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Yin R, Zhao M, Xu D, Wang Q, Li M, Zhang W, Zhang F, Zeng X, Huo Y, Hou Y. Relapsing polychondritis: focus on cardiac involvement. Front Immunol 2023; 14:1218475. [PMID: 37771578 PMCID: PMC10523381 DOI: 10.3389/fimmu.2023.1218475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/24/2023] [Indexed: 09/30/2023] Open
Abstract
Background Relapsing polychondritis (RP) with cardiac involvement may present with acute cardiovascular events, and may be associated with a negative prognosis. Herein, we analyzed the clinical characteristics of RP patients with cardiac involvement. Method RP patients, hospitalized from December 2005 to December 2021 at Peking Union Medical College Hospital (PUMCH), were screened. Univariate and multivariate logistic regression analyses were used to statistically analyze the clinical characteristics of these patients. Results The incidence of cardiac involvement in inpatients with RP was 24.1%. Univariate logistic regression analysis revealed age, central nervous system (CNS) involvement, neutrophil-to-lymphocyte ratio (NLR) > 6.41, and disease duration > 4 years as risk factors for cardiac involvement in RP. Conversely, the incidence of tracheobronchial and chest wall involvement was significantly lower in the group with cardiac involvement. Multivariate logistic regression confirmed that age, CNS involvement, NLR > 6.41, and disease duration > 4 years were independent factors for cardiac involvement. Subsequently, we identified five well-defined clinical patterns of RP, based on the involvement of different organs in our patients, and found that the heart-brain model was significantly mutually exclusive with the airway model. Conclusion Occurrence of cardiac involvement in RP is associated with age, CNS involvement, NLR, and disease duration. It is mutually exclusive with airway-related involvement. Regular echocardiography and electrocardiography are necessary for patients with RP.
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Affiliation(s)
- Ruxue Yin
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Mengzhu Zhao
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Dong Xu
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Qian Wang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Mengtao Li
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Wen Zhang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Fengchun Zhang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Xiaofeng Zeng
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
| | - Yuping Huo
- Department of Rheumatology, Jin Cheng People’s Hospital, Jincheng, Shanxi, China
| | - Yong Hou
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
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da Silva RMFL, Borges LE. Neutrophil-Lymphocyte Ratio and Red Blood Cell Distribution Width in Patients with Atrial Fibrillation and Rheumatic Valve Disease. Curr Vasc Pharmacol 2023; 21:367-377. [PMID: 37493166 DOI: 10.2174/1570161121666230726123444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/24/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023]
Abstract
The lifetime risk of developing atrial fibrillation (AF) is 1 in 3 adults, resulting in a prevalence of 2-4%. Rheumatic heart disease (RHD) is a frequent aetiology of valvular heart disease in lowand middle-income countries. Between 21% and 80% of patients with mitral valve disease, especially with stenosis, may have AF. Both these conditions, AF and RHD, present a state of persistent inflammation. In turn, inflammation is a frequent cause of anisocytosis, which can be evidenced through the parameter RDW (red bold cell distribution width). Factors associated with increased RDW are also known as risk factors associated with a higher incidence of AF. RDW may have an independent role in the pathogenesis of AF and the increased propensity of both thromboembolic and bleeding events. Another marker involved in the incidence of AF is the neutrophil-lymphocyte ratio. This is also a marker of oxidative stress and inflammation and is associated with a higher rate of AF recurrence. This review will evaluate these biomarkers and their association with cardiovascular events in patients with AF and RHD. The hypotheses and current debates about the relationship of biomarkers with the severity of chronic valve dysfunction, with acute rheumatic carditis in the paediatric population, and with the presence of thrombus in the left atrium will be discussed.
