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Fisher A, Fisher L, Srikusalanukul W. Prediction of Osteoporotic Hip Fracture Outcome: Comparative Accuracy of 27 Immune-Inflammatory-Metabolic Markers and Related Conceptual Issues. J Clin Med 2024; 13:3969. [PMID: 38999533 PMCID: PMC11242639 DOI: 10.3390/jcm13133969] [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: 06/11/2024] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Objectives: This study, based on the concept of immuno-inflammatory-metabolic (IIM) dysregulation, investigated and compared the prognostic impact of 27 indices at admission for prediction of postoperative myocardial injury (PMI) and/or hospital death in hip fracture (HF) patients. Methods: In consecutive HF patient (n = 1273, mean age 82.9 ± 8.7 years, 73.5% females) demographics, medical history, laboratory parameters, and outcomes were recorded prospectively. Multiple logistic regression and receiver-operating characteristic analyses (the area under the curve, AUC) were used to establish the predictive role for each biomarker. Results: Among 27 IIM biomarkers, 10 indices were significantly associated with development of PMI and 16 were indicative of a fatal outcome; in the subset of patients aged >80 years with ischaemic heart disease (IHD, the highest risk group: 90.2% of all deaths), the corresponding figures were 26 and 20. In the latter group, the five strongest preoperative predictors for PMI were anaemia (AUC 0.7879), monocyte/eosinophil ratio > 13.0 (AUC 0.7814), neutrophil/lymphocyte ratio > 7.5 (AUC 0.7784), eosinophil count < 1.1 × 109/L (AUC 0.7780), and neutrophil/albumin × 10 > 2.4 (AUC 0.7732); additionally, sensitivity was 83.1-75.4% and specificity was 82.1-75.0%. The highest predictors of in-hospital death were platelet/lymphocyte ratio > 280.0 (AUC 0.8390), lymphocyte/monocyte ratio < 1.1 (AUC 0.8375), albumin < 33 g/L (AUC 0.7889), red cell distribution width > 14.5% (AUC 0.7739), and anaemia (AUC 0.7604), sensitivity 88.2% and above, and specificity 85.1-79.3%. Internal validation confirmed the predictive value of the models. Conclusions: Comparison of 27 IIM indices in HF patients identified several simple, widely available, and inexpensive parameters highly predictive for PMI and/or in-hospital death. The applicability of IIM biomarkers to diagnose and predict risks for chronic diseases, including OP/OF, in the preclinical stages is discussed.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia
- Department of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia
- Medical School, Australian National University, Canberra 2601, Australia
| | - Leon Fisher
- Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Wichat Srikusalanukul
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia
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Li Y, Bai G, Gao Y, Guo Z, Chen X, Liu T, Li G. The Systemic Immune Inflammatory Response Index Can Predict the Clinical Prognosis of Patients with Initially Diagnosed Coronary Artery Disease. J Inflamm Res 2023; 16:5069-5082. [PMID: 37936598 PMCID: PMC10627051 DOI: 10.2147/jir.s432506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
Background Recently, the systemic immune inflammatory response index (SIIRI), a novel and expanded inflammatory response marker, has been an independent predictor of lesion severity in patients with acute coronary syndrome (ACS). However, its predictive role in patients with initially diagnosed coronary artery disease (CAD) remains to be explored. Patients and Methods We evaluated 959 patients with CAD undergoing an initial coronary intervention. Each patient had laboratory measurements, including blood cell counts, taken after admission and before interventional treatment. The primary endpoint was major cardiovascular events (MACEs), defined as cardiovascular death, nonfatal myocardial infarction(MI), and nonfatal stroke. The secondary endpoints included MACEs and readmission for congestive heart failure(HF). Results During a mean follow-up period of 33.3±9.9 months, 229 (23.9%) MACEs were recorded. ROC curve analysis displayed that the best cut-off value of SIIRI for predicting MACEs was 247.17*1018/L2. Kaplan-Meier survival curve analysis showed that the survival rate of the low SIIRI group was higher than that of the high SIIRI group (P<0.001). Compared with the low SIIRI group, the high SIIRI group had a significantly higher risk of MACEs (187 cases (39.53%) vs.42 patients (8.64%), P<0.001). Univariate and multivariate Cox regression analyses displayed that high SIIRI levels were independently associated with the occurrence of MACEs in patients with initially diagnosed CAD undergoing percutaneous coronary intervention (PCI) (adjusted hazard ratio [HR]: 3.808, 95% confidence interval [CI%]: 2.643-5.486, P<0.001). Adding SIIRI to conventional risk factor models improved the predictive value of MACEs. Conclusion Elevated SIIRI is associated with adverse cardiovascular prognosis in patients with initially diagnosed CAD. SIIRI can be a simple and practical index to identify high-risk patients with CAD after PCI.
