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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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Zhao M, Huang X, Zhang Y, Wang Z, Zhang S, Peng J. Predictive value of the neutrophil percentage-to-albumin ratio for coronary atherosclerosis severity in patients with CKD. BMC Cardiovasc Disord 2024; 24:277. [PMID: 38807036 PMCID: PMC11134736 DOI: 10.1186/s12872-024-03896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The neutrophil percentage-to-albumin ratio (NPAR), which is defined as the percentage of neutrophils divided by the concentration of albumin, is a cost-effective and readily available biomarker of inflammation. This study aimed to evaluate the association between the NPAR and the severity of coronary atherosclerosis in patients with chronic kidney disease (CKD). METHODS A total of 280 CKD patients who underwent coronary angiography were retrospectively enrolled in this study. The severity of coronary atherosclerosis was evaluated using the Gensini score (GS). Patients were divided into low-, medium- and high-NPAR groups according to the tertiles of the NPAR values. Logistic regression analysis was conducted to analyze the relationship between the NPAR and the GS. The cutoff points for the sensitivity and specificity of the NPAR in predicting the GS were estimated via receiver operating characteristic (ROC) analysis. RESULTS There was a higher prevalence of coronary artery disease (CAD) among CKD patients with higher NPARs (P =0.041). More patients in the high-NPAR group had complex CAD (triple-vessel disease and/or left main coronary artery stenosis) and chronic total occlusion lesions, and more of these patients required revascularization therapy (P<0.05). Multivariate logistic regression analysis revealed a significant positive correlation between the NPAR and the severity of coronary stenosis (adjusted OR 2.68, 95% CI 1.25-5.76, p=0.012), particularly among female and older (age ≥65) patients. The ROC analysis indicated that the optimal cutoff value for the NPAR in predicting severe coronary artery stenosis (GS>60) in CKD patients was 1.91 (sensitivity 0.495, specificity 0.749), with an area under the curve (AUC) of 0.650 (95% CI 0.581-0.719, P<0.001). A subgroup analysis according to sex revealed that the NPAR exhibited stronger predictive value in female patients (AUC 0.730, 95% CI 0.643-0.817) than in male patients (AUC 0.565, 95% CI 0.460-0.670) (P<0.001), and the optimal cutoff value for the NPAR in female patients was 1.80 (sensitivity 0.667, specificity 0.705). CONCLUSIONS Our study demonstrated that the NPAR is independently associated with the severity of coronary atherosclerosis in CKD patients, especially in female and elderly patients (≥65 years old). Moreover, the NPAR can effectively predict the severity of coronary atherosclerosis, exhibiting greater predictive value in females than in males.
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Affiliation(s)
- Mengqi Zhao
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Xin Huang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yang Zhang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Zuoyan Wang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Songli Zhang
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Jianjun Peng
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
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Zhang X, Wei R, Wang X, Zhang W, Li M, Ni T, Weng W, Li Q. The neutrophil-to-lymphocyte ratio is associated with all-cause and cardiovascular mortality among individuals with hypertension. Cardiovasc Diabetol 2024; 23:117. [PMID: 38566082 PMCID: PMC10985955 DOI: 10.1186/s12933-024-02191-5] [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: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Identifying reliable prognostic markers is crucial for the effective management of hypertension. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential inflammatory marker linked to cardiovascular outcomes. This study aims to investigate the association of NLR with all-cause and cardiovascular mortality among patients with hypertension. METHODS This study analyzed data from 3067 hypertensive adults in the National Health and Nutritional Examination Surveys (NHANES) from 2009 to 2014. Mortality details were obtained from the National Death Index (NDI). Restricted cubic spline (RCS) was deployed to visualize the association of the NLR with mortality risk. Weighted Cox proportional hazards models were employed to assess the independent association of NLR with mortality risk. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to access the predictive ability of NLR for survival. Mediation analysis was used to explore the indirect impact of NLR on mortality mediated through eGFR. RESULTS Over a median 92.0-months follow-up, 538 deaths occurred, including 114 cardiovascular deaths. RCS analysis revealed a positive association between NLR and both all-cause and cardiovascular mortality. Participants were stratified into higher (> 3.5) and lower (≤ 3.5) NLR groups. Weighted Cox proportional hazards models demonstrated that individuals with higher NLR had a significantly increased risk of all-cause (HR 1.96, 95% confidence interval (CI) 1.52-2.52, p < 0.0001) and cardiovascular mortality (HR 2.33, 95% CI 1.54-3.51, p < 0.0001). Stratified and interaction analysis confirmed the stability of the core results. Notably, eGFR partially mediated the association between NLR and both all-cause and cardiovascular mortality by a 5.4% and 4.7% proportion, respectively. Additionally, the areas under the curve (AUC) of the 3-, 5- and 10- year survival was 0.68, 0.65 and 0.64 for all-cause mortality and 0.68, 0.70 and 0.69 for cardiovascular mortality, respectively. CONCLUSION Elevated NLR independently confers an increased risk for both all-cause and cardiovascular mortality in individuals with hypertension.
