer or hematological diseases and those that were readmitted after hospital discharge. We performed a multiple logistic analysis to identify independent predictors of mortality. Results We included 466 patients (mean age 64.2 ± 12.8 years, 61.6% male). The prevalence of NRBCs in the sample was 9.1% (42 patients), with levels > 200/μL in 27 patients (5.8%). The mean MPV value was 10.9 ±0,9 and the mean NLR value was 3.71 (2,38; 5,72). In a multivariate analysis of serum NRBCs (HR 2.42, 95% CI: 1.35–4.36, p = 0.003), MPV (HR 2.97, 95% CI: 1.15–7.67, p = 0.024) and NLR (HR 5.02, 95% CI: 1.68–15.0, p = 0.004). The presence in the peripheral blood of NRBCs, increased in mean platelet volume and neutrophil to lymphocyte ratio were associated with higher mortality. Conclusions Nucleated red blood cells, mean platelet volume and neutrophil to lymphocyte ratio are independent predictors of intrahospital mortality. Therefore, an important tool in intrahospital clinical surveillance.
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19
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Chen C, Cong BL, Wang M, Abdullah M, Wang XL, Zhang YH, Xu SJ, Cui L. Neutrophil to lymphocyte ratio as a predictor of myocardial damage and cardiac dysfunction in acute coronary syndrome patients. Integr Med Res 2018; 7:192-199. [PMID: 29984180 PMCID: PMC6026362 DOI: 10.1016/j.imr.2018.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 12/22/2022] Open
Abstract
Background Neutrophil to lymphocyte ratio (NLR) in peripheral blood is established to correlate with the morbidity and mortality of heart disease patients. We aimed to define the severity of inflammation (NLR) by observing the association of NLR with cardiac functions or myocardial damage parameters in patients with acute myocardial infarction. Methods Data from 715 patients who underwent percutaneous coronary intervention (PCI) within 72 hours of incidence in 2016 were analysed retrospectively. Results The NLR ranges from 0.50 to 46 (medium ± SD, 2.76 ± 2.96) in 715 patients. NLR positively correlated with myocardial damage (NLR vs. CK-mB: p < 0.0001) but negatively correlated with myocardial function (NLR vs. EF: p < 0.0001; NLR vs. FS: p < 0.0001). Myocardial damage markers (CK, CK-mB, ASL, LDH) were significantly increased, and cardiac contractile parameters (EF and FS) were reduced at NLR > 2.76 compared to those of NLR < 2.76. ELISA analysis has shown that IL-10 was significantly increased when NLR ≥ 4.6 and TGF-β was increased at NLR > 4. The correlation was diminished between NLR and CK-mB at NLR > 2.76 or at NLR > 4, but that of NLR and EF or FS was maintained in NLR > 2.76 and at NLR > 4. EF and FS were comparable between NLR > 2.76 and NLR > 4. But myocardial damage parameters increased significantly at NLR > 4 compared to those of NLR > 2.76. Conclusion NLR is a strong predictor of myocardial damage in acute myocardial patients. High NLR are associated with myocardial dysfunction in all the patients. Severe inflammation (NLR) can predict the consequence of the heart in patients with coronary syndrome.
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Affiliation(s)
- Chen Chen
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Bai Lin Cong
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Min Wang
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | | | - Xiao Long Wang
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Yin Hua Zhang
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Shun Ji Xu
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Lan Cui
- Department of Cardiology, Yanbian University Hospital, Yanji, China
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Liang Y, Chen H, Wang P. Correlation of Leukocyte and Coronary Lesion Severity of Acute Myocardial Infarction. Angiology 2017; 69:591-599. [PMID: 29130316 DOI: 10.1177/0003319717740782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leukocytes play a pivotal role in the onset and progression of acute myocardial infarction (AMI). We evaluated the relationship between leukocyte count and coronary lesion severity of AMI. We carried out a retrospective study involving 815 patients with AMI undergoing primary percutaneous coronary intervention from 2005 to 2014 at a cardiovascular center. We recorded their risk factors, routine blood parameters, and cardiovascular events during hospitalization. When thrombus and nonthrombus burden groups were compared, leukocyte count (9.55 [7.80, 12.29] vs 10.70 [8.67, 13.04]×109/L, P = .005), neutrophil count (7.48 [5.65, 10.18] vs 8.61 [6.61, 10.80]×109/L, P = .001), and neutrophil–lymphocyte ratio (NLR; 4.99 [2.97, 7.16] vs 10.70 [8.67, 13.04], P = .003) were significantly different. Patients in the total occlusion group showed higher leukocyte count, neutrophil count, and NLR compared to the nontotal occlusion group. After multivariate logistic analysis, a neutrophil count ≥8.355 × 109/L was independently associated with high thrombus burden and total coronary occlusion. Leukocyte count, neutrophil count, or NLR was not significantly related to cardiovascular events during hospitalization. In conclusion, the neutrophil count might be an independent predictor of high thrombus burden and total coronary occlusion.