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Affiliation(s)
- Yuqing Li
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Geng Bai
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Yi Gao
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Ziqiang Guo
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Xiaolin Chen
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
| | - Guangping Li
- Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China
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Vakhshoori M, Nemati S, Sabouhi S, Shakarami M, Yavari B, Emami SA, Bondariyan N, Shafie D. Prognostic impact of monocyte-to-lymphocyte ratio in coronary heart disease: a systematic review and meta-analysis. J Int Med Res 2023; 51:3000605231204469. [PMID: 37848392 PMCID: PMC10586014 DOI: 10.1177/03000605231204469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Inflammatory biomarkers are novel tools to assess the prognosis of different cardiovascular diseases. We evaluated the impact of the monocyte-to-lymphocyte ratio (MLR) on clinical outcomes in patients with coronary heart disease (CHD). METHODS We systematically screened English-language articles in PubMed, Scopus, and Web of Science to 31 August 2022. Relevant articles reporting the MLR and its association with clinical outcomes (major adverse cardiovascular events (MACE), coronary artery disease (CAD) severity, mortality, cardiac rupture, subclinical CAD, acute coronary syndrome (ACS) prediction, thin-cap fibroatheroma, no-reflow phenomenon, MLR-related differences in percutaneous coronary intervention, heart failure hospitalization, and depression) in patients with CHD were collected for further analysis. RESULTS Nineteen articles were selected. The mean MLR was 0.34. A higher MLR was significantly associated with an increased risk of MACE among patients with CHD. The MLR was an independent predictor of MACE in patients with ACS. No significant association was found for CAD severity. A complementary analysis was not performed because of few studies focusing on the other predefined endpoints. CONCLUSIONS The MLR is a simple and widely available tool to predict MACE in patients with CHD. This biomarker can be utilized in emergency settings to prioritize high-risk patients and optimize therapeutic interventions.
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Affiliation(s)
- Mehrbod Vakhshoori
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sepehr Nemati
- School of Medicine, Tehran Azad University of Medical Sciences, Tehran, Iran
| | - Sadeq Sabouhi
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnaz Shakarami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Yavari
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Ali Emami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Bondariyan
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Shafie D, Abhari AP, Fakhrolmobasheri M. Relative Values of Hematological Indices for Prognosis of Heart Failure: A Mini-Review. Cardiol Rev 2023:00045415-990000000-00088. [PMID: 36946981 DOI: 10.1097/crd.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Owing to the augmented perception of heart failure (HF) pathophysiology, management of the affected patients has been improved dramatically; as with the identification of the inflammatory background of HF, new avenues of HF prognosis research have been opened up. In this regard, relative values of hematologic indices were demonstrated by a growing body of evidence to successfully predict HF outcomes. Cost-effectiveness, accessibility, and easy obtainability of these relative values make them a precious option for the determination of HF prognosis; particularly in low-income developing countries. In this short review, we aimed to present the current literature on the predictability of these hematologic parameters for HF outcomes.
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Affiliation(s)
- Davood Shafie
- From the Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Hua Y, Sun JY, Lou YX, Sun W, Kong XQ. Monocyte-to-lymphocyte ratio predicts mortality and cardiovascular mortality in the general population. Int J Cardiol 2023; 379:118-126. [PMID: 36905945 DOI: 10.1016/j.ijcard.2023.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/03/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Systemic chronic inflammation (SCI) is closely involved in the pathogenesis of many diseases. This study aims to investigate the association between MLR with mortality and cardiovascular disease (CVD) mortality in US adults. METHODS 35,813 adults were enrolled from the 1999-2014 National Health and Nutrition Examination Survey (NHANES) cycle. Individuals were categorized according to MLR tertiles and followed until 31 December 2019. Kaplan-Meier plots and log-rank tests were utilized to explore survival differences among the MLR tertiles. Adjusted multivariable Cox analysis was employed to investigate the relationship of MLR with mortality and CVD mortality. Restricted cubic spline and subgroup analysis were further used to discern non-linear relationship and the relationship in categories. RESULTS During a median follow-up of 134 months, 5865 (16.4%) all-cause deaths and 1602 (4.5%) cardiovascular deaths occurred. Kaplan-Meier plots revealed significant differences in all-cause and cardiovascular mortality among the MLR tertiles. In the fully-adjusted Cox regression model, individuals in the highest tertile of MLR had higher risk of mortality (HR = 1.26, 95% CI: 1.17-1.35) and CVD mortality (HR = 1.41, HR, 95% CI: 1.23-1.62) than those in the lowest tertile. The restricted cubic spline exhibited a J-shaped relationship between MLR with mortality and CVD mortality (P for non-linearity <0.001). The further subgroup analysis demonstrated a robust trend across categories. CONCLUSION Our study demonstrated that increased baseline MLR was positively associated with a higher risk of death in US adults. MLR was a strong independent predictor of mortality and CVD mortality in the general population.