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Affiliation(s)
- Rose Mary Ferreira Lisboa da Silva
- Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Postgraduate Program in Sciences Applied to Adult Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Espindula Borges
- Postgraduate Program in Sciences Applied to Adult Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Biocor Instituto, Belo Horizonte, Minas Gerais, Brazil
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Li S, Chen H, Zhou L, Cui H, Liang S, Li H. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion severity and long-term cardiovascular mortality in patients with unstable angina pectoris. Acta Cardiol 2022; 77:708-715. [PMID: 35969267 DOI: 10.1080/00015385.2021.1963564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Neutrophil-to-lymphocyte ratio (NLR), one of the composite biomarker of systemic inflammatory status, was proved promising in predicting clinical outcomes of acute coronary syndrome (ACS). However, there were no evidences that NLR was directly relative to the clinical outcomes of unstable angina pectoris (UAP). Therefore, this study was aimed to detect whether NLR could predict the coronary artery lesion severity (indicated as SYNTAX score) and clinical outcomes (especially long-term cardiovascular mortality) in patients with. METHODS In the single-centre retrospective study, 4110 patients with UAP were enrolled and divided into two groups according to their primary NLR values and followed up at a median time duration of 36 months. The differences of SYNTAX score and cardiovascular mortality between groups were analysed, and the predictive value of NLR was determined. RESULTS NLR was positively and linearly correlated with SYNTAX score (r = 0.270). Diabetes (p = 0.049), lymphocyte (p = 0.004), NLR (p = 0.002) and SYNTAX score (p < 0.001) were independent predictors of long-term cardiovascular mortality in patients with UAP. Kaplan-Meier analysis revealed higher occurrence of cardiovascular mortality when NLR > 2.38 (p = 0.015). Receiver operating characteristic (ROC) analysis showed that NLR = 2.76 is an effective cut point for predicting cardiovascular mortality (69.2% sensitivity, 64.8% specificity). CONCLUSIONS NLR value was positively related to the severity of coronary artery lesion and proved to be an independent predictor of cardiovascular mortality in patients with UAP. This study would contribute to therapy and prognosis optimisation of UAP.
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Affiliation(s)
- Shunbao Li
- Internal Medical Department, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Cardiology, Baoding First Central Hospital, Baoding, China
| | - Hui Chen
- Internal Medical Department, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Zhou
- Internal Medical Department, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hehe Cui
- Internal Medical Department, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Siwen Liang
- Internal Medical Department, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongwei Li
- Internal Medical Department, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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ÇAKMAK KARAASLAN Ö, BAŞYIĞIT F. Aort Kapak Sklerozunun Öngörülmesinde Yeni Hematolojik İnflamatuar Parametrelerin Önemi. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2022. [DOI: 10.25000/acem.1107825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: Inflammatory process plays a critical role in the progression of aortic valve sclerosis (AVS). This study aims to evaluate the haematological and biochemical inflammatory markers in AVS patients.Methods: A retrospective observational study was included consecutive 557 patients who underwent an echocardiogram between June 2021 and September 2021. The study population was divided into two groups according to the presence of AVS. The groups were compared in terms of C-reactive protein (CRP), Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-HDL cholesterol ratio (MHR).Results: The mean age was 63 ± 10 years. C-reactive protein (CRP), NLR, PLR and MHR were significantly higher in patients with AVS. The best cut-off values of the NLR were 1.4 (a sensitivity of 84%, a specificity of 74%), PLR was 116 (a sensitivity of 75%, a specificity of 54%), and MHR was 9.5 (a sensitivity of 78%, a specificity of 75%). CRP (OR: 1.246, 95% CI: 1.117 – 1.389; p < 0.001), NLR (OR: 2.10, 95% CI: 1.456 – 3.032; p < 0.001), and MHR (OR: 1.227, 95% CI: 1.125 – 1.339; p < 0.001) were independent predictors of the AVS when NLR and MHR analysed as a continuous variable. Using a cut off level of NLR > 1.4 (OR: 4.825, 95% CI: 2.430 – 9.583; p < 0.001) and MHR > 9.5 (OR: 13.937, 95% CI: 7.464 – 26.023; p < 0.001) were independent predictors of the AVS.Conclusion: Increased CRP levels, NLR and MHR were found to be independent predictors for AVS. Hematological inflammatory biomarkers are cost effective and helpful approach for prediction of AVS presence.