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Affiliation(s)
- Yunting Liang
- Department of Pediatric Cardiovascular Center, Anzhen Hospital, Beijing, China
- Yunting Liang and Hui Chen are the co-first authors
| | - Hui Chen
- Department of Cardiovascular Center, Friendship Hospital, Beijing, China
- Yunting Liang and Hui Chen are the co-first authors
| | - Ping Wang
- Department of Cardiovascular Center, Friendship Hospital, Beijing, China
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Meeuwsen JAL, Wesseling M, Hoefer IE, de Jager SCA. Prognostic Value of Circulating Inflammatory Cells in Patients with Stable and Acute Coronary Artery Disease. Front Cardiovasc Med 2017; 4:44. [PMID: 28770211 PMCID: PMC5509763 DOI: 10.3389/fcvm.2017.00044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/26/2017] [Indexed: 12/22/2022] Open
Abstract
Atherosclerosis is a lipid driven chronic inflammatory disease underlying the majority of ischemic events such as myocardial infarction or stroke. Clinical management of ischemic events has improved considerably in the past decades. Accordingly, survival rates have increased. Nevertheless, 12% of patients die within 6 months after the initial event. To improve secondary prevention, appropriate risk prediction is key. However, up to date, there is no clinically available routine marker to identify patients at high risk for recurrent cardiovascular events. Due to the central role of inflammation in atherosclerotic lesion progression and destabilization, many studies have focused on the role of circulating inflammatory cells in these processes. This review summarizes the current evidence on the potential of circulating inflammatory cells as biomarkers for recurrent adverse manifestations in acute coronary syndrome and stable coronary artery disease patients.
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Affiliation(s)
- John A L Meeuwsen
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marian Wesseling
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Imo E Hoefer
- Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Saskia C A de Jager
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
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Karakas MS, Korucuk N, Tosun V, Altekin RE, Koç F, Ozbek SC, Ozel D, Ermis C. Red cell distribution width and neutrophil-to-lymphocyte ratio predict left ventricular dysfunction in acute anterior ST-segment elevation myocardial infarction. J Saudi Heart Assoc 2016; 28:152-8. [PMID: 27358532 PMCID: PMC4917641 DOI: 10.1016/j.jsha.2015.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- Mustafa Serkan Karakas
- Department of Cardiology, Akdeniz University Medical Faculty, Dumlupinar Bouleward, Konyaaltı, Antalya, Turkey
| | - Necmettin Korucuk
- Department of Cardiology, Akdeniz University Medical Faculty, Dumlupinar Bouleward, Konyaaltı, Antalya, Turkey
| | - Veysel Tosun
- Department of Cardiology, Akdeniz University Medical Faculty, Dumlupinar Bouleward, Konyaaltı, Antalya, Turkey
| | - Refik Emre Altekin
- Department of Cardiology, Akdeniz University Medical Faculty, Dumlupinar Bouleward, Konyaaltı, Antalya, Turkey
| | - Fatih Koç
- Department of Cardiology, Akdeniz University Medical Faculty, Dumlupinar Bouleward, Konyaaltı, Antalya, Turkey
| | - Sinan Cemgil Ozbek
- Department of Cardiology, Ahi Evran University Education and Research Hospital, Kırşehir, Turkey
| | - Deniz Ozel
- Department of Biostatistics and Medical Informatics, Akdeniz University Medical Faculty, Dumlupinar Bouleward, Konyaaltı, Antalya, Turkey
| | - Cengiz Ermis
- Department of Cardiology, Akdeniz University Medical Faculty, Dumlupinar Bouleward, Konyaaltı, Antalya, Turkey
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Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther 2016; 14:573-7. [PMID: 26878164 DOI: 10.1586/14779072.2016.1154788] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Maxwell E Afari
- a Division of Cardiovascular Medicine , St. Elizabeth's Medical Center, Tufts University School of Medicine , Boston , MA , USA
| | - Tariq Bhat
- a Division of Cardiovascular Medicine , St. Elizabeth's Medical Center, Tufts University School of Medicine , Boston , MA , USA
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Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome. Rev Port Cardiol 2015; 34:465-71. [DOI: 10.1016/j.repc.2015.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 01/04/2023] Open