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Affiliation(s)
- Yang Hua
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Jin-Yu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Yu-Xuan Lou
- Southeast University, Nanjing, Jiangsu, China
| | - Wei Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China.
| | - Xiang-Qing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China.
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Overmars LM, van Es B, Groepenhoff F, De Groot MCH, Pasterkamp G, den Ruijter HM, van Solinge WW, Hoefer IE, Haitjema S. Preventing unnecessary imaging in patients suspect of coronary artery disease through machine learning of electronic health records. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 3:11-19. [PMID: 36713995 PMCID: PMC9707976 DOI: 10.1093/ehjdh/ztab103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 02/01/2023]
Abstract
Aims With the ageing European population, the incidence of coronary artery disease (CAD) is expected to rise. This will likely result in an increased imaging use. Symptom recognition can be complicated, as symptoms caused by CAD can be atypical, particularly in women. Early CAD exclusion may help to optimize use of diagnostic resources and thus improve the sustainability of the healthcare system. To develop sex-stratified algorithms, trained on routinely available electronic health records (EHRs), raw electrocardiograms, and haematology data to exclude CAD in patients upfront. Methods and results We trained XGBoost algorithms on data from patients from the Utrecht Patient-Oriented Database, who underwent coronary computed tomography angiography (CCTA), and/or stress cardiac magnetic resonance (CMR) imaging, or stress single-photon emission computerized tomography (SPECT) in the UMC Utrecht. Outcomes were extracted from radiology reports. We aimed to maximize negative predictive value (NPV) to minimize the false negative risk with acceptable specificity. Of 6808 CCTA patients (31% female), 1029 females (48%) and 1908 males (45%) had no diagnosis of CAD. Of 3053 CMR/SPECT patients (45% female), 650 females (47%) and 881 males (48%) had no diagnosis of CAD. On the train and test set, the CCTA models achieved NPVs and specificities of 0.95 and 0.19 (females) and 0.96 and 0.09 (males). The CMR/SPECT models achieved NPVs and specificities of 0.75 and 0.041 (females) and 0.92 and 0.026 (males). Conclusion Coronary artery disease can be excluded from EHRs with high NPV. Our study demonstrates new possibilities to reduce unnecessary imaging in women and men suspected of CAD.
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Affiliation(s)
- L Malin Overmars
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, Heidelberglaan 100 3584 CX, the Netherlands
| | - Bram van Es
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, Heidelberglaan 100 3584 CX, the Netherlands
| | - Floor Groepenhoff
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, Heidelberglaan 100 3584 CX, the Netherlands,Laboratory of Experimental Cardiology, University Medical Center Utrecht, Heidelberglaan 100 3584 CX, Utrecht, the Netherlands
| | - Mark C H De Groot
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, Heidelberglaan 100 3584 CX, the Netherlands
| | - Gerard Pasterkamp
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, Heidelberglaan 100 3584 CX, the Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Heidelberglaan 100 3584 CX, Utrecht, the Netherlands
| | - Wouter W van Solinge
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, Heidelberglaan 100 3584 CX, the Netherlands
| | - Imo E Hoefer
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, Heidelberglaan 100 3584 CX, the Netherlands
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Cankurt T, Celik İE, Ozturk S, Maden O. Inflammatory Conditions in Acute Coronary Syndrome Patients Treated with Percutaneous Coronary Intervention of Saphenous Vein Graft. Int J Angiol 2020; 29:237-244. [PMID: 33268974 PMCID: PMC7690989 DOI: 10.1055/s-0040-1714751] [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: 12/14/2022] Open
Abstract
The study aimed to evaluate the inflammatory blood parameters in acute coronary syndrome (ACS) patients with a history of coronary artery bypass graft (CABG) and treated with percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). A total of 347 patients who underwent urgent SVG PCI with the diagnosis of ACS were included in the study. After the application of exclusion criteria, 79 patients were allocated into two groups, namely, successful PCI ( n = 59) and unsuccessful PCI ( n = 20), and included in the statistical analysis. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) levels were significantly higher in patients with unsuccessful SVG PCI. In the logistic regression analysis, PLR, C-reactive protein, and diabetes mellitus emerged as independent factors associated with unsuccessful SVG PCI. The area under the curve for PLR was 0.70 (95% confidence interval: 0.55-0.85, p = 0.006). The cut-off value of PLR (128.99) was associated with 70.0% sensitivity and 69.5% specificity. Elevated inflammatory status is associated with unsuccessful PCI of SVG in ACS patients. Increased PLR levels on admission is an independent predictor of this situation. This cheap and simple marker can help us to predict unsuccessful SVG PCI in ACS patients.
