Platelet-to-hemoglobin ratio as a valuable predictor of long-term all-cause mortality in coronary artery disease patients with congestive heart failure

Platelet, Neutrophil and Lymphocyte Quantitative Abnormalities in Patients with Heart Failure: A Retrospective Study

Background

Heart failure pathophysiology and its clinical symptoms are characterized by inflammation. Elevated levels of leukocyte subpopulations are a well-known indicator of inflammation and play a predictive role in determining the prognosis of patients with cardiovascular diseases. Besides, platelets are essential mediators of inflammation, especially when they interact with leukocytes. Platelet synthesis, activation, and function are all impacted by heart failure. Thus, the study was aimed at determining the magnitude of platelet, neutrophil, and lymphocyte abnormalities in patients with heart failure.

Methods

A retrospective cross-sectional study was conducted from June to July 2022 at the University of Gondar comprehensive specialized hospital. A total of 245 medical records of heart failure patients were included. Data regarding socio-demographic, clinical, and some hematological and biochemical parameters were collected from medical records. Data was entered into Epi-Data 4.6.0.2 and then exported to Stata 11.0 statistical software for analysis. A binary logistic regression analysis with its odds ratio was calculated to identify factors associated with the outcome variables. P-value <0.05 was considered statistically significant.

Results

The most frequent leukocyte abnormality among adults with heart failure was neutrophilia, which was detected in 17.55% (95% CI: 13.26-22.87). Besides, lymphocytosis was observed in 10.20% (95% CI: 6.97-14.70) of patients. The magnitude of thrombocytopenia and thrombocytosis among patients with heart failure was 12.24% (95% CI: 8.67-17.01%) and 2.86% (95% CI: 1.36-5.90%), respectively. Only being female was significantly associated with neutrophilia in patients with heart failure (AOR = 2.33; 95% CI: 1.05-5.16). However, none of the variables were significantly associated with platelet and lymphocyte abnormalities.

Conclusion

Neutrophilia, lymphocytosis, and thrombocytopenia are the common leukocyte and platelet abnormalities in heart failure patients. Therefore, early detection and management of the underlying causes of those abnormalities may be important to improve patients' outcomes and prevent further complications.

Emerging Biomarkers for Predicting Clinical Outcomes in Patients with Heart Disease

Cardiovascular disease is most frequently caused by the development and progression of atherosclerosis. When coronary arteries are afflicted, and the stenoses caused by atherosclerotic plaques are severe enough, the metabolic supply-and-offer balance is disturbed, leading to myocardial ischemia. If atherosclerotic plaques become unstable and local thrombosis develops, a myocardial infarction occurs. Sometimes, myocardial ischemia and infarction may result in significant and irreversible heart failure. To prevent severe complications, such as acute coronary syndromes and ischemia-related heart failure, extensive efforts have been made for developing biomarkers that would help identify patients at increased risk for cardiovascular events. In this two-part study, we attempted to provide a review of existing knowledge of blood biomarkers that may be used in this setting. The first part of this work was dedicated to conventional biomarkers, which are already used in clinical practice. In the second part, here presented, we discuss emerging biomarkers which have not yet become mainstream.

Platelet-hemoglobin ratio predicts amputation in patients with below-knee peripheral arterial disease

BACKGROUND

Peripheral arterial disease (PAD) causes significant morbidity today. Atherosclerosis is evident in the pathophysiological process in most patients, so PAD has similar risk factors as coronary artery disease. Platelet-Hemoglobin ratio (PHR) has been proven to predict mortality in atherosclerotic heart disease. We aimed to determine the relationship between PHR and below-knee amputation.

METHODS

The study is a single-center retrospective study. Platelet count/hemoglobin amount formula was used for PHR. Only PAD patients with below-knee critical extremity ischemia and unsuitable for revascularization were included in the study.