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Affiliation(s)
- Xuexue Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Rui Wei
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xujie Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Wantong Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mengxuan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Tian Ni
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiliang Weng
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, No. 1, Xiyuan Playground, Zhong Zhi Road, Hai Dian District, Beijing, 100091, China.
| | - Qiuyan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
- Department of General Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, No. 1, Xiyuan Playground, Zhong Zhi Road, Hai Dian District, Beijing, 100091, China.
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Powrózek T, Skwarek-Dziekanowska A, Sobieszek G, Małecka-Massalska T. Correlation between Neutrophil-to-Lymphocyte Ratio, Platelets-to-Lymphocyte Ratio, C-Reactive Protein-to-Albumin Ratio and Clinical Picture of Elderly Chronic Heart Failure Patients. J Clin Med 2024; 13:433. [PMID: 38256568 PMCID: PMC10817038 DOI: 10.3390/jcm13020433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR) and C-reactive protein-to-albumin ratio (CAR) are believed to be potential inflammatory markers that are closely related to the prognosis and course of cardiovascular diseases. The main goal of this study was the evaluation of NLR, PLR and CAR as factors reflecting the clinical picture and the prognosis of elderly chronic heart failure (CHF) patients. METHODS In 150 elderly patients with newly diagnosed CHF, the NLR, PLR and CAR were correlated with cardiac, laboratory and nutritional parameters. RESULTS Systemic inflammatory ratios were correlated with selected patient's parameters. CAR was associated with an unfavorable clinical picture of CHF-a reduced EF (p = 0.007), an elevated PASP (p = 0.014), an increased LVESD in both males and females (p = 0.032 and 0.024, respectively) and a decreased TAPSE (p = 0.023). CAR allowed us to distinguish between NYHA I-III and NYHA IV classes with AUC of 0.830. By analyzing the five-year mortality rate in patients with different CAR values, the greater death rate was recorded for patients with high CAR values-one-year death rate (40.3% vs. 17.2%) and five-year death rate (80% vs. 58.3%) (p = 0.002). Both NLR and PLR correlated only with selected parameters. CONCLUSION An analysis of inflammatory markers, mainly CAR, allows the management of CHF, because its value can reflect the cardiac and nutritional status of patients with a prognostic value. NLR and PLR can serve as supplementary examinations for CAR evaluation.
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Affiliation(s)
- Tomasz Powrózek
- Department of Human Physiology of the Chair of Preclinical Sciences, Medical University in Lublin, 20-080 Lublin, Poland;
| | - Aneta Skwarek-Dziekanowska
- Department of Cardiology, 1st Military Clinical Hospital with the Outpatient Clinic, 20-049 Lublin, Poland; (A.S.-D.); (G.S.)
| | - Grzegorz Sobieszek
- Department of Cardiology, 1st Military Clinical Hospital with the Outpatient Clinic, 20-049 Lublin, Poland; (A.S.-D.); (G.S.)