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Affiliation(s)
- Tayyar Cankurt
- Cardiology Clinic, Amasya University Sabuncuoglu Sereefeddin State Hospital, Ankara, Turkey
| | - İbrahim E. Celik
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
| | - Selcuk Ozturk
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
| | - Orhan Maden
- Department of Cardiology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
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Sadeghi MT, Esgandarian I, Nouri-Vaskeh M, Golmohammadi A, Rahvar N, Teimourizad A. Role of circulatory leukocyte based indices in short-term mortality of patients with heart failure with reduced ejection fraction. Med Pharm Rep 2020; 93:351-356. [PMID: 33225260 PMCID: PMC7664721 DOI: 10.15386/mpr-1644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 01/24/2023] Open
Abstract
Background Pro-inflammatory signaling is mediated by a variety of inflammatory mediators which can cause myocardial apoptosis, hypertrophia, and fibrosis, and also ultimately lead to adverse cardiac remodeling. This study aimed to assess the role of circulating leukocyte-based indices in predicting the short-term mortality in patients with heart failure with reduced ejection fraction (HFrEF). Methods In a retrospective study, patients with HFrEF admitted to a tertiary referral center between January 2016 and January 2017 were recruited to this study. The association between neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dLNR = neutrophils/(leukocytes-neutrophils)), monocyte/granulocyte to lymphocyte ratio (MGLR = (white cell count-lymphocyte count) to lymphocyte count), platelet to lymphocyte ratio (PLR) and six-months mortality of patients were assessed. Results A total of 197 patients with HFrEF were enrolled in the study. NLR (P<0.001), dNLR (P<0.001), MGLR (P<0.001), PLR (P=0.006) and LVEF (P=0.042) showed significant difference between survived and died patients. In the Cox multivariate analysis we did not find NLR, dLNR, MGLR or PLR as an independent predictor of short-term mortality in HFrEF patients. Conclusions Although High NLR, PLR, MGLR and dNLR was associated with short-term mortality, it failed to independently predict the prognosis of HFrEF patients.
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Affiliation(s)
| | - Ilqhar Esgandarian
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Nouri-Vaskeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Ali Golmohammadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negin Rahvar
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abedin Teimourizad
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Quan XQ, Wang RC, Zhang Q, Zhang CT, Sun L. The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: a systematic review and meta-analysis. BMC Cardiovasc Disord 2020; 20:338. [PMID: 32669086 PMCID: PMC7362430 DOI: 10.1186/s12872-020-01614-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 07/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background The association between the lymphocyte-to-monocyte ratio (LMR) and prognosis in the patients with acute coronary syndrome (ACS) is not fully understood. We performed this systematic review and meta-analysis to evaluate the correlation between LMR and mortality or major adverse cardiac events (MACE) in patients with ACS. Methods A systematic search was performed in PubMed, MEDLINE, EMBASE, the Cochrane Library, Scopus, and Web of science. The association between LMR and mortality/MACE was analyzed in patients with ACS. The search was updated to April 15, 2020. Results A total of 5 studies comprising 4343 patients were included in this meta-analysis. The results showed that lower LMR predicted higher short-term mortality/MACE (hazard ratio [HR] = 3.44, 95% confidence interval [CI]: 1.46–8.14, P < 0.05) and long-term mortality/MACE (HR = 1.70, 95% CI: 1.36–2.13, P < 0.05). In the subgroup analysis, there was still statistical significance of long-term mortality/MACE in all subgroups. Conclusions This study suggested that lower LMR value might be associated with higher short-term and long-term mortality/MACE in ACS patients. Especially for younger ACS patients, low LMR was more closely associated with poor prognosis.
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Affiliation(s)
- Xiao-Qing Quan
- Department of General Practice, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
| | - Run-Chang Wang
- Second clinical medical college, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qing Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Cun-Tai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Sun
- Department of Pathology, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China.