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Affiliation(s)
- Özge ÇAKMAK KARAASLAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI
| | - Funda BAŞYIĞIT
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI
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Drugescu A, Roca M, Zota IM, Costache AD, Gavril OI, Gavril RS, Vasilcu TF, Mitu O, Esanu IM, Roca IC, Ghiciuc CM, Mitu F. Value of the Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting CPET Performance in Patients with Stable CAD and Recent Elective PCI. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060814. [PMID: 35744077 PMCID: PMC9229341 DOI: 10.3390/medicina58060814] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/05/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
Background and Objectives: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). Materials and Methods: Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. Results: Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups—poor FC (≤70%, n = 35) and preserved FC (>70%, n = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, p = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. Conclusions: Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.
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Affiliation(s)
- Andrei Drugescu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Mihai Roca
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
- Correspondence: (M.R.); (I.M.Z.)
| | - Ioana Mădălina Zota
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
- Correspondence: (M.R.); (I.M.Z.)
| | - Alexandru-Dan Costache
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Oana Irina Gavril
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Radu Sebastian Gavril
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Teodor Flaviu Vasilcu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Ovidiu Mitu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Irina Mihaela Esanu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
| | - Iulia-Cristina Roca
- Surgery II Department, Faculty of Medicine, ”Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Cristina Mihaela Ghiciuc
- Morpho-Functional Sciences II Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Florin Mitu
- Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.D.); (A.-D.C.); (O.I.G.); (R.S.G.); (T.F.V.); (O.M.); (I.M.E.); (F.M.)
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Are there any novel markers in acute rheumatic fever: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio. Cardiol Young 2020; 30:717-721. [PMID: 32364093 DOI: 10.1017/s104795112000089x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between C-reactive protein and erythrocyte sedimentation rate and neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios in acute rheumatic fever in children. METHOD In this retrospective study, 182 patients with acute rheumatic fever and 173 controls were included. Complete blood count parameters, and neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios were recorded for all the patients underwent transthoracic echocardiography. RESULTS Neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios were significantly higher in patients with rheumatic heart disease than patients without cardiac involvement (p < 0.05). C-reactive protein and erythrocyte sedimentation rate levels were found to have a positive correlation with neutrophil-to-lymphocyte (r = 0.228, p = 0.001; r = 0.355, p = 0.001), platelet-to-lymphocyte (r = 0.227, p = 0.01; r = 0.149, p = 0.005), and monocyte-to-lymphocyte ratios (r = 0.117, p = 0.005; r = 0.107, p = 0.044). Cardiac involvement was present in 152 (83.5%) of the patients. Neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios were significantly higher in patients with rheumatic heart disease than patients without cardiac involvement (p < 0.05). Patients with carditis were grouped according to mitral, aortic, or both valve involvement but there was no significant difference between the groups with respect to neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios. In addition, neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios were significantly higher in patients with Sydenham's chorea than without chorea (p < 0.05). CONCLUSION Neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios may help make the diagnosis of acute rheumatic fever and its prognosis by serial measurements in follow-up but none of them tell us the severity of carditis. Also, this is the first study showing the positive correlation between Sydenham's chorea and neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios. Further studies are needed to confirm this hypothesis, as this is the first study in the literature on this topic.