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Soylu K, Gedikli Ö, Dagasan G, Aydin E, Aksan G, Nar G, İnci S, Yilmaz Ö. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Zhang S, Wan Z, Zhang Y, Fan Y, Gu W, Li F, Meng L, Zeng X, Han D, Li X. Neutrophil count improves the GRACE risk score prediction of clinical outcomes in patients with ST-elevation myocardial infarction. Atherosclerosis 2015; 241:723-8. [PMID: 26132283 DOI: 10.1016/j.atherosclerosis.2015.06.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/30/2015] [Accepted: 06/15/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Both the Global Registry of Acute Coronary Events (GRACE) risk score and neutrophil count could predict clinical outcomes in patients with acute coronary syndromes. However, the ability of them to identify high risk patients leaves room for improvement. The purpose of the present study was to evaluate whether the combination of them could have a better performance in predicting clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). METHODS A total of 1287 consecutive STEMI patients were recruited at two centers in China. Neutrophil count was measured and the GRACE risk score was calculated. RESULTS During a median period of 37 months (IQR, 29-47), 135 (10.9%) patients had major adverse cardiovascular events (MACE), including 116 all-cause death. Neutrophil count and the GRACE risk score were higher in patients with MACE. Both neutrophil count and the GRACE score were significant and independent predictors for MACE [HR: 1.260 (1.203-1.319), P < 0.001; HR: 1.007 (1.002-1.011), P < 0.001; respectively). Combination of them increased the area under the ROC (0.698 vs. 0.796, P < 0.001). The addition of neutrophil count to GRACE model enhanced net reclassification improvement (0.637, P = 0.020) and integrated discrimination improvement (0.180, P < 0.001), suggesting effective discrimination and reclassification. CONCLUSION Both neutrophil count and the GRACE risk score are independent predictors for MACE in patients with STEMI. A combination of them could derive a more accurate prediction for clinical outcomes in these patients.
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Affiliation(s)
- Sumei Zhang
- Xi'an Medical University, Xi'an, Shaanxi 710021, China
| | - Zhaofei Wan
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Yongai Zhang
- Xi'an Medical University, Xi'an, Shaanxi 710021, China
| | - Yan Fan
- Gansu Provincial People's Hospital, Lanzhou, 730000, China
| | - Wei Gu
- Department of Nursing, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China
| | - Fei Li
- Xi'an Medical University, Xi'an, Shaanxi 710021, China
| | - Li Meng
- Xi'an Medical University, Xi'an, Shaanxi 710021, China
| | - Xiaoyan Zeng
- The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China
| | - Dongfang Han
- The First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China
| | - Xiaomei Li
- Department of Nursing, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710061, China.
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Zhang E, Li Z, Che J, Chen X, Qin T, Tong Q, Zhao W, Li G. Anemia and Inflammation in ST-Segment Elevation Myocardial Infarction. Am J Med Sci 2015; 349:493-8. [PMID: 25978119 PMCID: PMC4450907 DOI: 10.1097/maj.0000000000000471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/05/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND To investigate the factors predicting the onset of major adverse cardiovascular events (MACEs) after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) patients. METHODS Two hundred forty-eight STEMI patients (61.4 ± 10.8 years, 186 men) who underwent successful primary percutaneous coronary intervention were enrolled. Patients were followed-up for 1 year. Univariate, multivariate analyses, and receiver operating characteristic curve analysis were performed to determine the factors predicting MACEs. RESULTS There were 36 patients (14.5%) who experienced MACEs in the follow-up period. Multivariate logistic regression analysis demonstrated that hemoglobin (HgB) (odds ratio = 0.972; 95% CI, 0.948-0.998; P = 0.033), neutrophil/lymphocyte ratio (NLR) (odds ratio = 1.511; 95% CI, 1.148-1.987; P = 0.003), Global Registry of Acute Coronary Event score, and postprocedure left ventricular ejection fraction (LVEF) were independent predictors of MACEs. Further subgroup analysis showed higher NLR (> 8.61), Global Registry of Acute Coronary Event score (> 167) and lower HgB (< 131 g/L) all show superior predictive value for patients with relatively higher LVEF (> 48%); moreover, the c-statistic of NLR and HgB both exceed 0.7. However, among patients with lower LVEF (≤ 48%), higher NLR and lower HgB lost the ability for predicting 1 year MACEs independently. In addition, abnormally higher NLR (> 8) could predict 1-month MACEs efficiently. CONCLUSIONS In summary, among STEMI patients, elevated NLR, decreased HgB level on admission both predicted 1-year MACEs independently, especially for those with relatively preserved LVEF (> 48%). Besides, abnormally higher NLR on admission should attract their attention for short-term MACEs.