| | - Teresa Małecka-Massalska
- Department of Human Physiology of the Chair of Preclinical Sciences, Medical University in Lublin, 20-080 Lublin, Poland;
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Vakhshoori M, Bondariyan N, Sabouhi S, Kiani K, Alaei Faradonbeh N, Emami SA, Shakarami M, Khanizadeh F, Sanaei S, Motamedi N, Shafie D. The impact of platelet-to-lymphocyte ratio on clinical outcomes in heart failure: a systematic review and meta-analysis. Ther Adv Cardiovasc Dis 2024; 18:17539447241227287. [PMID: 38305256 PMCID: PMC10838041 DOI: 10.1177/17539447241227287] [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] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Inflammation has been suggested to play a role in heart failure (HF) pathogenesis. However, the role of platelet-to-lymphocyte ratio (PLR), as a novel biomarker, to assess HF prognosis needs to be investigated. We sought to evaluate the impact of PLR on HF clinical outcomes. METHODS English-published records in PubMed/Medline, Scopus, and Web-of-science databases were screened until December 2023. Relevant articles evaluated PLR with clinical outcomes (including mortality, rehospitalization, HF worsening, and HF detection) were recruited, with PLR difference analysis based on death/survival status in total and HF with reduced ejection fraction (HFrEF) patients. RESULTS In total, 21 articles (n = 13,924) were selected. The total mean age was 70.36 ± 12.88 years (males: 61.72%). Mean PLR was 165.54 [95% confidence interval (CI): 154.69-176.38]. In total, 18 articles (n = 10,084) reported mortality [either follow-up (PLR: 162.55, 95% CI: 149.35-175.75) or in-hospital (PLR: 192.83, 95% CI: 150.06-235.61) death rate] and the mean PLR was 166.68 (95% CI: 154.87-178.50). Further analysis revealed PLR was significantly lower in survived HF patients rather than deceased group (152.34, 95% CI: 134.01-170.68 versus 194.73, 95% CI: 175.60-213.85, standard mean difference: -0.592, 95% CI: -0.857 to -0.326, p < 0.001). A similar trend was observed for HFrEF patients. PLR failed to show any association with mortality risk (hazard ratio: 1.02, 95% CI: 0.99-1.05, p = 0.289). Analysis of other aforementioned outcomes was not possible due to the presence of few studies of interest. CONCLUSION PLR should be used with caution for prognosis assessment in HF sufferers and other studies are necessary to explore the exact association.
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Affiliation(s)
- Mehrbod Vakhshoori
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Hezar Jarib Avenue, Isfahan, Iran
| | - Niloofar Bondariyan
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadeq Sabouhi
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keivan Kiani
- Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazanin Alaei Faradonbeh
- Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sayed Ali Emami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnaz Shakarami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Shahin Sanaei
- Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Vakhshoori M, Nemati S, Sabouhi S, Yavari B, Shakarami M, Bondariyan N, Emami SA, Shafie D. Neutrophil to lymphocyte ratio (NLR) prognostic effects on heart failure; a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:555. [PMID: 37957565 PMCID: PMC10644447 DOI: 10.1186/s12872-023-03572-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Neutrophil to lymphocyte ratio (NLR), as a recent inflammatory index, has been reported to be a prognostic tool in different diseases. However, implication of this ratio in heart failure (HF) is less investigated. In this systematic review and meta-analysis, we aimed to assess the potential impact of NLR on HF clinical outcomes. METHODS Relevant English published records in PubMed, Scopus, Embase, and Web of Science were screened up to July 2023. Articles reporting clinical outcomes (follow-up or in-hospital mortality, readmission, HF prediction, extended hospital stay length, pulmonary vascular resistance, atrial fibrillation, renal disease and functional capacity) in HF sufferers were collected for further analysis with addition of NLR difference stratified by death/survived and HF status. RESULTS Thirty-six articles (n = 18231) were finally selected which reported NLR in HF sufferers (mean: 4.38, 95% confidence interval (CI): 4.02-4.73). We found 25 articles reported NLR and total mortality (either follow-up death (N = 19): 4.52 (95% CI: 4.03-5.01) or in-hospital death (N = 10): 5.33 (95% CI: 4.08-6.57)) with mean NLR of 4.74 (95% CI: 4.28-5.20). NLR was higher among deceased patients compared to survived ones (standard mean difference: 0.67 (95% CI: 0.48-0.87), P < 0.001)). NLR was found to be related with higher mortality risk (continuous variable: hazard ratio (HR): 1.12, 95% CI: 1.02-1.23, P = 0.013), categorical variable: HR: 1.77, 95% CI: 1.27-2.46, P = 0.001, T2 vs. T1: HR:1.56, 95%CI: 1.21-2.00, P = 0.001, T3 vs. T1: HR:2.49, 95%CI: 1.85-3.35, P < 0.001). Other aforementioned variables were not feasible to analyze due to presence of few studies. CONCLUSIONS NLR is a simple and acceptable prognostic tool for risk stratification and prioritizing high risk patients in clinical settings, especially in resource limited nations.
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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
| | - Behzad Yavari
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnaz Shakarami
- 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
| | - Sayed Ali Emami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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