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Sun H, Que J, Peng Y, Ye H, Xiang H, Han Y, Wang J, Ji K. The neutrophil-lymphocyte ratio: A promising predictor of mortality in coronary care unit patients - A cohort study. Int Immunopharmacol 2019; 74:105692. [PMID: 31228818 DOI: 10.1016/j.intimp.2019.105692] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe inflammation causes poor outcomes in coronary care unit (CCU) patients. The neutrophil-lymphocyte ratio (NLR), a biomarker used to monitor inflammation and the immune response, can predict a poor prognosis in various diseases. However, it remains unclear whether the NLR is associated with all-cause mortality in CCU patients. This study investigated the association between the NLR and CCU outcomes. METHODS Clinical data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database, which contains health data for over 50,000 patients. The primary outcome was 30-day mortality and the secondary outcome was 90-day mortality. Cox proportional hazard models were used to reveal the associations between NLR and outcomes. Multivariate analyses were used to control for confounders. RESULTS We enrolled 3563 CCU patients. For 30-day mortality, the hazard ratio (HR) (95% confidence interval [CI]) for the second (NLR 4.80-10.08) and the third (NLR ≥ 10.09) tertiles were 1.57 (1.24, 1.97) and 2.76 (2.23, 3.41), respectively, compared to the first tertile (NLR < 4.80). In the model adjusted for multiple confounders, the fifth quintile (NLR ≥ 14.17) showed a slightly lower mortality risk [HR (95% CI) 1.44 (1.07, 1.94)] compared to the fourth (NLR 8.82-14.16) [HR (95% CI) 1.55 (1.15, 2.10)]. A similar trend was observed for 90-day mortality. The interactions between the acute kidney injury, respiratory failure, and pneumonia subgroups and 30-day mortality were significant. CONCLUSIONS The NLR was an independent predictor of 30- and 90-day mortality for CCU patients. The NLR is a promising clinical biomarker as an integrated, readily available predictor of CCU mortality.
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Affiliation(s)
- Huankun Sun
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Jiaqun Que
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Yangpei Peng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Haihao Ye
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China; Department of Cardiology, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, Zhejiang, China
| | - Huaqiang Xiang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Yueyuan Han
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Jie Wang
- Department of Endocrinology, Affiliated Hospital of Yanbian University, Yanji 133002, Jilin, China.
| | - Kangting Ji
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang, China.
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Butt HI, Shahbaz A, Nawaz H, Butt K. Comparative Clinical Characteristics of Rheumatic Heart Disease Patients Undergoing Surgical Valve Replacement. Cureus 2019; 11:e4889. [PMID: 31423369 PMCID: PMC6689495 DOI: 10.7759/cureus.4889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To assess the prevalence patterns of isolated/mixed rheumatic valvular lesions and associated risk factors among rheumatic heart disease (RHD) patients undergoing surgical valve replacement. Methods An analytical cross-sectional design was used. Purposive sampling was used to select 87 RHD patients who underwent a first-time valve replacement for mitral, aortic, or both valves between April 1 and October 20, 2016, at Punjab Institute of Cardiology, Lahore, Pakistan. Patients with systemic hypertension, diabetes mellitus type-II, congenital heart defects, coronary artery disease, non-rheumatic valvular degeneration, positive test for hepatitis C, or undergoing concomitant coronary artery bypass graft or a ‘redo’ valve replacement procedure were excluded. A proforma was used to collect preoperative data on patients’ demographics, laboratory investigations, electrocardiogram (ECG), and transthoracic echocardiography reports. Results Age (mean ± S.D.) was 32.79 ± 13.06 years, which was divided into four quartile-based groups. Forty-six (52.9%) cases were males. The majority (56.3%) of patients underwent mitral valve replacement. Mitral regurgitation (MR, 80%) was the most common lesion. Of 71 available ECGs, atrial fibrillation was observed in 46.5% cases. Increasing age group was negatively correlated with MR severity (τc = -0.188, p-value = 0.033) and positively with aortic stenosis (AS) severity (τc = 0.141, p-value = 0.010). No significant elevations were observed for anti-streptolysin O titer, C-reactive protein, and leukocyte count, though the erythrocyte sedimentation rate was abnormally high in 46.94% cases. Conclusions MR was the most common lesion. MR was more severe in younger patients whilst AS was more severe in older cases. There is little evidence of ongoing residual inflammation.