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Wan H, Wang Y, Fang S, Chen Y, Zhang W, Xia F, Wang N, Lu Y. Associations between the Neutrophil-to-Lymphocyte Ratio and Diabetic Complications in Adults with Diabetes: A Cross-Sectional Study. J Diabetes Res 2020; 2020:6219545. [PMID: 32405503 PMCID: PMC7206875 DOI: 10.1155/2020/6219545] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and easily measurable laboratory index indicating systemic inflammation, while the application of many other inflammatory markers has been limited in daily clinical practice. However, large population studies about investigating the associations of the NLR level with diabetic complications including cardiovascular and cerebrovascular diseases (CVD), diabetic kidney disease (DKD), and diabetic retinopathy (DR) in the same population were limited. The aim of our study is to evaluate the associations between the NLR level and the prevalence of CVD, DKD, and DR in adults with diabetes simultaneously. METHODS A cross-sectional survey of 4,813 diabetic adults was conducted in seven communities in China. Persons underwent several medical examinations, including the measurement of anthropometric factors, blood pressure, routinely analyzed leukocyte characteristics, glucose, lipid profiles, urine albumin/creatinine ratio, and fundus photographs. RESULTS Compared with the first quartile of the NLR level, the odds of having CVD was significantly increased by 21% for participants in the highest quartile (OR 1.21; 95% CI 1.00, 1.47) (P for trend < 0.05). Similarly, the prevalence of DKD among participants in the highest quartile of the NLR level was significantly increased by 150% (OR 2.50; 95% CI 1.95, 3.19) (P for trend < 0.05). However, no association was found between the NLR level and the prevalence of DR (P for trend > 0.05). These associations were all fully adjusted. CONCLUSIONS A higher NLR level was associated with an increased prevalence of CVD and DKD, other than DR, in diabetic adults.
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Affiliation(s)
- Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sijie Fang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Neutrophil count as the centerpiece in the joined association networks of inflammatory and cell damage markers, and neuroendocrine stress markers in patients with stable angina pectoris following stenting. PLoS One 2019; 14:e0215209. [PMID: 30973928 PMCID: PMC6459524 DOI: 10.1371/journal.pone.0215209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 03/28/2019] [Indexed: 12/17/2022] Open
Abstract
Objective The primary aim of this study was to examine whether markers of cell damage and of the psycho-neuroendocrino-inflammatory/immune (PNI) system could be associated in patients with stable coronary artery disease (CAD) on the next day following percutaneous coronary intervention (PCI). Materials and methods Blood samples of 23 patients (18 men and five women, mean age 62.9 ± 10.6 years), were collected immediately before (pre-PCI), immediately after (post-PCI), and on the day following PCI (1d-PCI). Lactoferrin, LL-37 and interleukin-6 (IL-6) were assayed in plasma, in addition to cortisol and chromogranin A (CgA), as well as CK, ASAT and ALAT. Total and differential leukocyte counts were also analysed. Results At all the three time points, the monocyte fractions, the monocyte-to-lymphocyte and the neutrophil-to-lymphocyte ratios and CgA levels were elevated. We detected significant peri-procedural changes in the plasma levels of our PNI markers: IL-6 (p<0.05), lactoferrin, LL-37 (both: p <0.0001), CgA, (p<0.05), and cortisol (p<0.01). On the first day after PCI, highly significant associations were found of ASAT with IL-6 and neutrophil count (both: r>0.75, p<0.0001), and of CgA with neutrophil count and monocyte count (both: r>0.79, p<0.0001); furthermore, cortisol was also associated with neutrophil count (r>0.7, p<0.0001). Conclusions The findings suggest that myocardial damage could correlate not only with an inflammatory reaction but, via neutrophil count, also with increased level of stress in stable CAD after PCI. Furthermore, 1d-PCI neutrophil count may serve as an easy-to-obtain integrative PNI measure in stable CAD.
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12
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Fan Z, Li Y, Ji H, Jian X. Prognostic utility of the combination of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NSTEMI after primary percutaneous coronary intervention: a retrospective cohort study. BMJ Open 2018; 8:e023459. [PMID: 30341133 PMCID: PMC6196857 DOI: 10.1136/bmjopen-2018-023459] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate prognostic value of the combination of monocyte-to-lymphocyte ratio (MLR) with neutrophil-to-lymphocyte ratio (NLR) for predicting long-term major adverse cardiac events (MACE) in patients with non-ST elevated myocardial infarction (NSTEMI) who underwent primary percutaneous coronary intervention (PCI). DESIGN Retrospective cohort study. SETTING Civil Aviation General Hospital, Beijing, China. PARTICIPANTS 678 patients with NSTEMI undergoing primary PCI between July 2010 and July 2015 were enrolled. MAIN OUTCOME MEASURES The main outcomes were MACE. The cumulative MACE-free survival rates were calculated by Kaplan-Meier analysis and the independent predictors of MACE were assessed by Cox regression analysis. RESULTS According to the cut-off values of MLR 0.36 and NLR 2.15, the study population was classified into four groups: low MLR + low NLR group (n=319), low MLR + high NLR group (n=126), high MLR + low NLR group (n=102) and high MLR + high NLR group (n=131). The high MLR + high NLR group had a lower MACE-free survival rate than the other three groups (p logrank <0.001). Both MLR (HR 2.128, 95% CI 1.458 to 3.105) and NLR (HR 1.925, 95% CI 1.385 to 2.676) were independent predictors of long-term MACE. Moreover, the patients in the high MLR + high NLR group had an HR of 4.055 (95% CI 2.550 to 6.448) for long-term MACE, with the low-MLR + low NLR group as reference. Comparisons of receiver operating characteristic curves revealed that the combination of MLR with NLR achieved better performance in differentiating long-term MACE, compared with MLR, NLR, high-sensitivity C reactive protein and brain natriuretic peptide alone, and had similar performance to all other pairwise combinations of the four biomarkers. CONCLUSIONS Elevated levels of MLR and NLR were independent predictors of long-term MACE in patients with NSTEMI. Moreover, the combination of MLR and NLR could improve the prognostic value in predicting long-term MACE.