RESULTS

235 patients were included in the study retrospectively. The mean age was 65.7 ± 9.9 years and 175(74.5%) of them were male. In the amputated group, white blood cell, neutrophil, platelet, creatinine, glucose, and PHR were higher (p = .031, p = .045, p = .011, p = .048 p = .018, p = .004, respectively). Only hemoglobin values were lower (p = .003). Multivariable regression analysis showed; age, albumin and PHR were determined as independent risk factors for amputation (Age; OR (95%CI): (1.094(1.040-1.152), p = .001) (Albumin; OR (95% CI): 1.950(1.623-1.799), p = .001) (PHR; OR (95% CI): 1.872(1.246-2.812), p = .003). Receiver operating characteristics analysis performed to determine the optimal cut-off value of PHR for amputation, the optimal value was found 2.08 (65.8% sensitivity, 67.5% specificity, p < .001).

CONCLUSIONS

PHR was a good predictor for BKA. Using the PHR, it may be possible to identify high-risk patients for amputation.

Novel marker for predicting the severity and prognosis of acute pulmonary embolism: platelet-to-hemoglobin ratio

Background: We investigated the ability of the platelet-to-hemoglobin ratio (PHR) to predict mortality and disease severity in patients with acute pulmonary embolism (APE). Materials & methods: The severity of APE was classified as massive (high risk), submassive (intermediate risk) or nonmassive (low risk). PHR is defined as platelet count/hemoglobin count. Results: PHR was significantly higher in patients with massive APE, and this elevation showed a gradual increase from the nonmassive group to the massive group (p < 0.001). In-hospital and 1-month mortality were higher in patients with high PHR values. PHR was an independent risk factor for the development of massive APE (odds ratio: 1.014; 95% CI: 1.011-1.017; p = 0.009). Conclusion: PHR values predicted massive APE and were an independent predictor of mortality in APE.

Platelet-to-Hemoglobin Ratio Is an Important Predictor of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction

Background: Despite effective interventional treatments, the mortality of acute ST-segment elevation myocardial infarction (STEMI) is still high. Several mortality predictors are known in STEMI. Platelet-to-hemoglobin ratio (PHR) is a recently used mortality parameter in cardiac or non-cardiac diseases. We aim to investigate the relationship of PHR with in-hospital mortality in patients with STEMI.

Methods: Eight hundred eighty-four patients were included in the study. All of them underwent coronary intervention due to STEMI. Demographic characteristics, laboratory, electrocardiographic and echocardiographic parameters were analyzed from hospital records. A cut-off value for PHR was determined using receiver operating characteristic (ROC) curve analysis. Then, patients were divided into two groups PHR < 1.99 and PHR ≥ 1.99. The data of both groups were compared.

Results: The median age of the study population was 64 (54-75). Of these 633 (71.6 %) were male and 251 (28.4 %) were female. All cause mortality of the study population was 9.7% (n=86). In multivariable logistic regression analysis, PHR was independently associated with a significantly increased risk of in-hospital mortality for STEMI (OR: 2.645, CI: 1.641-4.263, p< 0.001). Also, age (OR: 1.044, CI: 1.021-1.067, p< 0.001), mean arterial pressure (MAP) less than 87 mmHg (OR: 2.078, CI: 1.185-3.645, p= 0.011), prior coronary artery disease (CAD) (OR: 2.839, CI: 1.345-5.993, p= 0.006), anterior myocardial infarction (MI) (OR: 1.912, CI: 1.069-3.421, p= 0.029), creatinine (OR: 3.710, CI: 2.255-6.106, p<0.001), alanine transaminase (ALT) (OR: 1.004, CI: 1.001-1.007, p=0.002), and neutrophil-to-lymphocyte ratio (NLR) (OR: 1.122, CI: 1.014-1.242, p= 0.025) were determined as independent predictors of in-hospital mortality.

Conclusion: In conclusion, we found that PHR is an independent predictor of in-hospital mortality in patients with STEMI.