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Affiliation(s)
- Hamza I Butt
- Statistics, Government College University, Lahore, PAK
| | - Ahmad Shahbaz
- Cardiac Surgery, Punjab Institute of Cardiology, Lahore, PAK
| | - Haroon Nawaz
- Internal Medicine, Lahore Medical and Dental College, Lahore, PAK
| | - Khurram Butt
- Internal Medicine, Florida Hospital Orlando, Orlando, USA
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Huang L, Chen C, Yang L, Wan R, Hu G. Neutrophil-to-lymphocyte ratio can specifically predict the severity of hypertriglyceridemia-induced acute pancreatitis compared with white blood cell. J Clin Lab Anal 2019; 33:e22839. [PMID: 30737845 PMCID: PMC6528595 DOI: 10.1002/jcla.22839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/30/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives We aimed to evaluate the values of neutrophil‐to‐lymphocyte ratio (NLR) and white blood cell (WBC) in predicting severity of acute pancreatitis (AP) with different etiologies. Methods We compared NLR and WBC levels in patients with different etiologies and AP severity. The optimal cutoff value for them to predict severe acute pancreatitis (SAP) was determined by receiver operating characteristic (ROC) curve analysis. Results Both NLR and WBC were elevated in patients with SAP. After subgrouping AP by etiology, NLR was predictive of SAP only in hypertriglyceridemia‐induced AP (HTG‐AP), while WBC could effectively predict severity in both gallstone and HTG‐AP. The best cutoff value of WBC for predicting SAP in gallstone AP patients was 12.81 × 109/L, with sensitivity and specificity of 78.9% and 70.2%. The best cutoff value for NLR and WBC to differentiate HTG‐SAP was more than 5.88 and 15.89 × 109/L, respectively, with sensitivity and specificity of 87% and 50% for NLR and 56.5% and 75.76% for WBC. Conclusions Our study firstly demonstrated that NLR selectively played a role in HTG‐AP, while WBC could predict the severity of both gallstone and HTG‐AP. Furthermore, we firstly elucidated that NLR was more sensitive and accurate in judging the severity of HTG‐AP compared with WBC.
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Affiliation(s)
- Li Huang
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Congying Chen
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijuan Yang
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Wan
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoyong Hu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Association of matrix metalloproteinase 3 and endogenous inhibitors with inflammatory markers in mitral valve disease and calcification. Mol Biol Rep 2018; 45:2135-2143. [PMID: 30302620 DOI: 10.1007/s11033-018-4372-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
Calcific mitral valve stenosis (MVS) is a common disease characterized by extensive remodeling of the extracellular matrix via matrix metalloproteinases (MMPs). The mechanism of calcification due to extensive matrix remodeling remains unclear. In this study, we investigated the relationship between MMP-3, tissue inhibitors of metalloproteinases (TIMPs) as well as pro-inflammatory cytokines and the phenomenon of calcification in MVS. 212 patients having rheumatic mitral stenosis (RMS) and 155 healthy control subjects were recruited in the Cardiology Department of La Rabta Hospital University. Levels of MMP-3, TIMPs, IL-6 and TNF-α were measured by ELISA sandwich assay, hs-CRP was measured by immunoturbidimetry. Plasma levels of MMP-3, TIMP-1 and MMP-3/TIMP-2 ratio were lower only in RMS women in comparison to the control group. Calcification degree correlated positively with MMP-3 in women and men. In addition, calcification was correlated positively with MMP-3/TIMPs ratio in women patients. The inflammatory parameters were positively associated with extracellular matrix turnover biomarkers in men patients. In patients, the level of MMP-3 was increased in men and women with a calcification score ≥ 5. In addition, MMP-3 level predicted the occurrence of calcification. At ROC curves analysis, the cut-off MMP-3 level was in women was 9.21 ng/ml (sensitivity 51.1%, specificity 89.3%) and in men was 12.84 ng/ml (sensitivity 78.6%, specificity 77.8%). The high levels of MMP-3 and the biomarkers of inflammation contribute to valvular remodeling and calcification of the mitral valve.
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Separham A, Pourafkari L, Bodagh H, Ghaffari S, Aslanabadi N, Nader ND. Predicting outcome after percutaneous balloon mitral commissurotomy. Herz 2016; 42:509-514. [DOI: 10.1007/s00059-016-4488-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/22/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
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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: 252] [Impact Index Per Article: 31.5] [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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