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Affiliation(s)
- Zeyuan Fan
- Department of Cardiovascular Diseases, Civil Aviation General Hospital, Civil Aviation Clinical Medical College of Peking University, Beijing, China
| | - Yang Li
- Department of Cardiovascular Diseases, Civil Aviation General Hospital, Civil Aviation Clinical Medical College of Peking University, Beijing, China
| | - Hanhua Ji
- Department of Cardiovascular Diseases, Civil Aviation General Hospital, Civil Aviation Clinical Medical College of Peking University, Beijing, China
| | - Xinwen Jian
- Department of Cardiovascular Diseases, Civil Aviation General Hospital, Civil Aviation Clinical Medical College of Peking University, Beijing, China
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13
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Kofink D, Muller SA, Patel RS, Dorresteijn JAN, Berkelmans GFN, de Groot MCH, van Solinge WW, Haitjema S, Leiner T, Visseren FLJ, Hoefer IE, Asselbergs FW. Routinely measured hematological parameters and prediction of recurrent vascular events in patients with clinically manifest vascular disease. PLoS One 2018; 13:e0202682. [PMID: 30192769 PMCID: PMC6128486 DOI: 10.1371/journal.pone.0202682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/06/2018] [Indexed: 12/25/2022] Open
Abstract
Background and aims The predictive value of traditional risk factors for vascular events in patients with manifest vascular disease is limited, underscoring the need for novel biomarkers to improve risk stratification. Since hematological parameters are routinely assessed in clinical practice, they are readily available candidates. Methods We used data from 3,922 vascular patients, who participated in the Second Manifestations of ARTerial Disease (SMART) study. We first investigated associations between recurrent vascular events and 22 hematological parameters, obtained from the Utrecht Patient Oriented Database (UPOD), and then assessed whether parameters associated with outcome improved risk prediction. Results After adjustment for all SMART risk score (SRS) variables, lymphocyte %, neutrophil count, neutrophil % and red cell distribution width (RDW) were significantly associated with vascular events. When individually added to the SRS, lymphocyte % improved prediction of recurrent vascular events with a continuous net reclassification improvement (cNRI) of 17.4% [95% CI: 2.1, 32.1%] and an increase in c-statistic of 0.011 [0.000, 0.022]. The combination of lymphocyte % and neutrophil count resulted in a cNRI of 22.2% [3.2, 33.4%] and improved c-statistic by 0.011 [95% CI: 0.000, 0.022]. Lymphocyte % and RDW yielded a cNRI of 18.7% [3.3, 31.9%] and improved c-statistic by 0.016 [0.004, 0.028]. However, the addition of hematological parameters only modestly increased risk estimates for patients with an event during follow-up. Conclusions Several hematological parameters were independently associated with recurrent vascular events. Lymphocyte % alone and in combination with other parameters enhanced discrimination and reclassification. However, the incremental value for patients with a recurrent event was limited.