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Affiliation(s)
- Enyuan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease (Key Lab-TIC) (EZ, JC, XC, GL), Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital, Tianjin Medical University, Tianjin, China; Intensive Care Unit (ZL), The Second Hospital, Tianjin Medical University, Tianjin, China; and Tianjin Medical University (TQ, QT, WZ), Tianjin, China
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Benites-Zapata VA, Hernandez AV, Nagarajan V, Cauthen CA, Starling RC, Tang WHW. Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure. Am J Cardiol 2015; 115:57-61. [PMID: 25456873 PMCID: PMC4262659 DOI: 10.1016/j.amjcard.2014.10.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 01/17/2023]
Abstract
Elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) and neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options from 2007 to 2010. Patients were divided according to low, intermediate, and high tertiles of NLR and were followed longitudinally for time to all-cause mortality or heart transplantation (primary outcome). The median NLR was 3.9 (interquartile range 2.5 to 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared with the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, compared with the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (hazard ratio [HR] = 1.61, 95% confidence interval [CI] 1.10 to 2.37 and HR = 1.55, 95% CI 1.02 to 2.36, respectively) and all-cause mortality (HR = 1.83, 95% CI 1.07 to 3.14 and HR = 2.16, 95% CI 1.21 to 3.83, respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF.
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Affiliation(s)
- Vicente A Benites-Zapata
- Unidad de Análisis y Generación de Evidencia en Salud Pública, Instituto Nacional de Salud, Lima, Peru
| | - Adrian V Hernandez
- Faculty of Health Sciences, Postgraduate and Medical Schools, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Health Outcomes and Clinical Epidemiology Section, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vijaiganesh Nagarajan
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Randall C Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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Yalcinkaya E, Yuksel UC, Celik M, Kabul HK, Barcin C, Gokoglan Y, Yildirim E, Iyisoy A. Relationship between neutrophil-to-lymphocyte ratio and electrocardiographic ischemia grade in STEMI. Arq Bras Cardiol 2014; 104:112-9. [PMID: 25424159 PMCID: PMC4375654 DOI: 10.5935/abc.20140179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/25/2014] [Indexed: 11/21/2022] Open
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future
adverse cardiovascular outcomes in patients with ST-segment elevation myocardial
infarction (STEMI). Changes in the QRS terminal portion have also been associated with
adverse outcomes following STEMI. Objective To investigate the relationship between ECG ischemia grade and NLR in patients
presenting with STEMI, in order to determine additional conventional risk factors for
early risk stratification. Methods Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG
performed on admission. White blood cells and subtypes were measured as part of the
automated complete blood count (CBC) analysis. Patients were classified into two groups
according to the ischemia grade presented on the admission ECG, as grade 2 ischemia
(G2I) and grade 3 ischemia (G3I). Results Patients with G3I had significantly lower mean left ventricular ejection fraction than
those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital
mortality rate increased proportionally with the increase in ischemia grade (p = 0.036).
There were significant differences in percentage of lymphocytes (p = 0.010) and
percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different
between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis
revealed that only NLR was the independent variable with a significant effect on ECG
ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120–1.403, p <
0.001). Conclusion We found an association between G3I and elevated NLR in patients with STEMI. We believe
that such an association might provide an additional prognostic value for risk
stratification in patients with STEMI when combined with standardized risk scores.
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Affiliation(s)
| | - Uygar Cagdas Yuksel
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy
| | - Murat Celik
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy
| | - Hasan Kutsi Kabul
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy
| | - Cem Barcin
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy
| | - Yalcin Gokoglan
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy
| | - Erkan Yildirim
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy
| | - Atila Iyisoy
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy
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