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Affiliation(s)
- Daniel Kofink
- Department of Cardiology, University Medical Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Steven A. Muller
- Department of Cardiology, University Medical Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Riyaz S. Patel
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
- The Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Jannick A. N. Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Gijs F. N. Berkelmans
- Department of Vascular Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Mark C. H. de Groot
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Wouter W. van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Saskia Haitjema
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Frank L. J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Imo E. Hoefer
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Folkert W. Asselbergs
- Department of Cardiology, University Medical Utrecht, University of Utrecht, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
- * E-mail:
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14
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den Harder AM, de Jong PA, de Groot MCH, Wolterink JM, Budde RPJ, Iŝgum I, van Solinge WW, Ten Berg MJ, Lutgens E, Veldhuis WB, Haitjema S, Hoefer IE, Leiner T. Commonly available hematological biomarkers are associated with the extent of coronary calcifications. Atherosclerosis 2018; 275:166-173. [PMID: 29920437 DOI: 10.1016/j.atherosclerosis.2018.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS We aimed to improve the understanding of potential associations between commonly available hematological biomarkers and the coronary artery calcification (CAC) score, which may help unravel the pathophysiology of coronary calcifications and subclinical coronary artery disease. METHODS A cross-sectional study was performed within the Utrecht Patient Oriented Database (UPOD). Patients with suspected or known coronary artery disease who underwent CT CAC scoring as well as standard hematology analysis that was part of routine clinical care (within 3 months of CT acquisition) were included. Complete hematology datasets were extracted from hematology analyzers. Linear regression adjusted for potential confounders was used to assess if hematological biomarkers were related to the CAC score. RESULTS In total, 1504 patients were included, of whom 43% (n = 647) had a CAC score of 0. Mean age (±SD) was 53 ± 13 years, and 34% of patients were women. Red blood cell distribution width (RDW, β = 0.20 [0.05-0.36], p=0.007), the fraction of immature reticulocytes (β = 0.97 [0.10-6.43], p=0.004), coefficient of variation of neutrophil lobularity (β = 0.13 [0.01-0.25], p=0.040) and mean lymphocyte cell size (β = 0.21 [0.08-0.34], p=0.001) were positively associated with the CAC score after adjustment for age, sex, body mass index (BMI), diabetes, glomerular filtration rate (GFR) and high-density lipoprotein (HDL). CONCLUSIONS This study confirms the known association of RDW with the CAC score, and presents the fraction of immature reticulocytes, coefficient of variation of neutrophil lobularity, and mean lymphocyte cell size as new markers associated with a higher CAC score.
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Affiliation(s)
- Annemarie M den Harder
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Mark C H de Groot
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Jelmer M Wolterink
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ivana Iŝgum
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Maarten J Ten Berg
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Esther Lutgens
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, the Netherlands; Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Saskia Haitjema
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Imo E Hoefer
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
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15
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Keustermans GC, Kofink D, Eikendal A, de Jager W, Meerding J, Nuboer R, Waltenberger J, Kraaijeveld AO, Jukema JW, Sels JW, Garssen J, Prakken BJ, Asselbergs FW, Kalkhoven E, Hoefer IE, Pasterkamp G, Schipper HS. Monocyte gene expression in childhood obesity is associated with obesity and complexity of atherosclerosis in adults. Sci Rep 2017; 7:16826. [PMID: 29203885 PMCID: PMC5714995 DOI: 10.1038/s41598-017-17195-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/22/2017] [Indexed: 11/18/2022] Open
Abstract
Childhood obesity coincides with increased numbers of circulating classical CD14++CD16- and intermediate CD14++CD16+ monocytes. Monocytes are key players in the development and exacerbation of atherosclerosis, which prompts the question as to whether the monocytosis in childhood obesity contributes to atherogenesis over the years. Here, we dissected the monocyte gene expression profile in childhood obesity using an Illumina microarray platform on sorted monocytes of 35 obese children and 16 lean controls. Obese children displayed a distinctive monocyte gene expression profile compared to lean controls. Upon validation with quantitative PCR, we studied the association of the top 5 differentially regulated monocyte genes in childhood obesity with obesity and complexity of coronary atherosclerosis (SYNTAX score) in a cohort of 351 adults at risk for ischemic cardiovascular disease. The downregulation of monocyte IMPDH2 and TMEM134 in childhood obesity was also observed in obese adults. Moreover, downregulation of monocyte TMEM134 was associated with a higher SYNTAX atherosclerosis score in adults. In conclusion, childhood obesity entails monocyte gene expression alterations associated with obesity and enhanced complexity of coronary atherosclerosis in adults.
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Affiliation(s)
- G C Keustermans
- Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D Kofink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Eikendal
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Internal medicine, Gastroenterology and Pulmonology, Red Cross Hospital, Beverwijk, The Netherlands
| | - W de Jager
- Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Meerding
- Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Nuboer
- Department of Pediatrics, Meander Medical Center, Amersfoort, The Netherlands
| | - J Waltenberger
- Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - A O Kraaijeveld
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J W Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Sels
- Departments of Cardiology and Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Immunology, Nutricia Research, Utrecht, The Netherlands
| | - B J Prakken
- Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.,Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - E Kalkhoven
- Molecular Cancer Research and Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I E Hoefer
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Pasterkamp
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H S Schipper
- Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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16
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Gijsberts CM, den Ruijter HM, de Kleijn DPV, Huisman A, ten Berg M, de Groot M, van Wijk RHA, Asselbergs FW, Voskuil M, Pasterkamp G, van Solinge WW, Hoefer IE. Hematological Parameters Outperform Plasma Markers in Predicting Long-Term Mortality After Coronary Angiography. Angiology 2017; 69:600-608. [DOI: 10.1177/0003319717743679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High-sensitivity troponin I (hsTnI) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) are predictors of coronary artery disease. Recently, routine hematological parameters emerged as mortality predictors. We examined the predictive value of hematological parameters (from the Utrecht Patient Oriented Database) and hsTnI and NT-pro-BNP for mortality in a coronary angiography population (Utrecht Coronary Biobank n = 1913). Using Cox regression, receiver operating characteristics, integrated discrimination improvement (IDI), and continuous net reclassification improvement (cNRI) analysis, we compared the predictive properties of hematological parameters with hsTnI and NT-pro-BNP for mortality. During a median follow-up duration of 1.8 years, 77 deaths occurred. A panel of 7 hematological parameters (leukocyte count, reticulocyte mean corpuscular hemoglobin concentration, red blood cell [RBC] green (FL1) fluorescence, %neutrophils, %large [>120 fL] RBCs, %monocytes, and coefficient of variation of neutrophil complexity) was highly predictive. Added to clinical characteristics, hematological parameters (area under the curve [AUC]: 0.855, P < .001; IDI: 0.04, P = .02; cNRI: 0.41, P < .001) were better predictors than hsTnI (AUC: 0.818) or NT-pro-BNP (AUC: 0.834) alone or combined (AUC: 0.834). Hematological parameters may provide mortality risk information following coronary angiography and may be superior to hsTnI and/or NT-pro-BNP.
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Affiliation(s)
- Crystel M. Gijsberts
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
- ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
| | - Hester M. den Ruijter
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dominique P. V. de Kleijn
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
- ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore, Singapore
| | - Albert Huisman
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten ten Berg
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark de Groot
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Richard H. A. van Wijk
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Folkert W. Asselbergs
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
- Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michiel Voskuil
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wouter W. van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Imo E. Hoefer
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
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Effect of Monocyte-to-Lymphocyte Ratio on Heart Failure Characteristics and Hospitalizations in a Coronary Angiography Cohort. Am J Cardiol 2017; 120:911-916. [PMID: 28779870 DOI: 10.1016/j.amjcard.2017.06.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/18/2017] [Accepted: 06/05/2017] [Indexed: 01/10/2023]
Abstract
Inflammation is a shared mechanism in coronary artery disease (CAD) and subsequent heart failure (HF), and circulating monocyte and lymphocyte counts predict CAD severity and outcomes. We investigated whether the monocyte-to-lymphocyte ratio (MLR) correlates with biomarkers of HF and extent of CAD, as well as future HF hospitalizations in patients undergoing coronary angiography. Therefore, we studied 1754 patients undergoing coronary angiography for stable CAD, unstable angina, or myocardial infarction. MLR was determined at blood draw before angiography and related cross-sectionally to HF biomarkers (ejection fraction, N-terminal pro-B-type natriuretic peptide [NTproBNP] levels) and CAD severity, as well as longitudinally with risk of HF hospitalizations during follow-up. In the entire cohort, median (interquartile range) MLR was 0.32 (0.24 to 0.43). High MLR was defined as the upper quartile and significantly associated with nonstable CAD (unstable angina; odds ratio [OR] 1.13, 95% confidence interval 1.06 to 1.21] or myocardial infarction [OR 1.10, 1.04 to 1.16]), more severe CAD (OR 1.39, 1.15 to 1.68), poorer ejection fraction (OR 1.63, 1.29 to 2.05), and higher NTproBNP levels (β 0.78, 0.59 to 0.96), all p <0.001. The associations with nonstable CAD and NTproBNP remained highly significant after covariate adjustment. Over a mean follow-up of 1.3 years, 46 HF hospitalizations occurred. A high MLR was significantly and independently predictive of HF hospitalizations during follow-up (hazard ratio 2.1 [1.1 to 4.1], p = 0.039) after adjustment for covariates and addition of MLR to the basic model significantly improved reclassification. In conclusion, MLR is strongly related to HF markers and predicts HF hospitalizations during follow-up in patients with CAD.
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18
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Ozturk S, Kurtul A. WITHDRAWN: Lymphocyte-to-monocyte ratio is an independent predictor for higher SYNTAX scores and associated with adverse events in acute coronary syndrome. Int J Cardiol 2017:S0167-5273(17)32318-5. [PMID: 28728849 DOI: 10.1016/j.ijcard.2017.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/30/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Selcuk Ozturk
- Ankara Research and Training Hospital, Department of Cardiology, Ankara, Turkey.
| | - Alparslan Kurtul
- Ankara Research and Training Hospital, Department of Cardiology, Ankara, Turkey
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Montecucco F, Liberale L, Bonaventura A, Vecchiè A, Dallegri F, Carbone F. The Role of Inflammation in Cardiovascular Outcome. Curr Atheroscler Rep 2017; 19:11. [DOI: 10.1007/s11883-017-0646-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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